International Journal of Drug Policy 17 (2006) 258–268
Commentary
The new policy mix: Alcohol, harm minimisation, and
determined drunkenness in contemporary society
Fiona Measham ∗
Department of Applied Social Science, Lancaster University, Lancaster LA1 4YP, United Kingdom
Received 2 June 2005; received in revised form 15 November 2005; accepted 28 February 2006
Abstract
This paper reflects on the relationship between harm reduction, demand reduction, and supply reduction (collectively, harm minimisation)
in relation to the individual, socio-economic, and legal regulation of alcohol, focusing on changing consumption patterns of youths and young
adults in the UK. Firstly, harm reduction and practices of self-regulation are considered within the British context of an apparent culture of
intoxication, with evidence of determined drunkenness amongst young people that builds upon a longstanding tradition of northern European
drinking characterised by weekday restraint and weekend excess. Secondly, demand reduction and the predominant public health programme
of recommended sensible drinking levels are discussed in relation to the credibility gap between such messages and contemporary alcoholrelated attitudes and behaviours. Thirdly, looking at supply, recent legislative changes and broader developments in the alcohol industry are
explored. They counterbalance economic deregulation of licensed leisure with the increased criminalisation of some drinkers. In order to
produce the most effective policy mix, individualised models of harm reduction and demand reduction need to be located within broader,
culturally appropriate, and context-specific policies that consider the socio-economic, political, and environmental factors influencing harm,
demand, and supply.
© 2006 Elsevier B.V. All rights reserved.
Keywords: Alcohol harm reduction; Supply and demand reduction; Young people; United Kingdom
Introduction
This paper addresses the relationship between policies
related to harm reduction, demand reduction, and supply
reduction (collectively, harm minimisation) in relation to
changing patterns of alcohol consumption by British youths
and young adults. Increased sessional consumption of alcohol
since the mid-1990s has led to considerable media and political coverage of the problem of “binge” drinking, without a
consideration of both the continuities of traditional British
drinking culture and the apparent emergence of a youth and
young adult culture of intoxication. It is argued here that the
current primary focus of both harm reduction and demand
reduction initiatives on individual behavioural change is constrained by a neglect of the broader socio-economic, cultural, and political contexts surrounding changing patterns
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doi:10.1016/j.drugpo.2006.02.013
of consumption—for example, that moderation and restraint
are culturally at odds with a contemporary emphasis on economic deregulation and excessive consumption. It is argued
that an emergent culture of intoxication has been facilitated by supply-side initiatives. In the UK, such initiatives
relate to legislative and economic developments that have
resulted in the deregulation, promotion, and expansion of
alcohol-based leisure within the last decade. The paper concludes by calling for a greater understanding of why and how
young people drink in order to design culturally appropriate, evidence-based harm minimisation strategies that can be
communicated in credible and effective ways.
Harm reduction and moderation in a culture of
intoxication
A well-established and well-regarding body of empirical
and policy-oriented work exists on the application of the con-
F. Measham / International Journal of Drug Policy 17 (2006) 258–268
cepts of harm reduction to legal and illicit (illegal and quasilegal) psychoactive substances (e.g., Friedman et al., 2001;
Heather, Wodak, Nadelmann, & O’Hare, 1993; Marlatt &
Witkiewitz, 2002; O’Hare, Newcombe, Matthews, Buning, &
Drucker, 1992; Plant, Single, & Stockwell, 1997). Evaluation
of the relevance of harm reduction strategies to gambling and
other addictive or excessive behaviours is at an earlier stage
of development (e.g., Dickson, Derevensky, & Gupta, 2004).
Much of this body of work discusses approaches that aim
to reduce the harm to the individual and society from the manufacture, marketing, and consumption of legal or illicit drugs
through the application of measures that prioritise decreasing
the risk and severity of adverse consequences from current
use over the reduction or elimination of use per se. In relation to alcohol, consumption can result in harm from drinking
itself (such as health outcomes) and when combined with
another activity (such as when driving or operating machinery). More recently, harm reduction approaches have also
included recognition of the longstanding pleasurable and
(sometimes) positive health roles of alcohol in Western societies (see for example, Peele & Grant, 1999).
In the UK, some of the most fully developed harm
reduction initiatives in relation to recreational substance use
focused on illicit drug consumption, particularly in dance
clubs. These efforts were initially implemented at the local
level, by local authorities and individual clubs, and gradually
become part of a national policy: for example, the groundbreaking local safer dancing initiative in Manchester in 1993,
which combined local government, voluntary sector drugs
agency, and academic input (Newcombe, 1994); and, more
recently, the national safer clubbing guidelines on good practice (Webster, Goodman, & Whalley, 2002).
Despite the far greater numbers of young people involved
and the far greater health, social, economic, and public order
harms from alcohol, the tailoring of these illicit drug-based
harm reduction measures to safer drinking initiatives has yet
to be fully developed in relation to national policy in the
UK. At the international level, alcohol harm reduction programmes include the following: unit and warning labels on
beverage containers, safer bars programs, designated driver
and responsible drinking companion schemes, subsidised late
night public transport, free water and non-salty bar snacks,
and consumption advice, such as interspersing alcoholic beverages with soft drinks and not mixing different types of
alcoholic beverages (Graham et al., 2004; Homel, McIlwain,
& Carvolth, 2004; Plant et al., 1997). Nevertheless, such
schemes often remain patchy, underfunded, and uncoordinated, lacking inter-agency collaboration and state support.
