1. Historical perspectives on alcohol problems in the UK Dr James Nicholls, Bath Spa University

3. Increased overall consumption = increased harm State responsible for reducing consumption Key levers: pricing, availability, marketing Alcohol ‘no ordinary commodity’ Public health / population approach

4. Gin craze 18th C. Teetotalism 19 th C Prohibitionism 19-20 th C Disease models 20 th C Public health 20-21 st C Model of harm Proposed solution Spirits = ‘new kind of drunkenness’ Alcohol creates habituation Addiction is a disease Continuum of harm Prohibit gin ‘Moral suasion’ProhibitionFocus on treatment and recovery Supply-side interventions

5. 17512005, 2006, 2007, 2008….

6. Morality SupplyTreatment

7. Morality SupplyTreatment SOCIAL IMPACT?

8. SubstanceDependency Substance misuse

9. [No risk?]Lower risk Increasing risk Higher risk SafeHazardousHarmful Moderate Alcoholic

11. Gin Habitual drunkenness Moral and economic decline Gin prohibition (1736-1743)

12. Benjamin Rush’s ‘Moral Thermometer’ (1784)

13. Alcohol Habitual drunkenness Moral and economic decline ‘Moral suasion’ (c. 1830-1850)

14. Alcohol trade Habitual drunkenness Moral and economic decline Prohibitionism (c.1850-1900)

15. The use or non-use of alcoholic liquors is a subject on which every sane and grown-up person ought to judge for themselves under his own responsibility The appetite for drink is unlike every other appetite. Indulgence is not followed by satiety, but by increased craving Mill Pope

17. Inebriety: ‘a diseased state of the brain and nervous centres, characterised by an irresistible impulse to indulge in intoxicating liquors or other narcotics, for the relief which these afford, at any peril.’ Norman Kerr (1884)

18. InebrietySubstance Substance misuse

19. PredispositionSubstanceAddiction

20. Morality SupplyTreatment

21. ModelsConsensusPolicy

22. Affordability / availability of alcohol Trends in overall consumption Continuum of harms

23. [No risk?]Lower risk Increasing risk Higher risk SafeHazardousHarmful Moderate Alcoholic

24. Dynamic not static Addiction model shapes policy solutions HegemonicCurrently unstable Models of harm