Dry January & temporary abstinence: is it worth it? With Prof. Matt Field

In this episode we talk to Prof. Matt Field about the evidence behind Dry January and temporary abstinence. We discuss what is known about the possible health and other benefits for drinkers from  temporarily abstaining from alcohol.  This includes who temporary abstinence may or may not be suitable for and implications for understanding drinking and alcohol addiction or dependence.

Professor Matt Field is a Professor of Psychology specialising in addiction at the University of Sheffield. He has published extensively on a range of addiction related topics including evaluations of Dry January, and is involved in ongoing research on the subject. 

Chapters

• 0:47 Prof Matt Field
• 1:29 Why take a month off?
• 3:26 Spotting liver damage
• 5:21 Lasting health effects of a month off?
• 8:34 What happens to drinking after?
• 10:12 Who takes part and why?
• 12:10 Different temporary abstinence campaigns
• 14:17 Behaviour change
• 16:16 Self-efficacy
• 18:37 What about dependence?
• 24:14 Moderation goals
• 26:59 Learning from a month off?

Transcript

James Morris: 0:00

So thanks for joining me, Matt, if you don't mind, just tell me briefly a bit about yourself and your kind of research interests in general.

Matt Field: 0:06

Yeah. So I'm a professor of psychology at the University of Sheffield. And I do consider myself to be an addiction researcher. So I'm interested in the psychology of addiction and understanding the kind of psychological mechanisms that underlie it. And most of my work has been on alcohol throughout my career. But I've also done bits and pieces on tobacco, smoking, cannabis, and more recently, gambling. And although I guess a lot of my work has been really quite kind of fundamental and testing theories and trying to derive kind of theory based treatments, I've also got a lot of applied interests. And one of those is the role of dry January and temporary abstinence, which we've published a few things on that and I believe that's the reason you've asked me to talk on the podcast today.

James Morris: 0:49

So yeah, like it, you know, in a general sense, what would we say a sort of starting with maybe the health benefits of a temporary abstinence period? And obviously, I suppose a month is, you know, a kind of most common target. But what's the kind of starting point for advocating for someone to take a month off who say, is drinking above the guidelines to some extent?

Matt Field: 1:09

Yeah. So there are some some nice studies on this. Read, I only published in the last few years, really, but basically, they have, it's been demonstrated that among people who drink above the guidelines, if they do take a month off, and that's been kind of verified, objectively, if they take a month off, then you do see improvements to physical health markers, so things like liver function, also cancer related growth factors and things like that. So immediately after they've had a month off, then you do see some physical health benefit, which is, which is encouraging, and perhaps not surprising, but it's important to demonstrate it. So yeah, there is that evidence there for at least short term benefit from taking a month off.

James Morris: 1:51

And presumably, there's a kind of linear relationship in terms of how much above the guidelines are drinking. I mean, it's a hard, hard thing to kind of test. But you know, you think that, you know, in line with the general sort of principle that the more you go above the guidelines, the more small reduction would have general health and well being benefits.

Matt Field: 2:10

Yeah, that's right. You think that and that's certainly logical, but it hasn't been studied to the best of my knowledge. And I guess the other thing to note is that with with, with a lot of alcohol related liver disease, things like alcohol related liver disease, obviously, when they reach a certain point, if it becomes if it's very, very severe things like liver disease, then abstinence will have a smaller effect, if you see what I mean, particularly if you've got, you know, really kind of end stage liver disease, just you do sort of mean, if you've got things like cirrhosis, then it's still worth giving up drinking, because your liver is amazingly capable of recovering, but there'll be a limit to that.

James Morris: 2:44

Yeah. I mean, that's that's kind of the sort of famous problem of liver diseases now that until until you get to sort of end stage liver damage, there's no kind of external signs or symptoms, often that you can have a mid stage cirrhosis, advanced fatty liver or whatever. And you just unless you had a proper liver scan, you wouldn't know. And indeed, I've often heard, you know, quite people I know who heavy drinkers sort of saying, I've had a blood test and the doctor says everything's fine. And you know, that, again, isn't a very, you know, good marker, it doesn't it's not a way to show that your livers fine.

