Category Archives: Alcohol facts and figures

Ever present alcohol

This was an excellent guest post for Alcohol Policy UK in May which I am sharing again here about alcohol availability in England – or as I see it ‘ever present’.

In this guest post, Colin Angus, a Research Fellow at the University of Sheffield, explores recent research on alcohol availability in England and considerations for policy.

A recent study from the Sheffield Alcohol Research Group highlights how widely available alcohol is in England, and how this has changed in the last decade. The study explores the availability of alcohol through measuring travel distances to the nearest outlet selling alcohol and counting the number of places where alcohol could be bought within walking distance (1km). Researchers looked at how availability had changed between 2003 and 2013, particularly changes in the type of outlets where alcohol was sold, and how availability was related to socioeconomic deprivation.

The key findings include:

  • The average distance from the centre of each postcode to somewhere selling alcohol was 323m, with 85% of postcodes being within 500m of an alcohol outlet.
  • The average English postcode has 31 outlets selling alcohol within walking distance (1km) of its centre
  • Alcohol is more available in the on-trade (places like pubs and restaurants where alcohol is sold for consumption on the premises) than the off-trade (shops where alcohol is sold for consumption elsewhere) based on numbers of licensed premises
  • The most deprived 20% of postcodes have around 3 times as many outlets selling alcohol within walking distance of their centre as the least deprived 20%
  • A rapid proliferation of convenience stores and metro supermarkets since 2003 has meant that access to pubs and bars has decreased by 8%, while access to off-trade alcohol has increased by over a third.
  • Pub closures have been far more common in deprived areas while pub access has increased slightly in other areas.

There are many possible explanations for these findings. Significant changes to licensing were introduced in the 2003 Licensing Act, which came into force in 2005 and made it substantially easier to apply for new off-trade licenses. It is also likely that the economic pressures of the recession have had a major part to play in the economic viability of many pubs, as well as the effects of the 2007 smoking ban. This may explain the more acute declines in deprived areas where the recession has hit harder and smoking rates are higher.

What does this mean for public health?

The physical availability of alcohol is clearly not a barrier to obtaining alcohol in this country. Whilst there is a strong body of evidence showing that reducing the availability of alcohol reduces alcohol-related harm, this evidence is overwhelmingly from countries such as Australia and the USA where there are substantially fewer places to buy alcohol from in the first place. Although a steady reduction in the number of UK alcohol outlets may yield benefits in the long-term, it seems less likely that the closure of a small number of outlets will result in significant reductions in harm as long as alcohol is still widely available.

Declining availability in the most deprived areas, which suffer the most alcohol-related harm, may be seen as a good thing. However, shop-bought alcohol is generally substantially cheaper than that bought in pubs and bars, and access to shops selling alcohol has increased. Some have also expressed concern that a shift from drinking in pubs to drinking at home may bring increased risks to health; pubs may potentially offer a more controlled drinking environment where bar staff and patrons act as a moderating influence on levels of consumption.   

Two recent studies have found an association between higher levels of licensing activity in local authorities (in terms of challenging license applications and introducing cumulative impact policies) and greater reductions in alcohol-related hospital admissions and crime. Our findings suggest that unless a radical change in levels of availability can be achieved, local licensing boards may be more likely to have a greater impact on harm if they focus on particular problem outlets. Seeking to address other aspects of availability may also be more fruitful, such as opening hours or the selling of high strength low price products, rather than seeking to reduce the overall number of outlets in an area.

The findings also suggest that licensing actions and government legislation over the past decade or so has done little to directly address the shift in availability from on- to off-trade. Indeed, recent cuts to alcohol duty rates, whilst portrayed by some groups as a boost for the pub industry, have increased the relative gap in prices between the on- and off-trades, potentially accelerating this trend. Whatever the underlying causes of this shift may be, cheap alcohol is easier to access now than at any point in recent history.  

This research was part-funded by Alcohol Research UK (R 2014/03).

I find some of those statistics staggering particularly these two: 85% of postcodes being within 500m of an alcohol outlet & the average English postcode has 31 outlets selling alcohol within walking distance (1km) of its centre.

Both shocking and unsurprising to me, how about you?

 

Statistics on Alcohol England 2017

An excellent blog post as always from Alcohol Policy UK in May looking at the latest statistics on Alcohol England for 2017 & Opinions and Lifestyle Survey (OPN) drinking figures.

Over to James:

The annual Statistics on Alcohol for England 2017 has been released, detailing national data for key alcohol-related indicators and health harms.

Mainly bringing together recent alcohol data releases, the overall trend remains one of falls in drinking amongst younger people, whilst many measures of harm including the latest alcohol-related hospital admissions continue to rise, largely driven by heavier drinking mid and older age adults. See here for Guardian and BBC reports.

Key headlines from the release include:

Hospital admissions – broad measure
  • There were 1.1 million estimated admissions related to alcohol consumption in 2015/16. This is 4% more than 2014/15.
  • This represents 7.0% of all hospital admissions which is similar to 2014/15 and 2013/14.
  • Blackpool had the highest rate at 3,540 per 100,000 population. Isle of Wight had the lowest rate at 1,400.

Hospital admissions – narrow measure

  • There were 339 thousand estimated admissions related to alcohol consumption in 2015/16. This is 3% higher than 2014/15 and 22% higher than 2005/06.
  • This represents 2.1% of all hospital admissions which has changed little in the last 10 years.

See here for the LAPE statistical commentary [pdf] on the latest alcohol-related hospital admission figures.

Drinking Prevalence

  • 57% of adults reported drinking alcohol in the previous week in 2016 which is a fall from 64% in 2006.
  • This equates to 25.3 million adults in England.
  • Those who drank more than 8/6 units on their heaviest day in the last week fell from 19% to 15%.

Deaths

  • In 2015, there were 6,813 deaths which were related to the consumption of alcohol. This is 1.4% of all deaths.
  • The number of deaths is similar to 2014 but is an increase of 10% on 2005.

[NB Age standardised death rates show a relatively stable trend since 2012].

Prescriptions

  • The number of prescription items dispensed in 2016 was 188 thousand which was 4% lower than 2015 but 63% higher than 2006. This breaks the recent trend of successive year on year increases.
  • The total Net Ingredient Cost (NIC) was £4.87 million. This is 24% higher than in 2015 and more than double the level ten years ago.

Consumption confounders?

The national statistics release includes the latest Opinions and Lifestyle Survey (OPN) data on alcohol consumption, albeit that Heaviest Drinking Day (HDD) in the last week is not well regarded as an accurate indicator of consumption. Health Survey for England (HSE) data may be considered better for consumption trends as it also includes questions on mean weekly or daily consumption.
Recent sets of both data though show similar findings in terms of identified trends and socio-economic or geographical variations. However a small decline in the OPN’s proportion of adult drinkers in Britain to 56.9% based on reported drinking in the last week is the lowest since 2005 when the survey began. This time point has however been described as ‘peak booze’ following several decades of steep increases before the turn of the century. As well as the many important demographic differences behind these overall trends in reported consumption, more detailed research has continued to highlight the ‘rich tapestry’ behind the various drinking groups and the extent of under-estimation in self-report data.
Prescriptions: an unexpected drop?
Whilst the ten year trend for prescriptions to treat alcohol dependency has risen significantly, a 4% drop on 2015 may be notable, though largely due to a significant fall in Disilfiram prescriptions. The release however notes a sharp rise of £22 for the Net Ingredient Cost for Disilfiram giving a likely indication as to why. Also of interest, prescription items for Nalmefene fell by 1,000 from 4,400 in 2015 to 3,400 in 2016 which may reflect the apparent decision by its producers Lundbeck ceasing promotion activity in the UK, but also potentially linked to questions raised over the evidence and licensing process.
Alcohol-related cancers: a further harm measure
The latest LAPE statistical commentary [pdf] also includes estimates of alcohol-related cancer based on the six cancer types which are known to have an alcohol link; mouth, throat, breast, stomach, liver and bowel cancer. The release suggests approximately 19,000 new cancer cases each year attributed to alcohol. Since 2004 these rates have been rising, but a recent small drop in alcohol-related cancer rates for men has not yet been followed by the rates for women.
Looking ahead: sales and pricing?
For those keen on assessing the potential future for harm and consumption trends, interest will no doubt be focused on forthcoming sales data which indicated a return to rising total UK alcohol consumption last year, largely driven by the continued growth in off-sales. As such, health advocates wish to see Minimum Unit Pricing (MUP) to curb the availability of the cheapest alcohol – a final conclusion to Scotland’s long running bid is expected imminently.
There has been a great deal of talk recently about JAM (just about managing) or “squeezed middle” in the UK and this share of expenditure being spent on booze can’t be helping financially or otherwise.

