November 2020

Editorial – November 2020

In this edition:

• Home drinking increasingly becomes the new normal during lockdown
• Economics think tank study says a reformed duty system would improve MUP’s effectiveness
• Alcohol Health Alliance UK pricing survey finds that alcohol is still being sold at pocket money prices
• Scottish Health Action on Alcohol Problems call for all MSP candidates to promise a total ban on alcohol advertising ahead of the 2021 elections
• IAS to hold an online event presenting new findings on alcohol policy and nudge theory 🎵 Podcast feature 🎵
• The Scottish Government launches a free FASD eLearning resource

We hope you enjoy our roundup of stories below: please feel free to share. Thank you.

Lockdown: home drinking becomes the new normal

November saw the UK enter into a second lockdown, as ministers realised that the tier system for controlling the virus could no longer contain the rising R rates throughout the UK. As a result, all pubs were forced to close from 05 November until 02 December (Morning Advertiser, 31 Oct), and anticipated bans such as that of alcohol consumed on ScotRail trains came into force (STV News, 16 Nov).

The penultimate month of the calendar year was also a time for reflecting on how people’s drinking habits had changed since the first lockdown.

A study from alcohol industry-funded body Drinkaware found that women were a bigger influence than men out of the 26% of people whose alcohol intake increased between March and June (Daily Mail, 02 Nov), the primary reason for doing so being that they had ‘more free time available’.

The Royal College of Psychiatrists observed that nearly half (45%) of its psychiatrists had seen a rise in patients whose alcohol or drug use had contributed to a deterioration in their mental health during the pandemic (The Telegraph, 15 Nov),

Dr Katherine Severi, IAS chief executive, explained that ‘the closure of bars and restaurants had driven people into drinking at home, which meant it was not only cheaper than buying in a restaurant but also that people were consuming more.’

Data from Public Health England (PHE) also showed that older age groups all significantly increased their alcohol intake during lockdown, with a fifth of those aged 45 to 74 years drinking more than 21 units a week. Those aged 55 to 64 who drank at least a pint a day (three units) jumped from 17·4% to 20·6% with one in 20 consuming more than 50 units weekly, almost three pints a day.

And an Opinion Matters poll of more than 1,000 people aged over 50 years, commissioned by We Are With You found that: 20% were drinking more since March; 10% earlier in the day; and more than half drink at a level that could cause health problems now or in the future, a cause of great concern for 35% of those surveyed who are children of those parents.

We’ve summarised the key findings from an @OpinionMatters_ poll we commissioned (Thread)

⭕️ More than 1 in 2 (51.2%) over 50s are drinking at a level that could cause health problems now or in the future, with nearly 1 in 4 (23.7%) classed as high risk or possibly dependent.

— We Are With You (@WeAreWithYou) November 18, 2020

Projected tax receipts and sales data appeared to confirm that off-licence vendors of alcohol have profited substantially from the pandemic.

The Office for Budget Responsibility’s economic and fiscal outlook revised alcohol duties upward by an average £1 billion a year, as receipts in 2020/21 held up much better than assumed (24 Nov):

The loss in receipts from closures of pubs and restaurants has been more than offset by higher sales in supermarkets and other shops. Alcohol consumption has therefore been one of the few tax bases left relatively unscathed by the virus.

The 2020 British Lifestyles Report from consumer research group Mintel estimated that annual retail value sales of alcoholic drinks will grow at its fastest rate for at least a decade – 16% – to reach £25.5 billion in 2020, ‘as people trade nights out for evenings in’ (20 Nov). Spending per household on alcohol is expected to average £129 in 2020.

Jack Duckett, Mintel associate director of consumer lifestyles research, also wrote of the potential for further growth from drinks makers appealing to the mature drinker:

The growth in the size of the older population over the next five years, and the fact that they are most likely to be insulated from the financial impact of the pandemic, makes targeting the ‘grey pound’ particularly timely for all brands including alcoholic drinks.

In Ireland, the Revenue discovered a slump in drinking outside the home, as their sales data recorded a 4.5% fall in alcohol consumption since the start of the year, mainly because of pubs forced to close for lockdowns. Alcohol Action Ireland warned that drinkers ‘had largely substituted their on-trade activity with unregulated home drinking’, a sentiment echoed by the Vintners’ Federation of Ireland chief Padraig Cribben. He told the Irish Sun it was ‘obvious that because of the pandemic a massive volume of alcohol is now consumed at home’ (03 Nov).