Matt Field: 3:19

No, it isn't. And a lot of those those blood tests that stuck at liver enzymes, you can actually have normal levels. I mean, normally you pick pick up some kind of liver disease with those with those blood tests, but it is possible for those things to come back normal. You could have really quite advanced liver disease and they wouldn't pick it up as you say you need to do the the the fibre scan, but the scan of the liver to really pick it up, but

James Morris: 3:42

that the liver scan technology was originally invented or came from something was developed to detect the ripeness of cheese, right. So yeah, it was a kind of a sort of scan the tracking of cheese to see whether it was ready readily. Right. But yeah, so yeah, obviously, liver benefits are going to be notable, as you say it has a strong capacity for kind of recovery. And a temporary break for for heavy drinkers is certainly going to show benefits in the liver or accrue benefits in some ways, even if they wouldn't necessarily feel or know, any kind of benefits. And it might be something that would reduce the risk of kind of damage down the line. And then that cancer thing is really big as well, because obviously it's you know, it's a lot of discussion about the you know, the low levels of awareness of various cancer risks. But obviously, it's a very powerful potential motivator for behaviour change, or conversely, something that kind of scares people and makes them feel more anxious and drink more we don't really know but yeah,

Matt Field: 4:45

no, no, that's right. And so the the evidence that we've got picked up basically short term improvements in markers of cut with what they call cancer related growth factors. So these are kind of biomarkers that occur before you get a cancer. diagnosis. But also I think some improvements to to alcohol or quit also causes cardiovascular disease. You know, there's this kind of myth that it is good for your heart, but it really isn't good for your heart in the doses that that that that many people drink. You see what I mean? It's so but yeah, so there's evidence that temporary abstinence can kind of have at least a short term beneficial effect on those things, which is all encouraging, you know, and that's, that's a good enough reason to abstain for a while that but what there is also evidence, I'm sure you're going to come to this, but I'll just get in there first is that when people resume drinking, after, after that period of abstinence, if they resumed drinking at their previous level, then those benefits quickly disappear? You know, so they are short term. And what we don't know, is we don't know if what happens kind of over the really longer term. So I suspect, anecdotally that many people kind of have dip in and out of temporary abstinence, you know, they'll have a month off or a few weeks off, and then they'll resume drinking, and then they'll, they'll, then they'll repeat that process. And what we don't know is kind of over the scale at which alcohol will lead disease happens, which is kind of over over decades, really, we don't know if that if those periods of temporary abstinence do have a enduring health benefits, we just don't have the we don't have the information. But that's a really interesting question, too, is to try and find that out if if repeatedly having a period of abstinence is overlooked, does that have a long term effect on your health? Because that's really more important than knowing about the kind of short term benefits?

James Morris: 6:36

Yeah, absolutely. Yeah, I think it would be intuitive to assume that there would be benefits that you would, you know, just reducing the the more periods of temporary absence you have, the more it kind of just totals up time that, you know, is kind of putting bits of the body under pressure, and so on. But yeah, obviously, there's so many assumptions within that we just, we need evidence.

Matt Field: 6:58

There are and there are and that's right, of course, you're right. If you if you have two months out of 12, every year off, then you're then assuming in the other 10 months, you're drinking at a standard rate, then yes, you're reducing your overall consumption. The problem is, though, is how, what the challenge is to understand not necessarily a problem is to understand well, are people actually immediately after they've had a period of temporary abstinence? Are they drinking at the level they were before? Or do they, in some way, compensate and maybe even drink more? And that's why it's a really important behavioural thing to understand. Because that's

James Morris: 7:33

been probably the main source of criticism or sicknesses cynical take on it, isn't it that people might say, Well, I've had a month off and now so now I'm going to celebrate the end of that month? And really, yeah, let go. And I suppose that might make more sense, depending on certain drinking motives, if you are taking a month off to prove to someone that you could you might be more likely to, but the evidence is that people generally drink less, isn't it?

Matt Field: 7:59

Yeah, so basically, this is where we kind of get into studies that look at people who do dry January, or, or similar, so that, you know, they sign up to a campaign. And basically, that evidence suggests that, that after people have had this month off, after people have had the dry January, most people or put it another way, on average, those people are drinking less sick, they look at six months later, so it only get to July, they're drinking less than they were before. And what they call rebound effects, which is like basically people actually up in their intake, a relatively uncommon only sort of, maybe 10 15% of people show these rebound effects. So on average, people are seem to be drinking less, if you look at people who sign up to dry January,

James Morris: 8:44

but then there's also been some sort of criticisms, or, you know, I guess, kind of valid questions about who takes part and, you know, are they sort of lower down the severity, alcohol use disorder, severity spectrum, or, you know, a sorts of people with more social capital, and you know, all those kinds of things?