Alcohol Pricing

An excellent blog post from Alcohol Policy UK discussing the Institute of Alcohol Studies updated fact sheet on alcohol pricing published in March.

Over to James:

The Institute of Alcohol Studies (IAS) have updated its factsheet on alcohol pricing as health groups seek to continue highlighting the importance of price in addressing alcohol harms.

Download ‘The price of alcohol’ [pdf] here or see a collection of pricing documents and research here.

Chapters covered in the report include:

Pricing, policy and the future of MUP?

Of central important to pricing debates is the relationship between price and consumption. Price, or more precisely affordability, influences the level of population consumption as has been shown by a wide literature. In the UK, attention has been on rising affordability and consumption during the second half of the 20th century, followed by the more recent decline since 2004. Rises in consumption over the last two years have indicated a possible return to an upward trend, whilst the price and sales gap between off-trade and on-trade prices has continued to widen. As such, attempts to see Minimum Unit Pricing (MUP) have been central to public health policy calls in England, while Scotland’s passing of MUP legislation in 2012 has yet to overcome industry-led challenges. A final verdict is expected this year.

Undoubtedly there are many complexities, with debates particularly focused on how pricing changes affect drinkers of different incomes and consumption levels. Whilst the well cited Sheffield Alcohol Research Group’s (SARG) various modelling has undoubtedly applied advanced and detailed methodologies, predicting the exact impacts is never possible. Indeed the factsheet acknowledges that ‘lower alcohol consumption generally reduces health risks’ and so there is ‘strong reason to expect that higher alcohol prices should improve health outcomes.’ Indeed the recent PHE evidence review found strong favour for pricing as a key desired policy, albeit complicated by issues such as the alcohol harm paradox and complexities in identifying longer term health impacts of harmful drinking.

Secondary to MUP, public health opportunities for taxation policy arise with each budget, though of course also facing strong opposing calls from some industry groups. Over the last decade duty changes have arguably gone both ways, with positive public health impacts reportedly seen as a result of the 2008-2014 duty escalator, but opponents subsequently seeing its end and cuts on certain drinks. This year’s budget ‘froze’ duty which would rise with inflation, although a tax consultation aimed mainly at ‘white ciders’ – typically one of the cheapest drinks per unit – is currently underway.

Affordability

Pricing debates as such are going nowhere, but the policy decisions are hard to call. The former coalition Government infamously u-turned on its 2012 MUP pledge, largely thwarted by the current Prime Minister as then Home Secretary. It was insisted MUP though was not being ‘ruled out’, rather than waiting for more conclusive evidence. Waiting to see what happens in Scotland arguably makes for sensible politics, albeit health groups argue that dealying MUP comes at the expense of lives. Wales and Ireland are also pursuing MUP, and with Brexit in the mix, the future of alcohol pricing policy is likely to remain uncertain.

Valuable research indeed.

A retrospective on 2016 (Friday sober jukebox: some riot)

So as I have pared down my blog activity and news sources the one I repeatedly return to is Alcohol Policy UK.  They wrote an excellent retrospective piece about 2016 which you can read here:

 

Alcohol policy in 2016 & what’s in store for 2017?

