Are you acting out the ‘tragic comedy’ of Irish drinking?

The drink. Its harm has cost the nation more than €2.3 billion per annum and over €40 million in alcohol-related absenteeism. Its abuse has led to over 5,000 people a year losing their jobs, more than 160,000 bed days in public hospitals and €1.5 billion in alcohol-related hospital discharges.

Worse, our drinking is responsible for more than 1,000 deaths a year across the nation, is a factor in 40 per cent of all deaths on Irish roads, half of all suicides and over a third of deliberate self-harm cases; aside from the 900 or so people a year diagnosed with alcohol-related cancers, over half of which prove fatal.

Which may make you wonder just how it is that something which causes so much damage to any nationality is also inextricably linked to what is positive, warm, enjoyable and uniquely inviting about the nation to so many millions overseas: the Irish pub.

Tally up the timeworn international stereotype of the "drunken Irish" with the present-day cost to the nation and what's striking is that we aren't even in the top 10 nations for alcohol consumption (per capita) in the world, according to the World Health Organisation (WHO). In fact, we aren't even in the top 20 worst offenders of WHO's 190-strong member states. Ireland limps in at 21, behind France (18) and Australia (19), according to WHO, and just marginally before Britain (25), while the cast of east European and ex-USSR states hog the top 10.

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Factor in that alcohol consumption in Ireland, having almost trebled between 1960 and 2001, has mostly decreased this century and it’s reasonable to ask if the age-old taunt of drink and the Irish might just be another hackneyed stereotype.

The answer? Just as it has been for decades: it's not how much we're drinking but how we are drinking that is causing such damage to our health, our families, our communities and our economy. According to WHO statistics, we are only second in the world to Austria when it comes to the binge drinking that swallows 75 per cent of our alcoholic intake each year.

The positives of Irish pub culture

"The single most important determinant of how you drink is the culture, community and the people you drink with," says Stanton Peele, a Brooklyn-based psychologist and psychotherapist specialising in addiction since 1970.

“Drinking is very much socially determined . . . So, the good news for all human beings, Irish included, is that if you choose a positive drinking environment – where people are positive and convivial, and they don’t act out when they drink, and they consume alcohol in a moderate, positive fashion – then it’s likely that such a positive experience is going to be beneficial for you.”

At the coalface of addiction research since his 1975 publication of the seminal “Love and Addiction”, Peele has long argued that addiction is not so much a consequence of drug or drink consumption per se, but more so how these substances fit into people’s lives and meanings.

"Systematic cross-cultural research has now found that southern European cultures, where alcohol is given to children at home, show decisively fewer alcohol problems among both teens and adults," Peele says. "In fact, fewer southern than northern European teens regularly get drunk. This is not a theoretical argument: Italy and other southern European countries have far lower rates of alcohol-related death, since people there are so much less likely to binge drink."

Binge drinking

Peele says there is great ambivalence around alcohol in Ireland: we drink less than southern Europeans, for example, because we tend to binge drink on weekends, while upwards of one-quarter of the population abstain from alcohol. "Italy, Spain, Greece, France, Portugal are countries where alcohol is distinctly integrated into family and community life, meaning they drink more with fewer problems," says Peele.

But what of the benefits of our uber-social drinking culture, as opposed to drinking alone at home, for example?

“I’m aware of the data that shows the Irish drink in a very binge-like fashion. However, I’ve been in a lot of Irish pubs that have been extremely moderate, pleasant and socially orientated. There can be music in these pubs too, where people just bring along their instruments, and you’ve got to love them. That’s a positive experience.”

Drink as a social lubricant

But what of those Irish pubs where adults, especially more conservative or traditional men, leverage alcohol as a social or emotional lubricant needed to express themselves?

“That’s kind of a double-edged sword,” Peele replies. “You could almost say that’s the tragic comedy of Irish drinking, and quite a bit has been written on this . . . Another thing we can point to, and not just expressiveness, is creativity. You might say there’s definitely people who get more creative when they’re drinking. And you might say [in response], well, God bless it. If you can come up with ideas when you drink that you otherwise wouldn’t have, then is that a bad thing?”

Does it always have to be the pub?

"In Ireland, you see teenagers often introducing alcohol to each other, and there may be peer pressure involved," says Dr Brian Osborne, a GP in Galway city and director of the mental health programme at the Irish College of General Practitioners.

“Teenagers can get hooked early, and fall into drinking more and more quantities of alcohol over time. But alcohol can also be introduced in the home. If that’s done in a sensible and mature way at the legal age of consumption, it may be a better way of introducing it into a young person’s life.”

While Osborne says drinking alone at home may often be an early indicator of problem drinking, this isn’t the case with everyone. Drinking alone can lead to more introspection or possibly feelings of low mood, depression, anxiety or paranoia, for example, but drinking alcohol above the recommended limits can do that in general, he says, regardless of whether you’re drinking alone or in a pub. And if you find the local pub is the only feasible place to socialise in, especially during the evenings in rural communities, you don’t always have to drink alcohol once there.

When enough is enough

According to Drinkaware, in Ireland we underestimate how much alcohol we drink by about 60 per cent. So what are its low-risk weekly alcohol guidelines? For women, it’s 11 standard drinks spread out over the week, while for men it’s 17 standard drinks spread out over the week, with at least two alcohol-free days per week for both men and women.

A standard drink is a half-pint of larger, beer or stout, or a small glass (ie 100ml) of wine or a single pub measure of spirits. Binge drinking, according to Drinkaware, is defined as six or more standard drinks in one sitting (for example, three pints of 4.5 per cent beer) and regularly drinking alcohol at this level can increase your risk of experiencing alcohol-related harms, such as stomach disease, stroke, cancers or depression.