It appears that, “. . . throughout the world, governments are
struggling with the concept of harm minimisation in relation
to legal drugs” (MacAvoy & Mackenzie, 2005, p. 87).
Many harm reduction initiatives have focused on pragmatic, compassionate, and non-judgemental approaches to
reducing the harm to the individual through behaviour change
emphasising moderation rather than abstinence. The goal of
moderation has been conceptualised by Duff (2004) in his call
259
for an ethics of moderation in relation to the self-regulation
of illicit drug use, drawing on Foucauldian notions of “a
transformative ethics . . . established according to specific
‘practices of the self”’ (p. 389). Duff’s focus on the extent to
which harm reduction policies are relevant to the individual
drug user and his commendable reincorporation of the pleasures of psychoactive consumption into the equation supports
the earlier work of Ettorre (1992) on women’s drug use. But
what potential does an ethics of moderation developed in relation to Australian policies on illicit drug use have for British
alcohol policy? Three issues arise from a consideration of
harm reduction in general and the application of an ethics of
moderation to British drinking in particular.
Firstly, what is the broader socio-economic and cultural
context to notions of moderation and self-regulation when
applied to contemporary British drinking, leisure, and the
pursuit of pleasure? One aspect of self-regulation already in
operation in the UK relates to the primacy of weekend leisure
time consumption. Drinking is characterised by an emphasis on (mostly) weekday restraint (drawing on the Protestant
industrial work ethic and temperance movements of northern European countries) and weekend excess, with a more
recent post-industrial ethos of hedonistic consumption superimposed on earlier rural/pagan traditions of finite periods of
carnival within the agricultural calendar (Dance & Mugford,
1992; Gofton, 1990; Harrison, 1971; Presdee, 2000).
Concerned by the perceived growing excesses of “intoxicated weekends” (Parker & Williams, 2003), the British government has expressly attempted to transpose what it sees as
a more relaxed southern European drinking culture of moderate daily alcohol consumption onto a British drinking culture
characterised by weekday restraint and weekend excess. The
2003 Licensing Act implemented in England and Wales in
November 2005 allows licensing applications for premises
to sell alcohol for up to 24 h a day with the aim of reducing the pressures of intensified consumption just before the
established UK closing time of 11 p.m. and the pressures on
transport and catering services after 11 p.m. (Office of Public
Sector Information, 2003). This Act has been discussed by
Home Office Minister Hazel Blears as part of an ambitious
policy to “change the culture for the long term,” whereby, it is
believed, longer licensing hours will result in more leisurely
(and, by implication, less problematic) consumption (United
Kingdom Parliament, 2005, para. 4). The explicit aspiration
held by the British government for a continental European
drinking culture was evident in the introduction of the Licensing Bill in the House of Lords. Writing in The Guardian, Kettle commented, “. . . to judge by the speech which Baroness
Blackstone made in the Lords when introducing the bill . . .
the government has succumbed to a fantasy. Too many Tuscan holidays or weekends in Paris may have weakened the
baroness’s grasp of British realities. She seems to envisage
this country becoming a café society in which moderation
rules and in which folk such as herself will pop into a subdued bar after a performance of La Traviata to discuss the
novels of Jose Saramago. . . . Sadly this will not happen. . . .
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F. Measham / International Journal of Drug Policy 17 (2006) 258–268
Longer hours will not mean more sensible drinking. Longer
hours will just mean more drinking” (2003, para. 8).
There is some consensus amongst researchers, however,
that the range of problems associated with alcohol comes not
simply from the effects of alcohol consumption or trading
hours, but also from the broader historical, socio-economic,
cultural, and situational contexts to consumption (Gofton,
1990; Marsh & Kibby, 1992; Sumner & Parker, 1995; Tuck,
1989). Socialisation into alcohol-based leisure within the
British cultural milieu includes an understanding of both
the effects of alcohol intoxication and the close association
for many people between drinking and intensive weekend
consumption patterns, aggression, unsafe sexual encounters,
public disorder, and other potentially risk-taking or harmful
behaviours. If alcohol-related harms are the result of cultural
expectations as much as of consumption per se, it is clear that
these problems will not be remedied simply by the extension
of licensing hours. The processes of cultural change may take
decades rather than years, as illustrated by changing attitudes
to drink driving, passive smoking, and the wearing of car seat
belts. As Keeling (1994) noted in relation to problem drinking and health education, “. . . this is no short-term project. It
will not fit neatly into the scope of 2 years of a grant” (p. 246).
Secondly, there is a distinct cultural context to British
licensed leisure since the mid-1990s. It appears that determined excess rather than restraint has come to predominate
not only with respect to consumption of psychoactive substances, but also in other aspects of young adult life, such
as fiscal management—as illustrated by growing levels of
consumer credit, debt, bankruptcy, and a shift in emphasis
from saving to spending in recent years (see, Summerfield
& Gill, 2005). In terms of illicit drugs, the “decade of
dance” from 1988 to 1998 saw a shift towards weekend
recreational consumption of club drugs (such as ecstasy,
LSD, amphetamines, and cannabis) with an associated overall reduction in alcohol consumption by a significant minority of young people (Measham, Aldridge, & Parker, 2001;
Merchant & MacDonald, 1994).
