Historical perspectives on alcohol problems in the UK Dr James Nicholls, Bath Spa University
Apr 01, 2015
Historical perspectives on alcohol problems in the UKDr James Nicholls, Bath Spa University
Increased overall consumption = increased harm
State responsible for reducing consumption
Key levers: pricing, availability, marketing
Alcohol ‘no ordinary commodity’
Public health / population approach
Gin craze 18th C.
Teetotalism 19th C
Prohibitionism 19-20th C
Disease models 20th C
Public health 20-21st C
Model of harm
Proposed solution
Spirits = ‘new kind of drunkenness’
Alcohol creates habituation
Alcohol creates habituation
Addiction is a disease
Continuum of harm
Prohibit gin ‘Moral suasion’ Prohibition Focus on treatment and recovery
Supply-side interventions
1751 2005, 2006, 2007, 2008….
Morality
SupplyTreatment
Morality
SupplyTreatment
SOCIAL IMPACT?
Substance Dependency Substance misuse
[No risk?] Lower risk Increasing risk Higher risk
Safe Hazardous Harmful
Moderate Alcoholic
Gin Habitual drunkenness
Moral and economic decline
Gin prohibition (1736-1743)
Benjamin Rush’s ‘Moral Thermometer’ (1784)
Alcohol Habitual drunkenness
Moral and economic decline
‘Moral suasion’ (c. 1830-1850)
Alcohol trade Habitual drunkenness
Moral and economic decline
Prohibitionism (c.1850-1900)
The use or non-use of alcoholic liquors is a subject
on which every sane and grown-up person ought to
judge for themselves under his own responsibility
The appetite for drink is unlike every other appetite.
Indulgence is not followed by satiety, but by increased
craving
Mill
Pope
Inebriety: ‘a diseased state of the brain and nervous centres, characterised by an irresistible impulse to indulge in intoxicating liquors or other narcotics, for the relief which these afford, at any peril.’Norman Kerr (1884)
Inebriety Substance Substance misuse
Predisposition Substance Addiction
Morality
SupplyTreatment
Models Consensus Policy
Affordability / availability of alcohol
Trends in overall consumption
Continuum of harms
[No risk?] Lower risk Increasing risk Higher risk
Safe Hazardous Harmful
Moderate Alcoholic
Dynamic not staticAddiction model
shapes policy solutions
Hegemonic Currently unstable
Models of harm