The politics of drinking
           September 17, 2012

On Griffith Edwards

Griffith Edwards died last week. He wasn’t exactly famous, except within alcohol policy circles, but as one of the intellectual pillars of what I term medical temperance his influence and ideas shape the politics of drinking today, from the nature of addiction to minimum pricing.

He was born in India and studied at Oxford before, in 1959, becoming a psychiatrist at London’s Maudsley Hospital, which was already leading research into alcoholism.

Edwards was a little different to the average doctor, though, in that he chose to take himself into the streets and get among the down-and-outs who were his patients and for whom the tipple of choice was at that time methylated spirits. As he told Betsy Thom, he wanted to “get out there on the bomb sites and find out who these people were”.

In Thom’s indispensable analysis of shifts in UK alcohol policy, Dealing With Drink, Edwards comes across as a central figure in a new movement bringing together professionals and voluntary agencies in the treatment of alcoholics. He was, for instance, active in establishing hostels for homeless people.

It made for useful research, too, into the nature of alcoholism, and by the early 1970s Edwards had largely stepped away from the streets to develop a public health perspective on the drink question.

He was inspired by the work of the Finn Kettil Bruun and co-authored with him in 1975 the founding text of medical temperance - Alcohol Control Policies in a Public Health Perspective, known in Britain as the ‘Purple Book’ because of the colour of the cover of the English translation.

In Alcohol: the World’s Favourite Drug, Edwards identifies the “key message” forcefully delivered by Bruun et al:

“Changes in the overall consumption of alcohol beverages have a bearing on the health of the people in any society. Alcohol control measures can be used to limit consumption: thus, control of alcohol availability becomes a public health issue.”

He took this message, the guiding premiss of medical temperance, into the National Addiction Centre, which he founded, and into the journal Addiction, which he edited. His name is also among the authors of the influential texts that have built on Bruun’s thesis: Alcohol Policy and the Public Good, in 1994, and Alcohol: No Ordinary Commodity, the second edition of which cam out in 2010.

He also worked closely with the World Health Organisation, which adopted Edwards’ own Big Idea – alcohol dependence syndrome.

One of the reasons that Bruun’s theory was able to take hold with Edwards, and now virtually the entire medical profession, was the weakness of the previous paradigm – the disease model of alcoholism.

While this was a valuable step forward from seeing drunkenness as a moral fault, it was proving difficult to identify an actual disease in the sense we would normally understand it. Dependence was a more flexible concept that better fitted the ‘total consumption’ public health approach.

There are varying degrees of dependence, for instance, and it makes it easier to conceive how people can develop an addiction to alcohol. The agent, as Edwards makes clear, is drinking itself – and that makes us all vulnerable.

Edwards was there at the birth of the total consumption model nearly 40 years ago, and he lived to see the idea win over first the medical establishment and now, in the adoption of minimum unit pricing as a policy by the UK governments, the political establishment.

 
In what was probably his last interview he is as determined as ever in believing the solution is to reduce the availability of drink, to increase the price.

Imagining Edwards among the meths drinkers on the bomb sites in the 1960s, we might speculate about how he came to embrace these broad population-wide conclusions. This clip of a late speech, from the FEAD website, is curious and revealing.

He declares treatment professionals to be peripheral to the business of recovery, working with tools and methods they can’t be sure are effective. You can detect his frustration, the desire, too, to make a difference, and, above all, a driving compassion, a commitment go on, to try and do something for these people.

That is admirable. Yet, faced with the too-frequent failure of the cure, is it any wonder that Edwards turned to a overarching theory of prevention, however dubious?

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