In response to the development of the dance club scene
and set against a pre-existing backdrop of northern European weekend drinking, the UK experienced five key trends
that facilitated increased sessional alcohol consumption from
the early 1990s onwards: (i) a development of new alcoholic beverages (a variety of flavoured alcoholic beverages
or alcopops, ready-to-drink spirit mixers, and so on); (ii) targeted aspirational advertising campaigns; (iii) the redesign
of licensed leisure venues to appeal to a new generation
and a broader socio-demographic profile of consumers; (iv)
changes in licensing legislation that led to the expansion and
liberalisation of licensed leisure in the UK; and (v) the merging of legal and illicit psychoactive markets with evidence
of a normalisation of recreational drug use both in the UK
(Measham, 2004a; Parker, Aldridge, & Measham, 1998) and
elsewhere (Duff, 2005). Indeed, the Regional Director of the
World Health Organization has suggested that alcohol consumption by young people “increasingly mirrors patterns of
drug use” and that “the boundary between moderate and
excessive drinking is a fluid one,” with people often moving “from one to the other without acknowledging the fact”
(Danzon, 2001, paras. 3, 5).
The consequences of these developments prioritising consumer and market freedoms over regulation by the individual, the alcohol industry, or the state have been evident in
increased sessional consumption across the last decade, with
indications from the early 1990s in the North-West of England (Measham, 1996) and in Scotland (McKeganey, Forsyth,
Barnard, & Hay, 1996). This is supported by annual national
schools surveys in the UK, which report that young people tend to drink more per session and are more likely to
drink ready-to-drink spirit mixers and alcopops than they
did 10 years ago (Balding, 2004). Amongst 16- to 24-yearolds, alcopops account for 35% of women’s and 14% of
men’s weekly alcohol consumption; strong beers, lagers, and
ciders account for 9% of young women’s and 25% of young
men’s weekly consumption (Lader & Goddard, 2004). The
increased sessional consumption of higher strength alcoholic
drinks and expansion of licensed leisure, in turn, are part of
the broader economic development of the night-time economy and urban regeneration of city centres across the Western
world (see for example, Chatterton & Hollands, 2003; Hobbs,
Lister, Hadfield, Winlow, & Hall, 2000).
What happens, then, when there are both a longstanding
tradition and recent pre-eminence of equating pleasure with
excess, when immoderation is the goal in itself? Foucauldian
notions of maximising pleasure through self-regulation may
seem somewhat abstract for young people out on the town on
a Saturday night. In relation to a legal drug (such as alcohol), the individual is operating within the economic and
political context of a powerful, attractive, and widely available product designed by alcohol producers and promoted by
alcohol retailers through multi-million pound development
programmes. Furthermore, the historical and political climate
influencing contemporary young adult drinking is rooted in
popular culture, with over 15 years of an established, mature,
and fluid dance club scene in the UK, associated government, local authority, and enforcement responses, and the
interaction between the use of legal and illicit drugs within
the night-time economy (Measham, 2004b).
Thirdly, moderation as a practice of the self raises concerns about the individualised emphasis on self-regulation,
responsibility, and choice on the one hand and the boundaries
between self-control and social control on the other hand. As
discussed above, the individual drinker is a customer operating within a modern consumer society, where sophisticated
manufacturing and retail industries specifically target their
main markets (such as young adult drinkers) with varying
degrees of commitment to regulatory codes of practice. In
his study of contemporary British alcohol advertising campaigns, Burkitt (with 20 years of experience as an alcohol
advertiser and 6 years of experience as an advertising regulator) commented that “the ‘advertiser’ in me recognises that
the specific rules on alcohol advertising are generally being
F. Measham / International Journal of Drug Policy 17 (2006) 258–268
followed, although the ‘regulator’ fears that the spirit of these
rules is being widely ignored . . . British drink advertisers may
be behaving unwisely” (2005, p. 133).
Thus, the ‘choice’ to consume relates not only to the rational cost-benefit analysis between perceived advantages and
disadvantages of consumption by an individual (Coffield &
Gofton, 1994; Parker et al., 1998), but also to the reflexive construction and presentation of the self by that individual, drawing on and utilised by the machinery of the
alcohol, tobacco, and leisure industries and set against a
backdrop of heightened uncertainties about identity and the
journey to adulthood by young people in contemporary society (e.g., Denscombe, 2001; Pavis, Cunningham-Burley, &
Amos, 1998). However, whilst there has been a shift in representations of drug users from helpless slaves of addiction
to reasoned and rational decision-makers, the primary unit of
analysis and, therefore, locus of responsibility remains with
the individual.
Sulkunen, Rantala, and Määttä (2004), however, have
warned that “the emphasis on moral management of the
self may lead to moral management of the other, which
strongly disadvantages most youth” (p. 427). In the UK, this
is evident in responses to both alcohol-related health and
crime problems. In relation to health, for example, the public
health agenda has repeatedly been broadened to the extent
that health professionals are engaging in what Fitzpatrick
(2001) has argued is the superfluous and largely unproductive scrutiny of patient lifestyles. In relation to crime, the
government’s Alcohol Harm Reduction Strategy for England actively promotes greater use of law and order responses
(such as fixed penalty notices, anti-social behaviour orders,
and acceptable behaviour contracts) to reduce drunk and
disorderly behaviour by young people (Prime Minister’s
Strategy Unit, 2004, p. 84). The Violent Crime Reduction Bill
currently working its way through Parliament proposes the
establishment of drinking banning orders and alcohol disorder zones to further address alcohol-related social outcomes
in the UK (House of Commons, 2005).