Matt Field: 9:05

I think that's absolutely right. Yes. Now, there is a study which which was an evaluation of a fairly recent dry January campaign, which did compare people who signed up to dry January with a with a general with a general population sample of just this was people who drank alcohol regularly it wasn't it wasn't people with a with an alcohol use disorder. And what they found actually was that people who did dry January tended to be heavier drinkers than the general population of drinkers if you like. So that would count perhaps argue against the idea that it's only attracting the lighter drinkers however, whether people who sign up for dry January are kind of representative of what I'm conscious of the need for careful terminology here but what you want to call them risky drinkers, heavy drinkers, problem drinkers. Whether people who sign up for dry January representative of them is a bit uncertain, I would say.

James Morris: 9:58

But then yeah, I mean, there's there's there's always So the other kind of issue, which is that, you know, it's dry January, or temporary abstinence campaigns are not targeting people with certainly moderate or severe alcohol dependence, because of course, those people, you know, there might be a risk from them physically withdrawing from alcohol, and they should seek medical advice or support or specialist treatment. You know, it's targeting people that don't have a clear degree of alcohol dependence, or at least not physical dependence. But it is an interesting question is, you know, I'm sure there is a cohort of people who are attracted to do it, because they're worried or questioning to what extent their drinking has been, maybe lay terms become a habit, or maybe some people would say, as addiction or whatever. But I mean, that's a really interesting question is, you know, how many people are doing it ultimately, because they want to test or maybe, you know, lay terms again, reset, and kind of break break the cycle of potential dependence?

Matt Field: 10:57

I think that's absolutely right. And in order to answer these questions you really want you really have to, basically, when you do these evaluations of temporary absence, you really have to understand why people are doing it, because you wouldn't expect a consistent pattern. If some people are just doing it because they had a heavy December. And they feel that they can then kind of go back to heavy drinking in February and have no plans to change, then that's very different from the person who is kind of a bit concerned about the effect of alcohol is having on their health. The evidence actually exists that people who sign up to dry January are more concerned about the effects of alcohol on their health than the kind of general population of drinkers. So with that, which kind of fits. One thing to note as well, though, is that dry, January's the most, probably the most, the highest profile, temporary abstinence challenge campaign, but there are others and they quit. They're increasingly popular. They have one in Belgium, they have one in Australia, which is in July, because of the seasons have flipped. They even have one in Thailand. So to various it's become increasingly popular in different countries. And we even have various campaigns in this country. So there's triathlon, which is also a UK campaign. But those campaigns have different emphases on things like fundraising and the kind of challenge element of it. So some of them really solid before October as well. So before October, yeah, exactly. That's sorry. Yeah, that's another another big piece,

James Morris: 12:13

if you will get them all in. Yeah, yeah, sorry. Yeah.

Matt Field: 12:15

But they, but some of them have a different emphasis. So some of them portray a temporary abstinence as a bit like running a marathon, as in, it's a long slog, and you're going to do it to raise money for charity, whereas others are, particularly enjoy, January's probably the best example of this very much about using it as a tool to kind of help people think about their relationship with alcohol and maybe, maybe drink a bit less. So it's not you can't really just look at all the campaigns together, they're all they will have slightly different emphases

James Morris: 12:42

and put about kind of people who sign up for it and maybe don't maybe halfway through they have a drink? And is there anything around how they feel or respond to that? I mean, you know, obviously, some people might feel, Oh, I've failed and sort of give up. But, you know, I think I think some of the campaigns are careful to frame that. As you know, that's a give up, you know, that's just sort of a hiccup, Providence relapse.

Matt Field: 13:05

And of course, and of course, in the, in the context of kind of conventional treatment for alcohol problems, therapists are at pains to emphasise that, aren't they? Well, in general, but generally, you know, if you receive something like cognitive behaviour therapy, then you're you're taught that relapse is common, and you just have to deal with it. But at the evidence coming back to dry January, the evidence actually suggests that if you look at if people managed to reduce their drinking six months afterwards, actually, you see that on average, people are reducing their drinking, if they take part in dry January, six months afterwards, regardless of whether they not they successfully abstain for the month. So that in itself is quite telling. I think it's something about trying signing up for the campaign that that is important, whether or not you actually achieve abstinence. And, you know, there's various different explanations for why that might be.

