Page last updated: Tuesday, November 18, 2008
The case against MODERATIONISM
By Stuart Walton
Who could possibly disapprove of moderation? How could one raise one’s voice against sensible drinking when the evidence of silly drinking is all around us? Subscribers to AIM Digest will have been aware of the report entitled ‘Your Very Good Health’ launched in the UK in early March by Alcohol Concern. Among its baleful statistics were the claim that 28,000 hospital admissions a year are related to alcohol dependency or acute alcohol toxicity, that one in six people attending accident and emergency units has an alcohol-related injury or other problem, that 25% of acute male admissions to hospital relate in some way to alcohol, and that the total annual cost to the National Health Service of managing alcohol misuse is in the region of £3bn. The numbers of annual fatalities arising directly from drink is put at 5,000.

Problem drinking seems to be on the increase on whatever index we choose to measure it, and it is only right that those involved in both prevention and treatment should seek to contain or at least ameliorate its effects. It does seem, however, as though public discourse on the subject is very often a matter of eerie historical displacement, in that although the outward lineaments of alcohol and its misuse are naturally very much of their time, the underlying moral tone to the debate about them is of great and venerable age. We may be talking about alcopops, breezers and pre-mixes these days, but the alarm they engender is just the latest manifestation of an anxiety that has been present in western societies since classical antiquity.

In the late eighteenth century, the distinguished American physician Dr Benjamin Rush set the moralistic tone for all subsequent medical advice on the subject when he explicitly linked the effects of misuse of alcohol with concomitant moral decline, so that a certain reckless intake of ‘spirituous liquors’ must inevitably turn any individual into a lying, blaspheming, thieving gambler. The medical profession may have grown up a little in its tolerance of alcohol since 1790, but not much. The Royal College of Psychiatrists was still able to call alcohol ‘a great and growing evil’ as recently as 1987, and the recent British Budget statement, in which most alcohol duties were frozen for another year, was met with predictable ululations of disapproval by the British Medical Association.

The spectacular comeback of alcohol as a social problem has spawned, on both sides of the Atlantic, a fundamentally misguided campaign of neo-prohibitionism, of which, I fear, the AIM movement is part. This consists in an attempt at vicarious control of the private lives of individuals by persuading them to police their own intake of intoxicants. All medical advice on the matter (much of it unsolicited) is predicated on the assumption that, however much one is drinking, it would be as well to cut down by some degree. The unit-counting system represents the best effort so far at codifying this approach, but it has been significantly undermined by woeful lack of consistency. Quite apart from the fact that the alcohol content of a unit differs hugely according to whether one happens to be British, American or Japanese, the recommended maximum intake has been revised upwards and downwards so often that an understandable measure of public cynicism as to the merits of these guidelines has resulted. (The famous ‘glass of wine’ that we are permitted as one unit is quantified, in terms of a standard 12% ABV wine, as no fewer than nine to the bottle. There is a name for people who try to squeeze nine glasses out a bottle of wine, and it isn’t polite.)

Never content with self-regulation though, the moderationist movement is also much given to suggesting social initiatives with more than a hint of 1940s paternalism about them. Thus, writing in the November-December 2001 issue of AIM Digest, Hanson, Heath and Rudy propose provisional drinking licences for under-21s in the US, under the terms of which no take-out alcohol could be bought, attendance at a course in responsible drinking would be mandatory, concluding with a formal examination, and ‘parents and other authorities’ would be empowered to revoke the said licence for whatever reason, after which all alcohol consumption would become once more a punishable offence. Such a system, the authors argue, would ‘permit a slow introduction to an adult privilege’. In which case, one must wonder why it makes no provision for treating its target population as adults in the first place.

The gaping cultural discontinuities between American and European societies are always to be taken into account when addressing such proposals as these. The USA is the only country in the non-Islamic world ever to have embarked on the disaster of total alcohol prohibition, and the interdictive undertow is still powerfully at work there in much public debate on the topic. But it is not only that such a regime of social control wouldn’t stand a hope in sweet hell of actually working — either in the States or among a European youth more given to regarding such nostrums with the cynicism they deserve. It is also that in its relentless targeting of a mass of society whose drinking is not, and is never likely to be, problematic, it fundamentally misses the point. Interventions that address only non-problem drinkers are, by definition, inventing a problem where none exists.

Except in very critical cases of chronic dependency, the negative consequences of excessive alcohol consumption are largely self-limiting: there is now a copious literature on spontaneous remission among the people referred to in a less enlightened era as ‘alcoholics’. Moreover, the hue and cry created recently over the Rowntree Foundation report that showed the age of first use of alcohol falling back to the early teens, so far from being another indicator of social decline, contained a germ of hope, if we could but see it. The only sure-fire way of finding your own tolerable capacity for alcohol is to light out into the territory for yourself. Not even the full might of prohibitionism at its most bellicose will prevent the teenager from finding this out for himself or herself when the moment comes. And what one experiences for oneself provides more reliable evidence of reality than what one accepts on trust from those with axes to grind, as everybody since St. Thomas can readily vouch. How would we know what moderation was, in any case, unless we had personally exceeded its limits?

We risk repeating the catastrophe that has resulted from drug prohibition if we keep over-pathologising non-problem drinking and exaggerating its risks. All questionnaires I have ever seen that claim to offer an initial guide to self-assessment as to whether one might have an incipient drinking problem have included some variation on the question ‘Do you ever find yourself really needing a drink?’ The very phraseology seems to invite the response of the great Tom Waits, who wrote in the 1970s, ‘I don’t have a drinking problem, except when I can’t get a drink’.

Alcohol is of course a psycho-active drug, and one that carries for a minority of individuals the risk of leading to a dependency state. The fallout from this condition can be measured in the catalogue of domestic grief, violence, ruined physical health and social and economic dysfunction that must trouble anybody with a concern for social well-being. Nothing could be more urgent than the treatment of those who have fallen into this trap. But we shouldn’t lose sight of the fact that one of the benefits we are entitled to expect from a life that hasn’t gone off the rails is the right to intoxicate ourselves, and to do so without being made to feel as though we were committing a transgressive act. This right, our biological inheritance, is as old as humanity itself.

And sorry, doctors, but — whose liver is it anyway?

The new edition of Stuart Walton’s book Out Of It: a cultural history of intoxication will be published by Penguin on June 27, and by Harmony Books in the United States in October.

For further information, please contact Stuart Walton at stuartwalton616@hotmail.com
All text and images © 2003 Alcohol In Moderation.