Passive smoking is treated as a serious hazard. So why have we been so slow to wake up to the dangers alcohol poses to those who live with – or have a devastating encounter with – a heavy drinker?
Helen Witty thought she had taught her children all about the dangers of drinking. She was raised with the knowledge that her great-grandfather’s alcoholism had led him to suicide. “It’s in the family,” her mother warned her. In a classic expression of the ripple effect of harmful drinking, Witty kept her own consumption modest. And she taught her two children to understand and to be careful of the long shadow cast by other people’s drinking.
But what none of the family had prepared for was the day when Helen Marie, Witty’s 16-year-old daughter, stood in the drive of their Florida home wearing her skates; she wanted to destress before a big school play. She flipped around, blew her mother a kiss and said she would be right back.
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| Family members of people killed by drink drivers hold pictures of their loved ones during a Mothers Against Drunk Driving rally in Washington DC. Photograph: Tom Williams/CQ-Roll Call |
She didn’t return. When her father went to look for her, he found a crime scene. Helen Marie had been hit while skating on a bike path by a 17-year-old driver who had been drinking tequila and smoking cannabis. Instead of bringing his daughter home, her father had to identify her body.
Helen Marie was killed by another person’s abuse of alcohol in a tragic example of so-called secondhand drinking. While the concept of secondhand, or passive, smoking is familiar, secondhand drinking is a growing field of study. Last week, the Alcohol Research Group at the Public Health Institute in Emeryville, California, published research showing that 53 million Americans each year experience harm from another individual’s alcohol use. That is one in four men, and one in five women. Given that passive smoking is treated as a serious public health hazard in countries from Mongolia to Colombia, Australia to the UK, why are governments so slow to notice, let alone challenge, secondhand drinking?
“Secondhand smoking really changed public opinion and paved the way for legislation to make bars and public places smoke-free,” says Sir Ian Gilmore, the chair of the Alcohol Health Alliance and the director of the Liverpool Centre for Alcohol Research. “There is undoubtedly harm from secondhand smoke, but the range and magnitude of harms is likely to be even greater from alcohol.”
“We are only just starting to appreciate the long-term impact of these harms,” adds Katherine Karriker-Jaffe, a senior scientist at the Alcohol Research Group in the US, and the author of the research published last week. Her team worked with 10 categories of harm, from harassment to assault. Although she cannot recall experiencing any secondhand harm herself, she is something of an anomaly because, as Gilmore points out: “There is hardly a family that hasn’t been touched in some way, whether it’s a child of an alcoholic or someone who has been punched on a night out. There are so many examples; it is genuinely unusual to come across a family where someone hasn’t been affected by alcohol.”
Often, the effects of alcohol use can ripple from one life into another. All too easily, a person who suffers a secondary harm can become a perpetrator of further harms.
Sam is the birth mother of a child with foetal alcohol spectrum disorder (FASD). When she was pregnant, her then partner had a problem with alcohol. “It was an abusive relationship,” she says. “I struggled with what was going on. When you’re in that part of your life where everything is overwhelming …” She trails off. She drank on average a bottle of wine a week, with “the odd binge”.
Sam’s son is now 12, but at the time he was conceived the UK government did not advocate abstinence during pregnancy. (Today, 41% of women in the UK are thought to consume alcohol while pregnant.) Sam believed her pregnancy was proceeding well. Every scan showed that her son was growing as he should be. The possibility of FASD “kind of flittered and then escaped my mind”.
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| A report suggests 41% of women in the UK drink alcohol while pregnant. Photograph: Jamie Grill/Getty/Tetra |
Sam’s son was nine and had repeatedly been excluded from mainstream school when he was finally diagnosed with partial FAS (foetal alcohol syndrome). “When the paediatrician confirmed my fears, I broke down and cried,” Sam says. “You have to come to terms with the fact that you harmed your child. You gave your child brain damage. There is a massive part of you that just wants to block it out. But you can’t. You have to live it, day in, day out.”
