Editorials

The alcohol harm reduction strategy for England

BMJ 2004; 328 doi: https://doi.org/10.1136/bmj.328.7445.905 (Published 15 April 2004) Cite this as: BMJ 2004;328:905

High rates of binge drinking may be caused by extreme latitude

High rates of binge drinking may be caused by extreme latitude

Alcohol over-consumption has two distinct aspects – excessive average
consumption, and the special ‘social’ problems caused by binge-drinking.
My sense is that the increase in binge-drinking is the main cause of
concern in Britain (and Ireland).

A graph appeared recently in The Economist [1] showing the
relationship between national average alcohol consumption per head and the
average number of drinks per session (a measure of binge-drinking).
Britain has both high average alcohol consumption and a high prevalence of
bingeing, France has higher average consumption but lower bingeing,
Finland more bingeing but a lower average consumption, and Ireland has the
worst of both worlds.

Binge drinking patterns seem remarkably robust to variations in
cultural attitudes. Britain is still bingeing despite recent changes to
more ‘continental’ levels of price, availability and products, and the
spread of ‘family-friendly’ pubs. Even socio-political disapproval, high
taxation and extreme restriction of availability (as in some Scandinavian
nations) do not eradicate the culture of bingeing. It seems unlikely that
government or medical propaganda will make much difference.

My interpretation is that while average alcohol consumption per head
is influenced by the price and availability of alcohol, bingeing seems to
be influenced mainly by latitude. In our hemisphere: the further north,
the more bingeing. Binge drinking probably shares a common cause with
Seasonal Affective Disorder –specifically the extreme summer-winter day-
length variability which increases with latitude [2]. It is not generally
appreciated that the UK and Ireland are situated considerably further
north than most of the population of Western Europe, the USA and Canada.

Humans evolved in Africa, near the equator, where there is not much
difference in day-length between summer and winter. Considering that
diurnal cycles are a powerful biological influence on many animals, it
would be surprising if humans were unaffected by extremes of seasonal day-
length variation. Some people at extreme latitudes may be using alcohol
intoxication to modify sub-clinical but subjectively-significant mood
disorders, probably caused by subtle endocrine imbalances, by drinking to
excess as an ‘antidepressant’ in winter, and because of ‘manic’ hyper-
arousal and sleep-deprivation in summer [3,4].

If a culture of bingeing is indeed caused by extreme latitudes, then
neither price controls nor campaigns to change social attitudes will be
significantly effective in reducing it. New ideas are needed, and
biologically-based approaches appear the most promising solutions to this
evolutionarily-caused problem. One preventive treatment might be to mimic
near-equatorial light-dark patterns, for instance using early-morning high
intensity light in winter [2] and black-out blinds in summer. This could
potentially become a matter of public health concern (eg. raising
awareness of the effects of lighting on health, subsidizing provision of
relevant technologies, regulation to enforce better lighting of workplaces
etc.).

Alternatively, or in addition, a less dangerous drug could be
substituted for alcohol during occasions of social intoxication.
Benzodiazepines are the obvious choice, since they have a similarly
relaxing and disinhibiting effect to alcohol; but are probably overall
considerably less harmful to personal health and social harmony, both
acutely and in the long-term [3,5].

These ideas sound bizarre at present, but if bingeing continues to
increase in the UK and Ireland, and if conventional approaches to alcohol
control and harm-reduction cannot be implemented or continue to fail –
then radical ideas will need to be tried.

1. The Economist. Drinking culture. The Economist March 18th 2004:
p36.
www.economist.com/displaystory.cfm?story_id=S%27%2988%2EPA%3F%25%20%20%2...

2. Lam, R. W. Seasonal affective disorder: diagnosis and management.
Primary Care Psychiatry 1998; 4, 63-74.

3. Charlton BG. Personal Freedom or Public Health? In Medicine and
humanity. Edited by Marshall Marinker. King's Fund: London, 2001, pp 55-
69.

4. Charlton B. Psychiatry and the Human Condition Radcliffe Medical
Press: Oxford, 2000.

5. Healy D. Psychiatric drugs explained – 3rd edition. Churchill
Livingstone: Edinburgh, 2002.

Competing interests:
None declared

Competing interests: No competing interests

19 April 2004
Bruce G Charlton
Reader in Evolutionary Psychiatry
Henry Wellcome Building, School of Biology, University of Newcastle upon Tyne, NE1 7RU
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