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My name is Sally Marlow and I research alcohol problems in women at the Institute of Psychiatry, King’s College London.  I started this blog to communicate the science, psychology and culture underlying drinking problems, and to put right some of the misinformation out there about women and how they use alcohol.  All views expressed here are my own.

A cautionary tale

I opened up my blog this lunchtime, turned to a colleague, and jokingly asked if she had any stories about women and alcohol.  I had no idea that she is currently dealing with the fallout of something, which she told me about.  She asked me to write about it anonymously.  Apologies if I get some of the details wrong, but the gist will be true to life.

During the Christmas/New Year holidays, my friend was in a pub with some family members, and a stranger joined them.  They had a few drinks and everyone got a bit merry.  The same stranger was in the pub on New Year’s Eve, and after a few drinks, my friend let him kiss her.  No more than that.  She regretted it the next day, but when he kept pestering her to go out for a drink with him, she did so.  It became clear to her that she didn’t fancy him, but also became clear that he wanted more from her than she would ever give him.  She’s a pretty straight talking woman, so she let him know that she didn’t want to date him, and didn’t think it could go anywhere.

He however would not take no for an answer.  Since that time she has been bombarded with text messages from him which she does not respond to; heard from other people that he’s given them the impression they are a couple; found he’d paid for tickets for her; heard that he turned up at a Ladies’ Night in a local pub and wangled his way in (she was supposed to be there, but had bailed out at the last moment); and has even seen his vehicle parked at the end of her road when he doesn’t live anywhere near her.

She thinks he interpreted her drunken kiss four months ago as more than it was.  She’s got to the point where she’s concerned, and is ready to take out a restraining order if it gets any worse.

So, be careful who you kiss when you’ve had a few.  You never know what it might lead to.

Parallel lessons for alcohol from cigarettes

Another high profile report from liver specialists about the harm excessive drinking can cause to the liver BBC Scandal of liver disease March 2014

There’s a parallel here between what is happening with alcohol, and what happened with cigarettes.  It was only once lung specialists and oncologists started flagging up the dangers of smoking that the harm caused by cigarettes was taken seriously by both government and by the general public.  The direct link between cigarettes and lung diseases is very clear.  Currently liver specialists are doing for alcohol what lung specialists did for cigarettes – highlighting the physical health risks.  There are, of course, other risks caused by both alcohol and cigarettes, but the health risks are in the easiest for some to recognise and accept. They are less controversial than, say, mental health issues associated with alcohol, or high rates of domestic violence.

Forget Pound Shops, we now have Pound Pubs

In Stockton-on-Tees, there is a pub rebranding itself as the Pound Pub, selling half pints for less than a pound, and a pint of beer for £1.50.  I know Stockton well from a personal perspective –  it’s where I was born, and I spent the first sixteen years of my life there.  I have relatives living there still, and I visit fairly regularly.  I also know Stockton well from a work perspective – the north east of England has some of the highest rates of alcohol problems in the UK, and it’s an area which comes up time and time again when I’m looking at facts and figures for A&E admissions, alcohol-related arrests, and liver disease.  The last thing it needs is a pub selling very cheap booze.  BBC News covers this story – a short video is here BBC News: Stockton’s Pound Pub

From laudanum to meow meow at the Royal Institution

Another great event at the RI last week – every time I go there I am struck by just what a valuable contribution it makes in so many areas.  Professors Sharon Ruston and David Nutt were discussing drugs past and present.  I hadn’t seen Sharon Ruston talk before, and she’s excellent.  It was a public lecture, so I was expecting something about the romantics, and she spoke about Thomas de Quincey’s opium use.

What I wasn’t expecting was to hear about Humphrey Davy’s addiction to nitrous oxide.  Better known for discovering a few elements and inventing the miner’s lamp, Davy also prepared and inhaled copious amounts of nitrous oxide.

This was sometimes in the basement of the RI itself, and he recorded his observations in his notebooks.  Who knew?

http://www.rigb.org/whats-on/events-2014/march/public-from-laudanum-to-meow-meow

Really? In 2014?

I did two radio interviews yesterday, for BBC Radio Newcastle and for the BBC Mark Forrest Show, on a news story that Northumbria Police issued 731 drunk and disorderly charges to women in 2012.

The BBC Newcastle reporter, @ruth_holliday, had put together a really nice package with some interviews.  Some of her interviewees particularly stood out.  There was a young woman who when asked why she thought people got drunk said because it’s cheap.  Spot on.  Then there were a couple of cab drivers, one of whom said when women are let loose for the weekend they get drunk, and another of whom said women go mad when they get away from their husbands.  Mmm.  Then there was the man who said women behave more badly than women.  Er, no, actually.

Drunk and disorderly arrests are for “offensive” behaviour, and what society finds offensive in men and in women is slightly different when it comes to alcohol.  Look at the work of Richard de Visser if you want evidence for this:

de Visser, Richard O. and McDonnell, Elizabeth J. (2012) “That’s OK. He’s a guy”: a mixed-methods study of gender double-standards for alcohol use.Psychology and Health, 27 (5). pp. 618-639. ISSN 0887-0446

And men are more likely to commit violent acts when alcohol is involved, which I would argue is much worse than a bit of flashing your knickers, swearing or vomiting in the street.

Don’t get me wrong, there is a problem with people drinking too much, men and women.  It’s just a shame that we have such double standards when it comes to women drinking.

Minimum Unit Pricing – what do medical students think?

The student version of the BMJ is running a poll today asking medical students to vote on whether minimum unit pricing for alcohol is a good idea.  At time of writing, 78% of those voting are in favour.  Students are more usually known for embracing alcohol in all its forms, but these students of course see the results of too much alcohol at first hand, as part of their training.

