More important research from Alcohol Research UK looking at alcohol pricing and purchasing among heavy drinkers in Edinburgh and Glasgow.
In Scotland adult sales of pure alcohol are one fifth higher than in England and Wales, with this difference being ascribed particularly to sales of cheaper sprits such as vodka. In 2011 alcohol-related death rates amongst Scottish men were 1.8 times those of their counterparts in England, for women the ratio was 1.75 (Beeston et al., 2013). In 2006 alcohol-related death rates amongst Scottish women actually exceeded those of men in England and Wales (Beeston et al., 2012).
The purpose of this study was to describe the purchasing patterns and consumption behaviour of heavy-drinking individuals who had been harmed by their alcohol intake.
The baseline sample had a mean age of 45.6 years. 72% were male, 28% female. Levels of alcohol consumption among participants were very high, with a median weekly consumption of 185 units. Weekly consumption among men (median=196 units) was significantly higher than among women (median=158 units).
Participants generally bought alcohol cheaply, paying a median price of 40p per unit. 95% of all purchases were made in off-licences and the median weekly expenditure was £70. The three most popular drinks were vodka (27% of all units purchased), white cider (24%), and beer (20%). Vodka accounted for the greatest proportion of alcohol purchased by women (41%); for men this drink was white cider (26%). Whisky, a spirit drink traditionally associated with Scotland, accounted for only 5% of purchases.
Off-sales accounted for 95% of purchases, of which 85% of units were purchased at a price of less than 50p per unit. 34% of all units were purchased from supermarkets, 49% from corner shops, 9% from off-licences and 3% other outlets e.g. petrol stations.
Comparison with pilot data collected in 2008/09 showed that a fall in the affordability of alcohol had been off-set by this type of heavy drinkers switching to cheaper products. White cider was an important buffer: its cheap unit price (average 17p per unit) allowed it to be used as a fallback drink when finances were restricted. It is already recognised that very heavy drinkers tend to buy alcohol cheaply; our findings demonstrate that, as long as very cheap alcohol is available, falling affordability is cushioned by trading down.
Among the general population of Scotland in 2012-13, most alcohol purchased in the off-trade was sold at 35-44.9p per unit (Beeston et al., 2013). In contrast, our participants purchased the largest proportions of their drinks within the 15-19.9p and 35-39.9p per unit price bands.
Despite the economic downturn and recent changes to the welfare system, usually resulting in reduced income, most participants were still able to maintain their level of consumption. This was especially the case for those drinking cheaper products such as white cider and vodka. However, consequences of increased expenditure on alcohol included a reduction in food purchasing and heating, and falling into – or increasing – debt. Some participants coped by pooling or sharing resources, either money or alcohol, with other drinkers. There was little evidence of substituting other substances for alcohol or consumption of illicit alcohol in our sample.
Men drank significantly more than women in deprivation quintiles 1, 2 and 4, but not in quintiles 3 and 5 (5 being least deprived). Among women, the association between alcohol consumption and harm was influenced by two key factors: increased deprivation and being recruited in Glasgow rather than Edinburgh. In this, the study findings reflected a phenomenon sometimes referred to as the ‘Glasgow effect’, in which health outcomes across a wide range of measures are worse for people living in Glasgow than elsewhere (Gray and Leyland, 2008).
In the 639 patients, 161 (25%) reported consuming white cider in their most recent or ‘typical’ week of drinking. Of these, 72 participants drank white cider exclusively. White cider drinkers consumed significantly more alcohol (median=249 units) than the no white cider group (median=174 units). Women were half as likely as men to be a white cider drinker. Those in the least deprived group were one-fifth as likely to drink white cider as those in the most deprived group. While men consumed significantly more alcohol than women overall, among white cider drinkers men and women consumed similar numbers of units.
All white cider was purchased exclusively at off-sales outlets: 77% of white cider units were purchased at independent licenced grocers, 13% from supermarkets and 10% from other off-licences (drinks retailers, garages and newsagents). When asked to state their reasons for purchasing white cider, the majority (83%) reported that it was chosen because of its cheapness. One participant advised that it was cheaper than heroin while others alluded to its role as a ‘buffer’ that was used as a fallback drink when funds were low.
No evidence was identified confirming anecdotal reports in the literaure suggesting an enhanced health harm associated with white cider consumption in particular. Increased health risks are more likely to be associated with the high levels of ethanol consumption among white cider drinkers (which were significantly higher than non-white cider drinkers). The health risk of the alcohol intake reported by participants (equivalent to 4-5 times the UK definition of harmful consumption) is likely to be compounded by smoking (70% of participants smoked).
Interviews with participants revealed a limited understanding of the predicted effects of MUP, but also a concern that removal of cheap alcohol would compromise the budgets of addicted drinkers. The majority of participants lived from day to day, sometimes from hour to hour, and were generally not able to plan ahead, let alone take account of legislation that might not be implemented for years, if at all. Their attitude was that they would deal with any issues if and when MUP (to them merely a vague and obscure concept) was in place. However, for the majority of people we interviewed, who have a high frequency and volume of purchasing, we anticipate that the impact of MUP could be immediate, particularly for the white cider and cheap vodka drinkers. Systems would need to be in place to address possible short-term consequences within this population, such as medical complications associated with alcohol-withdrawal.
Our participants tended to believe that any existing or proposed alcohol policy would not help them reduce their consumption, but that the introduction of, for example, MUP, might reduce the likelihood of younger people developing the same drinking patterns and harms that they had suffered.
Again I find this research valuable as it gives an insight into the reality of the issues of alcohol. Their median age is horribly young at 45.6 (so younger than me). Their consumption amount wasn’t a shock at almost 200 units for men and over 150 units for women as this is what I typically saw on the ward. I’m embarrassed to say I have been known to drink K cider and had no idea it had an ABV of 8.4%!! This and vodka seemed to be the drink of choice, not Scottish whisky. White cider has a horrifyingly low price per unit of 17p hence its popularity. White cider drinkers consumed significantly more alcohol (median=249 units) than the no white cider group (median=174 units). While men consumed significantly more alcohol than women overall, among white cider drinkers men and women consumed similar numbers of units. The most shocking revelation was: One participant advised that it (white cider) was cheaper than heroin while others alluded to its role as a ‘buffer’ that was used as a fallback drink when funds were low.
Cheaper than heroin. I simply don’t know what else to say ……..