Finding behavioural solutions for alcoholism
It is high time we employ the learning from new behavioural sciences to chart a new path to more effective solutions for alcoholism
Since biblical times, society leaders have been propagating the evils of alcoholism and exhorting temperance. But the results have not been encouraging.
Globally, alcohol causes 3.3 million deaths a year. It has been found that alcohol has a causal relationship with 200 diseases, including tuberculosis, pneumonia and HIV/AIDS. Additionally, if we include alcohol-induced road accidents, domestic violence, divorces and productivity loss, the burden of alcoholism on any society becomes prohibitive.
Historically, the most-used strategy to counter alcoholism was prohibition. Many governments’ attempts to enforce prohibition failed miserably. Evidence from across the globe shows that prohibition will only drive the problem underground, leading to bootlegging, illegal activities and corruption. Heavy drinkers will continue to get their daily quota of liquor from illegal sources.
All the organized religions, for thousands of years, have tried to make sure that their believers do not slip into alcoholism. Some of those religions even consider alcohol consumption to be a sin. Awareness about the ill effects of alcohol has been propagated from road signage to labels on liquor bottles. But despite these efforts, alcohol consumption continues unabated. Why?
One of the major reasons why past efforts to wean drinkers away from alcohol have failed is because most of those campaigns focused on the ill effects on the health of the individual drinker. From the point of view of new behavioural sciences, this strategy has some fundamental flaws.
The permanent health consequences of alcoholism happen far in the future, whereas the pleasure of drinking occurs in the present. It is very easy for the human brain to discount future risk, more so when the present benefits are strong.
The human brain’s reward systems are fully active by puberty. With the anticipation of a drink, just being in the physical proximity of alcohol is enough to activate these reward systems. They go into overdrive when there is even a hint of receiving pleasure hormones. Alcohol consumption itself increases dopamine in the reward system, which creates the feeling of pleasure.
It is the cerebral cortex that is expected to control the urges of the reward systems. The cortical areas of a human brain mature only by the age of 24. The brain of an adolescent has not matured enough to control the urges of its reward systems. Allowing adolescents, whose cortical areas are not fully mature, to consume alcohol is like allowing a teenager to drive a car without a brake.
Even with the first drink, one of the first parts of the brain to get affected is the cerebral cortex, its inhibitory system. So with each drink, the ability of the cortical areas to exert control over the reward systems become weaker and weaker. No wonder many a drinker who started drinking with the intention to just have one drink ends up having many more drinks than was originally intended.
Expecting the individual drinker to control and mange his drinking habit is very much like asking the fox to take care of the hen.
Anti-alcohol campaigners have a lot to learn from the success of anti-smoking campaigns. The impact of these campaigns was minimal when the focus was on the individual smoker and the ill-effects on his health. They showed a significant increase in effectiveness when the focus changed from the ill-effects of smoking on the smoker to the effects of smoking on the non-smoker. The campaigns found their sweet spot of effectiveness when smoking changed from an individual problem to a social evil.
Alcohol abuse too should be made into a social evil. Similar to smoking being banned in public places, anyone who has consumed any alcohol at all should be banned from driving any vehicle. This decision sends an unambiguous signal to everyone that alcohol and driving do not go together.
“I drink to get high”, “I am normal even after heavy drinking”, and the like are mental models drinkers employ regarding their behaviour. To effectively mitigate alcoholism, we need to demolish these mental models. The signs of getting drunk—binge drinking, the stumbling walk, the slurred speech—should be viewed from a zero-tolerance perspective as far as social reaction goes. Campaigns should be created to make these acts the signs of an uncivilized person.
Studies have shown that one of the best deterrents to alcohol consumption is playing up the emotion of shame that is associated with it. Drinkers who lose self-control after drinking should be reminded of how they are making themselves look like fools in front of their colleagues, and children. This informal deterrence strategy based on embarrassment has been found to be more effective than formal ban strategies in reducing alcohol related problems in many cases.
Countries in southern Europe like France and Italy have less alcohol-related crimes as compared to England and Ireland. Studies show that this could be related to the fact that drinkers in the former countries have the habit of consuming food along with their drinks. So creating new rituals around drinking alcohol that involve having food alongside the alcohol or having multiple glasses of water in between drinks could also help tone down the effects of alcohol.
We have relied on traditional solutions to address alcoholism for far too long. It is high time we employ the learning from new behavioural sciences to chart a new path to more effective solutions.
Biju Dominic is the chief executive officer of Final Mile Consulting, a behaviour architecture firm.
Comments are welcome at firstname.lastname@example.org