James Morris: 13:54

Yeah, and one of which would be that people signing up for it, or engaging in treatment, you know, have got to a point of motivation. Exactly. And they're looking for something to engage with. And that's why we might see to some degree dodo bird effects, you know, or win prizes. All treatments are equally effective, because people have got to a stage where they want to do something about it. And it works. If you work it as the sort of a saying goes,

Matt Field: 14:19

That's right. That's absolutely right. Another explanation, and that's something that we're looking at, I do believe that's a really important explanation, the fact that they're basically a self selected sample, and they will probably, they're likely, the people who sign up to these campaigns or a self selected sample who are concerned about their drinking, and they're, you know, they're probably likely to benefit from anything you give them at least on average. But another thing that that's the characteristic of temporary abstinence campaigns like dry January is that when you sign up, you get a lot of support, you get, you know, you don't have to use it, but you can quite often there's an app which lets you self monitor your drinking. There's often kind of supportive emails, which kind of contain things that you'd recognise. is for things like motivational interviewing and cognitive behaviour therapy. And of course, that support isn't provided to everyone. And it's possible that the extent to which you engage with that support, maybe that's one of the reasons why you end up reducing your drinking in the longer term. So that's something I want to I want to just name drop. Anna butters at Sheffield, he's doing a PhD with me. And she's doing some some longitudinal studies of people who are taking part in dry January, or doing a dry month in January without actually formally registering. And with those, those are some of the things that we're trying to unpick. So we're will be, will be we're collecting data on that now and including recruiting people for January 2023. And presumably,

James Morris: 15:40

sort of self efficacy is is factored into that, because that's obviously a big, you know, the belief that you can make changes is really big in sort of all behaviour change. But it certainly comes out strongly in the alcohol literature doesn't it doesn't

Matt Field: 15:52

it comes out really clearly, that's the clearest psychological construct that comes out in the evaluations of dry January. So there's the evidence shows that people who sign up to dry January report an increase in an increase in what's called Drink refusal, self efficacy, so the confidence in their ability to say no. And it's that actually that change in self efficacy, which explains which which mediates the reduction in drinking after six months, so the more your self efficacy improves, the after dry January, the more it improves after January, the more likely you are to reduce your drinking later. So that's what we see in the UK, it hasn't been consistently seen in other countries. But, you know, there's definitely a few studies which show that in the UK, so that's really interesting.

James Morris: 16:37

Do you think drink reviews or self efficacy, I mean, that's just sort of become the main measure of how correlate to self efficacy. But there's other ways to think about and measure it on there. And I sometimes things, some of those are a bit overlooked, you know, it's not just about the situations you're in where you know, someone offers you a drink, and you refuse it, it's also about how you think forward to possible drinking occasions, which might just be about yourself or your stress or how you're going to fill the time otherwise, et cetera.

Matt Field: 17:06

Yes, I agree. It could be a bit of a narrow focus, although in its defence, I mean, if the measure that's used to measure itself, because it does look at your confidence in your ability to decline drinking in not only in response to emotional, like negative mood, but also in social situations. And also out of I think the other one is out of kind of habit in so it's reasonably broad. But yeah, it might, there are other things which overlap with self efficacy, which some of which kind of stray into my kind of main interest, which is behavioural economic measures. And so these, these other things, like what you say, like, basically, if you weren't drinking, what would you be doing instead?

James Morris: 17:48

And then there's kind of response efficacy as well, which relates to what we talked about at the start, you know, how, how much benefit will i The belief about what is actually going to do if you do achieve the month off, so that's why early stuff's important as well to be able to demonstrate, I guess, and then sort of going back to the the kind of treatment stuff, because, you know, we've we've established that certainly the way that the camp, the month off campaigns are targeted is not that people have dependents. But there's obviously a long, long running controversy, albeit that the evidence isn't particularly controversial that, you know, some people do achieve control drinking, don't like the term but reduce their alcohol use significantly enough that they have significantly improved their quality of life or reduce their significant in their chances of future alcohol related problems, etc. But it's, it's, you know, really common, you might sometimes see that people say, to succeed, you know, in a sort of treatment context, or having had alcohol dependence to achieve kind of control, drinking or moderated drinking, or non abstinent recovery, you know, sort of period of three months is is necessary, but there's not really I've never seen any evidence for that kind of three month thing. I mean, again, it makes a lot of sense that three months is a fairly decent amount of time, which you know, in terms of behaviour really gives you time to sort of reset and reflect and maybe some of that kind of synaptic pruning or whatever the correct term would be from the soft, yeah, brain perspective. But yeah, do you have any kind of insights or thoughts on that? Yeah.