Nevertheless, empirical research suggests that young people intentionally manage their levels of desired and actual
intoxication by using strategies that incorporate aspects of
perceived risk, accessing well-informed and credible sources,
such as online scientific journals, health sources, and the popular dissemination and discussion of these on websites, in
chat rooms, and by mobile phones (e.g., Moore, 2004; Moore
& Miles, 2004). However, given that the probability of harm
and the precise implications are often unclear, it has been
suggested that “uncertainty” is a more appropriate term than
“risk” (Leigh, 1999), because the former recognises the possible unknown factors in the consequences of consumption,
such as outcomes of mixing alcohol with illicit drugs, ingesting substances of variable strength, dosage, and purity, and
limitations to scientific knowledge of short-term and longterm effects. For example, a recent national schools survey
of over 40,000 pupils reported that up to 20% of 14- to 15year-olds have mixed illicit drugs with alcohol on the same
261
occasion (Balding, 2005, p. 76). These aspects of intoxication suggest that there are significant limitations to the notion
of reasoned individual management of harm.
Thus, it is to be welcomed that recently there has been a
shift amongst academics and policy-makers from the interpretation of harm reduction at the level of individualist
behaviour change to the broader environment of consumption with an emphasis on social and economic factors as the
primary determinants of harm (Rhodes, 2002). In relation to
alcohol, Room et al. (2003) note, given that “injuries comprise a large proportion of the burden of alcohol, it is appropriate to enhance these policies with targeted harm reduction
strategies . . . focused on . . . specific high-risk settings” (p.
165). Identifying and reducing harm through regulation of
the environment has particular implications for the hundreds
of thousands of young drinkers and recreational drug users
who visit leisure venues and retail outlets at weekends.
This draws on earlier cross-disciplinary studies that have
identified the role of design, planning, and location of drinking environments as playing a part in reducing alcohol-related
harms, including crime and disorder (Marsh & Kibby, 1992;
Stockwell & Crosbie, 2001; Tuck, 1989). Overheated, overcrowded leisure venues in high-density locations with poor
infrastructure and irresponsible sales and management practices have implications in terms of health, safety, security, and
public order, particularly for customers who have been consuming psychoactive drugs, whether legal or illicit. This has
been operationalised since the early 1990s in relation to dance
events in the UK through safer dancing and safer clubbing
policies and made a condition of licenses in some cases, but
it has not been effectively and comprehensively transferred
to alcohol-based leisure in order to impact on the relationship
between alcohol and drinking settings. This issue is discussed
further in relation to supply-side policies below.
Demand reduction and prevention in a context of
consumption-oriented leisure
The traditional focus of alcohol education and prevention has been the reduction in demand for and use of alcohol through public health programmes targeted at either
the general population or specific “at-risk” groups. Despite
mixed evidence of the effectiveness of these strategies (e.g.,
Foxcroft, Lister-Sharp, & Lowe, 1997), they remain a key
priority. For example, in the UK, individual alcohol manufacturers introduced alcohol unit-based information labels
on alcohol products in 2004. Research on information and
warning labels across the world suggests varying degrees
of success with these approaches (e.g., Stockley, 2001). For
instance, it has been suggested that, “US alcohol labelling
policy is a case study of the alcohol producers’ political power
at state and federal levels” (Mosher, 1997, p. 790; see also
Parker, Saltz, & Hennessy, 1994).
As Duff (2004) has identified in relation to Australian drug
policy, there is a policy gap between prevention and treat-
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F. Measham / International Journal of Drug Policy 17 (2006) 258–268
ment, because most strategies address drug use “at the two
extreme ends of the drug use spectrum”: primary prevention
initiatives, which are directed at young people who have not
yet started their drug using careers, and treatment efforts for
clients whose use has already become problematic (p. 388).
Duff’s question relates as much to British alcohol policy as
Australian drug policy when he asks, “What exists for the vast
majority of existing drug users once prevention has failed and
before treatment is considered?” (2004, p. 388).
Similarly to Australian drug policy, British schools-based
drug education programmes tend to be limited to the period
before most young people have established patterns of recreational usage—and treatment is largely aimed at the small
minority of problematic users who present to services or who
are netted by the criminal justice system. The vast majority of
largely recreational users of illicit drugs are too old for education and prevention initiatives and not in treatment so, with
the exception of some local and grass roots initiatives such as
safer clubbing strategies, there is a policy and provision gap.
The same could be said for young adult drinkers. Research
shows that men and women aged 16–24 years are significantly more likely than other age groups to have exceeded the
recommended number of daily units on at least one day during the week prior to the interview and to have been “binge”
drinking (using the unit-based definition); they are also the
heaviest drinking age group by quantity although not by frequency of consumption (Lader & Goddard, 2004). British
young adult drinkers could thus be considered most “at risk”
of alcohol-related health, crime, and personal problems.
A key aspect of demand reduction in UK alcohol public
health programmes is the use of unit-based notions of sensible
and risky consumption levels. Understanding of alcohol units
and sensible drinking levels continues to grow in the general
population, with the most recent national surveys suggesting
that 83% of adults have heard of units as a measure of alcohol consumption and 61% have heard of daily benchmarks,
with higher awareness amongst younger drinkers (Lader &
Goddard, 2004). However, although most young adults know
about units of alcohol and many can recall recommended sensible drinking levels, this does not necessarily mean that they
then apply them to regulate their own consumption levels on
a night out. A study by Buck and Morgan (1999), for example, found that 13% of women and 27% of men drank above
sensible limits, and that 11% of women and 24% of men
thought themselves to be drinking above sensible limits. It
appears then that consumption levels do not reflect a lack
of knowledge of health risks, rather that young people are
aware of recommendations on sensible consumption but do
not consistently apply them to their own behaviour.
