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Keywords:

  • Adverse effects;
  • alcohol-related collateral damage;
  • collateral damage;
  • social costs

In their paper, Laslett et al. [1] have done a service not just to the research community, but to the millions of people who are affected by alcohol production, distribution and consumption every day in every corner of the world. In brief, the authors have provided a national-level assessment of how the drinking of individuals can affect the social fabric of a society. The impact is widespread and significant in terms of psychological, physical, social and economic costs. Negative effects from others' drinking were reported by over 70% of Australians in the past year, with 51% experiencing serious adverse effects. Although Australia may not be representative of countries with lower levels of per capita income and alcohol consumption, the article raises some fascinating questions about the ways in which alcohol-related problems are defined, conceptualized, measured, and controlled. For example, what other legally available consumer product (tobacco, automobiles, gambling, etc.) has a comparable negative impact on the majority of the population of an advanced industrialized country? How effective are our current scientific methods in estimating and explaining the collective harm attributable to alcohol? Can we improve our terminology and conceptual models to better communicate the damage attributable to alcohol? To what extent can our current alcohol control policies be improved by taking these findings into account?

As suggested by these questions, the article is evocative from a variety of perspectives, and this commentary can only touch on a few. The first issue is terminological and conceptual. What are we talking about, and can we improve communication with the public and the scientific community by a better choice of words? Laslett et al. [1] have chosen to focus on social relationships and how they are affected by the drinking of others. Negative social consequences are manifested in the form of spoiled social occasions, emotional wounds, arguments, physical violence, workplace problems, failed expectations, care demands, embarrassment and exposure to physical risk. What is not included in this analysis of the social phenomenology of alcohol-related victimization are the many other consequences that are more subtle, chronic and unseen. These include chronic stress, failed marriages, maladaptive family dynamics, unwanted noise, broken bottles and trash to clean up, childhood psychological trauma, fetal alcohol spectrum disorders, neighborhood crime, family members' increased health care needs, and environmental degradation connected with the production of alcoholic beverages (e.g. water pollution). This list is not complete or conceptually coherent, but it gives evidence of the broad spectrum of consequences that would not have occurred without the disruptive effects of alcohol on people's biology and behavior. The diversity of items in this list perhaps explains the lack of consensus about what to call it. Laslett et al. [1] refer to ‘harm to others’ and ‘adverse effects’. Giesbrecht et al.[2] have used the words ‘second-hand effects of drinking’ and ‘collateral damage’. Other terms, such as negative externalities, spillover effects and social costs have been applied by economists to account for costs incurred by a person who did not agree to the action and whose costs were not included in the original purchase price. This implies that drinking is more than a voluntary exchange between a buyer and a seller, but also includes additional costs to society. Whether common usage and scientific communication favor one or the other of these terms depends as much on the perspective of the observer as the nature of the problem. Beyond the preferences of different disciplinary orientations, there is the need for a term that captures the popular imagination for social marketing purposes in the public health sense. The term, ‘alcohol-related collateral damage’, may achieve this in the same way that ‘secondhand smoke’ and ‘passive smoking’ helped to mobilize popular support for tobacco control policies on an international level. Collateral damage is a term that initially referred to incidental or unintentional harm to people and property resulting from military action. The military metaphor has now been broadened to include other secondary effects, such as the unintended costs of controlling computer spam, so it is not a breach of poetic license to apply it to alcohol. In fact, during the 1970s, the late night entertainment area of downtown Boston, Massachusetts (USA) was commonly referred to as the ‘Combat Zone’ because of the concentration of bars and alcohol-related crime and victimization.

The second issue raised by the article is methodological. Because the survey questions used in this research were limited to the social relationships surrounding the respondent, they are likely to have produced conservative estimates of the damage caused by alcohol. What impacts have been missed in this exercise in social mapping? Which disciplinary perspectives (sociology, psychology, public health) offer the best forms of analysis? How can we study mechanisms of action? These questions await further exploration but this article provides a good beginning. If current survey methodology can document that almost one out of five Australians had at least one social occasion in the last year spoiled by a drinker, is it now possible to use a parallel set of questions to compare the social costs with the social benefits of alcohol?

The third issue raised by this paper is science policy. Ironically, science policy is often irrational or at best, lacking a clear grounding in public health. Most of our research is focused on individual costs, not social costs. Our research is also focused on the drinker, rather than the supply chain that constitutes the alcohol industry. Until we broaden the perspective of the research questions we investigate to include structural and population phenomena, the investigation of alcohol's second-hand effects will remain piecemeal, fragmented and uninformative.

This issue provides a segue into my final point: policy implications. Terminology sometimes helps to guide the public response to a social problem. Would the public pay as much attention to ‘binge drinking’ if it were called heavy episodic drinking? Alcohol-related collateral damage brings home the realization that in many communities, homes and families, the drinking environment has become a combat zone. In this metaphor, the drinker, often a young male ‘weekend warrior’, is not only doing damage to himself and other drinkers, but also to innocent bystanders and others' property. More importantly, these young combatants armed with bottles and intoxicated by alcohol's pharmacological powers are part of a broader political and economic system that is directing and profiting from the sale of alcohol, every bit as much as the military-industrial complex profits from the arms industry.

References

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