FactCheck: can you change a violent drinking culture by changing how people drink?

Peter Miller writes:

“You can’t change a culture by simply changing drinking. It is, of course, justifiable to explore the effectiveness of small measures such as advertising restrictions, increases or decreases in price, relaxation or restriction of hours, but such things tinker at the margins of culture and it is doubtful that they will alter the culture of violence and anti-social behaviour in any meaningful way.” – Dr Anne Fox, author of a report released by the Lion alcohol company, January 2015.

The Lion alcohol company recently released a report on Australian and New Zealand nightlife and violence. The study was conducted by an English anthropologist, Dr Anne Fox, working with a private […]

research company. In this report, the author visited towns in Australia and New Zealand and reviewed the literature on various drinking cultures. Dr Fox concludes that you can’t change a culture by simply changing drinking patterns.

There is a fair bit of opinion involved in determining the role that “culture” plays in alcohol-fuelled violence.

Dr Fox says we should be focusing on violence, misogyny, and aggressive masculinity. These things play a role, though they are usually poorly defined and require more sophisticated research.

However, the evidence shows that we can make a meaningful difference to curbing a culture of violence and anti-social behaviour by changing drinking patterns.

In fact, there is a massive body of independent research that demonstrates a lack of impact from so-called “culture change” interventions such as social norms campaigns, generic education in schools and occasional mass media campaigns warning of alcohol-related harm.

What the available evidence does show is that many assaults and hospital attendances that can be prevented by simple measures that alter drinking patterns, such as shutting licensed venues a few hours earlier. These measures cost the community very little compared to the vast expenditure on police and emergency services across Australia.

Global data

A rigorous body of experimental and observational evidence from around the world provides important insights into the real relationship between alcohol to violence, including that:

• If you shut the pubs and clubs in town two hours earlier, you see a 30% to 40% reduction in the number of assaults reported to police and the injuries turning up at emergency in hospital.
• If you stop repeat drink drivers from drinking, there is a 10% reduction in domestic violence cases reported to police state-wide.
• People who receive alcohol are more aggressive than those who receive no alcohol or placebo beverages.
• Intoxicated subjects are more likely to administer electric shocks to others when provoked – and when they do shock others, they select a higher voltage.
• Alcohol administration to men increases the level of negative verbal behaviour displayed by the men and their partners.
• Normally non-violent individuals can become violent when consuming a substantial amount of alcohol.
• Heavier consumption of alcohol results in conflict situations turning violent between partners.
• Alcohol use is more common among serious physical assault events.
• Consumption of six or more drinks predicts violent events in the family setting.
• Blood alcohol content (BAC) of 0.19 was reported in violent events compared to an estimated BAC of 0.11 in conflict events that did not include violence.
• Treatment for alcohol dependence is associated with reductions in intimate partner violence, and this reduction is observable up to two years post-treatment.

For every hour after midnight that pubs are open, there is a 15% to 20% increase in violence, drink driving and emergency department attendances. Shutting pubs at 3:30am in Newcastle, NSW, rather than 5am, resulted in a 37% decrease in assaults. Paradoxically, there has been a 25% increase in liquor licences in Newcastle and people simply go out earlier and even spend more.

So we do know that straightforward measures such as shutting pubs earlier are meaningful in the Australian context, but are extremely unpopular with industry. And across Australia there has been little action from political parties that receive industry donations.

How does alcohol increase the likelihood of violence?

Dr Fox makes anecdotal comparisons between countries such as Iceland, Spain and Italy. But put simply, Australia is not Italy. In Italy, when people drink, they drink less on any single drinking occasion than the average Australian. Dr Fox even relates a personal account about how, one night when she was at a bar, some young men started to get rowdy and the bartender gave them whiskey to calm them down.

This might make an engaging story but it falls well short of scientific evidence. We don’t know what happened to the young men later that night when they met on the street outside or when they got home. Real violence often happens in the blink of an eye.

It is well-documented what happens to humans when they drink alcohol: reduced cognitive ability, disinhibition, inability to think of consequences, poor interpretation of social cues and obsessional thinking about single details.

These effects have been found in many studies and are reliably replicated across many cultures.

Research from around the world has shown that people are much more likely to be victims of alcohol-related violence when they are heavily intoxicated.

This is why we have responsible service of alcohol laws. When people are drunk, they make poor decisions, especially the decision to keep drinking.

Verdict

It’s not correct to say you can’t “alter the culture of violence and anti-social behaviour in any meaningful way” by tackling the way people drink. There is a lot of evidence showing that changing people’s drinking hours and consumption patterns reduces violence and hospital admissions – which is a lot more significant than tinkering at the margins of culture.

* Peter Miller is Principal Research Fellow at Deakin University. He receives funding from Australian Research Council and Australian National Health and Medical Research Council, grants from NSW Government, National Drug Law Enforcement Research Fund, Foundation for Alcohol Research and Education, Cancer Council Victoria, Queensland government and Australian Drug Foundation, travel and related costs from Australasian Drug Strategy Conference. He is affiliated with academic journal Addiction.

Review

This review is a fair assessment of the question as to whether achieving cultural change is more effective than reducing alcohol related violence by curbing alcohol consumption.

As the reviewer rightly concludes, the evidence that measures to reduce consumption are effective is coherent and persuasive, while arguments to the contrary – including those put forward by Dr Fox – generally rely more on anecdote and intuition than empirical research.

Attempts to change Australia’s drinking culture using education campaigns have a poor record. At best, a small and temporary improvement is reported from some evaluations, while others show no change or even worse outcomes. The drinks industry is capable of spending many, many times more on continual and positive advertising than what governments can afford to spend on intermittent cautionary campaigns. This is not, and never has been, a level playing field.

The evidence is slowly accumulating for some control of alcohol advertising, marketing and promotion, as the current self-regulatory system is widely recognised to be worse than a joke. But no one should underestimate the political difficulties of achieving this. – Alex Wodak

* Alex Wodak is Emeritus Consultant at St Vincent’s Hospital, Darlinghurst. He is president of the Australian Drug Law Reform Foundation.

This article was originally published on The Conversation.
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