Thus, whilst the premise of alcohol demand reduction
strategies is that a shift in knowledge, attitudes, and/or values
will result in a shift in behaviour, it does not allow for contradictory, risk-taking, and sensation-seeking conduct (Duff,
2004). Just because people know something is risky or potentially harmful does not necessarily mean that they will stop
the behaviour, as is evidenced by levels of smoking amongst
young women (e.g., Graham, 1994). Large minorities of
the adult population across the socio-economic spectrum
regularly drink above recommended levels in the UK: for
example, 40% of women and 48% of men aged 16–24 years
drank more than the recommended sensible daily drinking
levels (3 and 4 units, respectively) on at least one day in
the week prior to interview, and 26% of women and 34%
of men drank more than double the recommended daily levels (6 and 8 units, respectively) on at least one day in the
previous week (Office for National Statistics [ONS], 2004).
Moreover, the reasons for this conduct may relate specifically
to the risk-taking aspects of consumption and the broader celebration of quality of life over longevity, in defiance of health
education advice and even as a challenge to mortality itself
(Cronin, 2004). This complex relationship between knowledge, motivation for change, and actual behavioural change
needs further consideration in relation to harm minimisation.
If alcohol education and demand reduction initiatives are
not grounded within their appropriate cultural context, a serious credibility gap develops between actual and desirable
behaviour. As Engineer, Phillips, Thompson, and Nichols
(2003) noted in relation to their Home Office qualitative study
exploring the social context to “binge” drinking amongst 18to 24-year-olds in the UK, “the acceptability of binge drinking is established both within the young people’s immediate
friendship group and through their perceptions of wider cultural norms. This can affect young people’s ability to regulate
their drinking, even when they begin an evening with cautious
intentions, and has implications for policies that aim to reduce
alcohol consumption among young adults” (p. 25).
It is suggested here that sensible drinking levels in the
UK guidelines have been determined by a primarily medical model without reference to the wider cultural context of
traditional and contemporary influences on British drinking.
Despite the strong cultural tradition of weekday restraint and
weekend excess that characterises northern European drinking cultures, the focus of government recommendations has
been on daily rather than weekly benchmarks since 1995
(United Kingdom Department of Health, 1995). In relation
to illicit drugs, Shiner (2003) has noted the limitations of
establishing classifications of harm based on medical consequences that are not necessarily grounded in the attitudes
and behaviour of users or wider society. Shiner’s critique of
the 1971 Misuse of Drugs Act (the legislation that governs
the criminalisation and classification of illicit drugs in the
UK) suggests that the Act is flawed because its overarching
scale of harm is a medico-legal classification based on medical knowledge of the harm caused by specific psychoactive
drugs that is both dated and limited. The same could be true
for national policies governing alcohol use. However, if we do
attempt to establish a more culturally appropriate level of sensible consumption than the current medical model of demand
reduction, where would we set levels of socially acceptable
risk in the pursuit of pleasure within a culture of intoxication?
The British government appears optimistic that it can instil
positive cultural change and reduce alcohol-related violence
F. Measham / International Journal of Drug Policy 17 (2006) 258–268
and disorder, whilst increasing the availability of alcohol in
licensed and off-license premises through extending trading hours with the 2003 Licensing Act. Empirical research
suggests that government policy is at odds with attitudes to
excess. Research by Measham and Brain (2005) with over
350 young adult weekend drinkers in Manchester found evidence of the pursuit of determined drunkenness as a specific
aim of weekend drinking. This is supported by a Home Office
study of “binge” drinking that found that, “young people
often go out with the definite intention of getting drunk,
and . . . many deliberately accelerate or intensify their drunkenness by mixing drinks, drinking before they go out, or
drinking beverages that they know have a strong effect on
them” (Engineer et al., 2003, p. 16). At the national level,
this new determined drunkenness has informed UK government policy with the Prime Minister’s Strategy Unit noting
that “drinking is often viewed as an end in itself, and public
drunkenness is socially accepted, if not expected. . . . Particularly evident . . . is a culture of going out to get drunk.
This culture is particularly associated with 16- to 24-yearold drinkers” (2004, p. 23). The pub consistently remains the
number one leisure venue in the UK (Summerfield & Gill,
2005). Moreover, the average drinker in the Manchester study
by Measham and Brain (2005) had already consumed enough
alcohol to have reached (or, in the case of male respondents,
to have surpassed) recommended sensible daily consumption levels, although respondents were interviewed towards
the beginning rather than end of their evening outing.
This is not a picture of unbridled excess however. Aside
from the weekday/weekend tradition of self-regulation, the
Manchester study found other processes of regulation at
work. The study explored the relationship between practices of self-regulation and social regulation and found that
when drinkers discussed their desired and actual levels of
intoxication in detail, they were bounded by concerns about
health, personal safety, image, identity, and so forth, and that
these in turn interacted with gender, age, ethnicity, and socioeconomic class to produce a complex amalgam of influences
on drinking practices to result in a “controlled loss of control”
(Measham & Brain, 2005; see also, Brain, 2000; Hayward,
2004; Measham, 2002). The Manchester study provided support for the argument that a new culture of intoxication is
emerging that features a determined drunkenness by young
adults as part of a broader cultural context of risk-taking and
hedonistic consumption-oriented lifestyles bounded by occasion and location. With the longest working hours in Europe,
a consumer-based “work hard-play hard” ethos (Parker &
Williams, 2003), transgressive carnivalesque practices within
a highly controlled and surveilled capitalist consumer society
(Presdee, 2000), and with growing evidence of emotional, as
well as economic, and political costs to globalisation (Elliott
& Lemert, 2005), it is to this cultural context that effective harm reduction and demand reduction policies must be
addressed.
