Alcohol problems and policies: Historical and contemporary perspectives

It is common in contemporary debates on alcohol policy to observe that alcohol is “no ordinary commodity”. It is not ordinary for obvious reasons: the fact that it is a powerful intoxicant with the capacity to create dependency (however that is understood) being the most salient. But what does the extraordinary nature of alcohol mean from a historical perspective, and what can history tell us that might inform the development of alcohol policy today? These are questions that were explored as part of an international conference held in London in the summer of 2013. Under Control: Alcohol and Drug Regulation, Past and Present brought together researchers from across the world to discuss historical perspectives on both alcohol and drug policy.¹ The conference drew attention to the many points at which alcohol and drug policy converge and overlap. Nevertheless, while the prohibition of alcohol in some western countries in the early twentieth century was largely repealed, the contemporaneous prohibition of other intoxicants became a seemingly intractable feature of national and global policy. Despite prohibition being an idea that was originally developed by Victorian temperance activists, alcohol was, in a sense, the “drug that got away” from the wave of early twentieth century prohibitionism. Therefore, its regulation raises a plethora of questions unique to a drug that remains inside the bounds of social and political legitimacy. A number of those questions are addressed in the papers collected here.

Undoubtedly, alcohol “got away” largely because it plays such a fundamental role in the social life of communities. Whereas the use of now illicit substances can be construed (among those who do not take them, at least) primarily in terms of their harms, such a construction is far more difficult for alcohol where most drinkers – which, in western societies at least, usually means most of the population – are keenly aware of the pleasures it affords. This poses a problem for policymakers when seeking to tackle the harms that alcohol also creates. Nor are the pleasures and harms of alcohol fixed and immobile: which pleasures are acceptable to whom and under what circumstances change through time, and the same is true, perhaps surprisingly, for harms. It has long been recognised that alcohol dependency, for instance, has a history – that its meaning, definitions, and the moral judgements brought to bear on it have changed many times. The same is true for other “problems”: what defines a “moderate” drinker? What levels of drunkenness are considered acceptable, and how does this change by setting, age, occasion or even by time of day? The history of alcohol policy, then, is not simply a history of how given harms were addressed, but how those harms were identified or constructed in the first place.

The historian Peter Borsay (2007) provided us with an excellent example of this in his consideration of the apparent parallels between the “Gin Crisis” of eighteenth-century England and contemporary binge drinking. For Borsay, the similarity lies in the way these phenomena were constructed as social problems, rather than in their nature, causes or consequences. Using a late twentieth-century critical term (Cohen, 1972), he identifies them as moral panics over the meaning and definition of acceptable drinking. Yet Borsay is keen to emphasize that this does not mean these panics are identical: for instance, the media play a wider role today, addressing a larger number of people who (crucially) have a degree of political agency denied to most eighteenth-century Londoners. To put it another way, Cohen noted that one of the consequences of a moral panic was that “the moral barricades are manned by editors, bishops, politicians and other right-thinking people”; none of those roles meant the same thing in 1751 as they did in 1972 or do in 2015 (1).

The essays in this collection tackle these issues from a number of different perspectives, some focussing on historical examples and others looking at contemporary policy issues with an eye on historical contexts. While we must always be careful in drawing direct historical parallels, it is clearly the case that debates on the control of alcohol have reached a pitch in recent years that has not been seen since the height of the global temperance movement in the late the nineteenth and early twentieth centuries. From World Health Organisation calls for more stringent alcohol control policies to debates over minimum unit pricing in Scotland, the development of transnational alcohol control advocacy organisations and the emergence of powerful global trade defence organisations, we see a resurgence of the intense debates over the supply-side of alcohol policy that receded with the decline of temperance in the 1930s. To say that we are entering an era of neo-temperance would be simplistic, but if nothing else, these developments provide an opportunity to reconsider the Victorian temperance campaigns and move beyond the simple assumption that they were merely a bout of authoritarian finger wagging, and to see them instead as complex social and political movements.

