Drinkaware have released a review on 'Drunken nights out', intending to inform possible future action the industry funded education charity could take.
The review attracted some headlines, largely relating to the finding that sexual harassment on nights out was common but often tolerated. Whilst much of the report describes what might be expected or previously identified in terms of attitudes and motivations towards what might more commonly be described as 'binge drinking', it offers a detailed exploration into these motives and other contributing factors.
The review drew on qualitative research including interviews and workshops with 80 drinkers aged 18 to 29, a review of literature, and interviews with key informants. By 'drunken nights out', the report refers to a package of behaviours, rejecting 'binge drinking' due to its inconsistent and often stereotyped use.
The full report and 20 page executive summary can be found here, press release here, and below we look at some of the key findings and implications.
Attitudes and motivations for 'drunken nights out'
In the review, 'drunken nights out' were found to deliver clear recognised benefits to participants, something previously highlighted by research criticising over-simplified attempts to address such behaviours via messaging about risks. The report explores four key 'benefits' identified with drunken nights out under headings of 'escape', 'bonding and belonging', 'social adventures' and 'stories'. It states there are few alternatives "which provide the same mix of benefits" and drinkers found hard to think of other things they could do.
Alcohol itself plays a crucial though not universal role in 'drunken nights out':
'Alcoholic drinks are treated as ethanol-delivery mechanisms, with calculations of ‘units per pence’ and appropriate concentrations guiding choice of drink. People value the effects of alcohol, which they see as giving them the confidence and reduced self-consciousness needed to do things they would not normally do; take on their drunken night out identity; and access the benefits of a drunken night out.'
It states that "drunkenness is therefore prized, not only for its direct effects, but also because it is an entry ticket to the social permissions afforded by the drunken night out." Furthermore, experiences of being sober in the night-time economy were experienced as "abnormal and uncomfortable", and so "drunkenness is a required condition of participation in the drunken night out."
Limits and attitudes to health
Such drinkers do express personal "limits" but not as a health consideration, rather than a point at which they do not intend to pass in terms of ability to control their behaviour. Reasons for doing so may include avoiding shame (beyond just embarrassment), but particularly for women, protecting themselves against vulnerability was valued. Groups played an important function in terms of perceived safety. However "as people become more drunk, they are less likely to regulate their consumption consciously, and more likely to respond to situational prompts to drink and conform to social norms."
Longer-term risks "were discounted altogether", in part as drinkers saw health problems associated with "alcoholics" or daily drinkers who overall were thought to drink more. Even where health harms were accepted, their young age and cutting back in the future were seen as reasons not to consider health risks.
In the review "pre-drinking" (or pre-loading) is considered "part of the overall package" of behaviours, and drinking games were common. Although the review, and Drinkaware in general, are not involved in pricing debates, it recognises "the opportunity to get drunk for less money does play a role". However it also suggests there is evidence that pre-drinkers may drink as much when out as those who have not pre-drunk.
Risks and Risk Management
Two key serious risk were identified in the review:
- There is a significant problem of violence associated with drunken nights out, skewed towards more serious incidents such as wounding. Many of our participants had witnessed or been victims of violence on a drunken night out.
- There is an association between alcohol consumption and sexual assault. Responses from our participants suggested that molestation and groping are common experiences as part of a drunken night out.
A strategic framework for Drinkaware
The review was conducted to inform potential activities Drinkaware could take, but acknowledges the limited impact of educational approaches, as many public health roles are keen to highlight:
'There is a substantial body of evidence that education and communications are best deployed as part of a wider package of behaviour change interventions – and that, by themselves, they are unlikely to achieve changes in behaviour. Education and communication interventions by Drinkaware need to be developed alongside efforts by other partners using other approaches. In particular, efforts to change the norms that shape drunken nights out will require co-ordination of multiple agents, covering both the delivery of messages to support new norms, and the elimination of messages which, intentionally or unintentionally, sustain and strengthen existing norms associated with increased harm.'
The review identifies four 'strategic territories' for possible education and communications interventions: 'boundaries'; 'conscience'; 'consequences' and 'vulnerabilty'. Within each of these, it suggests potential avenues for activities to help address some of the motivations and attitudes that may lead to 'drunken nights out' and its associated problems.
As explored previously, Drinkaware has some way to go to convince many in the public health community it has a valuable role to play in reducing alcohol harms. To what extent this work may help with that will remain to be seen. Regardless, Drinkaware remain the key player when it comes to ability to deliver messages to drinkers - whatever the effect may be.