Diazepam with your dinner, Sir? The lifestyle drug-substitution strategy: a radical alcohol policy

Over recent decades the drink problem in the British Isles has grown to become arguably the worst in the Western world, combining the high average alcohol intake of southern Europe with binge-drinking typical of extreme latitudes. Since the problem continues to worsen, and traditional strategies regulating price and access are probably untenable, radical new alcohol policies are required. The drug-substitution strategy is based on an assumption that most people use lifestyle drugs rationally for self-medication purposes, to achieve specific desired psychological effects, especially enhanced well-being. When there is access to an equally effective, but safer, alternative drug, then people would tend to switch to it (especially when the substitute is legal and socially-acceptable). There are several safer lifestyle drug-substitutes for alcohol, including benzodiazepines, SSRIs and marijuana. Southern Europeans use alcohol mainly as an anxiolytic social lubricant, taken in low but frequent doses with high annual per capita consumption, and for this pattern, benzodiazepines might be a medically safer lifestyle drug-substitute. Northern Europeans traditionally use alcohol in high doses as a euphoric intoxicant, and for this pattern, marijuana might be a safer and less-antisocial substitute. Since this risk-benefit calculus implies that there are better alternatives to alcohol, government policy should promote safer lifestyle drug-substitutes by removing legal barriers and altering the balance of economic and social incentives. © The Author 2005. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved.