What is drinking culture and how do we change it?

The development of the Alcohol Cultures Framework to inform health promotion practice and social change in drinking cultures

Emma Saleeba

Have you ever wondered exactly what the term ‘drinking culture’ means?

Whilst some may argue that its meaning is self-evident, the need for it to be clearly defined for public health purposes is required for social research and the design and evaluation of public health projects that target alcohol problems.

Many others use the term in its common sense form including the media, academics, governments and alcohol industry. Our goal was to develop a shared public health understanding that could guide our research and efforts to build evidence-based strategies for alcohol-harm reduction.

Within this post we discuss the developmental research, the Framework itself and its early application in Victoria, Australia to inspire social change in different subcultures and settings.

Developmental research

In 2015, The Victorian Health Promotion Foundation (VicHealth) partnered with Latrobe Universities’ Centre for Alcohol Policy Research (CAPR) to undertake a literature review to better understand the meaning of “drinking culture”, clearly define it and examine how health promotion practice could influence change.

We were surprised to find that the literature offered very little in terms of its meaning. However, searching the single term of ‘culture’ resulted in 164 different definitions – with little consensus.

The interesting thing about drinking cultures is that whilst the concept is ill-defined, we are all incredibly interested in them. Since the early 2000s, the number of academic journal articles that contain the term has steadily increased (see Figure 1).

Figure 1. Journal articles in the SCOPUS database containing the term “drinking culture/s” between 1967 and 2014.

This posed an important question – how can we expect to research or change drinking cultures and evaluate our efforts if we don’t have consensus about what it is we are trying to change?

To answer this, our team of researchers drew upon all of the evidence and posed an academic working definition, available here.

Considering the definition is not simple nor straightforward, below we summarise the key points.

• The concept requires a shift from thinking about individual behavior or alcohol as a product to focus on the norms – or the cultural rules of a group or society that affect behavior.
• Norms can operate at different levels, they are context specific and can impact the way people drink in different ways. For example a norm could be buying a round of drinks followed by reciprocation.
• The sanction of norms can be formal such as laws or policy (identification required to purchase liquor) or codes of conduct (in the workplace). Or they can be informal sanctions such as a raised eyebrow or a disapproving look from a friend.
• Norms are not static or homogenous, they are complex, multiple and moving and are part of a network of other interacting factors that influence the way people drink alcohol, for example gender, age, social class, social networks, masculinity, policy, marketing etc. The degree and nature of the influence that drinking cultures have on individuals is not inevitable but will depend on the configuration of factors in play in any given situation.

Our working definition provided an understanding of what drinking culture is, but we needed to be able to practically apply this concept and gain buy-in from our stakeholders.

The Alcohol Cultures Framework

To inform the Framework, VicHealth, CAPR and the Alcohol and Drug Foundation joined forces to collaborate on an extensive stakeholder consultation process to seek the opinions of the alcohol prevention and harm reduction sector experts and refine the approach for health promotion purposes.

In mid- 2016 we published our findings as the Alcohol Cultures Framework.

Its purpose is to be used as a planning tool for public health workers and others with an interest in shifting drinking cultures to reduce harm. The Framework defines alcohol cultures and provides a lens for designing and implementing programs.

We agreed upon a shorter and more practical definition, we define drinking cultures as…

“the way people drink including the formal rules, social norms, attitudes and beliefs around what is and what is not socially acceptable for a group of people before, during and after drinking”.

We articulate the vision we are seeking to achieve. We would like to see people socially supporting one another to engage in low-risk drinking practices.

Such a culture can be described as:

• a supportive policy, physical and social environment where people do not feel pressure to drink
• when alcohol is consumed it is done at levels of low risk
• social pressure supports low risk drinking and discourages high risk drinking
• occurrences of drinking are reduced
• intoxication is socially rejected.

We identified four frames for intervention: societal, setting, subculture and family-individual. The Framework outlines examples of factors that influence the way people drink across the frames and suggests critical questions to consider when planning health promotion strategies.

For a two minute overview of the Framework, watch this YouTube clip.

The Alcohol Culture Change Initiative

VicHealth has invested AUD $3.1 million – over 24 months – to test the application of the Framework in practice across nine projects that target different drinking cultures across Victoria, Australia.

For more about the projects, click here.

In December 2017, VicHealth launched the Culture Change blog, the articles are all written with the purpose of sharing real time updates and key lessons from VicHealth’s Alcohol Culture Change Initiative as they emerge.

The Initiative is being rigorously evaluated by LaTrobe University and includes the development of a set of common indicators to measure alcohol culture change. The indicators measure the following domains: drinking frequency with group, risk of short-term harm with group, very high risk of short-term harm with group, acceptance of not drinking with group, influence to drink more with group, influence to drink less with group, initiation of conversation about alcohol, recognition of visible drunken behaviour, alcohol culture – comfort with getting drunk, social customs – pre-loading, and social customs – round buying.

Indicators will be used across each project (where relevant) to measure change.

For further information and enquiries please email alcohol@vichealth.vic.gov.au.

Emma Saleeba is the Manager of Alcohol & Tobacco at VicHealth. Emma is responsible for VicHealth’s programs and investments in relation to preventing tobacco use and harm from alcohol. Emma holds a Masters degree in Public Health and has considerable experience across health promotion policy and program development, project implementation and advocacy.