Tuesday, 24 August 2010

Has Professor Nutt gone nuts about alcohol?

Professor David Nutt was controversially sacked as the government's chief drugs adviser by the previous Home Secretary, Alan Johnson, largely because he had the temerity to suggest that the classification of controlled substances should be based on scientific evidence rather than political prejudice or the opinions of the leader column in the Daily Mail. In the process he became a hero to both skeptics and libertarians - to the former for his evidence-based approach, to the latter because, well, he opined that the government shouldn't just go around banning things. Today, though, his attachment to the harm principle would seem to have gained him a whole new set of enemies.

In a blogpost, Nutt argues that alcohol is a dangerous drug - more dangerous, in fact, than many that are currently illegal - and that to mitigate its harmful effects on individuals and society its availability should be restricted and its price should be increased. In fact, he has come up with a twenty-one-point booze-busting plan, including teaching primary-school children about the dangers of the demon drink, bans on all advertising and happy hours and even the abolition of the government wine cellar (a philistine notion that would perhaps appeal to some of the more hair-shirted of our Coalition as an easy spending cut). He also suggests a draconian US-style ban on drinking by anyone under 21 (always a puzzle in the Land of the Free).

Nutt's proposals are fisked very cogently by Jackart here, and there's not much I would add to his detailed criticisms. I want to examine why it is that Nutt can appear simultaneously a liberal reformer when it comes to drugs policy and crazily authoritarian on alcohol. His prescriptions in fact derive quite naturally from two assumptions, both of which are superficially plausible. The first is that alcohol is a major (indeed, the major) social problem. Nutt calls it "the worst epidemic of public harm from a legal drug since the introduction of cheap gin in the 1700s". The second is that government should strive to reduce harm, basing its policy as far as possible on scientific evidence rather than on political or cultural considerations. Ideally, whether or not a drug happens to be illegal (like cannabis), legal but marginalised (like tobacco) or fully normalised (as alcohol still is) should have no bearing on what policies are adopted. The objective is reducing harm, and the mechanism is to be rationally discovered.

This is empirical, technocratic, emotionless policy-making from first principles, the sort that might be expected of a perfectly detached and enlightened despot or philosopher king. As a thought-experiment, it actually has much to recommend it. If you accept that alcohol is the prime cause of the ills that are associated with its over-consumption - the social disruption as well as the long-term health effects - then seeking to reduce its prevalence in society by persuasive and coercive means seems obvious. At the same time, it can convincingly be argued that many illegal drugs produce less public harm, and that much of the harm they do cause is a result of their illegality rather than their pharmacology. So treating alcohol and drugs in the same way (including expanding the category of "drug" to encompass alcohol) would result in a more liberal drugs regime and a less liberal one for alcohol. It may even produce a situation in which alcohol is subject to greater legal controls than currently illegal substances such as ecstasy and cannabis.

This much is obvious, and quite consistent with Nutt's general approach. Yet outside the ranks of the alcohol concern industry - for whom no restrictions will ever be sufficient - the result of Professor Nutt's seemingly logical approach is absurd. Alcohol and illegal drugs are quantitatively different. For one thing, alcohol is embedded in our culture in a way that narcotic drugs could never be, even if they were fully legalised. The government wine cellars Nutt would like to get rid of are testament to that. State banquets do not generally degenerate into drunken orgies with guests dancing on the table - at least, not since the passing of the Queen Mother. Health campaigners and moralists can only see the negative side of intoxicating drink and thus assume that alcohol (or at least its ready availability) is a bad thing. For all his aspiration to scientific objectivity, Nutt would seem to be a born-again Puritan.

Smoking, of course, was once socially as prevalent as the consumption of alcohol. Just watch Mad Men. Many would argue that the official discouragement of smoking has now gone way beyond anything necessary for the protection of health and amounts to the persecution of an increasinly unpopular minority. I tend to agree. But at least the health news about tobacco was unequivocally bad. Smoking kills. Passive smoking probably doesn't kill, but it does pollute the smoker's immediate vicinity in ways that are not pleasant. There are thus sound reasons for restricting it, and few countervailing reasons for indulging it (the main one being, of course, that people should be free to do what they want when and where they want). A smoke free world is a nicer place for non-smokers, and that, rather than the health arguments, is what has been decisive in securing public support for anti-smoking initiatives. There may well be stronger philosophical reasons for restricting and ultimately banning tobacco than for banning drugs which harm (if they harm) only those who take them.

Alcohol is different. Wine and beer both have proven health benefits. Nor does alcohol have negative effects on others. While other intoxicants are bad even in moderation, alcohol is good in moderation and bad only in excess. There is no such thing as passive drinking. People are killed in road accidents by drunk-drivers, not by alcohol; people are beaten up by drunks, not by drinks; a woman whose inebriation renders her more vulnerable to being raped is still the victim of a sexual assault, not of the vodka screwdrivers.

Of course alcohol can be abused by solitary addicts, but it is the most social of all intoxicants. The cultivation and enjoyment of alcoholic drink is a golden thread running through history - indeed, has been fundamental to human existence. Euripides, in a passage that inspired St Paul's description of the Last Supper (quoted at every celebration of the eucharist), wrote this:

The blessing that Dionysus, Semele's son, procured
and gave to man is counterpart to that of bread:
the clear juice of the grape. When mortals drink their fill
of wine, the sufferings of our unhappy race
are banished, each day's troubles lost in sleep.
There is no other cure for sorrow. Dionysus,
himself a god, is thus poured out in offering
to the gods, so that through him come blessings on mankind.

That's why David Nutt is wrong. Like most professionals and campaigners primarily concerned with health outcomes, he has developed tunnel vision. Alcohol policy can never be merely about health, or about anti-social behaviour or public harm, because every measure aimed at minimising the harm that it can do - whether increased taxation or restriction of supply - impacts on the good that it does. Nutt, for example, wants alcohol to be less affordable. That will inevitably increase the burden on moderate drinkers (as well as produce even more customs avoidance), including those whose glass of wine a day is helping to ward off heart disease. It will punish the innocent and the harmless - not to mention the poor. This is bad as a principle, because it is unfair.

There's one solution, but it is so authoritarian and nightmarish I dare not mention it for fear that someone will read it and think it is a good idea. That is to give everyone a weekly alcohol ration at an affordable rate of duty and charge progressively higher duties on every excess unit that person buys, with perhaps an absolute cap to prevent anyone from drinking dangerous amounts. Ensuring that everyone purchasing alcohol presented a smartcard would also, of course, solve at a stroke the problem - if it is a problem - of under-age drinking.