Sam’s long list of her son’s symptoms, which include sleep issues, manic behaviours, depression and low social maturity, is balanced by an equally long list of what she appreciatively calls his “highest qualities”: his creativity, his IT skills, his loyalty to friends and “massive heart”. She is clearly a loving, attentive mother who is highly attuned to her son’s needs. At some point, when her little boy has sufficient emotional maturity and stability, she will need to muster all of those qualities to explain to him his diagnosis.
It is the ultimate discharge of maternal responsibility, but Sam worries that the disclosure may take her away “as his one safe person. This is what secondary alcohol use has created in my family,” she says.
Even when a person harmed by secondary drinking acts to intercept the repercussions, the psychological impact can be inescapable. In 2014, Jabz Musinga’s father died after falling into the River Aire in Leeds. It took several weeks for his body to surface, but Jabz, 25, knew what had happened as soon as she saw the security video of her dad walking drunkenly beside the water.
The certainty must have felt strange, because she had spent her childhood “on tenterhooks”. What she had witnessed in her own home, her father’s behaviour, “carried into my adult life, trickled into my dating life”, she says. “I had low standards of what to expect from a guy, and even from friends. People easily took advantage of me.”
She soon found herself in an abusive relationship. “It was very brief. I put my foot down straightaway. It was like two weeks and I said: ‘This is not going to work.’” She was thankful, she says, that she was “able to stop” – which suggests that she may also have been able to continue. It took a particular conviction to intercede.
“It was very hard to say: ‘I’ve been affected by someone else’s drinking,’” Jabz says. “The focus tends to be on people who have addictions,” not those around them. But she has no doubt that alcohol changed her. “It shaped my personality. I would be a completely different person if it hadn’t happened. I do think about it, once in a while – the person I would have been,” she says, as if a ghost self shadows her. “I think I would have been more confident. Maybe a better person.”
Jabz sounds adjusted and happy in her life, but that last note of self-rebuke recalls the words of the MP Liam Byrne, another child of an alcoholic father and a patron for the National Association for Children of Alcoholics (NACOA), a charity that Jabz volunteers for. “You don’t know what’s normal, so you construct these perfect templates of what you think good looks like,” he says.
Self-medicating with perfectionism, Byrne wrote “long lists of attributes” to live up to – “a blueprint for being a superhuman with super powers”. He is 48 now. How old was he when he wrote his last list? He sighs heavily. “Forty-three? Forty-four?”
Secondhand drinking covers such a spectrum of human experience that a wide range of measures is required to confront it. Byrne, whose experiences have helped him to connect with the homeless population of the West Midlands, where he is campaigning to be mayor, points out that about 2.5 million children in the UK have an alcoholic parent, and 50% of these “go on to develop problems themselves”. Greater education of frontline workers with children, including teachers and GPs, would help – something that the all-party parliamentary group Children of Alcoholics, which he founded, is working to change.
Witty, who is now the president of the charity Mothers Against Drunk Driving, would like stiffer laws against underage drinking. Sam would like more support for children with FASD – and their mothers. At present, nearly 80% of the NHS’s clinical commissioning groups do not provide diagnosis for children with FASD, according to a freedom of information request by the National Organisation for Foetal Alcohol Syndrome-UK. Karriker-Jaffe is interested in the degree to which “negative impacts for people with heavy drinkers in their lives appear to be stronger for women than men”. But why can’t all the harms of secondhand drinking be addressed with the same sort of legislative determination that denormalised secondhand smoking?
“A single act, if I had a wish, would be to introduce a minimum unit price combined with increasing duty on alcohol,” says Gilmore, of the Alcohol Health Alliance. He cites the “duty escalator”, introduced by the Labour government in 2008, pushing up duty on alcohol by 2% above inflation year on year. “That was the first time we saw outcomes like cirrhosis deaths plateau off and begin to fall. Unfortunately, George Osborne as chancellor removed that duty escalator.