Matt Field: 19:19

So I just don't think there's any evidence for it. I think I think that's right, I think, to really answer that question, you would need to randomise people to either completely abstain or to complete completely abstain for varying periods of time before in starting to drink in a controlled way or resuming drinking in a controlled way. So it wouldn't be that difficult to do, I think, would it you know, you could just run you could tell one group of people to abstain completely for three months before starting to drink in a controlled way and another people, another group, you could just say, right, try and drink in a controlled way immediately. But I don't believe we have the evidence for that.

James Morris: 19:54

Yeah, no, that's one of the many questions that I thought about trying to pursue it. At some some funding.

Matt Field: 20:03

I mean, it's interesting that I do understand I think there's some research going on in Sweden, which is looking at temporary abstinence as an intervention for people in treatment. But I don't know any more about it than the fact that it's happening. But it's interesting that the alcohol change, you run the dry January campaign, emphasise that it's not for dependent drinkers. And as you say, that's largely because of the risk that that people could go into withdrawal and alcohol withdrawal, the alcohol withdrawal syndrome can be very serious, you know, can can be can lead to Fitz and, and other bad stuff. But, and so there's obviously a, we don't want that we don't want to be recommending that to people who are at risk of going into to having an alcohol withdrawal syndrome. But probably, as you know, and you've focused on in your podcast before, there's not really a there's not really a line in the sand is there between someone who's dependent and someone who isn't. And so there is a there is a risk, I think that actually people who might well benefit from trying a period of temporary abstinence, might be a bit scared to attempt it, when actually, the risk may be quite low. But um, but, you know, we need we developed, we lack the evidence base for that. And certainly, you know, if people, certainly if people have advised that if people have tried to reduce their drinking in the past, and they found it very difficult, then it's, it's better to seek seek some help. Talk to your GP? first instance, I don't know if that's controversial for you or not?

James Morris: 21:35

No, I mean, you know, it's, it's correct advice, but it's always a gamble. Because I think I think we can say fairly confidently, that the the advice or experience you get from an average GP is very mixed. Yeah, I mean, there are kind of consumption correlates of levels of dependence that are typically associated with physical dependence and withdrawal, I can't remember exactly what they are, but you know, it's kind of daily or, you know, daily drinking significant amounts. I mean, if, you know, most people, as you say, there's kind of less than 1% of the population who have, you know, more severe end of the physical dependence spectrum. So most people, you know, would be okay to do it, because they are a bit worried about particularly, you know, this kind of psychological aspect of their dependents, you know, a kind of feeling you need it to de stress or unwind, not to kind of really relieve kind of withdrawal symptoms. But, yeah, obviously, it's kind of safety first. So advicing

Matt Field: 22:35

Yeah, of course. Yeah, absolutely. But yeah, it's interesting, and it's, it's, you know, it's potentially very, a very valuable tool, really, something that's kind of assumed, but not, but not really, not really the evidence base for it.

James Morris: 22:48

And also, just, you know, the normalising non drinking. I mean, you know, obviously, I'm keen on also normalising moderate, Adrienne, Charles's books just just come out about his experience of moderating the stream, you're cutting down a lot. And a big part of that is the cynicism that, you know, he gets, he says, One really good bit where he says, you know, heavy drinkers don't like you as a moderator, because you're kind of exposing that they're drinking too much or and abstain as they like you because they don't trust you. I think you're kidding yourself. I mean, it's a I'm sure he'd accept that's a generalisation. But there is also a truth in it that, you know, obviously depends on your social context. But yeah, I think everyone would agree that that kind of more more social acceptability of Fe for abstaining or not drinking or actively trying to drink less and not being pressured to drink more, etc, kind of direction we've,

Matt Field: 23:39

yeah, definitely. And that's another another real benefit societally, I think of the increasing uptake of temporary abstinence and participation in things like dry January, and that kind of separately from the benefits for the people who take part, it's what it's doing is it's it's, uh, plays an important role in this normalisation of abstinence and moderation. And, you know, the, the, it just makes it more socially acceptable to to not drink alcohol in every situation.