And where drinking patterns have moved indoors, so have increased risks of alcohol-related harm. Consultant psychiatrist Rebecca Lawrence wrote in The Guardian that although it is difficult to determine the exact picture of British drinking habits during lockdown, we can ‘intuit’ some things (18 Nov):

I worry about those who were drinking just a bit too much before who have now tipped into problem drinking. It doesn’t take a lot, and there are many on this uncertain edge. Stress levels are high, with fears about infection or economic insecurity taking their toll.
Many of my patients who are already alcohol-dependent tell me they have relapsed due to boredom, and, even more importantly, lack of any human contact. When we talk about relapse prevention, we talk about seeing people, talking to people, going to groups, and all this is up the spout at present. There are groups online, but not everyone can access these. In any case, it’s not the same, as those of us who are all Zoomed out will testify to.
Sometimes too much contact is the problem: families are forced together, something that can be hard even for the most loving partners or parents. Alcohol can be a form of mental, if not physical, escape.
Whether newly dependent or relapsed, what’s clear is that people need help to get through this.

Funding public health: Winter plans and ‘Spending Reviews’

In the final week of lockdown, Prime Minister Boris Johnson revealed the government’s post-lockdown winter plan to the House of Commons: a return to the tier system, with the added detail of businesses to be permitted to serve alcohol ‘only as part of a substantial meal’ in designated tier 2 zones of the country, a move unlikely to curb increasingly routinised home drinking habits and their potential harms (23 Nov).

Furthermore, the lack of sufficient services for the rising numbers of people struggling with alcohol dependency and other substance misuse problems led to calls from the Local Government Association (LGA) – which represents councils responsible for public health – for the chancellor to invest in vital public health services ahead of the Spending Review (LGA, 21 Nov):

COVID-19 [has] exposed existing health inequalities which need to be levelled up if we are to protect our communities in future, and so to address this divide, the Spending Review ought to have reversed the £700 million of public health funding reductions experienced by councils over the previous five years.

Chancellor of the Exchequer Rishi Sunak authorised the provision of £254 million of additional resource funding in 2021/22, to ‘bolster’ substance misuse and frontline support services, for tackling homelessness and rough sleeping (HM Treasury, 25 Nov).

As we head into the winter, with alcohol-related health outcomes worsen for many drinkers across the UK because of the drastic change to consumption habits induced by the pandemic, the calls of local authorities to support public health services may yet grow louder.

Reformed duty system would improve MUP’s effectiveness

Economics think tank the Institute for Fiscal Studies (IFS) have published new research showing that while minimum unit prices for alcohol (MUP) are reasonably well targeted at heavy drinkers, they may come at the cost of reducing tax revenues (20 Nov).

Using data on millions of alcohol purchases made by Scottish and English households, the analysis shows that:

• Prior to the introduction of the minimum unit price, half of all transactions for alcohol bought in shops in Scotland were below 50p per unit. The minimum unit price led to a 5% increase in the average price per unit, but some very cheap products saw their prices double, while more expensive products were unaffected.
• This led to an 11% fall in units purchased per adult per week, with larger falls for more heavily drinking households.

However, the IFS fear that MUP creates windfall revenues for the alcohol industry, while reducing revenue for HM Treasury:

• The analysis finds that if the 50p minimum unit price were extended to the whole of the UK under the existing system of alcohol taxes, then tax revenue would fall by around £390 million per year.

This is in addition to projected annual losses from recent changes to alcohol duties averaging £200m to 2024/25.

The report’s authors conclude that ‘a minimum unit price, combined with a more coherent set of taxes on alcohol, would be just as well targeted at heavy drinkers and would limit the fall in revenue for the exchequer’.

Alternatively, they propose replacing the current system of duties with ‘a two-rate structure that taxes alcohol in proportion to its alcohol content, with a higher rate on strong spirits’, which would lead to an increase in tax revenue of over £70 million.

One of the report’s authors, associate director Kate Smith, said:

The current system of alcohol duties is incoherent – for example, if you prefer a pint of beer to cider, you may currently pay more than twice as much tax for a drink with the same alcohol content. Brexit offers a valuable opportunity to improve the way we tax alcohol. A simple reform that taxes drinks in proportion to their alcohol content, with a higher rate on strong spirits, targets the purchases of heavy drinkers while raising tax revenue.

Public health experts from Alcohol Health Alliance UK, the Foundation for Liver Research, the House of Lords, and the pro-vice-chancellor of health and life sciences at the University of Bristol, welcomed the report, stating that the measures proposed by the IFS could save more than 5,000 lives over the next decade.

In a letter to The Times (23 Nov), they wrote:

Although the money from minimum unit pricing alone stays with the retailer, the saving of costs to the NHS of reduced drinking outweighs that loss. Also, if combined with a scaled and consistent alcohol duty system to offset some of the wider costs of alcohol harm to society, these measures could save more than 5,000 lives in the next decade.

