Mid-life male drinking: findings from research with men aged 45 to 60

This research was commissioned by Drinkaware to support the development of a new campaign. It was designed to establish what role Drinkaware could and should play in reducing consumption of alcohol among men aged 45 to 60 who are drinking more than 21 units in a typical week.

The research highlighted a number of important patterns in the drinking practices of this group (you can download the full report at the bottom of this page). For example, clear differences were apparent between social drinking and what we called ‘routine home drinking’, with opportunities to reduce consumption using the tools at Drinkaware’s disposal largely concentrated in the latter category.

The importance of mental models

One point that struck me personally was participants’ lack of clear mental models of what alcohol was doing in their bodies. There’s a big difference between knowing that alcohol does you harm and having a clear picture of how it does it.

Even when participants did have mental models of harm, they were not always accurate. For example, some thought alcohol harmed the kidneys rather than the liver: they understood what a filter does, believed alcohol needed filtering out of the blood, and remembered that the kidneys are the body’s filters.

With regards to other harms – such as damage to the cardiovascular system, a major risk for this group – participants had no idea whatsoever what alcohol might be doing in their bodies. And this lack of a mental model made it harder for them to take the risks seriously.

Interestingly, when I searched online for an answer to this question – how does alcohol harm the cardiovascular system – I could find nothing (at least not at the time). There were plenty of studies establishing the statistical link between consumption and outcomes like raised blood pressure or stroke. There were plenty of advice sites reporting those links. But there was nothing telling me what was actually going on in my body when I had a drink.

I believe this is a common issue in public health. For people with technical public health expertise, population statistics and attributable fractions provide real and engaging reasons to avoid a behaviour. They’re right of course: but you don’t win arguments by being right.

Showing the rest of us population statistics does not give us a compelling picture of what is going on in our individual bodies: and it’s the latter that might give us pause to thought as we reach for that second glass.

Drunken nights out: motivations, norms and rituals in the night-time economy

This research was undertaken as part of a strategic review for Drinkaware. The remit of the review was to make evidence-based recommendations regarding the role that education and communications could play in reducing the harms associated with drunken nights out.

Perhaps not surprisingly, the research highlighted the limitations of education and communications in tackling these harms. Behaviour on drunken nights out is typically characterised as chaotic, reckless and out of control: but from another perspective it is in fact highly structured by the norms and rituals which define the social arena in which it takes place. It’s easy to come up with reasons not to get excessively drunk from outside these structures: from the inside, things look very different.

The example of pre-drinking

Take pre-drinking, for example. This practice may well have started as a way of getting drunk more cheaply, given the availability of cheap alcohol in shops. Whatever its history, however, our research suggested it is now held in place by multiple overlapping roles in the drunken night out, including:

• Providing a more conducive environment for a group to bond before going out, where the focus shifts to what we call ‘social adventures’
• Meeting a need to be drunk before one goes out – and to synchronise levels of drunkenness within the group
• Serving as a ritual passage from the norms of everyday life to the special social context of the drunken night out
• Filling the time until everyone else goes out, since everyone else pre-drinks

Reducing harm

Our findings regarding the complex social structures of the drunken night out raised a difficult question: to what extent can education and communications start to pick these structures apart?

Our answer was: very little.

In particular, it seemed to us highly unlikely that education and communications would have any meaningful impact on consumption.

Where we did see a potential for meaningful harm reduction was in relation to another aspect of drunken nights out reported by our participants: widespread sexual harassment and molestation. This was an aspect of the drunken night out that, although in some ways an inevitable consequence of the norms of that social arena, troubled many of those we spoke to.

In particular, our findings highlighted the potential value of simply reminding participants that they should not accept behaviour they would not accept when sober. This insight formed the basis for a successful and long-running campaign by Drinkaware.

The role of Drinkaware

The approach we recommended was potentially a controversial one. Tackling harms that occur when people are already drunk means not tackling the drinking itself. And this in turn could easily be interpreted as endorsing that drinking, especially if you just happen to be funded by the very companies that make and sell the drink.

My view is that, given the limited tools at their disposal, Drinkaware did a brave thing here. Running a campaign that sought to persuade young people to drink less on drunken nights out might have been much better for their reputation: but, based on the evidence, I don’t think it would have made a jot of difference. I think they spent their money on the right thing: trying to reduce harm, rather than trying to improve their own standing.

There’s a larger argument, of course, about whether Drinkaware should exist at all – and about whether someone like me should be prepared to work for them.

For what it’s worth (which is little if anything) I think that the existence of Drinkaware in its current form is indeed indefensible, and that the big alcohol producers use it as a talisman to ward off measures that would be far more effective but also far more damaging to their profits. At the same time, I think the activity of Drinkaware can nevertheless do good within the limited scope of operation it has been allowed.

And here’s the reality: most of my public sector work is for clients who don’t have access to the behaviour change levers that might really make a difference, and who have to accept the political constraints they are working under. Drinkaware’s compromised status is, I would suggest, less unusual than some make it out to be.

Of course, one can choose to keep one’s hands clean and rise above these compromises, and that’s a noble and defensible stance.

I chose to muck in and do the best I could in the circumstances. That may have been a naive decision, but it was not an unthinking one.