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I have been wrestling with this post for some considerable time, I am getting fed up with it being in my drafts – hanging over me every time I look at my list. I promised Alex Gazzola that I would write about this topic so I have decided to go ahead. It is nearly twelve months since I went out for lunch and asked for a small glass of wine…………

The picture on the right hand side is a portion of alcohol 125 ml – note the size of the glass, having asked for a small glass of wine I couldn’t help feeling rather disappointed at the arrival of what looks like a virtually empty glass. This is what the supersizing of alcohol has achieved, the old portion is now far from the norm and leaves you feeling slightly peeved when it is served. It is now no longer acceptable to have this size of glass offered as an option, so therefore, it rarely is.

We need to address this issue, increasing levels of alcohol use will no doubt increase the levels of alcoholic over consumption and the resulting health issues that result from it. We have rising levels of alcoholic liver disease in this country and this costs everyone. It is comparable with the obesity epidemic in some respects as the problem of alcohol is multifactorial and as a consequence extremely difficult problem to address. But make no mistake it does need to be addressed, I have treated patients with malnutrition associated with decompensated liver disease, and shockingly some of those patients have been under thirty years of age – it is tragic, at any age to be informed that you are to have palliative treatment and are unlikely to survive as a consequence of something you were unaware was causing damage, and very sad when this occurs at a young age. Neither do I wish to be a scaremonger, as liver cirrhosis won’t happen to everyone, however when it does it happens quickly, without warning and numbers are rising. Malnutrition occurs in a number of ways, poor absorption of nutrients due to the digestive tract being inflamed, poor storage capacity of glycogen and vitamins by a damaged liver, people choosing to drink rather than eat and poor processing of nutrients due to damage to liver cells. But how can we achieve change?

In 2005 the UK drank >12.5 litres per capita (who) with lower-income individuals consuming approx 75% more than higher income individuals. 4% of deaths worldwide are attributed to alcohol (who.) The problem of alcohol dependency has been around for considerable time – one of the first enduring images of this was Hogarth’s Beer Street and Gin Lane etching of the social effects of alcohol in support of the Gin Act in 1736. This act increased taxes, required a maximum amount of gin sold to individuals and a licence required, this was in response to the government encouraging distilling to increase trade and prop up grain prices. Increases in drinking alcohol were reported to have increased crime, increased levels of ill-health among children and produced an ungovernable people. So government encouraged the production and consumption of alcohol – seem familiar? Or is this the individuals responsibility? Shall we consider the issues?

Responsibility

This is obviously needed, you may feel – someone has to be held to account for the situation – but at whose door do you place this responsibility? Perhaps you may feel that it is the individuals responsibility to address their excessive alcohol consumption? This may be the  governments view, but is it just party rhetoric to blame the individual and allow the government to abdicate its responsibility in this regard? I would feel that some individual responsibility is required, here – however you also need to look at the overall picture and how easy is it for a person to change and accept this responsibility. It is easy to change when you are highly motivated to do so, but this is more difficult when you are affected by consuming alcohol – it impairs judgement, so this might be more of a challenge. The more you drink the less likely you are to be able to change – swings and roundabouts. The title of this post also suggests another reason people have issues in changing – life. When you are poor, have little to look forward to and your money doesn’t go very far, what do you spend your money on to treat yourself? What you can afford – food that lacks nutritional balance, cigarettes and alcohol. Now, cigarette smoking has become less socially acceptable and more difficult to actually do, are we seeing a shift in cigarette smoking to alcohol consumption I wonder? It is also very easy to get alcohol as this can be purchased very easily and very cheaply, but does making alcohol less available work in reducing the amount people consume?

Temperance movement, abolition and prohibition

Is this the answer to make alcohol less available or perhaps not available at all? During the nineteen twenties and early nineteen thirties in the USA alcohol was prohibited for thirteen years looking at what happened during this time we could make a judgement. Cirrhosis of the liver dropped by 2/3 during this time, but those people who were determined to get alcohol still did.

One unforseen consequence was that drinking became more normal in women in the speakeasies and this allowed a new untapped market to be accessed by the alcohol industry. We also have those who say why should the average majority be penalised because a few people cannot handle their alcohol.

Can ‘have it all’ generation and individualism

We could say that we have just lived through a period of rampant individualism, to some extent at the expense of society – perhaps you can’t have both. Margaret Thatcher famously said in a quote to Womens Own magazine – “there is no such thing as society.” We are now living through a period of austerity, now I don’t want to go into detail about the politics of individualism in this post but it is relevent to alcohol consumption, we have come to imagine we can have it all without consequences – this goes for both alcohol and the individual and society.

It is entwined, the more people drink to excess the more society suffers in the costs of alcoholism, this will no doubt be expected to change with austerity – but maybe the damage has been done. It perhaps is easy to imagine that people who have less money during a period of austerity will be able to afford less alcohol – I send you back to the paragraphs on responsibility and temperance. Those who want to drink to excess will find a way and as people can afford less they perhaps rely more on cheap fixes. Both increasing alcohol costs within a period of austerity is needed. The more I think about this subject the more complicated it becomes. Political rhetoric has changed however with David Cameron’s Big Society which is proposed to allow people more control to improve communities, but can a reduction in the excessive consumption of alcohol be achieved in an overtly commercial society?

http://healthculturesociety.wikispaces.com/A+Culture+of+Excess+-+How+Consumerism+and+Individualism+has+shaped+Generation+Y%E2%80%99s+health+behaviours

Industry, corporate responsibility and market demand.

Industry has in my view some responsibility for the society we live in. Is it ok to sell alcohol and then suggest that people drink responsibly whilst offering happy hours, having alcohol available for a longer time period and in more outlets than ever before? This is contradictory, companies should have some social responsibility and perhaps should alleviate some of the burden of the added costs to the NHS of the increase in alcohol and the health problems it creates. But this is not actually addressing the problem, prevention is better than cure. I also wonder why there is a large number of older individuals who drink alcohol, perhaps some intervention is needed here and a bit of thinking out of the box. Is it due to social isolation of the elderly perhaps? Would some funding to help with increasing social inclusion be effective in reducing numbers of elderly people who rely on alcohol?

If you look at the statistics they are truly shocking – if you are interested in knowing about the cost of alcohol in your local area check out the following website

http://www.alcoholconcern.org.uk/campaign/alcohol-harm-map

For Calderdale area there were 40,916 admissions and attendances in 2010/2011 including 4907 hospital admissions perhaps surprisingly only 307 of these were from 16-24 years of age and perhaps more shockingly 1027 people were over 75. The cost of this was 12.9 million pounds.

This topic is very complex – I can’t begin to consider what the solutions are, in problems such as this it does take lots of different initiatives to chip away at the problem. We do need people to think of different ways of solving these problems but at least writing this post has helped me to understand the issues. It will hopefully help people to understand that this perhaps is not a problem that should be thought of as the individuals responsibility, but the answer should be found for that person individually, with help from alcohol services as each person will have different reasons for needing help.

Related articles

• 1952-2012 austerity & celebrations, is alcohol the new tea? (clinicalalimentary.wordpress.com)
• Alcoholic liver disease risks more environmental than genetic (cbsnews.com)
• http://bma.org.uk/news-views-analysis/news/2013/february/alcohol-proposals-too-timid-says-bma
• Alcohol is killing too many of us | Kieran Moriarty (guardian.co.uk)