James Morris: 24:06

And that just sort of feeds into the idea that you know, it's you know, it's not an ordinary commodity is a drug that's legally regulated that has certainly too much social permission and loose regulation you could argue but that's a different subject. Oh, absolutely. And you know, I think you're quite open that you know, you've done several dry January's now and you've felt better for it. Is that right? What your kind of motivations and experiences?

Matt Field: 24:29

Yeah, I mean, yeah, so I mean, I don't always stick to the guidelines. I have peaks and troughs, I guess. But yeah, I'm gonna intend to do it in January 2023. And I must have done it. I'll I don't know five or six times and yeah, I generally find my personal experiences sleep a bit better and generally feel a bit better. And I guess one of the things the context in which I drink alcohol, what I really noticed is, you really notice how you don't miss Drinking in certain ways, colleagues are called Drink drinking occasions, or drinking practices, you really just don't. There's times when I kind of get in the habit of drinking if you like, where you really alcohol just really is a it's an unimportant part of that activity. So for example, like watching TV, or watching a movie or playing playing video game. Yeah, I'm, I'm a very interesting man. I like doing jigsaw.

James Morris: 25:30

And also cycling. Yeah, that's not be completely unfair.

Matt Field: 25:33

Like, well, yeah, cycling is a bit incompatible with with drinking, unless you're Belgian. But, but yeah, I mean, what I mean is, there's a lot of those things I might do at home would often be accompanied by a drink. And then when what you will quite often learn with dry January is actually, I can still do those things. And the enjoyment level derived from those things is, is certainly not impaired. And if anything, it's improved by by not drinking, and even going to the you just learn, I think that going to the pub going out for dinner type situations where alcohol is, you know, it becomes more expected. Just the realisation that actually if you take alcohol out of those situations, they're still fun. It doesn't really detract from them that much, obviously, obviously, there's a limit to that, you know, if everyone is, if everyone was going out with a, with a plan to, to get very drunk than you, if you're doing dry January, I would I would not I would probably go home early, if you see what I mean. But, but in most situations, I think that's one really important thing you learn you, you really gain some good insights into how often you drink and in what situations and what role alcohol is playing there. But you know, and that's not to deny, you know, there are certainly some situations where drinking alcohol is pleasurable and fun. And if you strip the alcohol out, it's it, I think it's probably not quite so fun. But that doesn't mean that that that every situation which you drink alcohol, you know, fits that criteria. So you really gain some insight into that.

James Morris: 26:57

Yeah, absolutely. And that's, that's one of Adrian Charles's big things is that he, you know, he says, he now has really refocused on the drinks that he does one. And throughout the kind of new book, he retrospectively evaluates, you know, through his kind of main drinking phases, you know, what proportion of the ones that he really wanted, and what the ones he really didn't, and now proactively cuts out those ones that you really don't want. And, you know, everything most people can relate to the sort of last drink usually being, you know, he talks about sort of law of diminishing returns, you know, he finds the first one is really satisfying the second one a bit less so and by time you get to the last one, that is really not, it's counterproductive.

Matt Field: 27:40

I think that's absolutely right. And that's, and of course, he's, I haven't read the book yet. I haven't going to, but he's, he's kind of discovered that through trial and error, I think, whereas the advantage is the risk of doing it through. If you do it through temporary abstinence, if you if you say to yourself, I'm gonna have a month off completely, then you can't talk yourself out of it. Well, you can. But if you what you're doing is you it's kind of a it's, it could be non negotiable, right? I can't, I'm not going to drink at all for this month. Whereas if you say to yourself, I'm going to try and cut out alcohol with meals, or we're watching the TV or in the pub, or whatever you choose. There's always scope for negotiate, negotiate, persuading yourself that I'll just have one. In this case, you see what I mean? And people with addiction are very prone to these, basically, what are what are basically decision making biases. And they're often I mean, Alan, Marla called them apparently irrelevant decisions, a lot of these things, but you basically, you persuade yourself that that it's just this once and Oh, when I said I wasn't good. For example, when I said I wasn't going to drink in the pub, I was thinking of bars. But this is a nice real ale pub, and they've got so many nice ales on that. I've just tried one. And you know what I mean, you it's, you're not gonna drink tomorrow, I'll make up I won't drink tomorrow, you can just negotiate with yourself. But and of course, that's, that's very easy to fall into that trap. Whereas if you if you say, I'm just not drinking for a month, then, you know, it's that's much harder to persuade yourself that it's okay to break that. Yeah. And

