04/24/2014 03:34 pm ET | Updated Jun 24, 2014

Behavioral Economics, Social Norms, Excessive Drinking and Why Everyone Wants to Be a 'Face in the Crowd'

Global Drug Survey runs the biggest drug survey in the world. The results of GDS2014, which received just short of 80,000 responses, (6,500 from the U.S.) were released on April 14. While we have a focus on illicit drugs, we never ignore that most permissive and accepted of drugs -- alcohol. So here is the third in a series of little blogs based on the findings of GDS2014 on how people understand their own drinking and how we can use that to reduce alcohol consumption and harm.

One of the most stunning findings from this year's Global Drug Survey was not only that 45 percent 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 one-third of this high risk group did not think their drinking placed them at high or extremely high risk of harm. How could it be that a group of predominantly well-educated people whose drinking placed them that a very high risk of harm and in the top 5-10 percent of drinkers in their country could be so "deluded"?

The answer lies in understanding some of common barriers to behavioral change and the way we choose to see ourselves to avoid dissonance and remain 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." Holding this dangerous, usually inaccurate perception means we are less likely to put things in place to reduce our risk of harm. Another common way 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 it's 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 (over 85 percent compared to about 75 percent of everyone else). And that is interesting because it is says they might be open to be influenced by being more aware of what what other people usually do, that is the social norms.

The dual concepts of social norms and behavioral economics (BE) are some 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. BE seeks to create environments that make the "right" decision easy for people. As a doctor, that is the healthy decision. Nudging people towards the right decision relies upon a number of factors that we unconsciously use to inform decision making. Some factors we can explicitly manipulate (like the tax on alcohol), others we than we can raise awareness of (personal vulnerability to harm and the behaviors of others) . Some key modifiers of one's own behaviors are the behaviors 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 -- "nine out of 10 dogs prefer the taste of woof woof biscuit." 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 vs. beached whale). You can nudge people to change their behaviors by helping them identify misperceptions around their own behaviors. Using social norms and behavioral economics can in some cases help people live healthier lives.

I have used the principals of social normative feedback and behavioral economics to create the free anonymous and confidential drinks meter app and app stores. 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, age and gender group and then let you see the health, economic and calorie benefit of removing a few unnecessary drinks each week. So if you think you're average or are finding those jeans a little tight go check yourself out on the drinks meter.

Need help with substance abuse or mental health issues? In the U.S., call 800-662-HELP (4357) for the SAMHSA National Helpline.

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