“My name is …and I’m an alcoholic” – Wednesday, 13 January – 10pm on Channel 5
We have a complicated relationship with alcohol. Many of us are as likely to drink to drown our sorrows as we are to celebrate our successes. Indeed the consumption of alcohol, often to excess, marks important rites of passage and is culturally embedded. Channel 5 documentary ‘My Name is …and I’m an alcoholic’ is screened tonight and has been described as a story of hope and struggle. The timing could hardly be more apt. “Dry January” is firmly in the calendar and there is currently considerable discussion of new UK guidelines for alcohol consumption revised for the first time in twenty years. These warn that drinking any level of alcohol increases the risk of a range of cancers and are supported by a new review from the Committee on Carcinogenicity. The implications and how these have been reported in our media tell us a great deal about societal reactions to alcohol in society and also highlight important problems with communicating risk.
Sir David Spiegelhalter, Winton Professor of the Public Understanding of Risk, University of Cambridge explains:
These guidelines define “low-risk” drinking as giving you less than a 1% chance of dying from an alcohol-related condition. An hour of TV watching a day, or a bacon sandwich a couple of times a week, is more dangerous to your long-term health. In contrast, an average driver faces much less than this lifetime risk from a car accident. It all seems to come down to what pleasure you get from moderate drinking.
The guidelines were also dismissed as further evidence of our descent into a ‘nanny state’ by UKIP leader Nigel Farage who has created a positive public image built on ‘man in the pub’ and journalist Rod Liddle who thinks these proposals are ineffective:
I wonder what is more effective in combating alcohol abuse — constant pronouncements that we may be damaging our health or the old method: the imposition of shame upon the drunk, that being paralytic is transgressive behaviour to be pitied or condemned.
Shame has been used before in an attempt to change drinking culture and there is little doubt that this theme runs through the documentary “My name is …”. It begins with some bold statistics for example: that ‘8 million people in the UK are estimated to be ‘alcohol dependent’; and 1.4 million people are registered alcoholics. This powerful documentary unfolds quietly as eight men and women from different social backgrounds tell their personal stories. The storytelling is chronological from recalling evocative memories of their very first drink to their gradual loss of jobs, families and friends to the point they reached their personal ‘rock bottom’ – the turning point that shocked each one of them into painful recognition that action was needed urgently.
Alcohol guidelines do not deal with the feelings and emotions associated with drinking. In the documentary ‘John’ describes first drinking aged 12 to cope with the grief of his mother’s death and feeling positive and socially confident as though ‘I’ve arrived’. ‘Rachael’ tasted alcohol and found she could use it “like medicine” slipping vodka into her water bottle to manage social anxiety when performing cello in an orchestra. ‘Lucy’ didn’t consider herself to have a problem because she lived in an ‘alco-centric world’ where drinking good wine in ‘nice’ wine bars was part of feeling sophisticated and connected.’ Liz’ used alcohol to switch off from the burden of being a responsible GP to her patients and ‘David’ declared almost triumphantly that his drinking had been largely funded by Rupert Murdoch. As former editor of the Sun newspaper David (Yelland) could of course claim expenses and his life included chauffeur driven cars and champagne in Claridges. He describes himself as ‘worshipping alcohol’ and explains:
“I had no friends. I had no real social life. I lived for the job and I lived for alcohol”
Their ages and backgrounds may differ but there are central shared themes of loneliness and the prominence of alcohol as being their main relationship “like a best friend, always there” “the most important relationship in my life”. Liz admits she rushed to get her daughter into bed for 7pm so that she could begin drinking without the infringement of childcare. She recalls that alcohol became “more important than my daughter’s happiness, which is a hard thing to admit”. Similar stories involved one woman hiding empty bottles of vodka in a toy box and under a baby cot, a man “selling myself to men just for the cider” and another burgling houses to steal video recorders from “poor people”.
Feelings of belonging and connectedness came from joining groups with a view to living an abstinent life however all have been honest about their struggle to avoid relapses. Self-management is central here. One participant explained that he now recognised triggers in his life whereas for Rachael “My trigger is being alive!” The interviewees have gone on to make significant contributions from founding alcohol support charities to writing books but all describe themselves as ‘in recovery’ and there is a clear sense that this is a process which is ongoing. Perhaps surprisingly most participants described comments from friends who assumed that at some point in the future they will be well enough to drink again, the implication being that their future drinking will be ‘socially acceptable’.
This documentary is worth watching. It is shot simply with no commentary and focuses almost entirely on the faces of the eight participants. This serves to make their stories more powerful and most viewers are likely to find some empathy for their situations and the raw experiences they recount.
Would the new guidelines on alcohol have helped these people? For a small group of the population who have a problematic relationship with alcohol then Government guidelines however well evidenced are unlikely to make a significant difference to their overall consumption. For those of us who think of ourselves as ‘moderate’ drinkers the guidelines are likely to be seen as irrelevant and for others they will be perceived in the context of ‘another pronouncement from the nanny state’ and thus easily dismissed. The problem is that there are a myriad of reasons to explain why and how people drink at different points in their lives and a ‘one size fits all’ approach risks failing everyone.
Charlie Davison on Jan 14, 2016
As Lesley points out, the new guidelines take (apparently unashamedly) a “one-size-fits-all” approach. But it’s worth asking what the one size is meant to fit and worth speculating what the effects might be.
In terms of the probability of alcohol-related cancers, the “one size” advice is apparently trying to ‘hard wire’ a relationship in the public mind between booze consumption and eventual cancer. The message is that “alcohol gives you cancer” in much the same way that “tobacco smoke gives you cancer”. A similarly definite and direct statement is easily findable on the Cancer Research UK website:-
“Alcohol causes 7 types of cancer, including breast, mouth and bowel cancers.” (http://www.cancerresearchuk.org/about-cancer/causes-of-cancer/alcohol-and-cancer)
One of the big problems with this kind of approach is that the probabilistic nature of any relationship between alcohol and cancer causation is conveniently glossed over.
This is important for one main reason. That is that, where the relationship between a behaviour and an eventual future illness is only truly discernible by crunching really quite large, complicated data sets, the potential for creating public scepticism is huge.
Many people will simply observe (in the context of their own lives) that lots of people who drink quite a lot DON’T get cancer. And lots of people who don’t drink that much DO get cancer.
Every time a behavioural guideline is tightened (and loudly trumpeted) it increases the likelihood of ordinary, sensible people being able to dispute it and “disprove” it by simple reference to their own health experience and that of their families, friends and neighbours (let alone celebs and people in the news).
You would have thought that enough had been written on this kind of “Lay Epidemiology” over the last 25 years that Public Health England and the Chief Medical Officer might have read some of it. But apparently not.