Calling time on problem thinking

The conference, titled Everybody's Doing It?, and taking place at the Scottish Parliament during Alcohol Awareness Week, will examine whether faulty perceptions about others' drinking habits are undermining health promotion work.

The event - which will hear claims that health advocacy groups have inadvertently contributed to the problem - is being hosted by Scotland's Futures Forum, the agency created in 2005 to explore solutions to some of the key social policy challenges faced by the country.

The event's title refers to the proposition that if we think that everyone around us is participating in a certain activity, we are more likely to do so ourselves.

Dr Wesley Perkins, of the department of anthropology and sociology at Hobart and William Smith Colleges, New York, established the power of social norms when he researched the beliefs of college students in the US about their peers' drinking habits. Perkins found that most students wildly overestimated the number of their fellow students who drank, how often they did so and how much they consumed.

When students discover the true picture about the habits of others, the effect is to change their own behaviour, with consumption dropping significantly.

Could Dr Perkins's approach provide new directions for public health strategists in Scotland? Members of the Scotland's Futures Forum certainly think so, and they have built the event on October 22 around his ideas, as part of their inquiry into alcohol and drugs.

Perkins also thinks Scotland could do more to overthrow what he catchily dubs "the reign of error".

"Alcohol abuse is a significant problem in Scotland; there is no question about that," he says. "There is a problem in terms of the amounts some people are drinking in Scotland and the harmful and risky ways they do so."

But, increasingly, research evidence is demonstrating the importance of attitudinal and behavioural norms, he argues. This has a significant impact in a country such as Scotland, where the government is working to change the national attitude to drinking.

The then Scottish Executive published an updated plan for action on alcohol problems in February, which states specifically that the goal is to change drinking cultures. Perkins says it may be our understanding of the problem that needs to change. He adds: "It is not about changing the culture, but changing the perception of the culture."

This chimes with some of the messages coming from the drinks industry, which is running Scotland's first Alcohol Awareness week from October 21 to 27 in partnership with the Scottish Government.

Campbell Evans, of the Scotch Whisky Association, is a member of the recently established partnership between industry and government designed to foster a culture of responsible drinking. He says that many in the industry would also like to see a shift in perception.

Evans says: "The question is rather than saying it's bad, it's bad', why don't we emphasise the positive. If 27% of men are drinking in excess of guidelines, that means 73% are not. Would it make more sense to ask people why are you one of the one in four who isn't drinking sensibly?"

Perkins' research work would probably support that approach. However, the main stated goal of the inaugural Alcohol Awareness Week is to get people to "think and talk about what a unit of alcohol is". This is likely to be ineffective, the American academic suggests.

He says: "The research is really clear. Traditional health education - teaching people about the effects of alcohol - doesn't change people's behaviour. The other main approach, health terrorism', tries to scare people by telling them about the bad things that can happen with high risk drinking. That doesn't work either; people say it probably won't happen to me, and mostly they're right.

"But the other issue is that if you constantly talk about the size of the problem, you may contribute to more misperception. The biggest problem is that what we think is normal and what we think others are doing is far more excessive than the reality. The problem with that, especially with young people and young adults, is that if someone doesn't want to drink heavily, but they think everyone else is doing it or expecting them to drink, then they are pressurised into drinking more than they otherwise would."

Meanwhile, genuine binge drinkers don't even consider whether their behaviour is excessive. Perkins continues: "Those who are at the upper end, with frequent, heavy consumption over short periods of time, think they are like everybody else."

Perkins points out that earlier this year, two University of Paisley academics demonstrated a similar effect among UK students. Paisley's social science department observed distorted beliefs and overestimates about other people's drinking in a survey of 500 students. The researchers concluded that normative beliefs about alcohol are also an issue in Britain.

The social norms theory of alcohol consumption- which Perkins pioneered - has now been demonstrated to apply to a wide range of groups, not just students and young people. And it can be used to change behaviour. Perkins and others have shown how US college students drink more moderately if given accurate information about their peers' habits.

In a different field, remarkable results were achieved at the Arizona Petrified Forest National Park, where signs warned visitors not to steal samples of fossilised wood from the protected area, as 14 tons was going missing a year.

Professor Robert Cialdini of Arizona State University, another proponent of social norms, advised that the appeal was actually encouraging more theft, by subliminally giving the message that tourists routinely helped themselves to souvenirs.

The signs were changed to depict thieves as an isolated minority, and a substantial reduction in vandalism was achieved.

In the field of combating alcohol abuse, the next stage is to use social norms to promote safer, healthier behaviour, Perkins will tell the Futures Forum next week. He will describe a scheme in the US state of Montana, where adults aged between 18 and 35 were quizzed about drink driving and discovered to overestimate grossly the number of fellow Montanans who drank while over the limit.

A public campaign was launched to alert people to the fact that only a minority engaged in this risky and illegal behaviour, and rates of offending fell.

Using the strategy to change behaviour isn't simple, but is more effective than any strategy we have now, says Perkins.

He prescribes a "hefty dose of truth" about the reality of our neighbours' drinking, using any method possible including poster campaigns, video clips, websites and even very localised advertising. But, he insists, it needs to be intensive and continuing: "People are pretty entrenched in these notions about how heavily everyone else is drinking. You can't just hang up a poster during Alcohol Awareness Week," he says pointedly.

Speaking for the drinks industry, Campbell Evans welcomes Perkins's ideas, but says a range of tactics are needed to help address the social problems caused by alcohol. He points out that television plays a role in glamourising alcohol, with the Portman Group and the home secretary both recently calling that industry to task for its representations of drink.

Evans says: "The social norming ideas are a useful approach. The question is, how do you change a culture? What does that actually mean? We are not going to solve everything by the end of one awareness week in October, but we can reach those who want to hear the message and it will start to permeate down."

Meanwhile, Perkins stresses that he is not trying to deflect the alcohol industry from responsible marketing, or endeavouring to talk down the problems caused by alcohol. He says: "Some see the industry and advertising as the epitome of evil. The social norms approach is not pro- or anti-industry.

"If beverage companies promote their products in ways that suggest people use them in heavy or irresponsible ways, a social norms approach would be critical of that. But, equally, we would argue that health advocacy groups have contributed to the problem."

Perkins concludes with a hard-hitting prescription: "Some people when hearing this might think we are trying to sugar coat the problem, and saying it is not a big deal. In fact it causes a lot of damage and destroys lives. But the point is that it is not the majority doing it and we need to exploit the power of the majority."