Positive Relationships Alcohol: On a binge

Alcohol has been part of the UK culture for centuries, with men more likely than women to experience alcohol-related problems, both psycho-social and physical. This remains the case. However, while drinking by British men has stabilised since the 1980s, consumption levels among women - particularly young women - has continued to rise.

In 2000, a survey of women and men in Scotland, England and Wales showed that 8 per cent of the 18- to 24-year-old women reported drinking at least 35 units* of alcohol in the previous week (Plant et al 2002) - a drinking level defined as 'high risk' by the UK Government. Other large-scale studies have reported similar findings (Office for National Statistics, 2006).

The most recent European School Survey Project on Alcohol and Other Drugs (ESPAD), involving 15- and 16-year-olds, reported that teenage girls were more likely than teenage boys to 'binge' drink (Plant et al 2005). In this context, a 'binge' is defined as five or more UK drinks, three times or more in the past 30 days.

In a further worrying development, per capita alcohol consumption in wine-drinking countries, such as France and Italy, has decreased over the past 30 years, while in the UK it has increased.

PATTERNS OF CONSUMPTION

The pattern of consumption dictates the kinds of problem that stem from it. So, in the wine-drinking countries, where people used to drink with meals and getting drunk was culturally unacceptable, people were more likely to develop physical damage, rather than the social harm we see in the UK. This harm includes accidents, aggression and physical harm, including rape.

Physical harm

Alcohol is associated with harm to most organ systems in the body. For example, it is linked to:

- problems of the gastro-intestinal tract, such as stomach ulcers and liver damage

- problems of the circulatory system, such as the heart and high blood pressure

- exacerbating an existing cancer

- some cancers such as those of the mouth and oesophagus and, in particular, breast cancer.

DRINKING IN PREGNANCY

The evidence is clear that heavy or problem drinking in pregnancy carries a risk of foetal harm. At its most serious this could be Foetal Alcohol Syndrome (FAS), which includes four categories:

1. pre- and post-natal growth deficiency

2. cluster of facial features

3. moderate to severe learning difficulties

4. diagnosable drinking problem in the mother.

However, more recently the term Foetal Alcohol Spectrum Disorders (FASD) has emerged as an umbrella term covering the range of alcohol-related harm, from FAS to the milder alcohol-related birth defects. This term is not a diagnostic one but rather a way of describing the wide range of harm associated with alcohol consumption in pregnancy.

There are several important issues and some confusion around drinking in pregnancy. First, the evidence for alcohol causing harm at lower levels of alcohol consumption is weak.

Until recently the UK Government guidelines recommended 'one or two units once or twice week'. This has now changed to 'Pregnant women and women planning to become pregnant should be advised to avoid drinking alcohol in the first three months of pregnancy... If they choose to drink alcohol while they are pregnant, they should drink no more than one to two UK units once or twice a week.'

The reason for defining the first three months is clear. This is the time when the baby's organs are being developed and when the foetus is most vulnerable. However, many women are unaware of when they become pregnant and may be seven or eight weeks pregnant before they realise the fact.

Evidence suggests that this group of women will continue to drink at pre-pregnancy levels during this time and will often continue to do so until they receive a positive pregnancy test. Up to 80 per cent of teenagers who become pregnant in the UK report their pregnancies are unplanned, so this group may continue to drink heavily further into their pregnancies than older women.

A CHILD WITH FAS

A second issue is that the term Foetal Alcohol Syndrome may in itself be misleading. A child with FAS will not 'grow out of it'. These children are affected for life and many will never be able to live independent of some degree of supervision.

As the child with FAS gets older, they may also develop various cognitive and behavioural problems, which will be different at different ages.

Up until the age of three years, they may experience sleeping and feeding difficulties, and under- or over-sensitivity to pain. Over-sensitivity may be a lifelong problem and cause real distress to both child and parents in the early days, when touching or cuddling may leave the crying baby even more distressed.

It is important to stress that not all children with FAS have severe learning difficulties. Some will manage at regular schools, but there are certain common features of the syndrome, including:

- difficulty with learning cause and effect

- the child's ability to conceptualise is far behind their verbal skills

- Poor memory.

So, children with FAS will often find themselves in difficulty with authority figures, such as teachers, who may attribute their behaviour to stubbornness rather than an inability to understand or remember.

These children are often very lonely and their need for friends can result in their being 'easily led' by others into behaving in ways which put them in opposition to the authorities.

Living with a child with FAS can be difficult for parents and siblings. These children are often loving and wonderful company, but it is important that any adoptive parent be informed of the kind of problems that lie ahead for the child and the family.

PARENTS WITH DRINKING PROBLEMS

Children are affected by a parent's drinking problem to a greater or lesser degree. Such children tend to grow up very quickly and may end up parenting their parents. They often lose part, or all of their childhood.

Parents with drinking problems are often inconsistent. Their parenting may swing from abusive behaviour, through neglect, to showering the child with presents in an attempt to ameliorate their guilt. Promises of outings and tickets to football matches are often given but rarely delivered, as the parent forgets or gets drunk on the day.

A more positive effect is the resilience in these children. People used to assume that such children were either born with the ability to be resilient in tough situations, or not. More recently, the work by Velleman and Orford (1999) has shown that resilience can be learned and developed, so long as the child has at least one adult who relates to them in a consistent manner - someone whom they can talk to, someone who, when they say they will do something, will do it.

This person can also be helpful in 'giving the child permission' not to feel responsible if their parents argue or fight, and in encouraging the child to leave the parents, rather than step in and defend the non-drinking parent, when arguments or fights break out. That is not a child's job.

As these children grow up, some may go through a period of heavy drinking or even develop a drinking problem themselves, because their experiences and learned behaviours all pointed to heavy drinking being the norm. Conversely, the young adult may avoid alcohol completely to avoid developing a drinking problem like their parent. (Interestingly, children of abstaining parents may also struggle in a world where drinking is viewed as normal and abstaining as in some way abnormal.) Various researchers and scientists have spent many years and millions of dollars trying to find an 'alcoholic gene' - it doesn't exist.

What is clear is that the 'nature versus nurture' debate is misleading. Both nature and nurture combine to bring us into the world and to a large extent define who we become. Although Jung's belief that 'nature decides' is too rigid, it is clear that experiences before birth and in the early years are key to the child.

Moira Plant is Professor of Alcohol Studies, Alcohol & Health Research Unit at the University of the West of England, Bristol

REFERENCES

- Office for National Statistics (2006) Statistics on Alcohol: England 2006. London: Office of National Statistics

- Plant, M A, Miller, P and Plant, M L (2005) 'Trends in drinking, smoking and illicit drug use among 15- and 16-year-olds in the United Kingdom (1995-2003)' in Journal of Substance Use, 10, 331-339

- Plant, M L, Plant, M A and Mason, W (2002) 'Drinking, smoking and illicit drug use among British adults: gender differences explored' in Journal of Substance Use, 7, 24-33

- Velleman, R and Orford, J (1999) Risk and Resilience: Adults who were the children of problem drinkers. Amsterdam: Harwood Academic Press

*WHAT IS A UNIT?

A UK unit of alcohol is the equivalent of half a pint of ordinary strength beer or lager, a small glass of wine or a small pub measure of spirits. The larger glasses of wine now sold in clubs and pubs contain between two and three UK units of alcohol.