More recently in the UK, the emphasis has shifted from
behaviour change through unit-based alcohol advice to atti-
263
tudinal change, with attempts to alter British attitudes to
drunkenness. A key input into alcohol education directed at
the general young adult population of drinkers are mediabased public health campaigns such as the Portman Group’s
web-based Drinkaware campaign (www.drinkaware.co.uk;
but see Demopoulos, 2004) and the Portman Group’s cinemabased Ms Jekyll or Ms Hyde? campaign, which was the first
anti-drunkenness campaign in the UK. In recognition of both
the acceptability and desirability of altered states of intoxication amongst young people in the UK, the British government
devised a £5 million advertising campaign for the Christmas
holiday period of 2005/2006 that aimed to make public drunkenness less socially acceptable.
Perhaps a more optimistic assessment of the current wave
of determined drunkenness is that the level of sessional
consumption has now reached a plateau after 10 years of
escalation. Demand for specific legal and illicit psychoactive
substances remains in flux. After over 10 years of increased
sessional consumption and the expansion of alcohol-oriented
leisure in the UK, the emergent teenage cohort might be
expected to differentiate itself from the young adult cohort
that preceded it in terms of fashion, music, and leisure
lifestyle; conversely, as certain alcoholic beverages become
more popular with a wider age range, adults too will want
to differentiate their leisure identities and consumption patterns from younger drinkers. One of the early indicators that
the plateau in drinking volumes may have been reached is the
lack of increase in alcohol consumption according to the most
recent annual national school survey conducted by Exeter
University (Balding, 2005). Amongst the general adult population, national surveys suggest that overall consumption
levels have levelled off in the early 2000s (e.g., ONS, 2004;
Rickards, Fox, Roberts, Fletcher, & Goddard, 2004).
Types of alcoholic beverages consumed are far from static,
however. Recent figures from market analysts suggest that,
following a lull in sales of flavoured alcoholic beverages in
2003–2005 (which was in part a response to increased taxation in 2002 and alcopops’ popularity among youths under 18
years of age), the market is consolidating with further product
development and diversification. New products include premixed branded cocktails, ready-to-drink spirit mixers, and
milk-based alcoholic beverages targeted at 18- to 34-yearolds who are showing preferences for less sweet and more
sophisticated alcoholic drinks (Mintel International Group,
2005).
The political climate is also changing. Alongside aspects
of deregulation through licensing legislation, recent concerns
have been expressed by criminal justice agencies, alcohol
researchers, and commentators regarding the need to minimise alcohol-related harms and their costs to individuals and
wider society. This is evident in the Alcohol Harm Reduction Strategy for England (Prime Minister’s Strategy Unit,
2004) that includes an emphasis on the responsibilities of
alcohol producers and retailers (in terms of self-regulation of
advertising, promotional strategies, and sales practices) and
consequent initiatives—such as the introduction of Standards
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F. Measham / International Journal of Drug Policy 17 (2006) 258–268
for the Management of Responsible Drinks Promotions, published by the British Beer and Pub Association (BBPA), the
leading representative of the brewing and pub sector (British
Beer and Pub Association [BBPA], 2005).
Thus, many harm reduction and demand reduction initiatives concentrate on the individual drinker—whether through
regulation, prevention, medically dominated models of sensible consumption levels, or theories of rational decisionmaking and risk assessment. And so we come to the third
corner of the framework: the regulation and control of supply
through state, voluntary sector, and alcohol industry initiatives.
Supply reduction in a climate of economic
deregulation
Alongside socio-economic and cultural influences on
fluctuations in demand, supply-side production, promotion,
licensing, access, and sales policies and practices also play
an important part in patterns of consumption. Media coverage of young people’s “binge” drinking in the UK has led
alcohol policy back to centre stage, making reconsideration
of the role of supply regulation within harm minimisation
timely.
As discussed above, evidence suggests that a new culture of intoxication has emerged in the UK, facilitated by
significant developments in licensed leisure (Brain, 2000;
Measham, 2004a). In part, this is a response to the perceived popularity of unlicensed leisure and alternative recreational drugs, most notably with the development of the acid
house, rave, and dance club scene from the late 1980s (e.g.,
Collin and Godfrey, 1997). Economic deregulation is evident with alcohol becoming more affordable in the UK since
the 1970s due to increased disposable income (ONS, 2004),
increased off-license availability through supermarkets and
other retailers (alongside increased on-license availability
through licensing extensions from the late 1980s onwards),
and the re-commodification of alcohol and redesign of
licensed venues from the mid 1990s. Within this context,
whilst excessive consumption by individual drinkers might
precipitate bad publicity for the industry (and undoubtedly
most within the alcohol industry would advocate voluntary self-regulation by the industry as preferable to state
regulation), deregulation has ultimately led to increased
sales/profits across the UK (McKeganey, 1998; Roberts,
Blakey, & Tudor-Smith, 1999), whereas a shift towards individual moderation would lead to reduced sales/profits.
