Practising drinking, practising health. The consumption of alcohol is shaped everywhere by social norms, material settings, temporal rhythms and cultural.
COMMENTARY
Practising drinking, practising health The consumption of alcohol is shaped everywhere by social norms, material settings, temporal rhythms and cultural meanings, even though the full measure of these impacts is difficult to assess. Quantitative analyses of alcohol consumption often overlook these aspects, emphasizing instead modifiable risk factors associated with the behaviour of individual drinkers. Meier, Warde & Holmes [1] seek to correct this oversight by offering the notion of practice as a methodological and epistemological alternative to more established approaches in alcohol studies. They are especially critical of approaches that emphasize the social determinants of variations in consumption within and between populations, and those that focus on the agency of individual drinkers, arguing that population interventions grounded in either orientation have ‘delivered only limited public health gains’ [1]. What is most welcome about Meier et al.s’ analysis is their insistence on the need for new quantitative approaches to studying alcohol consumption, rather than heeding the more common call for richer and more varied qualitative studies [2,3], which have had narrower impacts on the forms of knowledgemaking that underpin public health interventions. I do not regard this approach as dismissive of the value of qualitative research. Rather, I see it as recognition of the primacy of quantitative research in the design of public health interventions [4,5], with the corollary that more sensitive quantitative research models will probably have the greatest impact upon these interventions. Besides, few qualitative researchers with an interest in the contexts of alcohol consumption could quibble with Meier Meier et al.s’ focus on the role of practice, even if few have been so bold as to find in extant theories of practice a means of transforming the epidemiology of alcohol use. However, I would encourage the authors to follow the implications of practice theories for public health interventions a little further by emphasizing how the focus on practice troubles the very objects and purpose of these interventions. The designation of particular patterns (or practices) of alcohol consumption as problems within contemporary public health discourses rests on an apparent consensus with two key features; one that Meier et al., acknowledge, and another that they do not. With respect to the first aspect, public health discussions of problems arising from the consumption of alcohol share the assumption that individuals are independent ‘decision-makers’ with ‘substantial autonomy’ [1] over their drinking behaviours. This is the major reason why, as Meier et al. note, public health interventions tend to be ‘heavily influenced’ by theories of behaviour change [1]. © 2017 Society for the Study of Addiction
It reflects a consensus that individuals are the most important agents of change in any effort to transform drinking behaviours. Theories of practice confound this consensus by calling attention to the role of exogenous factors in mediating drinking behaviours. However, the problematization of certain patterns of alcohol consumption in public health discourses also rests upon a putative consensus about the therapeutic value of moderation. It is assumed that the health and social costs of excessive alcohol consumption, however this excess may be understood, are recognized universally, even if some individuals stubbornly ignore these costs. Theories of practice challenge this consensus, particularly the assumption that individuals will naturally seek to reduce their exposure to risk once they have been made aware of it. These theories call our attention to the ways in which the relationship between alcohol consumption, risk, health and wellbeing is itself an outcome of practices, such that immoderate alcohol consumption may be understood just as readily as health promoting in certain contexts as abstinence or moderate consumption. This, I would wager, is the most significant implication of the authors’ discussion of the practice of ‘wine-o-clock’, which disrupts any simple consensus about the riskiness of alcohol use. Indeed, practice theories imply that ‘wine-o-clock’ may be understood just as readily in terms of health, recreation and wellbeing as risk or harm. Practice theories, in these ways, provide useful insights into why population efforts to reduce alcohol-related harms, including the promotion of safe-drinking guidelines, often fail [6,7], for practice theories expose the faulty assumptions that these interventions typically rest upon, particularly the assumed consensus regarding the therapeutic value of moderation. Safe drinking is a practice with discrete material, spatial, cultural and temporal elements [6]; it cannot be mandated by fiat. Designing novel interventions to reduce alcohol-related harms will require fresh insights into the ways these elements cohere in practice and how, equally, they may be transformed in practice. Declaration of interests None. Keywords Alcohol, harm reduction, prevention, public health, safe drinking, theories of practice. CAMERON DUFF School of Management, RMIT University, Melbourne, Victoria, Australia
Addiction
2
Commentary
References 1. Meier P., Warde A., Holmes J. All drinking is not equal: how a social practice theory lens could enhance public health research on alcohol and other health behaviours. Addiction 2017; https://doi.org/10.1111/add.13895. 2. Neale J., Allen D., Coombes L. Qualitative research methods within the addictions. Addiction 2005; 100: 1584–93. 3. Rhodes T., Stimson G. V., Moore D., Bourgois P. Qualitative social research in addictions publishing: creating an enabling journal environment. Int J Drug Policy 2010; 21: 441–4. 4. Butler S., Elmeland K., Thom B. Alcohol, Power and Public Health: A Comparative Study of Alcohol Policy. Chichester, UK: Taylor & Francis; 2017.
© 2017 Society for the Study of Addiction
5. Babor T., Caetano R., Casswell S., Edwards G., Giesbrecht N., Graham K. et al. Alcohol: No Ordinary Commodity: Research and Public Policy. 2nd edn., Oxford: Oxford University Press; 2010. 6. Harrison L., Kelly P., Lindsay J., Advocat J., Hickey C. ‘I don’t know anyone that has two drinks a day’: young people, alcohol and the government of pleasure. Health Risk Soc 2011; 13: 469–86. 7. Keane H. Intoxication, harm and pleasure: an analysis of the Australian National Alcohol Strategy. Critical Public Health 2009; 19: 135–42.
Addiction
