The Social Model of Alcohol and Substance Use

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So as to avoid any accusations of hypocrisy I must immediately own up to having done more than my share of emptying bottles down the throat. My mother’s well fertilised rose bushes were testimony to this after countless occasions of teenage chucking up in the early hours of the morning after a heavy night clubbing. I had also indulged in more than a little pill popping and smoking of illegal substances as a student; it was in the job description. I did grow out of the illegal stuff when I entered the ‘real’ world, however did, for many years after, continue to indulge in the joys and pain of over-consumption of alcohol; that is until the onset of Diabetes. It was only then that I discovered that my drinking partners and I had been behaving in an extremely juvenile way and talking crap all those years. Sobering up was a cold and somewhat embarrassing experience.

Since being required to reduce my alcohol intake to a maximum of 2 daily units I have discovered that living within the dominant British culture without drinking is quite a challenging business. Whilst my background culture tended to structure life events around food and family, the British way does, in my experience, largely centre on the bottle. We celebrate with alcohol, socialise through alcohol, commiserate through alcohol and mourn through alcohol. How do we function without confronting the demon drink and without being regarded as being rather odd; or even odder in my case?

For some years I worked with people with a variety of eating disorders. What so many clients pointed out to me was the challenge of controlling eating within normal parameters when food was socially so central as well as a survival necessity. Unlike food, Alcohol and drugs were avoidable. Not so today. How do people function in our society without being exposed to alcohol and without retreating into an abstemis laager of the formation kind? It is very difficult indeed avoiding alcohol in a society where alcohol has such prominence in the supermarket, the high street, at festivities, on television. It’s tough, especially in a society that ritualises drunkenness, and places the value of overindulgent celebrities above the worthy. We say ‘isn’t it awful’ but playfully and warmly mock out of control behaviour. E.g. George Best and Oliver Reed. “Oh dear, they did go too far didn’t they; the naughty boys” Yet, often these folks are just one or two steps ahead of our own patterns. Dressed up with gallows humour and feigned embarrassment we exclaim ”Gosh I was legless last night; boy James was off his head”; hero stuff.

I had been aware of the increasing volume of alcohol intake within our society over the years. My own tendency was to overindulge at a dinner party, at a celebration; perhaps on a Saturday night; however after these brief episodes of binge drinking I and friends would suffer the hangover, go through the regret and never-touch-another-drop resolutions until the next occasion. More recently I have been aware that in addition to the major bouts, people I come across seem to keep this up on a constant trickle-trickle basis; daily pub visits, a bottle of wine over each meal, a few cans in front of the TV. My own evidence is anecdotal; however recent figures demonstrate that my impressions are not inaccurate. Alcohol use/misuse is highly institutionalised; normalised.

Most of us manage to get by without pickling our livers before the age of forty. Most of us manage to somehow function kind of ‘normally’ and integrate our drinking into our lives without needing to check into the Priory for treatment. So, we spend too much on the bottle and struggle with the mortgage; so we fell down at that wedding, but it was, after all, a celebration; its okay; not a serious issue. We do, however avoid acknowledging the very significant minority who drink instead of feeding their children; who buy booze rather than books; who trip to the pub rather than a holiday. We get by and we very conveniently project our behaviour onto those less able to cope. Those who provide the support are often hanging on by the skin of their teeth.

How do we cope with supporting those who are just a few steps ahead of our own behaviour? A troubling question. We introduce euphemisms. We do so under the guise of respectful language and being ‘Person Centred’. Thus we no longer refer to ‘alcoholism’ or ‘drug addiction’. We no longer even refer to ‘alcohol misuse’ or ‘substance misuse’. We now work with ‘substance use’ Okay, so where do we go with that one? Jenny uses substances. Wow! Surprise! I used toothpaste this morning and then washing up liquid, coffee, all bran, cigarettes. Where does this end? When does this begin to mean anything? In my view, by immersing ourselves in meaningless euphemistic jargon we deny the service user the right to real support by those who are sadly often lacking in the ability to do so with integrity; so blinded by jargon and professional preciousness.

Our projections are, in my view abusive. We as a society have created the very structure and process whereby it is inevitable that a proportion of our fellow citizens are going to get hooked and have their lives destroyed. Whilst the issue is manifest as their problem, it is a collective problem; one that we all own. Thus we need to find a way for collective ownership of the issue; acknowledge the part society as  a whole has played in setting up these ‘victims’ and the courage to acknowledge our duty to support them without being weasel mouthed about naming the huge tragedy that we impose on those less able to cope.

In order to provide effective support I believe that we need to:

Stop the gobbledegook; name the issues without endlessly toying with language that denies the reality of the tragic loss of personality, talent, good health and potential. We need to dispense with the term, once and for all “Alcoholic” as by labelling people we introduce a diversion to any cooperative therapeutic relationship i.e. arguing about the definition, thus damaging the potential for meaningful engagement. Describe the behaviour; not label the person.

We need to acknowledge that medical guidelines are perhaps the only legitimate reference we have to describing unhelpful drinking patterns and thus when we, and I stress the word ‘we’ drink more than the recommended quota we own up to misusing alcohol.

We need to agree to use the law as a guideline to the boundaries that differentiate between acceptable and unacceptable drug use; and stop the nonsense going-around-in-circles discussions characterised by ‘who am I to judge’, ‘It is a cultural issue’ etc. If we are unable to subscribe to a legal definition, I believe it is highly questionable as to whether we should be providing support to those who are battling with the issue. We simply cannot support and be subversive simultaneously.

We need to acknowledge the dependence that people develop and that by virtue of this their choices are often limited. People do not choose to land up sleeping rough, neglect themselves, spend their money on drugs/alcohol, mistreat their children and beat up their partners. Dependence is extremely powerful. It is in my view that it is sadistic to expect people to make life choices when their lives are so chaotic and dependant on substances. I am often surprised that we are surprised and indeed angry that a service user has spent their rent money on drink/drugs. For heaven sake what on earth do we expect! Offering ready cash to someone dependant and without appropriate support is, in my view, cruel and the resulting recriminations and threats of eviction unbelievable unjust.

We, as a society need to acknowledge that this is a ‘there by God go I’ situation and get off our high horses that somehow the folks needing help come from an alien world. They are fellow citizens and that could be me, someone I care for; given certain circumstances.

We need to seriously and generously fund help, treatment and rehabilitation and ensure that our taxes are spent effectively.  I deliberately use the word help, for this is, I believe is what people require. It is bad enough living a chaotic life without having chaotic supporters who are unclear about what their job is and whose personal behaviour is often questionable

We need to question the idea of ‘support’. What does this mean? Does it mean supporting someone to continue to misuse? By definition it could be the case.

We as a society need to clean up our own act. We must decide if it is acceptable for us to have such an epidemic of child abuse, spouse violence and poverty as an integral feature of British life. We need to decide whether it is acceptable for our alcohol and drug fuelled young people to maraud through the streets of our towns and cities rendering them no go areas. We are only going to make a difference when we accept collective responsibility and modify our nation’s behaviour.