Posted: 14 April 2014

Deluded drinkers and the failure of guidelines

One of the most stunning findings from this year’s Global Drug Survey was not only that 45% of people were unaware of their country’s drinking guidelines but that on average 1 in 4 people who could be considered as dependent on alcohol (by scoring 20 or more on the World Health Organization’s Alcohol Use Disorders Identification Test — AUDIT) thought their drinking was average or less average. In addition about a one third of this high risk group did not think their drinking placed them at high or extremely high risk of alcohol related health harm (which it does). How could it be that a group of people who’s drinking placed that a very high risk of harm and in the top 5-10% of drinkers in their country could be so ‘deluded’?

The answer lies in understanding some of common barriers to behavioural change and the way be selectively see ourselves to keep ourselves internally consistent. The first is that we all tend to overestimate our personal invulnerability to harm. Many smokers will say ‘of course smoking kills, other people not me – I’ve got good genes’. This dangerous, usually inaccurate perception means we are less likely to put things in place to reduce our risk of harm. Another common was of avoiding the need to contemplate the need for change is to look to our friends and those around us (often rather selectively) to reassure ourselves that we are just like everyone else.  When it suits us we adopt something called a ‘normative misperception’ (in the case of heavy drinkers, believing your alcohol use is less than average) and it’s a predictor of higher levels of alcohol use. We see examples of this self-serving perceptual bias every day and all of us do it. In the current example it means heavier drinkers tend to think they are just like everyone else. If you don’t want to think about changing your use of alcohol thinking its neither risky or particularly unusual it is just the sort of selective evidence you need to make you comfortable in doing nothing. What was amazing was that this ‘delusional’ group of drinkers were the ones most interested in how their drinking compared to others. And that is interesting because it is says they might be open to be influenced by the behaviours of others.

The idea of social norms and its allied discipline behavioural economics (BE) is what underlies the Drinks Meter app. Behavioural economics is one of the buzziest ideas in public policy. Made famous by the book ‘Nudge’ by T Richard Thayler, BE is a blend  of psychology and economics that seeks to create environments that make the ‘right’ decision easy for people. As a doctor that is the healthy decision. Nudging people to the right decision relies upon a number of factors that we unconsciously use to inform decision making. Some factors we can manipulate, others we than we can raise awareness of. Some key modifiers of one’s own behaviours are the behaviours and actions of others. We like to conform – ‘to run with the herd’- be ‘a face in the crowd’ (as my dad would say). We all seek social proof from the world around us to validate our choices in life. The principal has been used by ad agencies for decades ‘9 out of 10 dogs prefer the taste of woof woof biscuits’. We are also often motivated to ‘do the right thing. People like to have internal consistency. Our own self-expectations influence how we behave — we get uncomfortable if what we do does not sit neatly with how see ourselves. I have just been on a diet and lost 8 kg because of a photo taken of me over Christmas was inconsistent with how I saw myself (athletic v beached whale). You can nudge people to change their behaviours by helping them identify misperceptions around their own behaviours. Using social norms and behavioural economics can thus help us help people live healthier lives.

I have used these principals in the alcohol app I have developed the drinks meter — free on the app stores and at Not only will this app tell you how much you drink and adjust your consumption based on your personal risk factors but it will convert your alcohol into calories, cheeseburger and chips and take you through the AUDIT, compare to you other drinkers in your country and then let you see the health, economic and calorie benefit of removing a few unnecessary drinks each week.