The two routes of state regulation and industry selfregulation are in evidence in the recent legislative changes
in the UK. The government has chosen a route of industry
regulation through a voluntary social responsibility scheme
in England and Wales, established in the Alcohol Harm
Reduction Strategy for England (Prime Minister’s Strategy
Unit, 2004), and by omission from the 2003 Licensing Act
implemented in November 2005 (Office of Public Sector
Information, 2003). This is in contrast to the 2005 Scottish
Licensing Act that follows a more radical policy of supplyside controls, restricting alcohol marketing and certain sales
strategies that are seen as encouraging irresponsible or excessive consumption (for example, “happy hours,” bottomless
glass drink-all-you-can promotions, and so forth) (Office
of Public Sector Information, 2005). So whilst English and
Welsh legislation regulates consumers, Scottish legislation
regulates both retailers and consumers.
A key feature of both Licensing Acts, however, is the
relaxation of statutory permitted drinking hours (a feature
of British licensing legislation for over 100 years), allowing license applications of up to 24 h a day. The reasoning
behind the liberalisation of licensing legislation is the belief
that increased access to alcohol will reduce alcohol-related
harms, such as violence and disorder, by staggering closing
times, by reducing accelerated consumption just prior to closing time, and by reducing congestion and aggression amongst
late night drinkers. This policy has faced widespread opposition from health professionals (Bentham & Temko, 2005),
criminal justice professionals, alcohol researchers, and even
some alcohol retailers in the UK because it is seen as inappropriate and unrealistic in the current climate of determined
drunkenness by young drinkers (Measham & Brain, 2005).
Thus, the economic deregulation and liberalisation of
licensing has led to increased availability of a wider range
of stronger alcohol products alongside a reduction in supplyside controls, with the British government arguing that
increased access to supply will result in the reduction of
alcohol-related harm. This is mirrored in parallel government policy on gambling, whereby the provision of gambling
venues is increasing across the UK through the liberalisation
of gaming laws.
The evidence base that individual legislation can
instigate cultural change towards a more relaxed—yet
responsible—model of drinking (or gambling) through
licensing deregulation is less clear, however. The result of
increased trading hours have been mixed in Australia, Ireland,
and New Zealand, countries with drinking cultures similar to
those in the UK: there is evidence that alcohol-related crime,
disorder, health problems, and overall consumption levels can
increase (e.g., Butler, 2003; Chikritzhs & Stockwell, 2002).
Furthermore, trading hours are just one aspect of a complex
interplay of factors that contribute to crime, disorder, and
transgression in the city at night. Research suggests that the
night-time economy operates within a carefully constructed
“wild zone” within cities, where the regulation and bounding of individual behaviour is governed by a multitude of not
only individual but also socio-economic, cultural, and political factors (see, Hayward, 2004; Hobbs, Hadfield, Lister, &
Winlow, 2003; Stanley, 1997).
The question of how demand and supply interact in a culture of intoxication that includes the pursuit of determined
drunkenness can be illustrated by the example of “happy
hours” and other promotional practices. Such initiatives are
losing favour and are seen as a contributory factor in the cur-
F. Measham / International Journal of Drug Policy 17 (2006) 258–268
rent problem of “binge” drinking. Unfavourable comments
on such retail practices and the threat of state regulation (as
in Scotland) have led to establishment of voluntary codes of
practice by the manufacturing and retail trade in England and
Wales (BBPA, 2005). For example, according to the BBPA’s
point of sale promotions standards, whereas “well managed
promotions are a wholly legitimate way of maintaining and
developing business,” the BBPA members are committed to
“driving irresponsible promotions out of the trade” (2005, p.
4). An irresponsible promotion is defined as one “that encourages or incites individuals to drink to excess, behave in an
anti-social manner, or fuels drunkenness” (BBPA, 2005, p.
4). If “drinking to excess” is defined as drinking more than
the recommended sensible levels that dominate UK public health campaigns, then any promotion that encourages
female customers to drink more than three units in a session
and male customers to drink more than four units could be
considered a breach of standards and result in a BBPA investigation and/or be used as evidence in opposition to license
renewal by the police and licensing authorities. Again, as for
individual drinkers, there will be a credibility gap between
recommended practice for retailers and the realities of current
consumption and sales practices.
The aim of reducing the incidence of excessive sessional
consumption through promotional restrictions (and increased
costs) in on-trade alcohol products is grounded in a wellestablished inverse relationship between alcohol availability
and consumption levels, with increased cost/taxation recognised as one of the most cost-effective policies to reduce
alcohol problems (Gray, Saggers, Sputore, & Bourbon, 2000;
Room et al., 2003; Stockwell & Crosbie, 2001).
However, restricting availability/increasing cost by reducing promotions through licensed retailers alone can lead to
a displacement effect. In the Manchester study by Measham
and Brain (2005), respondents reported that the perceived
high price of on-trade alcohol products led to greater consumption both before and after visiting city centre bars, thus
displacing sales from licensed to off-license retail outlets and
maintaining or even increasing overall consumption levels.
In particular, the practice of buying and consuming a bottle of spirits in a small group of friends at home—vodka
and absinthe being the favourites in the 2004 Manchester
study—was widespread and seen as both cost-effective and
sociable by respondents, but resulted in the majority of
study participants consuming above recommended sensible levels before they had even entered licensed premises.
Whether alcohol-related disorder may also have been displaced or reduced along with the displacement of consumption was more difficult to ascertain (Ditton, 2000). Furthermore, the Manchester study found that young drinkers
tended to choose bars with promotions outlined as irresponsible practice according to the BBPA standards. This was
not only because such promotions were considered to offer
better value for money, but also because the bars were perceived to be the busiest, hence most popular, most lively, and
most fun. Some of the promotional practices identified in the
265
Manchester 2004 fieldwork—such as “happy hours,” “twofor-one” deals, free shots with every drink, and so forth—have
continued since the establishment of the BBPA standards
in 2005.
