By James Morris, (@jamesmorris24), a Research Fellow at Centre for Addictive Behaviours Research at London South Bank University (@CABR_LSBU).
In this blog James Morris highlights why we need to look more closely at the stories we tell and hear around alcohol use and problems.
Several years ago, myself and colleagues Sharon Cox and Tony Moss began a conversation about some examples of people we knew who drank heavily, but arguably saw little reason to do otherwise. In part this was a reflection of how alcohol is deeply embedded within our culture, but also about the complexity of alcohol use and problems, and the often intangible line between the two.
Whilst there are a range of reasons for low problem recognition amongst heavy drinkers, one thing we agreed on was that for some people, heavy drinking is quite normal – even positive – in many ways. This lead to an ongoing discussion and eventually the publication of an opinion piece called ‘Drinkers like us? The availability of relatable drinking reduction narratives for people with alcohol use disorders’.
A particular focus of the paper is that most ideas (or narratives as we refer to them) about ‘problem drinking’ derive from two ways of thinking about the issue; recovery from ‘alcoholism’, and the more recent development of positive sobriety. Whilst absolutely not criticising the value of these narratives, which undoubtedly are a positive force for many, we highlight how there are still many heavy drinkers who are unlikely to identify with either of these as a catalyst for changing their drinking.
The most obvious reason for this is that many heavy drinkers simply do not want – or indeed need – to stop drinking altogether. Irrespective of the role of moderate drinking as a legitimate outcome for some dependent drinkers in treatment, many heavy drinkers can easily argue they don’t need to give up because they are still functioning in their lives. This points to the common idea of an alcohol problem as ‘being an alcoholic’, characterised by severe problems and for whom moderation is impossible. Many heavy drinkers therefore point to the ‘alcoholic other’ to position their own drinking as ‘normal’ and not in need of change.
Understanding problem drinking as ‘alcoholism’ is central to those who recover through Alcoholics Anonymous (AA). But for those who do not find the AA approach appealing, particularly those who feel that they are still meeting their everyday roles and responsibilities, alcoholism framing is not helpful. In one conversation I witnessed, a group of male friends were scrutinizing one of the heavier drinker’s relationship with alcohol: “You’re an alcoholic” one of them bluntly told him. His instant reply was, “How can I be an alcoholic, I’m happy!!”, seemingly unfazed. The accuser had no response and the conversation moved on.
Could something else have been said that would have been more effective in prompting some reflection about his alcohol use? It’s hard to say in that exact context, but we have emerging evidence that continuum beliefs, which reflect a broader spectrum approach rather than binary ‘all or nothing’ framings, are more likely to increase problem recognition. A significant part of this may be increasing the acceptability of drinking reductions as a goal. Indeed brief interventions, which have a large evidence base, operate on the basis of encouraging a person to reflect on personal benefits of cutting down (after highlighting their drinking risk level non-judgmentally).
Unfortunately, brief interventions have proven difficult to implement. Part of this is likely to be the heavily stretched healthcare system, but also the backdrop of narratives about alcohol use and problems that rarely reflect the experience of cutting down alcohol use. One exception we discuss in the paper has been Adrian Chiles’ documentary ‘Drinkers like me’. Following the show, in which he talked to people with a range of different experiences, reports of significant increases in help seeking and drink tracking app use has since been referred to as ‘the Adrian Chiles effect’.
In our paper, we conclude by calling for more stories that reflect a wider range of drinking experiences, particularly those that might reflect moderation goals or less severe characterisations of alcohol problems. I sometimes share my own story for this reason. I stopped drinking at the age of 21 after some alcohol-related health problems from regular heavy drinking episodes and failing to moderate. I didn’t drink for 8 years and then ‘experimented’ with moderation as things felt very different for me. This time I approached alcohol in a very different way, and have been drinking moderately now for over ten years. I now see alcohol as a way to complement a meal or a social occasion, rather than a way to deal with difficult feelings or blow off steam as I did previously.
This is not to say moderation is for everyone, nor that people who have found abstinence should attempt it. But moderation is something that will be more acceptable to many drinkers who would never consider lifelong abstinence. For these groups, we need to share more stories that may resonate with their experience. My co-authors also drink, sometimes abstain, and sometimes moderate. Our stories may initially not seem like stories worth sharing – in the sense that they aren’t particularly interesting or emotionally charged in their content. But there are many ways in which alcohol can cause low-level problems and harms, and correspondingly there are many ways for people to reduce their alcohol use.
Many of these stories of moderation may seem wholly unremarkable contrasted with the far more powerful stories shared in the existing recovery literature, but we argue that they are no less important. There is no one size fits all, so let’s promote, listen to and reflect on the wide range of ways that people experience and change their alcohol use.
With thanks to co-authors Dr Sharon Cox, Professor Tony Moss and Professor Paula Reavey for their contributions. You can read the full open access paper: ‘Drinkers like us? The availability of relatable drinking reduction narratives for people with alcohol use disorders’.
SHAAP Blogposts are published with the permission of the authors. The views expressed are solely the authors’ own and do not necessarily represent the views of Scottish Health Action on Alcohol Problems (SHAAP).