But what really struck me about this blog were the images featured at the end entitled: Selected alcohol slides from the ‘most interesting things about drugs and alcohol in 2016’ from Andrew Brown:

The top image was the first which highlighted how over half (54%) of strong ciders sold in the off-trade in England and Wales in 2015 were sold at below 20p a unit  <pauses to let that sink in for a minute>  so for less than the cost of a pint of milk! 🙁

Below I share the other three because visual images can be so much more impactful than words.  They all tell a compelling story which as yet is not being addressed by our govt sufficiently to change the trajectory of the graphs.

Association between the experience of physical and sexual abuse in the lives of women and dependence to drugs and alcohol …..

 

 

The number of offences committed pre and post treatment for alcohol use disorders ……

 

 

 

Graphic confirmation that those with the most problems with alcohol are more likely to use the NHS …..

 

 

 

I’ll finish with a haunting performance from Elbow and the BBC Concert Orchestra of Guy Garvey’s ode to a friend lost to alcohol addiction  – some riot.

The impact of alcohol is all too plain to see and hear to those who have eyes and ears.  Shame our govt is looking the other way with its collective fingers in its ears (except perhaps Liam Byrne) …..

PS Yesterday was day 1250!

Alcohol misuse most often treated in middle age

This report featured in the Institute of Alcohol Studies report in November 2016.  This report struck me because I stopped drinking just before my 45th birthday.

Average age of alcohol only clients seeking treatment is 45 years (04 November)

Drinkers in their forties make up the most number of alcohol only treatment users for substance misuse in England, according to new figures published by Public Health England (PHE).

The National Drug Treatment Monitoring System (NDTMS) report ‘Adult substance treatment activity in England 2015-16’ shows that in the 12 months to 31st March 2016, clients exhibiting problematic or dependent drinking represented a total of 144,908 individuals, the second largest group in treatment (see pie chart, illustrated right). Of these, 85,035 were treated for alcohol treatment only and 59,873 for alcohol problems alongside other substances.

The overall number of individuals in treatment for alcohol fell by 4% compared to 2014-15, with the numbers for alcohol only decreasing by 5% since then, to reach its lowest total since 2009-10 (illustrated below). However, this figure still represents more than double the annual number of alcohol only clients recorded since records began in 2005-06 (35,221 clients).

The report noted that those in treatment for alcohol only and opiates tend to be much older than individuals who have presented for problems with other substances. The median age of alcohol only clients was 45 years, with 68% aged 40 or over and 11% aged 60 years and over.

Roughly three-fifths of alcohol only clients were male (61%) although this was a lower proportion than those representing the entire treatment population in 2015-16 (70%). The report’s authors suggested that this finding is “likely (to) reflect the differences in the gender prevalence of problematic alcohol and drug use.” PHE will be releasing estimates of alcohol dependency late 2016.

Individuals starting treatment in 2015-16 were most likely to present with problematic alcohol use (62%, or 84,931 new clients) (illustrated, below). But alcohol only clients also had the highest rates of successful exits of all clients presenting for treatment, with just under two-thirds (62%) successfully completing treatment, up on 61% in the previous year.

However, there were also more deaths among those accessing treatment for alcohol only problems; there were 817 deaths in 2015-16, 3% more than the previous year.

The report also noted that since alcohol service providers started reporting to NDTMS in 2005-06, alcohol citations have remained relatively stable, although the gathering of information on alcohol treatment service providers since 2008-09 may have been one of the main drivers of an overall increase in clients seeking treatment for substance use in general over the last decade.

Responding to the latest figures, Rosanna O’Connor, Director, Alcohol, Drugs & Tobacco within the PHE Health and Wellbeing Directorate, said:

“It is clear from the data that there is an increasing need for services to meet the complex needs of older more vulnerable drug and alcohol users in treatment as well as finding ways of helping those accessing services for the first time to get the treatment they need and move on with their lives.

“Within the data there is much to be hopeful about… But we certainly can’t be complacent – PHE, national and local government and providers, all need to enhance our efforts to ensure that treatment is a safe platform from which to achieve recovery.”

Before you pick up a drink again maybe reflect on this data and if you are in this age range perhaps ask yourself the question whether you really want to go back to that cycle of drinking or whether a longer period of abstinence might be helpful to evaluate your relationship to drinking further?  Just a thought 🙂

Do I Drink Too Much?

So it’s the last day of January and to those of you taking part in Dry January congratulations if you made it this far.  Have you been reflecting on whether you drink too much as part of that month off?  Perhaps on your last night of sipping sparkling water you might want to watch this documentary which aired in December on BBC Wales.  Thanks to my friend Libby for bringing it to my attention!

Lib featured it as part of her News and Update round-up for December on Alcohol Policy UK and if you wish to read all of it you can find it here:

News & updates December 2016: middle-age health, drink-driving, the rise of alcohol-free & the return of benchgirl

Public Health England publish review of evidence on alcohol

Public Health EnglandThis summary report was published by Alcohol Research UK in December.  It looked at Public Health England’s new published review of evidence on alcohol.

Public Health England has published a review of international evidence on alcohol policy and harm reduction.  The new report, based on almost two years of research and analysis, addresses a number of key policy areas.

These include:

  • The price of alcohol and its effect on consumption
  • The impact of both the number of alcohol outlets in a given area, and the times at which they operate, on a range of potential harms
  • The effectiveness of existing controls on marketing, sponsorship and promotion
  • The role of ‘brief interventions’ in preventing harmful drinking
  • The effectiveness of schools-based education programmes
  • The evidence on alcohol treatment in tackling harmful and dependent drinking

We welcome this important contribution to the literature on alcohol harm prevention. It provides both a resource for identifying key evidence and an evaluation of the relative effectiveness of policy interventions based on an extensive process of reflection and review.

Today’s report also provides a new analysis of drinking trends and their economic effects. It confirms that average consumption has been falling in the UK for over ten years, especially among young people. However, it also shows that trends vary between social groups, reminding us that average consumption provides only a rough guide to where harms are concentrated, and that harms can rise even when overall consumption falls.

Importantly, the report confirms previous studies showing that around one third of all the alcohol consumed is drunk by the heaviest drinking 5% of the population.  This demonstrates not only how heavy drinking is concentrated, but the very high proportion of alcohol that is sold to people with serious drinking problems.

The report draws particular attention to the impact of alcohol on economic productivity: suggesting that drinking causes more years of life lost to the workforce than are caused by the top ten most common cancers combined. While the precise social costs of alcohol remain hard to quantify, this report shows clearly that heavy drinking creates an enormous burden for the wider economy.

The PHE report echoes previous evidence reviews in demonstrating that price is a key policy lever in shaping consumption. Its findings suggest that a combination of minimum pricing and more targeted taxation could reduce both harmful drinking and health inequalities (especially the so-called ‘alcohol harm paradox’). Clearly, this is a significant finding as the Scottish Government continues to deal with a prolonged legal challenge to MUP from the Scotch Whisky Association.

The report also argues that while evidence on factors such as outlet density is less compelling than is the case for price, nonetheless limiting hours of sales can reduce antisocial behaviour and drink-driving. While, in the UK, evidence on the relaxation of licensing hours since 2005 has not shown a clear effect in terms of crime, disorder or hospital admissions the authors point to international studies and reviews that show a stronger correlation.

The report also follows previous reviews in pointing to evidence that exposure to marketing can lead to earlier and higher levels of consumption among young people. It finds no robust evidence that existing marketing controls are effective in preventing youth exposure to marketing, and so will strengthen calls for a reassessment of the current regulatory framework.

It also finds no clear evidence that voluntary industry-led partnerships (including the recent ‘Responsibility Deal’) reduce alcohol harms. This is partly because there are insufficient independent and robust evaluations of such schemes to provide clear evidence of an effect, and also because it has been argued that many of the changes introduced under the Responsibility Deal would have happened anyway.

While the report confirms that, from a public health perspective, price, availability and marketing are key issues, it also addresses questions around treatment and interventions. This is especially important as the impact of austerity continues to be felt in widespread cuts to budgets for treatment services across the country.

