Page last updated: Tuesday, November 18, 2008
Dealing With Drink: Alcohol And Social Policy
By Dr Betsy Thom
This is a comprehensive study, which reveals many layers and threads about the understanding and response to alcohol problems. Frankly, the subject is a complicated moral maze, involving interaction between professional bodies, voluntary organisations and policy campaigners committed to action not necessarily based on medical research. Dr. Thom’s immensely detailed research unravels the confusion in both the professional and lay understanding of how perceptions have gradually changed from the alcohol as a disease concept to controlling consumption.

This book, coincidentally, acts as an ‘aide-memoir’ to the UK Government in its decision to develop a National Alcohol Strategy.The prologue reads: ' This book starts from the premise that, however great the changes which have taken place, alcohol policy today is embedded in the past. In examining evolution and change in policy formation and implementation in the alcohol field, the intention is to enhance understanding of current approaches to dealing with the adverse effects of alcohol consumption'.

At the same time, this account of alcohol policy provides a case study which will be useful to those who have an interest in how social policies emerge, change and develop. How do issues move on and off policy agendas? Why do some policy statements fail to be implemented? What is the role of civil servants, professional leaders, or pressure groups in policy formation? How do inter-departmental tensions or the conflicting interests of different social groups influence policy objectives and policy outcomes? To what extent is policy ‘evidence based’? These are some of the questions which are raised and illustrated through an examination of alcohol policy over the past fifty years.

The book tracks the fundamental change in the treatment and management of alcohol problems, mainly in the post war period, with excellent earlier historic references. The chapter on ‘The Case Study of Women and Alcohol’ is particularly interesting as the following extracts reveal;

'Academic and medical papers written at the turn of the century claimed ‘strong evidence' to show that alcoholism is spreading at an alarming rate among females. Typically, no figures were offered in support of the contention; rather observations of changing patterns of social behaviour were provided as evidence. Young girls were alleged to be indulging in drinking and smoking and there was a continuing outcry over the employment of young women as barmaids and the subsequent decline of many into alcoholism.

Women were regarded as being particularly at risk of succumbing to temptation and of drinking immoderately because they suffered from ‘an inherent vulnerability of the nervous tissues’ which lowered their resistance to alcohol. By the late 1950's the female alcoholic, as she emerges from the clinical literature of the period, is a stereo-typical figure suffering from greater pathology than the male alcoholic and having a poorer prognosis. For example, writing in the 1950s, Lincoln Williams described the "Immature female psychopathic addict, often emotionally labile and a possible suicide risk, perhaps sexually frigid, perverse or promiscuous ... the woman patient, so vulnerable to emotional disturbances, finds it more difficult to readjust her life and to make a successful recovery than the male".

It was not until the mid 1970s that the ‘female alcoholic’, as a subject of research and treatment concern, was rediscovered in the UK. For instance, one of the few policy statements in the early 1980s regarding women and alcohol was a statement in 1983 concerned with drinking during pregnancy. Certainly, women involved in the early ‘activist’ group felt that interest in foetal health gained greater policy attention than the treatment needs of women alcoholics. Comments from Shirley Otto, a research psychologist, give some insight into their thinking at that time: "We drew our ideas from feminist thought and from the work on homeless women. We were guilty of ending up taking about ‘empty nest’ syndrome and such like but it was all we knew at the time ... We were also caught up fighting off the foetal alcohol stuff. That just gave the boys such fun. As soon as they got hold of it they ran with it. Because it was such a lovely stick to beat women with. But it didn’t come off - it hasn’t come off. They were less interested in women, more interested in foetal alcohol syndrome. At first it was not too difficult to stave it off, because it was unclear what it was and how it applied. And people were using very different definitions of it. But it’s something that gets money. It implied the idea of the degeneration of the race although they did not use these terms. Very, very occasionally they could think of providing provision for mothers and babies which was an acknowledgement that women had children, but they wouldn’t provide creches that gave women fuller lives".'

There is much, much more to recommend in this book to all those who need to understand the historic, professional and political background leading up to the UK Government's review of alcohol strategy.

Dealing with Drink by Betsy Thom is published by FA Free Association Books, 57 Warren Street, London W1P 5PA @ £15.95. Email, phone 020 7388 3182.

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