Alcohol prices are ‘small change’ to drinkers, survey finds

Adapted from the Alcohol Health Alliance UK press release

Alcohol continues to be sold at pocket money prices in England, with it being possible to drink the weekly low-risk drinking guideline of 14 units of alcohol for less than the price of a cup of high street coffee, according to a new report from the Alcohol Health Alliance (AHA) UK, a coalition of more than 55 organisations including medical royal colleges and health charities (10 Nov).

Comparing the prices of alcoholic drinks sold in shops and supermarkets across England, Scotland and Wales, researchers found the cheapest products were all sold in England, the only nation of the three not to have a minimum unit price of 50 pence.

Cider is the cheapest available product in England and is being sold for as little as 19p per unit of alcohol, meaning that consumers can reach the weekly low-risk drinking guideline of 14 units of alcohol for just £2·68 – about the price of a large coffee in high street coffee chains. A single bottle of the cheapest cider also contains more alcohol than eight pints of beer – and costs 8 pence less than a single pint in a pub.

For the price of a standard cinema ticket (£7·11), you could buy two bottles of wine, containing 19·5 units and have 13 pence change leftover, and a one-litre bottle of vodka, which contains 37·5 units, is cheaper than a large pizza at Dominos (£14·99).

In light of the findings, the AHA calls on the government to commit to tackling cheap, high-strength alcohol in its review of the alcohol duty system and through introducing minimum unit pricing in England. AHA chair, professor Sir Ian Gilmore, said:

The low price of high strength alcohol continues to cause immeasurable damage to the health of our nation. Alcohol is linked to 80 deaths in the UK every day, as well as seven types of cancer and stroke.
To tackle the harm alcohol causes, we need to urgently address its price. Alcohol duty is currently too low to cover the costs of alcohol harm to the NHS and other public services. Public Health England estimates that alcohol costs the UK at least £27 billion a year. Yet over the past five years, alcohol duty has raised just £10·5-£12·1 billion annually. To pay for the costs to society that alcohol imposes, stronger drinks should be taxed more. Reforming alcohol duty will help create a fairer system for everyone as well as improving our nation’s health.
With alcohol-related hospital admissions at record highs, and liver disease rates on the rise, we can’t afford for alcohol to remain at such low prices.

In other research

New annual mortality and morbidity statistics for Scotland showed a mixed outlook: there was a substantial improvement for the former, but not so for the latter.

The number of alcohol-specific deaths was 1,020 deaths in 2019, 10% down on the previous year’s tally of 1,136 (National Records of Scotland (NRS), 24 Nov).

2019 represents the first substantial decrease in recent years, after a period of general
increase since 2012, and is only the fourth occasion when there has been a reduction in alcohol-specific deaths of around 10% or more in a single year (in 2007, 2009 and 2012) since records began. However, the NRS was quick to note that ‘although an annual decrease of this magnitude is notable, further years will be required to see if this reduction continues and conclude that this is a sustained shift in alcohol-specific deaths in Scotland.’

 

In comparison, annual alcohol-related hospital statistics show incremental changes in admissions (35,781) and patient (23,685) numbers to general acute hospitals in 2019/20 compared with the previous year (Public Health Scotland, 17 Nov). There has been no significant improvement in numbers since 2012/13.

 

Researchers from the Behaviour and Health Research Unit at the University of Cambridge have developed a preliminary typology of drinking behaviours from existing evidence of the impact of glassware design on those behaviours, as a basis for reducing alcohol consumption to improve population health (Health Psychology Review, 18 Nov).
Despite the ‘paucity of evidence’ over the issue, the team were able to cut a distinction between macro (measures of drinking outcomes involving consumption, or proxies for consumption) and micro (a form of short-term influence on drinking) -drinking behaviours. They also explored the roles of two sets of possible underlying mechanisms – perception and affordance – in determining a drinker’s actions.
The study’s authors concluded that using this typology as a framework and starting point for understanding the micro-structure of a drinking episode may harness important insights for developing interventions aimed at reducing consumption, such as how an intervention works to reduce intake, plus other important effects on drinking behaviours ‘that may not be captured by a “macro” measure of drinking in a given study’.

 

Almost three quarters of 15 and 16-year-olds in Ireland have tried alcohol, with around half of these using alcohol ‘to make social gatherings more fun’, according to the new iteration of the European Schools Project for Alcohol and Other Drugs (ESPAD) (Irish Health, 17 Nov).
The survey of almost 2,000 secondary schoolchildren found that 73% of respondents had tried alcohol, while 41% had drunk alcohol in the previous 30 days. 49% said drinking made social gatherings more fun, while almost as many (48%) did so to enjoy a party. The most common age that teenagers began drinking alcohol was 15 (52%), and a sixth (16%) said they had been drunk in the previous 30 days.
The survey also found that increased alcohol use among the teens was associated with lower parental education levels and lower parental monitoring, truancy and lower school grades.

