The Normalisation of Binge Drinking? An Historical and Cross Cultural Investigation with Implications for Action

Key findings and implications

This section draws together what has been learnt from the study and considers the policy and research implications. There is a great deal of overlap and inter-play between the issues, although they have been separated for the purposes of clarity.

Historical and cultural perspectives

• Heavy drinking akin to binge drinking has been endemic in British society over many centuries and has been culturally embedded in a variety of social and work practices.
• It has not always attracted social disapproval or government intervention.
• Key episodes such as the gin craze show that social responses were based on the problem but also focussed only on some aspects such as consumption by the poor which were not necessarily the most important.
• Increased disapproval of heavy drinking had its origin in broader shifts in society after industrialisation. Such disapproval often concentrated upon women’s drinking because of wider social anxieties.
• We need to study binge drinking as a social phenomenon and also be aware of the social construction of government and public attitudes to it.
• In recent history there has been a shift in the meaning of the term binge drinking, with the ‘old’ (extended, clinical) definition being largely displaced by the ‘new’ (episode of acute intoxication) definition. However, there is still some resistance to this change and the two meanings co-exist, if somewhat uneasily.
• It is unclear from this study quite how this change came about, what the drivers were or the policy implications. This is an area of recent history that requires further investigation.

The definition and measurement of binge drinking

• There are is no agreed definition of binge drinking. Two distinct meanings have been ascribed to the phenomenon: as an extended period of drinking linked with clinical definitions of alcohol use and dependence and also as single episode of acute intoxication, often expressed in terms of number of drinks consumed.
• Within the ‘new’ binge there is no consensus on the amount of alcohol that constitutes a ‘binge’ and a variety of ‘cut- offs’ are used. The cut offs used vary between nations, studies and professionals and even within nations, this makes it difficult to make comparisons. Cut off definitions have also been criticised for ignoring contextual factors (e.g. speed of drinking, venue, whether food or not has been consumed).

The contemporary situation in cross national perspective: current prevalence data and trends

• In the UK men of all ages are more likely to binge drink than women and to die from alcohol related causes. The perception is that binge drinking amongst young people, and more specifically young women has risen steadily in the recent past; in fact the evidence suggests a more complex picture and indeed the most recent data suggests that the rate has reached a plateau and is perhaps declining.
• The current preoccupation with specific ‘risk’ groups (young people, women) means that other groups appeared to be overlooked (e.g. middle aged men). Moreover, at times there seems to be a somewhat limited understanding of the behaviour of these risk groups. There is evidence that young people drink in a variety of ways but the picture presented is of a mono-drinking culture. Such a partial picture is not a sound basis for policy making: there is a need to understand the diversity of drinking styles adopted by young people and investigate binge drinking in groups other than the young.
• There has been a focus on public space – on licensed premises, public disorder and public nuisance caused by young binge drinkers – with little attention to drinking in the home, although the recently revised National Alcohol Strategy identifies consumption at home as a key policy issue (HM Government, 2007).
• Given that there is no consensus definition of binge drinking it is difficult to make meaningful cross national comparisons. However, within Europe there is evidence of a continuing gap between northern countries (e.g. UK, Finland) with their ‘dry’ culture characterised by patterns of intermittent drinking, weekend drinking and drinking to intoxication and southern countries (e.g. Italy, France) with their ‘wet’ culture of daily drinking with meals and avoiding intoxication.

Lessons for policy

• Binge drinking is nothing new in British society and has not always attracted disapproval. Its historical change from a ‘ manly’ activity to one associated with out of control women represents wider social change and policy interests as well as the reality of a problem.
• Institutions, professions and individual professionals differ in the way in which they define and think about binge drinking and these differences reflect their particular agendas and priorities. Moreover, these differences are not necessarily recognised. ‘Binge drinking’ is often used in a way which implies a common understanding between the various stakeholders. Without a shared understanding amongst stakeholders it is difficult to see how any ‘solutions’ can be reached.
• Binge drinking is an important driver for alcohol policy, but as there is no agreement as to what is actually being measured it is difficult to build up an evidence base on which to formulate policy and this leaves any subsequent policy on shaky ground.
• The prominence of binge drinking perceived as a problem of young people in public places recognises a phenomenon but foregrounds it to the detriment of other areas of increased alcohol consumption, for example in the family and at home.