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There is no illness here.
- Adrian R. Leahy (14 March 2008)
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Saving the next generation.
- Antoine Kass-Iliyya (17 March 2008)
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Adrian R. Leahy, Staff Grade in psychiatry Bolton
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Public drunkeness is not an illness, but the result of a collection of individuals who for their own reasons gain some reward out of this behaviour. If it did not fulfill some need within the participants, they would not do it. We don't tend to do things to ourselves that we don't like in some way or at some level. History shows that human beings are very cunning in finding ways around unwelcome barriers placed before them. High taxes on cigarettes in the UK have led to an unprecedented consumption of European imports, legal or not - just look at discarded packets on the street. Mass social experimentation failed with banning or reducing access to alcohol during American Prohibition, failed with the dream of Communism to eradicate inequality and is still failing now to stem the tide of illegal drugs. There is much more to be said for changing behaviour at an individual level and I entirely agree with the principle of introducing some negative consequences, in this case a financial penalty, to ensure that each individual has to weigh up the advantages of getting drunk and believing that they then have license to misbehave antisocially, against the unhappy consequences of something bad happening to them. In practice however once one enters the law courts to dicuss penalties, the intended check may not come to pass. The cost of court time, appeals, time in preparing cases and clever lawyers arguing over procedural minutiae may soon overwhelm the system and pulic support may be weakened by the predictable reported injustices of peaceful citizens being stopped by an overzealous Constable for wobbling on their way home after a quiet night's peaceful drinking. These sort of concerns must be taken into account in one's individual creative thinking on how to address the problem. As a profession however I believe that we should leave the politicians and lawyers to sit in their own mess. I am aware of no evidence base to support the act of Doctors giving credence to social engineering experiments, or being great politicians or legislators. I could for example suggest that patients might be charged for any treatment needed if they were drunk, but then what of the innocent passer-by who is attacked and coincidentally has been peacefully drinking to excess ? Am I to refuse to treat this person until they produce cash, do I get a nursing colleague to "lean on them" for payment, do we hire "enforcers", will we have a Trust solicitor pursue them through the courts, will the hospital then hire baliffs to take their television away ? As a Doctor I think it better to suggest nothing of this nature at all. As a profession I believe that we should just treat whoever turns up, do our jobs and go home again without worrying about the rights or wrongs of how this came to be. The NHS is a state funded service, controlled by politicians. Fact. The public elect politicians to guide society's changes. Doctors are only trained as Doctors. We should not get involved professionally with guiding the law. This letter has already been widely reported in the media on the basis that a Doctor, not an individual, has made this suggestion. This should never have been in the BMJ. As free citizens we are of course all entitled to write to newspapers to air these sort of suggestions, but in a medical journal? I don't think so. Otherwise let's have motoring articles, film reviews, a wine tasting page and celebrity photographs. I note that this letter is based on the premise of "Weren’t we always taught at medical school that prevention is better than cure?". Well, we weren't taught politics, law or social management and should not therefore attempt to give expert advice on these matters. Public drunkeness is not an illness. Competing interests: None declared |
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Antoine Kass-Iliyya, F2 Respiratory Medicine University Hospital of North Staffordshire, ST4 6QG
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I think the author has raised a very good point which is finding the root of the problem. Like in medicine, if you treat the symptoms only without finding the root of the problem, you will be carrying out treatment for a long time, and the patient will only get worse. I believe we can come close to the root of the problem by considering two major areas (both focus on childhood): 1- Early education 2- Building a relationship of Trust and Good Communication/ Role Modeling First: Early Education I believe educating children about alcohol abuse is literally priceless... The child brain is amazing; children master languages to a perfection that many adults cannot achieve. What a child learns as right or wrong, especially if taught by a sincere, graceful teacher, stays with him/her for many years to come. Second: Building a relationship of Trust and Good Communication/ Role Modeling when we build a relationship of trust and open dialogue with our children, when we are honest and sincere, when we listen as much as we preach, we can teach them at a very early age the dangers of alcohol misuse, (i.e. liver, brain damage, cancers, social catastrophes).. When we as adults do not abuse alcohol, and when we stay healthy and drink only in moderation, our children will automatically be inspired and think ten times, before abusing alcohol. unfortunately drinking alcohol and smoking in our current culture has become so common, that some teenagers consider it a sign of becoming an adult, and unfortunately many follow and fall for that trap, but if they were properly taught about what can be the consequences, and if parents- children relationship is one of mature communication and mutual respect, then not wanting to harm this precious relationship will be the most powerful drive for them not to become alcoholics. Giving your child the choice is very important, and giving him/her all the elements to make an informed decision and learning to say no when offered alcohol, is also equally as important. I come from the Middle East, and although people are equally stressed, the problem of alcoholism is on a much smaller scale. Religion, traditions, proper children education and Strong family values, are few of the reasons for the above. If our modern life is weakening our family bonding, if we are more and more missing out on family dinners and warm communications, if our children are hanging out with the bad guys, I believe the school or the church are our last saving grace, they are increasingly becoming the substitute of the traditional close family. To that end I believe, drug and alcohol awareness programmers should be introduced, from as early as primary schools, teachers and parents should set the best examples, alert children to the dangers of alcoholism, opening their eyes to the horrible consequences, and most importantly -as a society- labeling alcoholics as careless, bad people not as revolutionists or heroes, because bad people do not inspire copy-cats. Competing interests: None declared |
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