BMJ also featured an article, which I have to declare an interest in as I co-wrote it with Alice Buchan, a fourth-year medical student at Oxford. It’s called A Minimum Price for Alcohol:  what you should know and why you should care.  I’ll post it up when the electronic version is available.

Being pregnant is hard enough… now this?

There’s another story out today about drinking while pregnant, and how it can increase the risk of miscarriage.  Read it here http://www.bbc.co.uk/news/health-26239576

It’s an interesting one this, because it opens up the question of whether it’s safe to drink in pregnancy, even a small amount.  You may not be surprised to learn that government guidelines are far from helpful:  NICE (the body which considers all the evidence and produces government health guidelines) advises alcohol should be avoided in the first three months of pregnancy because of increased risk of miscarriage. However, in the same guidance advice is given that if women choose to drink alcohol during pregnancy then they should drink no more than 1 – 2 units once or twice a week. Contradictory?  What the guidelines seem to say is don’t drink, but if you do, drink a little.  In the USA they are much more clear, and the National Institute on Alcohol Abuse and Alcoholism has also considered all the evidence, and state “no amount of alcohol is safe for pregnant women to drink”.

The problem with alcohol is that the molecule can and does cross over from the mother into the foetus, and can interfere with developmental processes in the foetus.  Also the liver of the foetus is not sufficiently developed to metabolise the alcohol it receives from the mother through the placenta. There are a range of problems found in children whose mothers drank during pregnancy, most of them “neurodevelopmental”, ie to do with the developing brain, and these problems range from mild to severe.  Although not all children whose mothers drank will have these, by any stretch of the imagination, some will, and it’s hard to say why some children are affected and others aren’t, which is why in my opinion the advice really does have to be don’t drink at all during pregnancy.

Easy to say, less easy to do….. and if your pregnancy wasn’t planned, how were you supposed to know to stop drinking?  As with all things to do with women and alcohol, it’s complicated.

Evidence on Minimum Unit Pricing for KCL Biomedical Society

I recently gave a talk to the King’s College London Biomedical Society on the legality of alcohol when compared to other drugs, and one of the topics which came up in questions was that of minimum unit pricing.  I said I would post up my thoughts on this blog, along with the evidence we have to date.  My thoughts are in these previous posts

http://www.sallymarlow.com/2013/07/23/minimum-unit-pricing-my-view/

http://www.sallymarlow.com/2014/01/25/minimum-unit-pricing-the-debate-continues/

This link details the evidence (summarised very comprehensively and helpfully by Dr Margaret McCartney, whose blog and twitter feed I would highly recommend to anyone interested in all aspects of medicine)

http://margaretmccartney.com/2013/03/19/references-for-tonights-inside-health-19313/

And if you want to hear last year’s Radio 4 Inside Health programme where Margaret and I discussed minimum unit pricing and other alcohol issues, there’s a description of it and a link here

http://www.sallymarlow.com/2013/03/20/radio-4-inside-health-19032013/

Is neknominate really that difficult to understand?

Just in case you’ve been treking across the Sahara with no internet, satellite or smoke signals for the past few weeks, let me explain.  Neknominate is a drinking game, which involves drinking a glass of something alcoholic down in one (“necking” your drink), in a weird place, whilst being filmed.  At the end of the drink you nominate someone else to do the same, then you post the video on Facebook.  The more revolting your drink, or the more outrageous the setting, the more likely it is that people will share your video, and hey presto, you get your fifteen minutes of social media fame.  I’ve seen a woman in Tescos on horseback neknominating next to the chill counter, and numerous young men neknominating with their heads in a loo bowl (original, huh?)

As with all drinking games, people can die, and there have been deaths. These appear to have happened because of the acutely toxic effects of alcohol – drink a bottle of vodka over three days and you might feel pretty ill, but you won’t die.  Drink a pint of neat vodka down in one in less than a minute, and the risks are high – your body can’t handle it, and nor can your brain.

There’s been a lot of outrage in the press about why people would play a game like neknominate, but for me it’s really not that difficult to understand.  Firstly, it’s about the thrill of taking risks (young men are  particularly prone to this, for neurological reasons). Secondly, peer pressure is involved – you’re nominated by someone you know, and it’s on social media so the world can see whether you do it or not.  Thirdly, it’s narcissistic (again, a particular problem for young men and women, whose brains have not developed enough for them to know they are not the centre of the universe – do they really believe the rest of the world cares whether they drink a pint of alcohol down in one?  Yes, they really do.)  Fourthly ,drinking alcohol has already proved a positive experience – a learned behaviour if you like.  Alcohol alters mood, in a good way most of the time and if you get the levels right.  Those neknominating have learnt that from previous episodes of drinking, so why should they believe that the effects of neknominating will be any different?  Fifthly, it’s competitive – you have to go one better than those before you.  Humans are nothing if not competitive.  Sixthly, no-one thinks they’ll die – it’s a bit like smoking in that you don’t think it will get you.  How many of the outraged commentators are ex or current smokers?  How many of them have driven a car too fast to see what it feels like? Thrown themselves down a black run knowing that their skiing wasn’t actually up to it?  Stayed for another drink or six when they know they have to get up for work in the morning?  I smell a little hypocrisy here.

The vast majority of people who participate in neknominate will be fine, ill but fine.  We’ll find some other “youth” behaviour to tut and obsess over next week – legal highs again perhaps, teenage sex, increasingly strong cannabis.  I’m not arguing that we should ignore this stuff.  I just think that doing something effective about it needs to start from a position of understanding why something happens, not from throwing our hands up in horror.

By the way, neknominate stories in the UK appear to be on the wane now, but the US media has got hold of it.  Let’s see what comes out….  Here’s CNN on the subject http://edition.cnn.com/2014/02/18/world/europe/neknominate-drinking-game/