The review finds considerable evidence that screening and brief interventions in primary care can help prevent harmful drinking. On a policy level, a key question now is how to support GPs in actually carrying out screening and delivering interventions effectively where there is a need. Currently, delivery of interventions in primary care remains low so work to better incentivise and train GPs is needed. The review, however, also notes that the evidence for the effectiveness of brief interventions in other settings (such as the workplace or local pharmacies) is much less robust..

In line with most previous reviews, the report finds that while education can play an important role in raising awareness and knowledge, the evidence for its effectiveness in changing behaviour is weak. This is not necessarily because schools-based prevention and education is wholly ineffective, but because its impact is inevitably limited (behaviours are driven by far more than simple knowledge of harms) and because the delivery of programmes is often highly inconsistent.

Finally, on drink-driving, the review finds strong evidence that reducing the blood alcohol limit is effective in reducing accidents. England and Wales currently have a BAC limit of 0.8 g/l – the highest in Europe, alongside Malta.

Overall, this report represents a key summary of the available evidence on alcohol. It confirms that there are policy levers available to Government that can have a measurable impact on alcohol harm reduction. Clearly, alcohol policy needs to balance a range of interests, but if the Government is serious about seeking to reduce the health impacts of alcohol then this evidence review is of critical importance.

The PHE report is based on a very wide-ranging analysis of available research and an extensive process of peer review. We hope that it forms a key element in the development of alcohol policies in future.

So 5% of the population equates to approximately 2.6 million people here in the UK …… (source).  And Alcohol Policy UK pose the prompted question which I’d like to know the answer to as well:

PHE evidence review 2016: will Government policy respond?

 

 

Alcohol-related cancers projected to rise – can mass media campaigns help?

cruk-university-of-sheffield-logoThis was published by Alcohol Policy UK in December regarding alcohol-related cancers.

Increasing recognition of the risks of alcohol-related cancer has been a priority for a number of health organisations, with recent research identifying limited levels of awareness and projected rises in incidences.

report released last month commissioned by Cancer Research UK (CRUK) attracted significant media coverage of its findings that alcohol-related cancers could cause around 135,000 deaths over the next 20 years in England. The modelling was carried out by Sheffield University and analysed figures under a number of consumption forecasts, and also provided updated estimates of the potential benefits of Minimum Unit Pricing (MUP). A 50 pence MUP could reduce all alcohol-attributable deaths by 7,200, including 670 cancer deaths over the next two decades, reducing alcohol-related healthcare costs by £1.3 billion.

The report follows findings released earlier in the year by CRUK stating the understanding of the link between alcohol consumption and cancer was “worryingly low”; only 13% identified cancers as a possible risk when asked to identify alcohol-related health conditions associated with drinking too much. Recognition improved when prompted with possible cancer types, but those such as breast cancer had far lower recognition than less prevalent alcohol-related cancers. See here for a CRUK alcohol and cancer page.

Data used from the report though has just been published in BMC Public Health journal revealing significantly higher awareness of the links in the North East region, where Balance North East has been conducting media campaigns including TV advertswww.reducemyrisk.tv and #7cancers Twitter activity.

Media campaigns: a question of behaviour change?

Health groups though tend not to want to see health campaigns in isolation owing to the limited impact on behaviour. Indeed similar debates have taken place with regard to the awareness of the revised drinking guidelines and the limitations of their impact on consumption.

Ealier this year Chief Medical Officer Dame Sally Davies attracted controversy for suggesting drinkers should think ‘Do I want the glass of wine or do I want to raise my own risk of breast cancer?’ each time they drink. Whether any significant number of people have taken on the CMO’s advice – or indeed deliberately rejected it – will remain unknown, but based on the evidence of the complexity of behaviour change it would seem unlikely.

As such health groups, including CRUK, not only wish to see media campaigns and improved information through mandatory labelling, but also action on price, availability and marketing. Such levers have considerably stronger evidence to support an impact on drinking behaviours, but are of course opposed by those who may support informed individual decision making but not the Government in influencing it via regulation.

