Issue 36 / 17 September 2012

IN a fascinating case of strange ideological bedfellows, the American Society of Addiction Medicine recently reiterated its opposition to legalisation of marijuana in the US; siding with the hardcore anti-drugs warriors.

The core unrelenting conviction that the substance is the cause of problems, not its irresponsible use, is all pervasive and thus ASAM would have harmless users thrown in jail to prevent the wrongdoings of a few.

This conviction is also emerging in alcohol policy in Australia.

Measures proposed to reduce “alcohol-related violence” in Sydney’s Kings Cross represent a terrible capitulation in the fight against Australia’s developing culture of violence.

If we continue to reinforce the message that “it’s not my fault — it is my alcohol abuse problem” and blame the availability of alcohol, it’s reasonably foreseeable this could have severe consequences in our society.

A much publicised study on early closing times at pubs in Newcastle, NSW, claimed its findings “are consistent with the … availability hypothesis; namely, that increasing the physical and/or economic availability of alcohol increases consumption and therefore alcohol-related harm”.

The folly of such policy direction is probably best encapsulated in the following parody of the Josh Booth incident during the London Olympics: “The people of London should be ashamed. They failed a vulnerable young Aussie. By not advocating 6pm lockouts, by not mandating warning labels on alcohol products, by not enforcing strict responsible-service-of-alcohol policies, the people of London were conspiring enablers of Big Alcohol to peddle their killer product. Josh Booth was another in the long line of innocent Aussie victims to the epidemic of alcohol-related harm.”

It’s a moral and intellectual outrage that violent behaviour can be nihilistically categorised as “alcohol-related harm”. It is like a primitive cult blaming the evil god of alcohol. When deciding to drink and while intoxicated, people remain culpable for violent and antisocial behaviour.

The crackdown in Kings Cross stemmed from the death of Thomas Kelly, whose alleged killer has rightly been charged with murder.

However, the problem is that all the other assaults that do not lead to death and therefore do not attract national media attention are not ruthlessly pursued. Instead we wring our hands and blame the booze.

I don’t want my daughters growing up in a society where there is an epidemic of lack of individual responsibility — a moral jungle where someone can have their life ruined in an instant by another’s primitive urges, completely unrestrained by any societal pressures to take responsibility.

Martin Luther King famously told of the dream he had that his four children “will one day live in a nation where they will not be judged by the color of their skin, but by the content of their character”.

If we reduce everything about our behaviour and actions as the inevitable result of a “disease” or addiction or substance-related harm, then we are debasing character.

In the Newcastle study, a reduction in incidents of assault after restrictions on pub closing times is one small example and has to be considered against the malignant problem of lack of individual responsibility that arises when we collectively punish every decent person who causes no trouble at all for the violent outbursts of a few.

One issue I do agree with is replacing glass containers with plastic, as it is a reasonable and unobtrusive measure. It is the least likely to send a societal message of abrogation of personal responsibility.

However, it is questionable whether closing venues early will make an overall dent in total community violence, especially when it seems violence for many is seen as trendy and completely excused with very little chance of any consequences.

Whether it is alcohol-fuelled, road rage-fuelled or fuelled by the umpiring decision at the kid’s footy, violence is a criminal not a health matter. Until we take our heads out of the politically correct sand and acknowledge that, we will follow ASAM and their comrades into yet another front in the war on drugs.

Dr Michael Keane is adjunct associate professor at the Centre for Human Psychopharmacology at Swinburne University, Melbourne, adjunct lecturer in public health at Monash University and a consultant anaesthetist.

Posted 17 September 2012

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6 thoughts on “Michael Keane: Alcohol-fuelled cop-out

  1. David Meldrum says:

    I agree that we’re increasingly shifting responsibility for bad behaviour from the individual to external factors (alcohol, addiction, mental health problems). I’m frequently asked to write a letter explaining how some teenager’s bad behaviour should be excused because of ADHD, conduct disorder, etc.
    However, given that behaviour change is notoriously difficult to bring about, surely some environmental manipulation is appropriate to reduce the harmful effects on others. You seem to be arguing that we should start the brewers’ trucks rolling into dry indigenous communities again?

  2. Frank Ekin says:

    Alcohol excess changes or at least reveals latent personality traits. In some alcohol induces sleepiness, in others loquacity and others hyperbole are revealed. Sadly aggression is another trait revealed in some.

    I favour encouragement of personal alcohol testing in the same way as we favour reflectance meters and personal peek flow meters for diabetes and asthma.

    Further, advertising equivalent to the current beer and motor car advertisements on TV. might alter the general public’s view on alcohol.

    Fights outside pubs are an accepted phenomenon, though despite 9 years in Dublin and being an assiduous habitue of pubs, I never witnessed a fight.

  3. RayT says:

    A twofold approach is needed. The opportunity to “push” alcohol needs to be restricted by reducing the hours of premises geared only to selling alcohol to those going out to get drunk. However, personal responsibility has to be stressed too. The current idea in society that you haven’t had “fun” if you don’t get drunk needs to be addressed, and to reinforce the sense of being responsible there need to be a consequences if you are drunk and disorderly in public. That is a policing matter.

  4. William Huang says:

    As a Kings Cross GP and Addiction Medicine specialist. I disagree. If less alcohol was sold in Kings cross, not only would there be less violence, but less falls and accidents. There would also be less sexual assaults and unsafe sex. Acute alcohol intoxication produces more health costs, especially via accidents, which then need the trauma team ICU and hospital stay, and then rehabilitation etc. I don’t find the ideas that the new stringent measures harm innocent safe drinkers. I’m sure a survey of residents and police of the area would argue the whole ambience would improve if less alcohol was sold in the cross. Addiction medicine, famously unrenumerated by the MBS Referral Item 104 $70 review item 105 $35, has contributions to make by combining public health measures, the classic one quoted to me by Alex Wodak “Seat belts”, and individual responsibility “driver education”. I work with my patients and their substance use on the basis of them being responsible for how their life turns out. If it were newly discovered and marketed, the two carbon compound ethanol would never of course be approved by current food and drug regulators, with its rates of organ damage, contributions to depression, and low grade carcinogenicity. It does show some promise as an clean burning high octane biofuel. The thrust of the article troubles me as it seems to say, using the seat belt analogy: Why does every one have to wear a seat belt when there are only a few bad drivers.

  5. Dr Joe says:

    Brilliantly said. It is time to stop allowing people play the medical card when it suits them as an excuse for bad behaviour. Alcohol per se is not the problem.How some people choose to use it and what they do afterwards is the problem.
    The medical card is also used by gamblers and those who wont control their sexual urges. Time to hold people accountable for the consequences of their actions and stop inventing medical excuses.

  6. cboughton says:

    William Huang says it all. Hours for the availability of alcohol need to be limited, but the AHA opposes this. Limitation of hours will not inconvenience responsible drinkers, but may inconvenience those who do not accept personal responsibility for their actions. The results in Newcastle prove the point.

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