How To Communicate The Health Risks of Drinking Without Being Really F*!*ing Annoying
Plus a Very Juicy Rattle Bag
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John & Paul has hit the New York Times bestseller list! Since it’s still in the Sunday Times list, it’s currently a bestseller on both sides of the Atlantic. Crazy but true. To help me keep it there, click this way…
I’ve been talking J&P in Liverpool (!), St Andrews, Glasgow and Edinburgh. Our audiences have been lovely: informed, enthusiastic, and friendly. I was slightly nervous about going to Liverpool, home of the real Beatles experts, but they couldn’t have been nicer. One audience member had seen the Beatles at the Cavern and has written extensively about them; when he told me he loved my book I felt rather proud. Thanks to everyone who came along to these events. Next week: Swansea. Get your ticket now!
So let’s get the bad news out of the way: according to a new study, even low-level boozing is bad for you. Four thousand adults kept a record of their drinking patterns over a fourteen-day period, and provided data on past habits, health and lifestyle. The headline finding is that even conscientious drinkers - those who abide by the NHS’s stringent alcohol guidelines - have higher rates of cardiovascular disease and cancer than those abstain altogether.
The researchers don’t claim to have proved that moderate boozing causes bad health outcomes, only that it’s associated with them; that’s to say, it was spotted in the area with a crowbar just around the time the window got smashed in. It’s just one study, commissioned by a charity which campaigns against harms caused by alcohol, but its results are consistent with other evidence. Sorry about that. Anyway, let’s put the research itself aside, because what I really want to talk about is how its findings have been communicated.
The Sky News report I link to above is more or less a vehicle for the charity’s message, which is that any alcohol consumption is bad for you. The charity’s director says he wants to move on from the idea that only heavy drinkers have “an alcohol problem”. If you drink alcohol at all, you have a problem: “Alcohol is taking a toll on our health and wellbeing right across the drinking spectrum, even at 'low-risk' levels.”
Professor David Nutt, an ally of the charity and a long-time anti-alcohol activist and would-be entrepreneur (he’s trying to create non-alcoholic booze), chimes in:
"There are people who think, 'I've got 14 units, I can have seven drinks on a Friday, seven on a Saturday, that's okay’…the harms are undoubtedly magnified by binge drinking within that low-risk weekly level. We know that drinking the maximum allowance in one or two goes is very dangerous…some of the harms are undoubtedly magnified by binge drinking within that low-risk weekly level.”
To me this sounds slightly mad. First of all, how many people even know what the NHS recommended maximum is - and how many of those people treat it as a target? Are there really people out there who think, “Oh man, I can’t wait to get smash my NHS allowance tonight”? Maybe there are, but I suspect not many.
Second, let’s recall that 14 units means about six pints of beer (or six glasses of wine). So Professor Nutt is talking about three pints on a Friday, three on a Saturday. Now, I get that drinking three pints, two nights in a row every week, is not great for you. But is it “very dangerous”? Maybe if you then get behind the wheel of a car or go snipe hunting. Otherwise, this seems a little dramatic.
It is certainly reasonable of Nutt to highlight distribution of intake as well as volume (even if that wasn’t investigated in this study). There’s quite strong evidence that drinking a moderate weekly amount over several days is better for your heart than consuming the same amount in one or two bouts (though it doesn’t seem to make a difference to cancer risk). But even if Nutt and his fellow campaigners are right about the science, they ought to be able to see that making claims which sound absurd to most drinkers undermines their cause.
Yes, part of their job is to recalibrate ideas of what “moderate” drinking is. But by not allowing that any drinking can ever be OK, they come across as joyless extremists - and really annoying ones. That means they can be easily dismissed. This is a classic communication error made by campaigners, activists and politicians. In fact it’s a bit unfair of me to pick this particular example, since it happens all the time in public life.