As for the near future, momentum may continue with a general trend in increasing awareness of alcohol health harms. Whether this will be supported in England by legislation to ensure mandatory labelling on containers, or indeed change environmental influences, is uncertain. In the meantime, alcohol-related cancers are likely to rise before they fall, even should consumption fall further.

estimated-trends-in-annual-alcohol-attritubutable-cancer-deaths-following-reduction-in-consumptionA picture paints a thousand words ……

And edited to add this small celebratory footnote: Voted  Top 100 Addiction Blogs Winner from thousands of top Addiction blogs in Feedspot’s index using search and social metrics.  Ranked 53rd based on Google reputation and search ranking, influence and popularity on Facebook, Twitter and other social media sites, quality and consistency of posts and Feedspot’s editorial team and expert review 🙂

Back to life, back to reality … Women closing the drinking gap on men

women-closing-the-drinking-gap-on-menIt’s the end of the Christmas and New Year break and most of us head back to work or school, hence the Soul II Soul lyrics in the blog post title.  And part of that reality is that women are closing the drinking gap on men as reported by the Institute of Alcohol Studies in October 2016.  Over to their analysis:

Trend most evident among young adults, international analysis shows (25 October)

Women are catching up with men in terms of their alcohol consumption and its impact on their health, finds an analysis of the available international evidence, spanning over a century and published in the online journal BMJ Open.

This trend is most evident among young adults, the findings show. Historically, men have been far more likely than women to drink alcohol and to drink it in quantities that damage their health, with some figures suggesting up to a 12-fold difference between the sexes. But now evidence is beginning to emerge that suggests this gap is narrowing.

In a bid to quantify this trend over time, a research team pooled the data from 68 relevant international studies published between 1980 and 2014. The studies calculated male-to-female ratios for 3 broad categories of alcohol use and harms (any alcohol use, problematic alcohol use and alcohol-related harms) stratified by 5-year birth cohorts ranging from 1891 to 2001, generating 1,568 sex ratios (see above data table).

Sixteen of the studies spanned 20 or more years; five spanned 30 or more. All the studies included explicit regional or national comparisons of men’s and women’s drinking patterns across at least two time periods.

Results:

The pooled data showed that the gap between the sexes consistently narrowed across all three categories of any use, problematic use, and associated harms over time.

Men born between 1891 and 1910 were twice (2.2) as likely as their female peers to drink alcohol; but this had almost reached parity among those born between 1991 and 2000 (1.1, illustrated). The same patterns were evident for problematic use, where the gender gap fell from 3 to 1.2, and for associated harms, where the gender gap fell from 3.6 to 1.3.

After taking account of potential mathematical bias in the calculations, the gender gap fell by 3.2% with each successive five-year period of births, but was steepest among those born from 1966 onwards.

Associated health harms fall disproportionately on female drinkers

The calculation used was not designed to address whether alcohol use is falling among men or rising among women, the researchers caution.

But among the 42 studies that reported some evidence for a convergence of drinking levels between the sexes, most (n = 31) indicated that this was driven by greater use of alcohol among women, and 5% of the sex ratios were under 1, suggesting that women born after 1981 may actually be drinking more than their male peers, the researchers claimed.

Conclusions

The researchers wrote: “Findings confirm the closing male–female gap in indicators of alcohol use and related harms. The closing male–female gap is most evident among young adults, highlighting the importance of prospectively tracking young male and female cohorts as they age into their 30s, 40s and beyond.”

While they did not set out to explain the reasons behind their observed findings, they emphasised that their results “have implications for the framing and targeting of alcohol use prevention and intervention programmes.”

They concluded: “Alcohol use and alcohol use disorders have historically been viewed as a male phenomenon. The present study calls this assumption into question and suggests that young women in particular should be the target of concerted efforts to reduce the impact of substance use and related harms.

“These findings (also) highlight the importance of further tracking young male and female cohorts as they age into their 30s, 40s and beyond”, they added.

Institute of Alcohol Studies director Katherine Brown said: “The findings from this study illustrate a trend that has been in the making for decades. Women are increasingly subjected to heavily targeted marketing practices by alcohol companies enticing them to drink more. This is a global phenomenon, with drinks manufacturers producing sweet, often pink, fizzy alcoholic beverages that appeal to young women, with glamorous advertising campaigns.

