It seems only right to have a sober jukebox dedicated to the late great David Bowie who had been in recovery since the late 70’s following being given custody for his son. The track, Space Oddity, is both my favourite of his and also speaks to the disconnect in opinions about the value of Dry January campaigns. And as we head into the last days of the campaign it seems a good time to reflect.
Here is the BMJ’s Head to Head take on it:
Two questions should be asked of any public health message about alcohol: is it evidence based and who is the target audience? Now in its fourth year, the Dry January campaign, which uses peer pressure to encourage abstinence from alcohol for the month, is promoted by the charity Alcohol Concern in England and Wales.1 It is supported by Public Health England so in effect has government approval. The campaign estimates that “Last year over 2 million people cut down their drinking for January.”1
But popular doesn’t necessarily mean effective. Alcohol Concern’s ambition is to alter people’s relationship with alcohol by encouraging us to reduce the amount we drink, not just for a month but for life. Unfortunately, this type of campaign has had no rigorous evaluation.
Self selecting participants
It is not clear who Dry January is targeting. Because participants select themselves it could attract the people at lowest risk from health problems related to alcohol. Because they consume less alcohol they are also likely to find a month of abstinence relatively easy, as a recent study indicates.2 The campaign should offer a range of advice and more carefully tailor these messages to match the individual’s use of alcohol.3 For example, one high risk group is people aged over 65. Trying to communicate a message about alcohol to the over 65s at the same time as the under 25s risks the message not being heard, as the way these groups use alcohol is likely to be different.
Many of us can be economical with the truth when it comes to how much we drink. Research comparing self reported alcohol consumption with total alcohol sold found a large disparity.4 It is not clear whether this mass denial affects Dry January. At the very least an appraisal of how much and how often an individual really drinks will influence whether they see a need to test their ability to go without alcohol for a month or simply view the campaign as more nagging and switch off. If people aren’t honest with themselves about their drinking, how can Dry January help?
All or nothing
Dry January also risks sending out a binary, all or nothing, message about alcohol—that is, either participate by abstaining or carry on as you are. Dry January could be adding to the confusion we know exists in communicating messages about alcohol—for example, in public health advice about safe levels of alcohol consumption using recommended maximum daily or weekly units of alcohol. Health professionals lack understanding about units.5 Beyond the problems of misinterpreting the guidance, the advice depends on people keeping a tally of the number of units they consume; only 13% do this.6
Dry January has the potential to compound this muddle. Although not the intention, people may view their 31 days of abstinence as permission to return to hazardous levels of consumption till next New Year’s day. “I’ve had a month off, so now I can drink as much as I did before, ignoring the need for regular breaks from alcohol.”
Most people can stop using alcohol without any immediate harm. However, for some heavy drinkers or people who have experienced withdrawal previously, abrupt abstention from alcohol can induce serious symptoms such as seizures.7 This is not a group of people who should be participating in a do-it-yourself detox such as Dry January. They will need expert help and a supervised detoxification programme to ensure their withdrawal from alcohol is managed safely. If Dry January’s campaign material made this clearer it would go some way to minimise potential harm. Otherwise, the campaign risks setting up dependent drinkers to fail, compounding their inability to gain control of their drinking. We don’t know what effect the additional attention given to alcohol through the promotional activity of Dry January has on this group.
In sum, parched of evidence Dry January could have unintended consequences which would do more harm than good.
Although successive Westminster governments may have difficulty in acknowledging the scale and scope of alcohol related harm in the United Kingdom, few readers of The BMJ will fail to make the connection in their daily work (and play) between our increasingly uneasy relationship with our favourite drug and the burden on the NHS and emergency services and harm to others.
Our per capita consumption has doubled over 40 years, we have 1.5 million heavily dependent drinkers in this country, and alcohol has become a central part of most social occasions.6 So what could possibly be wrong with encouraging and supporting the estimated two million or so adults who decide on Dry January8—to take a month off the booze and have time to reflect on their drinking?
Sustained drop in drinking
Maybe it is the “nanny state” and interference with personal choice? Well, it is just a personal choice to take part in this voluntary event instigated by the charity Alcohol Concern, which receives no direct government funding. There has been some support in kind from Public Health England, and its independent evaluation of 2015’s Dry January showed that 67% of participants said they had had a sustained drop in their drinking six months on.8 In an earlier evaluation by the University of Sussex, 79% of participants said they saved money, 62% of participants said they slept better and had more energy, and 49% said they lost weight.9
Indeed, researchers at London’s Royal Free Hospital showed that one month’s abstinence produced quite remarkable changes in such diverse aspects as blood pressure, liver stiffness, γ glutamyltransferase concentrations, insulin resistance, and body mass index.10
Greater wellbeing, better sleep
More studies are needed to see how sustainable some of these benefits are, but the overwhelming experience of those participating is greater wellbeing, better sleep, and a sense of achievement. That and the relief that they are not as dependent on that regular “anxiolytic agent” as they thought; there is a life out there that does not have to revolve around drinking.
There are no “prohibition” or “temperance movement” agendas here, and the majority of people choose to return to drinking, although 8% of those followed up by Public Health England six months later had decided to capitalise on the benefits and stay dry.8
The campaign is aimed at social not dependent drinkers, and heavy drinkers are recommended to see their general practitioner before stopping suddenly and completely. But each year Dry January brings to light some dependent drinkers who need professional help, and services for them are still patchy and inadequate.11 But it can’t be bad that some of the 1.5 million dependent drinkers in this country make the first steps towards help.
Some myths around Dry January need to be addressed. It should not be treated as a money raising sponsoring opportunity, culminating in drunken celebration at the month’s end, nor as an excuse for thinking “job done; body detoxed; I can go straight back to the old ways for the rest of the year.” But evaluations indicate that campaigns like Dry January are being used more as a way of people examining their relationship with alcohol and making longer term changes. Further study is needed, not just of the 50 000 people who sign up with Alcohol Concern1 and get support but also the estimated two million people who simply decide to quit the booze after the Christmas break for a month.
Release of the UK chief medical officers’ guidelines on drinking is timely, with their emphasis on having several alcohol-free days each week—some “dry weekdays.”12 Although it is unlikely that this will have much impact on health measures such as blood pressure and insulin resistance, it should be a focus for further research. Until we know of something better, let’s support growing grassroots movements like Dry January and Dry July in Australia and take a month off.
BMJ 2016;352:i143 (references on link page)
I completely agree with Sir Ian Gilmore as it was that month off and having a chance to reflect on my drinking that started the ball rolling to me stopping for longer. What are your thoughts?
OK so over to Mr Bowie: