Joan Smith: The real cost of booze is rising fast

The existence of a widely acknowledged social problem, accompanied by a scandalised rejection of measures designed to tackle it, is an example of cognitive dissonance

Just about everyone claims to dislike Britain's binge-drinking culture. People complain bitterly about the state of our town centres on weekend nights as young people spill out of pubs and clubs, barely able to stand; they sympathise with the police, who have to deploy officers to deal with drunken disorder when they could more profitably be used elsewhere; they shake their heads over the waste of NHS resources as A&E departments struggle to cope with patients who are there solely because they've consumed huge quantities of alcohol.

It's widely believed that the British, unlike the French, have an unhealthy relationship with alcohol. Supermarkets are full of cheap booze, bars lure passers-by inside with "happy hours" and our drinking culture is loutish and competitive. It's all dreadful and somebody should do something about it – but that's where the agreement ends. Firm proposals to reduce alcohol consumption, such as those published yesterday by the National Institute for Health and Clinical Excellence (Nice), are generally greeted with scepticism and even outrage.

Nice is advocating a minimum price for alcohol, an advertising ban like the one imposed some years ago on tobacco products, and better screening for drink problems in the general population. The latter proposal means GPs taking the extraordinary step of asking patients about their drinking habits, an idea which has been greeted as though it's a massive and distasteful invasion of privacy. (Do it, I say. And ask them about their weight while you're at it.)

The existence of a widely acknowledged social problem, accompanied by a scandalised rejection of measures designed to tackle it, is evidence of cognitive dissonance. Public attitudes to drinking in the UK are confused, irrational and mixed up with other factors such as celebrity and class. The public disapproves of alcoholism in general but is willing to make endless excuses for individuals such as the late George Best, who was romanticised even as his life was visibly being destroyed by drink. Then there's the grudging admiration in some quarters for men (though not women) who continue to consume "heroic" amounts of booze in defiance of advice from their doctors.

There is a semi-excuse for this: anyone over the age of 40 grew up thinking that half a bottle of wine with dinner each night qualified as "moderate" consumption, so it's a shock to look at up-to-date tables which show how small a single unit actually is. You don't have to drink seven pints a night to have a drink problem; a couple of large glasses of wine each evening adds up to several dozen units per week, way above "safe" limits for both men and women. Recent medical knowledge requires a mostly unwelcome adjustment on the part of social drinkers who want to stay healthy; some individuals have cut back – women know more these days about the link between unsafe drinking and breast cancer – but the cultural norm is still to drink more than doctors recommend.

That makes it easy for sceptics to dismiss any attempt to tackle binge-drinking on the grounds that the medical establishment is much too cautious in its approach to alcohol. Why should "moderate" or "sensible" drinkers be affected by measures which clearly ought to be targeted on young people who regularly drink themselves legless? It's true that the Nice recommendations would make booze more expensive for everyone; the panel didn't recommend a minimum price but worked on an example of 50p per unit, which would raise the price of a two-litre bottle of cider to £7.50, and a 500ml can of lager to £1.14. But there is an element of targeting here, since higher prices have the biggest impact on the heaviest drinkers and on young people, who spend a relatively high proportion of their income on alcohol. If the rest of us cut down as well, that would bring more health benefits, as well as reducing the cost to the NHS of drink-related illness.

People who complain about the "nanny state" ignore the fact that alcoholism and other lifestyle conditions, such as obesity, place a huge burden on taxpayers. According to Professor Mike Kelly, Nice's public health director, excessive drinking costs the NHS £2bn each year and leads to half a million crimes, 17 million lost working days, 1.2 million violent incidents and just under 15,000 alcohol-related deaths. I'm not as a rule in favour of banning things, whether we're talking about recreational drugs, tobacco or alcohol, but the social and financial cost of alcohol-related illness is a powerful argument for greater regulation.

The biggest obstacle to bringing that about is surely denial. Most people think the problem relates to strangers, whether it happens to be kids on a night out – almost exclusively girls, judging by the photographs chosen to illustrate articles on the phenomenon – or some shabbily-dressed blokes sharing a park bench and several bottles of cider. They're the ones who need to be brought under control, not the upper-middle-class youths whose evenings end (as Bullingdon Club feasts are said to have done) in damaged property and flights from the police. Upper-middle-class drinking is less visible and more readily excused, whereas working-class drinking habits – booze cruises, supermarket trolleys packed with cans of lager – are harder to overlook.

Booze undoubtedly plays a role in other problems, such as domestic violence, but some Labour MPs shy away from minimum-pricing because they see it as an imposition on their working-class constituents. The same people opposed the ban on smoking in public places, as though poor people's lives are so resistant to improvement that they have to be allowed to smoke and drink themselves to death. Such counsels of despair are even more depressing than the proposition that the answer to our drink problem is to "change the culture", one of those lovely ideas that has not yet been achieved – the UK isn't France – and isn't likely to be.

Cultural change is often most effectively brought about by legislation. Thirty years ago, people didn't think twice about drink-driving but a crack-down by the police has got even some of the worst offenders out of the habit. Our cheap-booze culture didn't come about by accident, and it's no good just trying to wish it away. If we want our friends, relatives and complete strangers to drink sensibly, the answer is tough but simple: regulate.

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