Why has harm to others been neglected for so long? 2012 Hans Olav Fekjær

The alcohol problems have been perceived in five different ways Here, we will look at the Basis Focus Strategy Consequenses for action Price Outcome of the five paradigms

1. paradigm: Drunkenness Basert on laymen’s observations Focus: Harm to others (like families) ”Less use will give less problems” (like today’s ideas on illegal drugs) Policy was restrictive. In order to reduce harm, several people abstained from consuming and serving alcohol. Combatting harm this way did not cost money Outcome: Strong reduction of use and harm in spite of strong increase in prosperity (ca )

2. paradigm: The theory of alcoholism Invented by stock broker Bill Wilson Focus on problems among heavy drinkers Perceived as if general use, price and availability did not matter Thus, policy was liberalized and abstention perceived as futile Combatting harm was expensive because of treatment and research to find the mystical ”alcococcus” Outcome: Strong increase in consumption and harm (from ca. 1950) Still has a strong impact on most people’s thinking

3. paradigm: Public health perspective Introduced by leading researchers in 1975 Focus: the drinkers’ health problems Recommended restrictive policy Not costly to implement Outcome: Still, liberalization of policy and increase in harm carried on in the Nordic and English speaking countries (1975-)

4. paradigm: A brain disease Biological researchers (ca ) Focus on daily drinkers (”addiction”) Belief: effects on the brain can explain continued use Aiming to find medicine or vaccine towards addiction Large funding of research since the 1990ies Steadily reports ”interesting findings” and that ”we are close to a breakthrough”

5. paradigm: Harm to others Leading researchers in recent years Focus on harm to others This has been shown to be the most widespread problem Example: 33 % have been harassed or harmed by others’ drinking last year, while only 9 % have had problems from own drinking (Canadian data) Most instances seem to be due to single incidents of drinking, not ”addiction”

Some Norwegian data Deaths (estimate) Injuries, accidents (survey data) Diseases (data lacking) Several thousand Harassed in public place Harassed in private Physically harmed Harm to property Scolded Afraid in public place Kept awake At least one problem Health problems from alcohol, last year: Harassed/harmed by drunk persons, last year:

Declaration of Human Rights, 1789, § 4: Freedom is the right to do anything that does not harm other people. If the main alcohol problem is drinkers’ harm upon themselves, consumption may be seen as a purely private matter. Alcohol restrictions may be seen as a nanny mentality. But the individual’s right do freedom does not include the right to inflict harm and problems upon others. If the most widespread problem is inconsiderate behaviour, limiting consumption is a very natural task for the society.

Focus on harm to others - consequences for attitudes and policy: ”Success on another big public health killer – tobacco....a key element has been raising awareness about the impact of passive smoking.” (Chief Medical Officer’s yearly report, Britain 2008) Publication of data on harm to others ”could elevate political will for effective alcohol controls.” (Int J Environ Res Public Health 2009) ”Focusing on the second-hand effects of drinking has substantial potential in moving the alcohol policy agenda forward”. (Editorial in the journal Addiction, 2010) ”The substantial harm to non-users is a key argument for democratic governments to use regulations and taxes to minimise harm from alcohol.” (New Zealand Medical Journal, 2011)