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Comment
Journal of Psychopharmacology 20(3) (2006) 327–328
By W. Miles Cox School of Psychology, University of Wales, Bangor, UK.
Recognizing the growing problem of the misuse of alcohol, Professor Nutt raises the issue of whether harm-reduction strategies, similar to those that have been used to combat the problem of tobacco smoking, would be beneficial. Specifically, he asks whether a safer alcohol or a drug to serve as a substitute for alcohol could be developed.
How could scientists facilitate such developments? Professor Nutt points out that, because the toxic ingredient in alcoholic beverages is ethanol, one way to make alcoholic beverages safer would be to reduce the amount of ethanol in them. A reason why such action seems reasonable is that the ethanol concentration in some alcoholic beverages (beers and lagers) has been gradually increasing over the years. Could the reverse trend be set in motion, and would reducing the concentration of ethanol help to curtail alcohol-related problems? As a harm-reduction – but not as a harm-elimination – strategy, some steps in that direction would seem to make sense. For example, the concentration of ethanol could be limited (and reduced from the current level) in alcoholic beverages sold in certain venues, namely those where the greatest acute, negative consequences from excessive consumption occur (e.g. public intoxication, binge drinking, aggressive acts resulting from drinking). As Professor Nutt points out, such measures have already proven successful in Scandinavia.
Of course, the ultimate step in this direction would be to remove all the ethanol in ‘alcoholic’ beverages. Removing ethanol entirely from all beverages would, of course, be tantamount to prohibiting alcohol. This extreme measure would likely be doomed to failure, judging from the lack of success in both the United States and Scandinavian countries in eliminating alcohol from society (see Thom, 2001).
Professor Nutt suggests alternative, less extreme approaches: (a) to improve the quality of non-alcoholic beers, lagers, and wines so that they taste the same as their alcoholic counterparts and (b) to make non-alcoholic beverages more widely available. It should be noted that non-alcoholic beer and wine have been available for many years, and certain non-alcoholic beers have been shown to be indistinguishable from alcoholic beers, especially for less heavy drinkers (Cox and Klinger, 1983; Martin et al., 1990; Martin, Earleywine, Finn, & Young, 1990). Thus, it seems doubtful that further improvements – at least in the case of non-alco-holic beers – would do much to increase the consumption of the non-alcoholic products. Furthermore, in my view, most people don’t drink alcoholic beverages merely because they like the taste or because they want to quench their thirst, even though people sometimes report these motivations for drinking. Rather, people drink alcoholic beverages for the effects that they obtain from the alcohol.
Professor Nutt also suggests that reducing the price of nonalcoholic beer and wine by lowering the taxation on them would encourage their consumption. This suggestion makes a great deal of sense to me. Clearly, people’s behaviour – including their drinking behaviour – can be controlled by its consequences (see Correia, 2004; Wong et al., 2004), and it has been shown that alcohol taxation can be used to curb alcohol consumption (Oesterberg, 2001). People could be rewarded monetarily – by having to pay less tax – for drinking alcoholic beverages with lower concentrations of ethanol. Current taxation on alcoholic beverages is more-or-less proportional to the percentage of alcohol in each category of beverage (beer, wine, spirits; e.g. Smith, 1999); however, the system of taxation could be refined in order to reinforce drinkers even more strongly than they currently are for drinking beverages with lower concentrations of alcohol.
Finally, Professor Nutt asks about the feasibility of developing safer ‘alcohol’. One possibility would be to prescribe a tranquilizing medication for excessive drinkers that they could take for its anxiolytic effects and as a substitute for drinking alcohol. In the United Kingdom, clomethiazole and various benzodiazepines have already been used for this purpose, as has gammahydroxybutytrate in Italy. However, the disadvantages of these medications are well known. They can be dangerous – especially when taken in combination with alcohol – and are highly addictive. Accordingly, Professor Nutt asks whether modern pharmacology could help to engineer a beverage that would (a) be similar to alcoholic beverages in terms of its positively reinforcing effects, (b) not have the negative consequences that ingesting ethanol has, and (c) be legally available. Such an agent presumably would bind to receptor sites whose stimulation leads to the positive effects of drinking (e.g. relaxation, enhancement of positive affect) but not to those sites whose stimulation leads to the negative effects (e.g. aggressive behaviour, memory impairment).
One’s imagination can run wild with the types of beverages that could be developed in the future. The kinds of new products that might be engineered as a safer alternative to alcohol remind me of ‘soma’, used by the characters in Huxley’s Brave New World. Soma was taken as tablets in prescribed doses: ‘half a gramme for a half-holiday, a gramme for a week-end, two grammes for a trip to the gorgeous East, three for a dark eternity on the moon’ (Huxley, 1932: 47). It was used for various effects – to reduce anger, increase fortitude, create positive perceptions of stimuli in the environment, or give a person a ‘holiday from the facts’. In short, it was a chemical elixir.
With the current rapid advances in psychopharmacological technology, a new form of alcohol – with properties resembling those of soma – might well soon become a reality. How would we want the new beverage to be designed? It might be one that a person would imbibe when he or she wanted to feel good (enhance positive affect), to get ‘high’, or to cope with ongoing negative feelings (reduce negative affect). Yet the beverage would cause neither sickness to the stomach nor flushing of the skin; it would not promote aggressive behaviour, muscular incoordination, or memory impairment. And when metabolized it would not produce acetaldehyde – the toxic metabolic byproduct of alcohol that contributes to hangovers and many of the chronic, negative health-related consequences of excessive drinking.
Can such a beverage be designed? Could it be made legally available? Would the public accept it as a replacement for alcohol? The answers to these questions might not lie so very far in the future.
References
Corresponding author: W. Miles Cox, School of Psychology, University of Wales, Bangor, LL57 2DG, UK.
© 2006 British Association for Psychopharmacology
ISSN 0269-8811 SAGE Publications Ltd, London, Thousand Oaks, CA and New Delhi
10.1177/0269881106063043