Binge drinking: why punitive measures alone are not enough

Who's up for another round here? I'm not talking about another round of drinks. I'm referring to another discussion on an alarming problem that is pervasive through all demographics and geographical regions of this country. A problem that is destroying young lives every single day. Staggeringly, 13% of all deaths for 14-17 year old Australians relate to alcohol.

I'm a health professional who comes face to face with this issue every day. But not in the way you might imagine. I'm not a paramedic who responds to emergency cases of injuries sustained in alcohol-fuelled violence; nor am I a nurse or doctor in the emergency room spending Saturday night after Saturday night treating case after case of alcohol poisoning, alcohol related injuries and alcohol related deaths.

No. I'm a psychoanalytic psychotherapist in private practice in Melbourne and I am receiving an influx of requests from people seeking help from the fallout of their binge-drinking lifestyle or requiring help for the underlying issues that trigger an alcohol binge. In my practise we've collated a huge range of data into a single illustration here which really demonstrates the scale of this problem. In the past couple of years in particular we've heard rising alarm and growing reports of our nations' binge drinking problems combined with accompanying plans and campaigns to reduce, solve or resolve. One thing that is missing from this discussion, like the proverbial elephant in the room, is any consideration of the emotional and psychological drivers.

Binge drinking is a complex social issue with a multitude of contributing factors. Previous and recent attempts to address this difficult problem have often failed to appreciate the multi-layered nature of binge drinking and have instead conceptualised it in an over simplistic manner. In 2008, the federal government announced the investment of $53.5 million into the National Binge Drinking Strategy to specifically try to address this problem in young people. There have been a number of awareness campaigns, legislative measures and an additional $10 million of funding in the form of Community Level Initiative grants. While these interventions are underpinned by positive intent, I'd argue that the effectiveness is undermined by the fact that in many cases action is simply punitive and treats symptom, not cause.

This is clearly illustrated with the so-called "Alco-pop" tax; rather than reduce teen binge drinking raised $4.5 billion in tax with no evidence of reduction in consumption or hospital admittance as it seems (surprise) that teenagers are rather resourceful and can quite easily find something else to drink. In terms of future legislation there seems to be growing pressure from organisations such as the Federation for Alcohol Research and Education (FARE) and support within political parties to discuss a ban on alcohol company sponsorship in sports. Again, while the intent is positive, I'm not sure anyone is under the illusion that alcohol makes you fitter or enhances sporting performance and breaking the brand association of say, VB and the Australian Cricket team will not make anyone forget the beer exists.

In terms of campaigning for other punitive types of legislation there seems to be some movement in bidding to raise the legal drinking age to 21, given that the 2010 National Drug Strategy Household Survey showed an increase in support from 40-50% from 2008. This is possibly related to the efforts of the Delgarno Institute and their 21 Be There campaign. Again, I'd argue firstly that young people will often find a way to pursue something particularly if it is suddenly made even more elusive and subversive to them. Part of adolescence is pushing the boundaries and discovering the breadth and limits of individual autonomy and power. Secondly, as previously documented on this site by Rafaele Piccolo, whilst there was a correlation between an increase in per-capita consumption of alcohol in this country and the lowering of the age of consumption from 21 to 18 in the 1970s, this has reduced to almost the same levels as previously. We're drinking pretty much the same amount per-capita now as we were when the legal age was 21. Piccolo concludes that there is no magic cure and that binge drinking is not purely a young person's problem but that it is intrinsic to Australian culture.

Whilst I'd certainly agree that there's no magic cure I feel Piccolo stops short of really explaining why or how binge drinking is culturally acceptable in Australia and is in fact both a common problem and culturally intrinsic to many other countries including the US, UK, Iceland, Ireland and parts of eastern Europe. As an aside I'd also argue that the cultural aspect is well known and in fact there are substantial campaigns underway and gaining momentum such as the ANPHA Be The Influence campaign, which uses social media awareness tactics to provide positive behavioural modelling to young people. Australian University Sports, The Australian Paralympic Committee, Surfing Australia and many more organisations have pledged their support. Clearly there is a great desire amongst government, sporting bodies and educational institutions to devise a strategy that can effectively address binge drinking in Australia. So what's the missing piece?

Unfortunately the government climate seems to be preventing people from getting the help they need. It's one thing that most presenting patients do not want to know why they binge, but to have the government throwing down barriers at every step and turn, no wonder this task is made so much more difficult. A massive and no easy task which therapists have involves getting people to open up and talk, to take an interest in their unconscious. Many drinkers especially do not want to consider why they drink, what their unique reasons are. It's sad that our government does not encourage or fund any such self reflective, preventative methodologies either, as I've delineated here.

