Booze Nation

Ours is a drinking culture: even 15-year-olds are waking up with hangovers three times a month. And that is just the tip of the ice cube where alcohol related problems are concerned. Until the will exists on all sides to challenge this culture, we will remain a society in denial, writes Kathryn Holmquist.

Guinness is Good For You. It's a quaint notion that, today, Guinness would never dare assert. The volume of bad press about alcohol is too great. "Live Life to the Power of Guinness" is the modern version.

So many people are living life to the power of alcohol that three out of ten 15-year-olds drink to get drunk three times a month, and there's been a four-fold increase in teens intoxicated in public places since 1996. At the Rutland Centre in Dublin, which treats addiction, most residents are in their 20s and are as likely to be female as male; 20 years ago the typical alcohol addict in treatment was a 45-year-old man.

"The average drinker is going out to get drunk, not to have a pint or two," says John O'Connor, director of the National Drug Treatment Centre, which is seeing an epidemic of alcohol abuse.

"The entire society is in massive denial of our alcohol problem," says Stephen Rowen, director of the Rutland Centre. In the past decade, alcohol consumption in the Republic rose by 46 per cent, according to the Strategic Task Force on Alcohol Interim Report last May.

Marie Murray, director of psychology at St Vincent's Hospital, Fairview, Dublin, comments: "The ambivalence of our relationship with drink mimics the relationship of the alcoholic with drink. We love and despise it. We treat alcoholism as something suffered by individuals rather than a reflection of an entire societal approach to drink. The solution is not to prevent 'the alcoholics' drinking but to look at why they drink in the first place."

It's a view reflected by Anne Wilson Schaef, author of several New York Times best-sellers, such as The Addictive Organization and When Society Becomes An Addict. The addictive process, which has denial of responsibility at its centre, makes society as blind as the addict to the true effects of addiction, she asserts.

The Rutland helpline receives on average 45 calls per day from people who want help to stop drinking, as well as from distressed family members and concerned employers. A typical call last week came from the supportive husband of a young mother who had become addicted to alcohol. He was at his wits' end. Ireland is the only country in Europe where females have caught up with males in alcohol consumption.

"Alcohol," says Rowen, "is an equal opportunity destroyer."

Gerry Cooney, who runs the Rutland's helpline, also took a call last week from a man whom he had known for many years. The caller had received treatment and had become sober. But drink had got the better of him again and he had "given up". The man had decided to surrender to the power of alcohol and drink himself to death, Cooney confides.

Pat Barry, of Guinness Group Sales, says "the industry is looked on as a source of difficulty and concern, and it's an image that is unacceptable from an industry point of view. The vast majority of people consume alcohol moderately. What we have to do to tackle the issue of alcohol abuse is to focus on the reasons why there is alcohol abuse. We have to explore the social issues that cause alcohol abuse; we have to look at underage drinking, because it is social issues rather than advertising that are causing the problems. A lot of problems have been created by changes in society - greater affluence, combined with greater pressure, and stress is causing people to turn to alcohol as a means of relief. We want to try to focus more on personal responsibility" .

It's ironic, comments economist Sean Byrne of the Dublin Institute of Technology, that "in 19th-century Ireland, the alcoholism epidemic was blamed on poverty, and today it's being blamed on affluence".

What Pat Barry is saying is that drink isn't the problem; the drinker and the context in which alcohol is used cause the family breakdown, the loss of productivity, the accidents, the crime and the loss of souls to the contents of a bottle. Barry believes alcohol advertising is not culpable for the fact many people feel they need alcohol to deal with the stresses of modern life.

"Alcohol helps you cope" is not the slogan on any particular brand, but it is the subtext to the industry's pitch to governments around the world. As Barry implies, it's not the alcohol industry's problem that the effects of Government policy have made life so stressful for so many people that they need a freely available, legal, over-the-counter drug to help them survive.

This spin is not unique to Guinness; it's the philosophical platform of the International Centre for Alcohol Policies (ICAP), an international drinks industry-funded lobby group based in Washington, DC, that supports ethical research and co-operation among industry, government and the scientific and academic communities.