Two essays in this collections address that issue directly. Greg Ryan’s study of debates over alcohol prohibition in New Zealand clearly illustrates not only the international nature of Victorian temperance but also the contours of debates at the time. Those debates were characterised by themes which remain familiar today: including questions over personal liberty, industry responsibility, the role of the state in shaping behaviour and the interpretation of evidence in legitimising political action. The paper demonstrates that individuals and groups who opposed prohibition did so for very different reasons, just as those committed to temperance did not share a single political standpoint, denomination or philosophy. Annemarie McAllister invites us to look again at one of the most significant temperance groups of the Victorian era, the Band of Hope. While it may be tempting to dismiss the Band of Hope as merely a case study in the exploitation of children towards a political end, McAllister shows just how significant the movement was in both scale and influence. She also provides insights into the tropes and frames through which the Band of Hope leadership constructed the alcohol problem – and how their construction of the child (and childhood more broadly) combined notions of threatened innocence and political agency. As “young recruiting sergeants for temperance” children and young people in the Band of Hope were encouraged to think of themselves as good and responsible citizens even before they were able to vote.

While the Band of Hope constructed alcohol consumption as a universal and menacing social risk, James Kneale and Shaun French uncover a very different, but contemporary, discourse on risk. Looking at the development of Victorian life assurance, they show how insurers sought to produce actuarial measurements of alcohol risk that leaned heavily on medical research. In contrast to mainstream temperance, which saw alcohol as a general threat, life assurance sought to parse and quantify this threat: who was at risk, and how much consumption created what level of risk? In pursuing this question, insurers made great use of guidelines for sensible consumption developed by the English doctor Francis Anstie – guidelines which are remarkably similar to those which, in the UK, came to be recommended by the Royal Colleges of Physicians and Psychiatrists in the 1980s and adopted by the Government in the 1990s.

Although heavily reliant on the figure of the hopeless drunk for much of its rhetorical power, the Victorian temperance movement sought to establish alcohol as a threat to all: whether through the “slippery slope” that moderate drinkers risked careening down, or through the kind of incremental risk levels that groups such as the Band of Hope detailed in their more medical tracts. However, with the decline of temperance and rise of psychological explanations for “addiction” after World War One it became increasingly common to identify alcohol harms as being isolated within specific social groups, rather than spread across whole populations. Stella Moss draws attention to one example of this: a brief but intense spate of concern over drinkers of methylated spirits in the 1930s. She demonstrates the extent to which the construction of this problem was overlaid with issues of class and gender – a dynamic that is one of the more constant features of discourse on alcohol throughout history. Her paper also reminds us of the ways in which media representation interacts with more formal policy activities. Alcohol policy is something that is worked out on the interface of media depictions, expert analysis, political advocacy, civil service problem-solving and ministerial hunch. The case of methylated spirits drinkers in 1930s in England is one overlooked, but telling, example of this.

That media and policy interact at a profound level is made eminently clear in Katikireddi and Hilton’s study of recent policy development around minimum unit pricing (MUP) in Scotland. MUP represents, potentially, a sea-change in the national regulation of alcohol: a supply-side intervention in the market which sets a baseline below which alcohol cannot be sold. As such, it has quickly gained widespread support among alcohol control advocates, but equally been attacked with vigour by an alcohol industry fearful of what such a precedent might mean for both domestic sales and (perhaps more pertinently) the development of their products in emerging markets. Two papers in this collection look at this critical juncture. Katikireddi and Hilton show, through detailed quantitative analysis and interviews with policy actors, the critical role of media discourse in framing the debate on MUP. They also demonstrate the extent to which media framing played a strategic role in industry resistance to the policy, and how the selective use of evidence by industry actors subtly varied between public and policy circles. Nicholls and Greenaway consider why MUP presents such problems for mainstream English political parties, how this fits into a longer history of ideological complexity and party (in)discipline over the question of alcohol, and what this can mean for the fate of novel policy interventions. Both papers draw attention to the fact that contemporary debates over minimum pricing, while focussed on a single policy instrument, pull in an enormous range of long-standing questions over the nature of alcohol harms, the proper limits of state intervention in markets, the freedom of the individual and the role of evidence in influencing policymaking processes. They also, like several other papers presented in this issue, demonstrate the often unexpected bedfellows that may line up to support or resist alcohol policies: reminding us that there were and are no monolithic blocs of “trade” and “temperance”.

It may be assumed that while the proper responses to alcohol harms are the subject of intense debate, there is at least general consensus on what some of those harms are. In particular, youth drinking and the kind of excessive behaviours associated with binge drinking – especially in the night time economy – may widely be felt to be “unproblematic problems” that is, problems where there is little debate as to why they are an issue. However, Will Haydock asks us to reconsider these simple assumptions. Amid the drive to do something about binge drinking, Haydock reminds us that we need ask what it is we are doing something about. Why, exactly, is drunkenness a problem? Is it because of aggressive or antisocial behaviour associated with it? Is it because of associated health risks? Is it (as is often the case of media representations around young women’s drinking) something to do with social decorum, moral transgression or poorly articulated ideas about public decency? Or, rather, how do these and many other frames cohere in different contexts to produce a range of overlapping constructions of the “alcohol problem”? To ask these questions is not to turn a blind eye to harms, rather it is to do what history and historically informed perspectives do best: remind us that, on occasion, we need to reflect on our own assumptions and think about their genesis. Critical, and intellectually provocative, reflection on otherwise common sense beliefs is essential to ensure that those presuppositions do not ossify. The justification for received wisdoms is not that they are received, but that they can legitimately withstand criticism and interrogation.

Historically informed explorations, then, provide far more than simply interesting or diverting tales; far more than moments where we might say either “how different things were!” or “plus ça̧ change!” Historical accounts should be more than just the light relief between more sober medical or epidemiological accounts of alcohol harms (a role they sometimes fall into at conferences). Rather, they encourage us to reflect on where we are, why we see things as we do, and whether our perspectives are themselves conditioned by processes beyond our own awareness. History should also help to inform policymakers how to act – or, perhaps more often, how not to act. There are not only many historical instances of policy failure and unintended consequences but also unexpected success which policymakers should note and take seriously as part of the evidence base inherent in the development of evidence-based policy. Furthermore, history can also stand as a critical friend to anyone interested in alcohol policy debates: inviting reflection and consideration on key principles and underpinning beliefs.

Of course, there are still difficult issues to be considered when trying to work between historical and contemporary understandings of alcohol and alcohol policy. Perhaps most obvious are questions of methodology and approach. The editors of Addiction recently reminded their readers that they were “keen to receive and publish excellent qualitative research” (Neale et al., 2013, p. 448), making several changes to the submission process to encourage papers of this kind. This served to highlight the importance of, but also the challenges inherent in, bridging between the quantitative approach of much public health research and the qualitative methodologies of social science and humanities (a process Drugs: Education, Prevention and Policy has long supported). Historical writing makes these differences even more apparent: it is more discursive, rests on different kinds of evidence, and, by necessity, may be more circumspect in its appraisal of this evidence. Working across disciplines and methodologies can lead to misunderstandings and incomprehension, but it also opens up the possibility of productive dialogue. To make the most of these possibilities, we need to think about obstacles that may get in the way, and be generous and patient when attempting to understand different perspectives. And as Borsay pointed out in his comparison of the Gin Crisis and contemporary binge drinking, “using the past to inform the present is as much about identifying the differences as the similarities” (np).

The papers in this collection are a small contribution to an incredibly rich body of historical literature on alcohol policy. We would encourage readers to explore that literature further, but also hope the papers contained here provide some reminder of why those perspectives have relevance today.

Acknowledgements

The editors would like to thanks Betsy Thom for her invaluable work in bringing this collection together, and the reviewers who provided timely and constructive comments on the papers. They would also like to thank the other members of the organising committee for Under Control: Alex Mold, Noelle Plack, Dan Malleck and Ingrid James. Videos of papers from the conference are available on the Film Exchange on Alcohol and Drugs website http://www.fead.org.uk/event.php?contributorid=60

Declaration of interest

The authors report no conflict of interests.

Notes

¹The conference – organized by James Nicholls, Alex Mold, Noelle Plack, Dan Malleck, James Kneale and Ingrid James for the Alcohol and Drug History Society – was held at the London School of Hygiene and Tropical Medicine, and was supported by Alcohol Research UK, Brock University, Bowling Green State University and the Society of the Social History of Medicine.