A consideration of illicit drugs illustrates some of the
dilemmas of the potentially effective but not necessarily
popular supply-side regulation of alcohol. Presumably, the
current voluntary self-regulation of the manufacturing, advertising, and retail alcohol trade in England and Wales would
be unacceptable to all but the most radical libertarians in
a post-prohibition model of illicit drug supply. In relation
to illicit drugs, favoured post-prohibition models include
important recommendations on the state regulation of supply and recognise the importance of restrictions on advertising, sale, dosage, concentration levels, specified outlets,
vulnerable groups, and so forth (e.g., Rolles, Kushlick, &
Jay, 2004). Nevertheless, the widespread availability of illicit
drugs across the Western world and the illicit production and
consumption of non-commercial alcohol products in developing and “dry” nations (Haworth & Simpson, 2004) suggest
that restrictive supply-side alcohol policies can be subverted
by customer demand.
Conclusions
This paper has considered the relevance of Duff’s call for
an ethics of moderation regarding illicit drug use in the Australian context to alcohol use in the British context. It is suggested that some processes of self-regulation and economic
regulation operate in relation to British drinking in terms
of the longstanding tradition of weekday restraint/weekend
excess and more recent practices of bounding consumption.
However, both an ethics of moderation and current public
health programmes that focus on individual recommended
daily sensible consumption levels collide with an emergent
culture of intoxication, with evidence of determined drunkenness by individuals, an economic climate of deregulation of
the alcohol market, and a political context of licensing reform.
This results in a credibility gap between recommended and
actual practices for drinkers, alcohol manufacturers, and alcohol retailers.
Clearly, the current media, political, and public perception of unbridled British “binge” drinking youths rampaging
the city streets after dark needs tempering. With the development of alcohol harm minimisation strategies, there is
the need for continuing consideration of all three aspects of
the supply-demand-harm reduction nexus and of the importance of understanding the broader socio-economic context
to changing patterns of leisure, pleasure, and psychoactive
consumption.
It is suggested here that demand reduction policies have
a credibility problem because of the gulf between recommended and actual practices of consumption. Harm reduction
is pushing against a culture of intoxication that celebrates the
pursuit of weekend excess facilitated by developments within
266
F. Measham / International Journal of Drug Policy 17 (2006) 258–268
a multi-billion-pound industry. Meanwhile, the subtle processes of self-regulation (such as the bounding of consumption by occasion, location, and weekly cycle) operating within
the above context have yet to be fully explored. Currently in
the UK, supply control policies have a popularity problem
with the general public and are underpinned by a political
ideology, which presumes that increased access to potentially
addictive legal substances and behaviours (such as alcohol
and gambling) will not increase associated harms—and, in
the case of alcohol, will actually decrease problems. So a
two-pronged approach—voluntary and statutory—is evident
in relation to British policy on the regulation of supply. Yet,
the professed government aim of cultural change in drinking
practices clearly cannot be instigated by one piece of legislation alone.
In relation to the bounding of alcohol consumption,
central to our understanding of how and why young people
drink are the levels of desired and actual intoxication
experienced by young adult drinkers in situ, the role
of emotionality and rationality in the hedonistic pursuit
of pleasure in contemporary consumer society, and the
relationship between intoxication, pleasure, and excess. By
understanding the context to young people’s drinking, their
lived experience, the processes of consumption, and how it
is both individually and socio-culturally bounded, we can
better understand the relationship between self-regulation,
social regulation, and economic deregulation of alcohol
within the current cultural context of weekend determined
drunkenness. Furthermore, there is a need to shift from
individualised analysis to an understanding of the socioeconomic, cultural, and political contexts to the relationship
between supply, demand, and harm reduction on the level of
the city (Hayward, 2004), licensed leisure locations and their
broader socio-cultural surroundings (Measham, 2004b), and
the trans-national stage (Cooke et al., 2004; Room et al.,
2003).
The question then is how we might manage an ethics of
moderation in relation to alcohol consumption within a prevailing public health paradigm of demand reduction, against
a socio-economic backdrop of market deregulation and consumer choice, when individuals are operating within a culture of excess? The importance of evidence-based realism
in public health demand reduction programmes needs to be
noted, alongside the development of strategies to reduce harm
focusing not only on the individual but also the wider environment of consumption through safer drinking initiatives,
multi-agency and multi-site efforts, and greater prioritisation
of the health, safety, and security of customers in licensed
leisure venues. Further exploration is needed of the nature of
the relationship between self-regulation by individual users,
social regulation of consumption, and economic regulation
of the alcohol industry in the policy mix. Above all, alcohol
policies must attempt to bridge the “credibility gulf” between
the scientific evidence on risks to health and safety and the
need to be culturally appropriate, context-specific, and credible to be effective.
Acknowledgements
Thanks to Marjana Martinic, Sue Penna, Eddie Scouller,
and the two anonymous referees for very helpful comments
on an earlier draft. Thanks also to those who worked on
the ‘Binge’ Drinking and Bounded Consumption Research
Project: Kathryn Blennerhassett, Chris Brady, Kevin Brain,
Ros King, and Chendi Ukwuoma. This paper draws on a
conference paper presented by Fiona Measham at the 16th
International Conference on the Reduction of Drug Related
Harm (2005) in Belfast, UK.
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