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