Why has harm to others

been neglected for so long?

2012

Hans Olav Fekjær

The alcohol problems have been perceived in five different ways

Here, we will look at the

• Basis

• Focus

• Strategy

• Consequenses for action

• Price

• Outcome

of the five paradigms

1. paradigm: Drunkenness

• Basert on laymen’s observations

• Focus: Harm to others (like families)

• ”Less use will give less problems” (like today’s ideas on illegal drugs)

• Policy was restrictive. In order to reduce harm, several people abstained from consuming and serving alcohol.

• Combatting harm this way did not cost money

• Outcome: Strong reduction of use and harm in spite of strong increase in prosperity (ca. 1880-1950)

2. paradigm: The theory of alcoholism

• Invented by stock broker Bill Wilson

• Focus on problems among heavy drinkers

• Perceived as if general use, price and availability did not matter• Thus, policy was liberalized and abstention perceived as

futile

• Combatting harm was expensive because of treatment and research to find the mystical ”alcococcus”

• Outcome: Strong increase in consumption and harm (from ca. 1950)

• Still has a strong impact on most people’s thinking

3. paradigm: Public health perspective

• Introduced by leading researchers in 1975

• Focus: the drinkers’ health problems

• Recommended restrictive policy

• Not costly to implement

• Outcome: Still, liberalization of policy and increase in harm carried on in the Nordic and English speaking countries (1975-)

4. paradigm: A brain disease

• Biological researchers (ca. 1990-)

• Focus on daily drinkers

(”addiction”)

• Belief: effects on the brain

can explain continued use

• Aiming to find medicine or vaccine towards addiction

• Large funding of research since the 1990ies

• Steadily reports ”interesting findings” and that ”we are

close to a breakthrough”

5. paradigm: Harm to others

• Leading researchers in recent years

• Focus on harm to others

• This has been shown to be the most widespread problem

• Example: 33 % have been harassed or harmed by others’ drinking last year, while only 9 % have had problems from own drinking (Canadian data)

• Most instances seem to be due to single incidents of drinking, not ”addiction”

Some Norwegian data

Deaths (estimate) 1000-1400

Injuries, accidents

(survey data)

70 000

Diseases

(data lacking)

Several thousand

Harassed in public place 554 000

Harassed in private 271 000

Physically harmed 114 000

Harm to property 176 000

Scolded 524 000

Afraid in public place 447 000

Kept awake 777 000

At least one problem 1 466 000

Health problems from alcohol, last year:

Harassed/harmed by drunkpersons, last year:

Declaration of Human Rights, 1789, § 4:

Freedom is the right to do anything that does not harm other people.

• If the main alcohol problem is drinkers’ harm upon themselves, consumption may be seen as a purely private matter. Alcohol restrictions may be seen as a nanny mentality.

• But the individual’s right do freedom does not include the right to inflict harm and problems upon others. If the most widespread problem is inconsiderate behaviour, limiting consumption is a very natural task for the society.

Focus on harm to others -consequences for attitudes and policy:

• ”Success on another big public health killer – tobacco ....a key element has been raising awareness about the impact of passive smoking.” (Chief Medical Officer’s yearly report, Britain 2008)

• Publication of data on harm to others ”could elevate political will for effective alcohol controls.” (Int J Environ Res Public Health 2009)

• ”Focusing on the second-hand effects of drinking has substantial potential in moving the alcohol policy agenda forward”. (Editorial in the journal Addiction, 2010)

• ”The substantial harm to non-users is a key argument for democratic governments to use regulations and taxes to minimise harm from alcohol.” (New Zealand Medical Journal, 2011)