ICAP, in co-operation with the National College of Ireland, will hold a conference partly funded by the drinks industry in Dublin in October, which will be launched, and thus endorsed, by Michael McDowell, the Minister for Justice, and closed by Pat Cox, MEP, president of the European Parliament. The keynote speaker will be Peter Coors, of the Coors Brewing Company in Colorado, who will be accompanied by the heads of alcohol manufacturing companies from all over the world.

The conference will be based on a system of dialogue between the industry and academic researchers which is called "The Dublin Principles", established here in 1997. All over the world, the drinks industry is promoting personal responsibility, rather than government regulation, as the way forward.

In Ireland, where young people are among the biggest consumers of booze, drugs and cigarettes in the EU, people find themselves - through "The Dublin Principles" - at the nexus of a new world order of governments co-operating with multinational drinks companies to combat the huge social problem of alcohol abuse.

Alcohol, according to ICAP's rationale, is a problem of individual responsibility that cannot be solved by licensing laws, tax regimes or advertising restrictions. This "neo-liberal view", as Shane Butler of TCD's Addiction Unit describes it, suits the Irish Government that drew in an estimated €1.6 billion in excise duty and VAT on alcohol in 2001.

Yet the economic cost of dealing with the problems of alcohol abuse is likely to have totalled at least €2.2 billion, based on the last recorded estimate by Sean Byrne in 1999. Even then, this is a "conservative" estimate, according to Byrne.

That's a large bill for a social problem. On the other hand, as Barry implies, alcohol abuse helps to mask social problems, which is central to our denial of the fact too many people are dying for a drink.

Alcohol abuse accounts for at least 25 per cent of road accidents, 80 per cent of public order offences and at least 7 per cent of all health costs (including 25 per cent of A&E costs alone). Some 20 per cent of people visiting their GPs have alcohol-related problems, often undiagnosed, according to the Irish College of General Practitioners.

Not even counted in these figures is the inestimable emotional and financial suffering of the families of alcoholics. Spouses of alcoholics have double the cancer rate of other people according to the Rutland Centre, a statistic which is the tip of the iceberg where family suffering is concerned.

Alcohol is the chief cause of death in cases in coroners' courts, a major factor in family breakdown, including failed relationships among children and even grandchildren of alcoholics, as well as unwanted pregnancies and the spread of sexually transmitted diseases.

Alcohol abuse is well-documented as a root cause of poor productivity. The Strategic Task Force on Alcohol Interim Report estimates it cost €1,075 million in 1999alone.

Admitting to the harm alcohol does "would mean admitting that, in our family and our lives, in our country, in our genes, in our psyche and in governmental ineffectiveness, there lies this problem. Besides, if we are 'under the influence' we won't notice the demise of our economy, the demise of our health and social services, rising taxes and 'broken' election promises," says Marie Murray.

The Government has established a task force to look at the problem, but as long as it tries to balance the demands of the drinks industry against the huge social cost of alcohol, there remains a certain ambivalence. "It may pay lip-service to the problem, but when did you last see a bottle with 'dangerous to your health' written on it?" comments Murray.

If the Government were to admit the problem and acknowledge that licensing - largely unenforced where the young are concerned - and advertising - which is aimed at the young - are to blame, then it would have to confront an industry at the heart of the Irish economy. If the Government were to admit that the quality of life of its citizens is to blame, it would be forced to hold itself culpable for policies that increase stress and pressure. But if it blames the individual, then it's not the Government's problem, not society's problem and certainly not the drinks industry's problem. Individual responsibility is the perfect way out.

It's not the drink, it's the drinker.

Another conference will be held in Dublin on September 28th. It's a series of public lectures organised by the Rutland Centre, which believes sobriety is the solution. Our society's alcohol problems are not just being caused by a few problem drinkers. The entire society is addicted, according to the Rutland Centre's philosophy.

"We are a society in huge denial of our alcohol addiction problem, a problem that causes far more harm than illegal drugs," says Rowen.