“Another major driver of alcohol consumption is price, with very cheap products commonly on sale for as little as 16 pence per unit in shops and supermarkets. We are no longer a nation of pub goers, with two-thirds of all UK alcohol drunk at home. Pre-loading on cheap shop bought alcohol before a night out is common practice and police have reported strong links to crime, disorder and vulnerable behaviour in towns and city centres.

“Alcohol places a huge strain on our NHS and emergency services, with the total costs to society at £21 billion each year. We need to take this issue seriously and introduce evidence-based measures such as minimum unit pricing and marketing restrictions in order to protect out future generations and improve the health and wellbeing of our most vulnerable communities.”

Coverage from Alcohol Policy UK:

‘Women have caught up with men’ in alcohol consumption levels, headlines reported across the media. According to international research the gap between men and women is closing rapidly when it comes to use and alcohol-related harms, though in the UK men still drink more. See NHS behind the headlines analysis or BBC, The Sun and Guardian reports.

To act as a counter-balance to this view here is a recent article from the Guardian citing another BMJ study:

Female binge drinkers unfairly stigmatised by media, says study

It’s worth a read and has an interesting conclusion that begs the question: who is funding this research?

Further evidential data:

(taken from HSE 2015)

Health Survey for England 2015: latest consumption figures

Eight in 10 middle-aged Britons ‘are overweight or exercise too little’ (oh and drink too much!)

Ladies it’s the beginning of January and it’s not too late to join us for Dry January.  You can start the clock today and not become part of these statistics of the future.

Understanding the relationship between poverty and alcohol

CPH poverty and alcohol misuse 2016This rapid review examined evidence of the association between poverty and alcohol use. The research primarily focused on work undertaken in the UK and was commissioned by the Joseph Rowntree Foundation as part of their programme to develop Anti-Poverty Strategies for the UK. The purpose of the rapid review was to provide an evidence base that the Joseph Rowntree Foundation could use in developing their strategies, and to inform how alcohol misuse was addressed.

What struck me about this review was the section on stigma and marginalisation:

How people respond to others’ alcohol use exacerbates harm (World Health Organization, 2007). Alcohol dependence is a highly stigmatized health condition and as Room (2005) argues, “the use of alcohol [and drugs] is strongly moralized, and those transgressing moral norms are subject to stigma and social marginalization”. The relationship between alcohol dependence and stigma particularly manifests itself through the perception that those affected have personal control over their illness (Livingston et al., 2011). The WHO Expert Committee on Problems Related to Alcohol Consumption noted that “there a clear tendency for many cultures to marginalize particularly those who are both poor and habitually intoxicated, and that there are many pathways by which poverty can enable or exacerbate the stigmatization of intoxication” (World Health Organization, 2007). People who are poor or living in poverty may be less able to avoid or  buffer the social consequences of their drinking unlike their more affluent counterparts. Police surveillance of ‘anti-social behaviour’ such as public drunkenness may also be heightened in poor communities. Thus in affluent societies, the WHO Expert Committee (World Health Organization, 2007) highlighted “that there is a very strong overlap between the most marginalized population and those defined as having serious alcohol problems”.

What is the extent of problem alcohol use among people living in poverty?
As there are no figures available to determine what proportion of the estimated 13 million adults who live in poverty overlap with the categories of problem drinkers the extent of the problem is unknown.
According to Public Health England (2014), around 9 million adults in England are hazardous drinkers with 2.2 million also harmful drinkers. An estimated 1.6 million adults in England may have some degree of alcohol dependence. Of these, around 250,000 may be moderately or severely dependent on alcohol.  According to the 2007 Psychiatric Morbidity Survey, 8.5% of men and 3.0% of women in the lowest income quintile had experienced any symptoms of alcohol dependence in the last 6 months; 2.5% and 0.1%, respectively, had experienced moderate or severe symptoms of dependence that would indicate a need for assisted alcohol withdrawal.
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