Better Together

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It might sound obvious, but alcohol is more than just a beverage. For many of us, it’s a cornerstone of social life, a key component of cultural traditions, and even a part of our identity (just ask anyone who’s into craft beer… if you dare). We use alcohol — and the intoxication it brings — to connect with each other, to unwind after a long day, and yes, to have some good, old-fashioned fun.

But as we all know, when it comes to drinking, staying within healthy limits isn’t always easy. There are a lot of complex reasons why people overindulge, ranging from the biological, to the psychological, to the social. But whatever the cause, overindulgence can spiral into devastating consequences.

In South Africa, alcohol has a long and complex history, intertwined with that of colonialism and racism in the country. From the seventeenth century until the late 1900s, many Black South African laborers were paid in alcohol rather than money,¹ sowing the seeds for widespread alcohol dependency. Later, during apartheid, Black residents weren’t allowed to sell or even drink alcohol,² and were banned from many places of business. In an act of resistance, many Black South Africans started running illegal pubs known as shebeens, which became community hubs and venues for political discussion. Today, alcohol remains an important part of social life, and an economic driver: the industry employs hundreds of thousands of people.³

But the ubiquity of alcohol has serious consequences for the health and safety of South Africans. In excess, alcohol consumption fuels violence (including gender-based violence, or GBV), leads to traffic accidents, and exacerbates a wide variety of health problems. During the COVID-19 pandemic, South Africa has underwent four separate alcohol bans in an attempt to discourage social gatherings and free up hospital beds. These policies succeeded in dramatically reducing hospitalizations² — but also put a major dent in the country’s economy, and jeopardized the livelihoods of thousands.

TDL partnered with Distell, a multinational brewing and beverage company based in South Africa, to tackle this problem from a behavioral point of view. This partnership led us to develop and pilot a digitized program to combat binge drinking, with extremely promising initial results: by the end of our initial testing, program participants had decreased their drinking by two thirds.

Empowerment through community

Our partnership started with fieldwork on the ground in Soweto, South Africa. TDL surveyed and interviewed more than six hundred locals about their drinking habits and the role alcohol played in their lives. We translated our initial research into a playbook of behavioral interventions, then worked closely with the Distell team to develop what we thought were our highest-potential ideas into a pilot program to reduce alcohol overconsumption.

One of the themes that came up time and time again in our fieldwork was the social nature of binge drinking. A minority of our participants reported drinking at home; instead, most drank in social settings like bars, nightclubs, and other gatherings. They saw this issue not as a personal problem to be dealt with in private, but as a communal challenge to be solved together.

*Fig. 1: What our research revealed about the drivers of binge drinking in South Africa*

chart on alcohol use in South Africa — *Fig. 1: What our research revealed about the drivers of binge drinking in South Africa*

It’s easy to see how social dynamics and “peer pressure” can end up having a negative effect on our drinking habits. But our team wondered if we could leverage these forces for good instead — to nudge people away from binging behaviors. If we frame overconsumption as a problem to be overcome as a community, instead of alone, could we wield social norms as a tool to cut down on overconsumption?

It was from this question that the BetterTogether program was born. BetterTogether is a digital program that draws on community and peer support to help participants cut back on alcohol. People who enrolled in the pilot were put in a small group with 4–5 others, as well as a coordinator who worked with members one-on-one to set goals. Coordinators also led their groups in communal activities based in positive psychology, where members could congratulate each other on their successes and perseverance.

The digital nature of BetterTogether helped to tackle another major barrier that came up in our research: the ubiquitous nature of alcohol. One of the reasons it’s so easy to fall into habitual drinking patterns is that drinking takes place in so many locales, from taverns, to parks, to the workplace. By opting for online connection, we gave participants access to connections they could take with them anywhere. This portability also makes BetterTogether affordable and scalable.

Focus on the positive

The social nature of drinking means that the decision to forgo alcohol often means forgoing socialization as well, inviting feelings of FOMO and disconnection. Meanwhile, many traditional programs to reduce alcohol consumption rely on guilt, shame, or fear to get results. Unfortunately, negative emotions can actually prompt more of the behavior we’re trying to deter — and even when fear tactics are impactful, they aren’t sustainable in the long run.

Because alcohol is so often used to manage negative emotions, programs based in shame or guilt can also end up feeding the desire to drink. Stress tends to increase cravings for alcohol, as we found in our Soweto fieldwork. If behavioral interventions are stressful, they could backfire by inducing the desire to cope through consumption.

To prevent this, BetterTogether is focused on positivity and affirmation, and on providing an alternative community to fall back on when other social events might pose a threat to participants’ goals. Groups were designed to be a judgment-free space: if someone exceeded their consumption goal or needed to set a new one, their peers would support them through whichever stage of the process they were at.

Our pilot test of BetterTogether was wildly successful, resulting in a 27.9% decrease in participants’ desire to drink. Even more impactful, there was a 66.3% decrease in alcohol consumption per capita among its participants — meaning that even when participants were craving a drink, many were able to hold off with the support of their BetterTogether peer groups.

*Fig. 2: The BetterTogether program decreased the daily average number of drinks participants consumed from 10.72 to 4.39*

chart on rolling average of standard drinks consumed per day — *Fig. 2: The BetterTogether program decreased the daily average number of drinks participants consumed from 10.72 to 4.39*

BetterTogether is now in its second phase of testing: we’ve built an app that houses all the program’s necessary functionalities in one place, and expanded it to include 360 participants across 3 additional regions in South Africa (Eastern Cape, Western Cape, and KwaZulu-Natal). As the program continues to scale up, we’re hoping that BetterTogether can program a safe harbor for people across the country who are looking to change their relationship to alcohol.