He believes the macrocosm of society denies the harm of alcohol abuse in the same way the microcosm of the family and, indeed, the individual, turns a blind eye. The alcoholic will say: "If I'm in trouble in my life, it's not because of alcohol". Alcoholics will blame family, upbringing, social circumstances - anybody but themselves.

Similarly, society will apportion blame away from itself and blame the drinker, not social policies, for the problem.

Rowen says that, when society is in denial, "you cannot see that you are paying higher taxes for a health service that is not as efficient as it would be if alcohol were not siphoning off resources. You do not see that your children are likely to underperform in school because they are drinking too much and too often. You do not see that you are more likely to be hit by a drunk driver, and if you live with someone with severe alcohol dependence, you are more likely to develop cancer."

Next week, Trinity College, Dublin will host an alcohol addiction conference, which will showcase successful social policies that limit alcohol abuse. However, Shane Butler, co-director of the Addiction Research Unit at TCD, is pessimistic regarding the effectiveness of these policies because they come from "Protestant" societies with traditions of temperance. "In a predominantly Catholic society, you don't have that tradition," says Butler.

And while the drinks industry advocates the education of young people, Butler says there is ample proof such education does not work. "You can talk until the cows come home, but it will not make a difference."

The young ape the old. You must change the attitudes of the entire society, not just those of underage drinkers, he argues, and Rowen agrees.

Sweden and Russia have successfully discouraged alcohol abuse by raising taxes on alcohol and limiting access. France has banned alcohol advertising. In the US, age limits on the purchase of alcohol are strictly enforced. In this country, we have done the opposite, extending licensing hours and keeping drink affordable, especially for young people, who have easy access to drink. We do not have the political will to solve the problem because government and the drinks industry are too entrenched, says Byrne.

Dr Joyce O'Connor of the NCI believes the keys to solving the problems are corporate social responsibility and "open and honest" debate between the drinks industry, government and health professionals. Drinking to get drunk is a cultural issue, and until the will exists on all sides to challenge this culture, we are not even at the first step of implementing a programme that could reduce the harm of alcohol.

The Irish in the US always had a reputation for drunkenness, says Byrne. When the Irish emigrated to the US in their hundreds of thousands, their drinking increased the more affluent they became. What we are seeing now in Ireland is affluence allowing the Irish at home to behave like Irish-Americans once did, he suggests. To change that culture would require a major shift in social attitudes.

Nothing will change, Butler asserts, until government challenges the drinks industry's concept that "if you are not an alcoholic, there's not a problem with your drinking; alcoholism is in the drinker not the drink. The truth is that you don't have to be an alcoholic to be a problem to society."

Many of the alcohol-related accidents, health problems and social problems that cost taxpayers money arecaused not by alcoholics, but by people who abuse alcohol discreetly over many years in socially acceptable ways.

In Ireland, discussion of alcohol runs along two parallel and contradictory courses, Butler points out. The public health perspective, offered by the 1996 National Alcohol Policy and the recent National Alcohol Strategy, drawn up by the Department of Health, sees alcohol abuse as a social problem requiring social sanctions and limits. It has been neutered by the Commission on Liquor Licensing, which was set up following the Intoxicating Liquor Act 2000. The commission rejects social sanctions and is neo-liberal, extending licensing hours and placing responsibility squarely on the individual. This policy encourages competition in the sale of alcohol and makes alcohol more accessible.

Butler believes that you cannot solve the problem in this way because money talks, and the drinks industry has the money - so neo-liberalism will win out. Become an addict, and it is your fault. Don't blame anybody else, because the government and the drinks industry won't accept their involvement.

Centre for Corporate and Social Responsibility at the National College of Ireland conference runs from October 16th to 18th. For information contact Niamh Farrell, tel: 01-4068123 or e-mail nfarrell@ncirl.ie

Trinity College, Dublin, conference, September 26th, Addiction Research Centre, tel: 01-608 2230, e-mail: bcullen@tcd.ie

The Rutland Centre is holding five public lectures, beginning on September 30th with Anne Wilson Schaef, and continuing until October 10th with Tony Humphries. Cost for September 30th and October 10th, €15 (€10 unwaged, students and OAPs). Other lectures cost €10. For further information, tel: 01-4946358