The current flavour of the month in the world of psychology and psychotherapy is a regimented outcome driven approach called cognitive behaviour therapy (CBT). How did it get to be flavour of the month? It is a relatively simple approach that is extremely well suited to the randomised control trials that prevail in scientific research. It is easily quantified and can be applied in an almost mindless way that fails to consider the individual and the deeper dynamics of their personality and life history. While CBT can sometimes address the behavioural element of drinking, long term improvements are questionable with this method alone, especially when the deeper, more complex thoughts, feelings and motivations underpinning binge activities are overlooked. In my view there are other measures with scientific verification which take a longer term and more thorough approach, such as psychoanalysisor long term therapy, to invite a deeper construction and invite people to speak about more than just their drinking, but all aspects of themselves, including those facets which they do not like or want themselves or anyone else to know anything about. What we need to move away from I believe, is a cultural emphasis and more towards singularity, to that of the individual causes of binge behaviour. Whilst many binge drinkers purport to want to change, to understand the cause, few realise how difficult this is.This may partly reflect the lack of complex understanding of binge drinking evidenced in simplistic, punitive based previous government measures and the normalisation of the role of alcohol in Australian culture. In most celebrations and events, whether they be weddings, funerals, job promotions, job retentions, engagements or relationship break-ups, part of the acknowledgement and process can often involve alcohol. It is interesting nobody has ever really stopped to question why this is the case.

This is exemplified by one case I had with a professional man in his thirties who would binge every weekend and sometimes during the week, often to the point of blacking out and engaging in 'embarrassing and risky behaviour'. He presented as intelligent, well dressed, logical and very matter of fact in his speech. However he started the first session with "I know exactly why I drink. Simply put, I'm Aussie, and it's part of the culture. All my mates drink. I'm expected to drink and impress customers at work functions too. There's no choice. But my wife said I had to get help. I just really, honestly want a quick fix or some strategies to manage this so it doesn't get out of control."

He maintained there was nothing new to learn. That he was not an alcoholic. That it was simply a bad habit. But, what makes such a habit persist is never simple! Here, in the first few words, we can detect the wish to maintain denial, to avoid engaging in the process of self discovery. It took many sessions to engage this fellow in psychotherapy, which meant helping him to take responsibility and assume a genuine curiosity towards his own mind, including those aspects of himself that he didn't like.

In the final session he said: "Blaming culture. Blaming peer pressure. Blaming myself. Heck even blaming parents, and I know mine had a huge influence on my urges. These excusessolve nothing, if anything they make binge drinking continue. It's not culture that walked me into a bottle shop, or up to the bar, it was me all along, because when I was a drinker I wanted to self destruct. I know that now, in more ways than one. The enjoyment of drinking used to rank higher than living, how crazy is that! But not anymore. I now prefer to live. My real mates understand."This was a highly successful therapy, not due to me 'educating' him, but really his eventual courage to take a curious interest in his own mind, no matter how confronting the journey became. The same patientactually returned a year later to talk through some different matters. He reported he had not touched a drink at all because his desire to live and pursue what he really loves outweighed his self destructive urges. He stated that this was easier than he originally thought it would be.

This case reflects the missing components of prior government policies when it comes to addressing binge drinking. Most people drink because it makes them (to some degree) feel good. It helps them escape an unsatisfying marriage or a critical and overbearing boss. It helps them feel free and spontaneous and escape the real world rules, limitations, heartaches and challenges. But it also helps people to cope with parts of their personality they don't like but feel powerless to manage any differently. Whether it's being controlled by their spouse, being abusive to their partner and children, or warding off feelings of shame, poor self-esteem, anger, anxiety, depression and unresolved loss. Many of these deeper but not necessarily observable reasons for binge drinking can be traced back to early life experiences that were handled in an inadequate and damaging way as well as traumatic events such as parental death or separation, and frequent or infrequent abuse and neglect. Binge drinking can develop when these difficult memories surface after, sometimes many decades as prior psychological defence structures lose their power, and the past can no longer be forgotten.

Of course, not every case is successful. This person discussed in the case above could afford to pay for long term therapy. Not everyone afflicted with alcohol abuse problems has the funding to engage in psychodynamic therapy and unfortunatelythe government have elected to allocate funding to a very limited range of psychological therapies. While the cost of long term therapy is expensive, the short sighted vision of the current and prior government fails to appreciate that addressing long-standing psychological difficulties would enhance work productivity, increase the number of people returning to work after a workplace injury and reduce the number of drug and alcohol related deaths. Not only would there be fewer people with binge drinking problems, but there would be fewer people with depression and anxiety that is so severe it renders them unable to function, work and contribute to society. With such little education and understanding about the benefits of engaging in psychoanalytic psychotherapy, with short term treatments being privileged, small wonder why there's such a problem at scale. In fact, I would argue that binge drinking in itself is a failed attempt at a psychological quick fix. So why offer yet another false promise, another quick fix under whatever guise, despite best intentions. Drinking won't remove loss & grief, depression, anger, relationship conflicts, or countless other difficulties giving rise to binge drinking problems. It'll suppress such forces and make them stronger.

There is however strong evidence emerging for psychodynamic therapy, but this limited awareness may be politically influenced, and a dominance of the medical model and those psychologists who want power, recognition and to position their practice as a science. But we need to ask more useful questions. Like, why does our culture seem to live up to the mandate to enjoy rather than moderate enjoyment? Why are we obsessed with quick fixes? How can we raise awareness of the value of psychodynamic psychotherapy not only for the wealthy or worried well, but for anyone who could be at risk of becoming a binge drinker?This is arguably a logical alternative we can as a society address this alarming problem and work to create a healthier collective psyche.