Daily Archives: 23/02/2016

How do we tackle alcoholism? First, stop denying that it’s part of the culture of poverty

povertyThis was an excellent piece in The Independent in January.

I need you to think hypothetically for a moment. Go with me on this.

Imagine a new, designer drug came onto the black market, whose side effects included inducing irrational and dangerous behaviour, loss of sensory awareness, bouts of violent activity, vomiting, seizures, hallucinations, sleep deprivation, severe psychosis, long-term mental health problems, organ failure and possible instantaneous death.

Horrific, yes? You would assume this narcotic would be graded as a Class A substance and made illegal immediately.

Now, call this drug “alcohol”. Suddenly it becomes acceptable, and consumption of high levels the norm.

As the country recovers from its corporate-induced over-indulgence during the “Festive” period, figures released in late December by the Nuffield Trust showed a 63 per cent rise in the number of alcohol-related hospital in-patient admissions since 2005, coupled with a 104 per cent rise in the number of A&E attendances due to alcohol poisoning in the past 6 years. Overall alcohol consumption in the UK is now above the OECD average, and the NHS cost to every taxpayer is £120 per year.

Delve a little deeper into the statistics, however, and the trends become even more concerning.

Rates of A&E admissions due to alcohol poisoning were 3 and a half times higher among those living in the 20 per cent most deprived areas of England than those in the least (and the gap is widening). Across the seven defined socioeconomic statuses (SES), 24 per cent (the highest figure) of all alcohol-related deaths were in the bottom category (“Routine Occupations”), and these individuals are nearly 3 times more likely to develop alcohol-related liver disease than those in the top.

All this begs the question – why are the poorest in society seeing the most damaging effects of alcohol?

Drinking habits are a pertinent issue. A study for the BMJ showed that people with the highest SES generally consumed alcohol more regularly than the most deprived in society; however, when the pattern of consumption was studied, the poorest were the most frequent and heaviest “binge drinkers” (i.e. consuming at least double the guideline limits in a single day) – and bingeing accounts for the majority of alcohol-related A&E attendances, of which over 50 per cent are on Friday, Saturday and Sunday nights.

Social Contagion” is another aspect – that is, mimicked behaviours spread rapidly across social groups, carried from one person to another, without criticism or, necessarily, intent. To put it bluntly, if everyone around you is going out and getting bladdered on a Friday night it’s highly likely you will too – hence the culture of binge drinking amongst those in the lowest SES categories.

But overall, deprivation is the key factor.

Socioeconomic stress is a known major player in why individuals (especially men) have high levels of alcohol consumption. But it’s the “culture” of poverty which probably has the biggest impact. As Lisa McKenzie describes in her ethnography “Getting By”, “You don’t want to live in absolute hardship with no comfort. Struggling to make ends meet is a misery, and, as Orwell surmised, lots of sugar in your tea… goes some way to relieving, even just for a minute, the endless misery”.

This is a stunningly pertinent analogy of why the most deprived binge drink. Shift work, financial constraints, underlying health issues, caring responsibilities, negative external imagery and social exclusion all contribute to why the poorest go out for one or two nights a week and get annihilated – compared to the least deprived who drink more frequently, but in lower quantities at a time.

There are also distinct parallels between the underlying causes of alcohol abuse in the lowest SES, and the other two biggest lifestyle risk factors for disease and death in the UK – smoking and obesity. Both are more prevalent in the most deprived sections of society, and both can be attributed to the same reasoning as erratic alcohol consumption.

So, all of this in layman’s terms? The rich and the poor drink roughly the same amount of units of alcohol a week. However, the rich spread it out over seven days, while the poor cram it all into a couple – hence the initial strain on the NHS and society more broadly, and the higher levels of alcohol-related health conditions.

None of this is, of course, to say that alcoholism per se is a socioeconomic-specific problem. Dependency doesn’t care who you are – an MD of a multinational company; a teacher; a housewife; an unemployed person – merely that a person has an open window in their character that it can sneak through while they are not looking.

However, the societal effects of excessive drinking are, sadly, at their worst when enacted by the poorest amongst us, with deprivation and inequality being the key drivers – something which the Government’s own alcohol strategy fails to even cite as an issue.

I don’t write this as a middle-class, degree-educated journalist – I’m not.

I write this as a chronic alcoholic of over a decade who at his worst has been subject to a Deprivation of Liberty Order (DOLO) due to severe psychosis induced by withdrawal, and as someone who spent nearly a decade living in one of the 10 per cent most deprived areas of the UK.

Medical professionals, academics and university-educated commentators can bandy around minimum pricing, “Dry January’s”, restricted advertising et al all they wish.

But until the UK tackles chronic socioeconomic inequality, it will continue to have a chronic drink problem which drags the whole of society down with it – and one which is only going to increasingly deteriorate.

Further coverage of the alcohol harm paradox:

The alcohol harm paradox: using a national survey to explore how alcohol may disproportionately impact health in deprived individuals

Internationally, studies show that similar levels of alcohol consumption in deprived communities (vs. more affluent) result in higher levels of alcohol-related ill health. Hypotheses to explain this alcohol harm paradox include deprived drinkers: suffering greater combined health challenges (e.g. smoking, obesity) which exacerbate effects of alcohol harms; exhibiting more harmful consumption patterns (e.g. bingeing); having a history of more harmful consumption; and disproportionately under-reporting consumption. We use a bespoke national survey to assess each of these hypotheses | Springer, UK

The alcohol harm paradox explained

New research from a collaboration including Bangor University, Liverpool John Moores University and Alcohol Research UK explains why people in deprived communities have higher levels of alcohol-related ill health than people in non-deprived communities, despite drinking the same amounts of alcohol — the alcohol harm paradox | Science Daily, USA

I have to say I agree. There is a distinct practice in the UK  (and I’m not sure if it’s unique to this island) where the upper and middle class sit at home with their glasses of wine or tumbler of spirit pointing their fingers at and deriding the so called lower classes for their drinking while MP’s hide their own issues with booze, via denial of FOI requests, while suggesting punishment via cutting of benefits.  How exactly does that help?