“[With cigarettes] we have relentlessly pushed the price up.” Gilmore points out. “Quietly, but relentlessly. And that’s made a huge impact. The UK is the leading European country in reducing smoking rates. The government has a real opportunity to show it is at the forefront of reducing alcohol-related harm, including harm to others. It needs to stop leaving alcohol to the free market like soap powder and treat it as a potentially serious health risk, as it has done with tobacco.”
There are differences between smoking and drinking, of course. More than 90% of the 181 governments to have signed up to the World Health Organization’s Framework Convention on Tobacco Control (WHOFCTC) have implemented some form of smoking ban; Article 8, which relates to secondhand smoking, is the most implemented of all WHOFCTC articles. But with alcohol, the desired outcomes – the appropriate limits – are more variable, more open to discussion. And no doubt the normalisation of alcohol in an array of social situations, from family celebrations to weekend binges, means that its abuse remains highly stigmatised: a harmless pursuit that has simply exceeded control.
“People say that if you smoke you harm others, but with alcohol you only harm yourself,” says Amy, 30. She vehemently disagrees. Her sister began to drink in her early 20s – just “having a wild weekend”, as medical staff initially described it to the family. Within seven years, she died of heart failure. “Anyone else who had a terminal illness would have an abundance of understanding from friends, colleagues. But you don’t have that support,” Amy says. “In fact, you don’t have the ability to talk about it without stigma.”
Amy, who is from south Wales and volunteers for the charity Alcohol Change UK, was training for a new job while her sister’s condition deteriorated. “I’d be in the hospital, then come straight to work as if nothing had happened. I work in a fairly professional environment, and I know it sounds silly, but I wouldn’t want it [her sister’s alcoholism] to impact on people’s view of me as a professional,” she says.
She is not alone. The day after we speak, Karriker-Jaffe emails to say that she would like to alter her answer about her own experience of secondhand drinking. “I watched an extended family member struggle with an alcohol use disorder that I believe eventually contributed to her death,” she says. “I think about her often in relation to this work.” Karriker-Jaffe adds that she is unsure why she did not mention this on the phone. “Stigma, I suppose.”
Her revelation, as an expert in this field, suggests that alcohol abuse, and the harms of secondhand drinking, need to be destigmatised in order for its scale to be properly confronted. In the UK, it is widely seen as deplorable to smoke in the company of children – but even the most conscientious parents display few qualms about drinking. Does it matter, for instance, if children see a parent habitually reach for a glass of wine to de-stress? Byrne laughs drily. “It does, yeah. Because you need to be able to model self-care.”
“We need to reframe what we believe is problem drinking,” agrees Josh Connolly, a life, leadership and performance coach who has experienced secondhand drinking as the child of an alcoholic parent, and as an alcoholic parent himself. “I say: come away from quantity and how often you are doing it. Because if your children know you get them to bed, get the wine out, have one glass of wine and relax, what they see is that they can’t help you relax: you go and get a glass of wine. It’s about the behaviours, the feelings that alcohol use creates.”
Twelve-step programmes, including that of Alcoholics Anonymous, helped Connolly eliminate alcohol from his life. But, in his sober years, he has found that his presence can make drinkers feel uncomfortable in their relationship with alcohol – and this, he thinks, is where everyone who enjoys alcohol could benefit from some self-appraisal.
“The strange thing, as somebody who is seven and a half years sober, is that I now face more stigma from society for not drinking than I did as a dad who drank,” he says. No doubt this reluctance to examine our relationship with alcohol helps to make secondhand drinking so hard to acknowledge. As he says: “Society doesn’t have a line to cross on this. So how is an individual going to have one?”
Maybe it is time to explore not only the ways in which we have, as individuals, experienced a secondhand harm from alcohol – but also those in which we may have perpetrated one.
(Source: The Guardian)