The error has two components. First is the assumption that readers of articles like this are open to its message when most people, most of the time, will find any reason they can to screen out unwelcome information - and telling me I shouldn’t drink even in moderation is very unwelcome. Nobody likes being lectured. Unless there’s something different or intriguing about a campaigner’s pitch, I’ll ignore it.
Second is that if you tell me something bad for me, my kneejerk reaction is to want more of it. This isn’t just because I’m hopelessly perverse, although that’s true. It’s human nature. Psychologists call it reactance: the strong, often irrational reaction people have to the perception of being coerced, however subtly, into certain behaviours.
People will do almost anything to protect and assert their individual sovereignty. Addiction therapists learnt long ago that if you tell a patient to stop drinking, they will come up with reasons to drink more, even if that means self-destruction. The therapists used to think they had to try and break the patient’s resistance to their message by repeating it ever more forcefully. They discovered that it’s more effective to let the patient work out, over the course of a sympathetic dialogue, their own reasons for stopping.
Skilled interrogators understand this principle. The most effective ones don’t scream at interviewees that they have to talk, which makes the interviewee dig in and shut down. Neither do they skip or skim over the reading of rights (‘You have the right not to say anything’). In fact, they go out of their way to emphasise it. The aim is to make the interviewee feel as if it’s their choice to talk or not. I can’t make you talk and neither can anyone else. It’s up to you. Hearing this, hardened terrorists will choose to spill their guts more often than you might expect.
The political equivalent of old-fashioned addiction treatments, or ineffective interrogation, is moralising: telling people that if they oppose immigration it’s because they’re bigoted. Well, maybe they are, maybe they’re not, but as soon as you tell them they are, they are pretty sure to become more staunchly anti-immigration than ever. Similarly, health campaigners ought to realise that the louder they shout how bad moderate drinking is the more likely people are to want a drink. (At least, as long as the health effects are relatively small, as opposed to, say, the effect of smoking on lung cancer).
The problem is not just with what the campaigners say, however. It’s also with what they don’t say. They don’t ever say, drinking is fun. They don’t acknowledge that people who drink in moderation derive valuable benefits from it. They should! If moderate drinking didn’t have harmful effects, doctors would prescribe it. It relaxes us, frees up our minds, brings us closer to other people, enhances the enjoyment of food, and so on. Of course, the costs to long-term health may well outweigh those benefits. But those benefits are real.
Why would an anti-alcohol campaigner ever refer to the upsides of alcoholic drinking? In order to get heard. As soon as they acknowledge the indubitable truth that, under certain circumstances, drinking is is really great, they will have a more persuadable audience. Firstly, because that’s not how health campaigners usually talk; it would be a surprise, and surprises win attention. Secondly, because they will be speaking to people where they are. They’ll be talking to real, grown-up adults, rather than to the obedient pupils they seem to imagine they’re addressing. It will stop them sounding like moral missionaries, and make them sound like people interested in my wellbeing.
If I was campaigning against alcohol usage, I’d frame the message like this:
For many people, drinking is a valuable source of pleasure and relaxation. We get that. We’re not here to stamp on anyone’s joy. All we’re suggesting is that people should be informed about the choice they’re making. When you choose to drink for a few nights every week, you’re also choosing to increase your risk of heart disease and cancer. Some of you will stick to that choice even after considering the evidence of harms; others will conclude that drinking isn’t worth it. We can’t tell you what to do. We’re just here to tell people about the risks. After that, it’s up to you.
Life, as Jeremy Bentham observed, is a trade-off between pleasure and pain, and alcoholic drinking, properly understood, is a trade-off between immediate, tangible pleasure and the risk of potential future pain (in the case of a night of heavy drinking the pain isn’t very far into the future, of course). Most moderate drinkers recalibrate this calculus as they get older and drink less or stop altogether. The job of the campaigner is to speed up that recalibration by magnifying our estimation of future pain. But they’ll do that more successfully if they acknowledge the trade-off and avoid triggering our deepest wish: to do whatever the hell we want.
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