Nearly two in three people feel the current ‘drink responsibly’ message on bottles is too vague and should be replaced with specific health warnings, specialists at the Priory Group addiction and mental health service found (LBC, 18 Nov).
In a poll of 1,000 adults for Alcohol Awareness Week, 59% said beverages should display a cancer warning and eight in ten feel the UK ‘has a problem’ with binge drinking.

The 2019/20 adult substance misuse treatment statistics report published by Public Health England suggests that an estimated 82% of adults in need of specialist treatment for alcohol do not receive it (26 Nov).
Alongside small year-on-year changes to the numbers of adults in treatment, the figures showed that people in treatment for alcohol only are the second largest group (28%) of all adults in treatment, the majority of people (59%) who started treatment for drug and alcohol problems in 2019/20, said they had a problem with alcohol, with 65% (50,957) reporting that it was their only problem substance, and although still relatively high, the proportion of people with alcohol only problems leaving treatment free of dependence has fallen three percentage points since 2015/2016 (from 62%), hinting at the start of a declining trend.

SHAAP manifesto calls for total ban on alcohol advertising

Alcohol control campaign group Scottish Health Action on Alcohol Problems (SHAAP) have urged every candidate in next year’s Holyrood election to support a ‘total ban’ on alcohol advertising (STV News, 19 Nov).

Publishing their manifesto ahead of the vote in May, they list four ‘focus areas’ aimed at reducing alcohol-related harms that all parties should support:

• Affordability, availability and attractiveness
• Investing in and improving treatment and support services
• Supporting recovery and reducing health inequalities
• Protecting children and young people

The manifesto states that ‘as we approach the Scottish parliament election of 2021, it is more important than ever that we do not lose sight of long-term public health measures that can improve the health and wellbeing of everyone in Scotland, build the resilience of our NHS and local care services, and benefit the economy’.

SHAAP chair Dr Peter Rice said:

COVID-19 has shone a light on the patchy and often disjointed nature of alcohol treatment service provision, even prior to lockdown, and we do not yet know what long-term impact the pandemic will have on people’s drinking behaviours, though research so far indicates that heavier drinkers have increased their consumption.
Our 2021 manifesto highlights cost-effective, evidence-based policies that, if properly implemented, will work to ensure that COVID-19 does not exacerbate alcohol-related harm and health inequalities in Scotland and that we are able to meet long-term public health goals that are essential if we are to build a healthier, fairer future.

Online event on alcohol policy and nudge theory

🎵 Podcast feature 🎵

The Institute of Alcohol Studies (IAS) is holding a seminar exploring the latest evidence on nudge theory in alcohol policy, in conjunction with a new report (02 Dec).

Using a case study of UK Government alcohol policy since 2017, IAS research and policy officer Lucy Bryant examined the framing of individuals and alcohol industry actors within public health nudge policy interventions, revealing ways in which nudge theories risked undermining support for better evidenced public health alcohol measures such as pricing interventions in practice.

Bryant’s findings will be presented alongside new research from Professor Mark Petticrew (London School of Hygiene and Tropical Medicine), as well as insights from the gambling field from Philip Newall PhD (postdoctoral researcher at CQUniversity’s Experimental Gambling Research Laboratory).

Dr Gillian Shorter of Queen’s University Belfast, who is chairing the event, said:

With alcohol implemented in over half the Sustainable Development Goals, now really is a good time to act with responsible policies to preserve health… so we posit to you: to what extent can we use nudge policies for effective behaviour change, and to what extent do they crowd out other potentially more effective policy options? We invite you to come along, have your say, and tell us what you think.

For more details of the event and to register your attendance, please view the image below, or click on this link.

FASD: Invisible, Not Inconsequential

Adapted from the Queen’s Nursing Institute Scotland website

The Scottish Government has launched a free FASD eLearning resource on the NHS Education for Scotland (NES) website, a move that could have significant benefits for professionals and the individuals/families affected if widely used and shared.

Foetal Alcohol Spectrum Disorder (FASD) is both the most common and the most overlooked neurodevelopmental condition in Scotland. The Scottish Government estimates that approximately 172,000 children, young people and adults across the country have their lives and life chances adversely affected by FASD. And yet, only a small proportion of people with FASD have been diagnosed, actively assisted or effectively supported.

Created by a Scottish Government Expert Group, the eLearning resource aims to help overcome the longstanding misdiagnosis, misunderstanding and mistreatment of people with this life-altering condition.

For further information, please contact one of the members of the group, Dr Jonathan Sher, at jonathan.sher@qnis.org.uk or on 0744 333 1953.