James Morris: 29:11

that's one of the key arguments that people say for why abstinence is necessary or was necessary for them is, you know, I certainly relate to that. I'm a moderate drinker. But I did have eight years of kind of unplanned abstinence in my 20s. And, you know, certainly that followed a period of failed moderation attempts, partly because, yeah, yeah, I was constantly arguing myself out of why I wouldn't drink that that night or whatever. So but yeah, I do think the sort of term mindful drinking is probably, you know, works for me in terms of how I see my drinking now, and it's not just doing things on automatic. I mean, a while ago, I was walking home and I saw someone sitting in a traffic jam, you know, eating a chocolate bar, and I sort of thought, you know, it's a bit of a waste, you know, They're not really enjoying the chocolate bar. They're just lots of calories, because they're actually focusing on the driving at the moment. And I guess I sort of feel similarly that anything we do that's too much of it is not good for your health, you need to sort of maximise the benefits of it in the moment, which means that you're focusing on it and not just doing it. But the other thing is, I think, you know, they've kind of normalised drinking in cinemas in some of the trendy ones near where I live, and I sort of thing Yeah, our point of seeing a film is that you kind of lose yourself in the movie and that kind of stuff. So drinking things particularly pointless in that context, but each their own.

Matt Field: 30:33

Yeah, no, I agree. But yeah, I mean, that's just part of the bigger cultural shift, isn't it to normalising it in creasing variety of circumstances?

James Morris: 30:41

Well, well, it's been really great talking to you as so unless you have any sort of final comments or reflections on kind of dry January or temporary absence months, this guest The conclusion is that if you are drinking above the guidelines is certainly not going to do any harm. And it's probably unless you are physically depending on which we've covered. And but there's by the looks of it quite a bit to be gained, potentially, in terms of, you know, maybe short term well being and functioning effects, but also kind of just, you know, maybe realise readjusting the dial a bit in terms of kind of understanding how alcohol fits in and your expectancies and motivations and, and kind of future drinking kind of trajectory.

Matt Field: 31:20

Yeah, no, I think that's absolutely right. I guess I'll just close by by saying that we don't know much about it. I mean, anecdotally, I think a lot of risky drinkers do have periods of temporary abstinence, particularly if they when they become a bit concerned about the the effect that outcome might be having on their health. And I suspect that is a lot more common than signups to these these official campaigns. Yeah. And but so they were really important group to study. But it's really hard to study, isn't it? Because people might do it, you know, how do you how do you identify those people? Yes, we thought about this. But it's really difficult to study. So that's why a lot of the evidence for this comes from looking at people who why happens to people who sign up to dry January, and that in evidence is really informative. But you just have to bear in mind that that evidence that dry January is a very particular context, you know, people are signing up to a campaign, they're receiving support, it's a particular time of year. It's particular type of people that are attracted to that. And that really, I think, limits the extent to which we can kind of extrapolate what we see with people who do dry January and other temporary episodes challenges, can we how much can we extrapolate that to the much bigger population of risky drinkers. But as you say, it's unlikely to do any harm. And it's more likely to be useful, both in terms of your physical health, your mental health, but also you're just just getting in a bit of a window a bit of insight into the role that alcohol plays in your life. But, but it shouldn't be viewed as something that you do to, to kind of mitigate or excuse kind of very heavy drinking throughout the rest of the year. Because there's there's no evidence that it really will. Do you know, if you drink heavily for 11 months and abstain for one, there's no evidence that that will improve your health? And there's plenty of reasons to suspect that it probably wouldn't. So if you aren't going to do it, do it for the right reasons. would be my advice?

James Morris: 33:17

Yeah, that's really good. Good point. I guess in that context, it could be one of those self deceiving kind of permissions, you know, I'm doing a gigantic but yeah, I think I think that's a really, really important point to end on that temporary abstinence doesn't always come in the form of, you know, sponsored month or whatever, that to some degree, most drinkers are probably on some level moderating or kind of actively thinking about how much they drink, at least on a subconscious level. So So yeah, it's yeah, it's really understanding in that broader context, I think it's really important point as well. Brilliant. Well, Professor Medfield, thank you so much for joining us. Thanks, James.