Heather Black

The price of a drink: levels of consumption and price paid per unit of alcohol by Edinburgh's ill drinkers with a comparison to wider alcohol sales in Scotland

Aim To compare alcohol purchasing and consumption by ill drinkers in Edinburgh with wider alcohol sales in Scotland. Design Cross-sectional. Setting Two hospitals in Edinburgh in 2008/09. Participants A total of 377 patients with serious alcohol problems; two-thirds were in-patients with medical, surgical or psychiatric problems due to alcohol; one-third were out-patients. Measurements Last weeks or typical weekly consumption of alcohol: type, brand, units (1 UK unit 8 g ethanol), purchase place and price. Findings Patients consumed mean 197.7 UK units/week. The mean price paid per unit was £0.43 (lowest £0.09/unit) (£1 = 1.6 US

Alcohol purchasing by ill heavy drinkers; cheap alcohol is no single commodity

or 1.2€), which is below the mean unit price, £0.71 paid in Scotland in 2008. Of units consumed, 70.3% were sold at or below £0.40/unit (mid-range of price models proposed for minimum pricing legislation by the Scottish Government), and 83% at or below £0.50/unit proposed by the Chief Medical Officer of England. The lower the price paid per unit, the more units a patient consumed. A continuous increase in unit price from lower to higher social status, ranked according to the Scottish Index of Multiple Deprivation (based on postcode), was not seen; patients residing in postcodes in the mid-quintile paid the highest price per unit. Cheapness was quoted commonly as a reason for beverage choice; ciders, especially ‘white’ cider, and vodka were, at off-sales, cheapest per unit. Stealing alcohol or drinking alcohol substitutes was only very rarely reported. Conclusions Because patients with serious alcohol problems tend to purchase very cheap alcohol, elimination of the cheapest sales by minimum price or other legislation might reduce their consumption. It is unknown whether proposed price legislation in Scotland will encourage patients with serious alcohol problems to start stealing alcohol or drinking substitutes or will reduce the recruitment of new drinkers with serious alcohol problems and produce predicted longer-term gains in health and social wellbeing.

Heavy drinkers' perspectives on minimum unit pricing for alcohol in Scotland

Objectives Potential strategies to address alcohol misuse remain contentious. We aim to characterise the drink purchases of one population group: heavy drinkers in contact with Scottish health services. We contrast our findings with national sales data and explore the impact of socio-economic status on purchasing behaviour. Study design Cross-sectional study comparing alcohol purchasing and consumption by heavy drinkers in Edinburgh and Glasgow during 2012. Methods 639 patients with serious health problems linked to alcohol (recruited within NHS hospital clinics (in- and out-patient settings) 345 in Glasgow, 294 in Edinburgh) responded to a questionnaire documenting demographic data and last weeks or a ‘typical’ weekly consumption (type, brand, volume, price, place of purchase). Scottish Index of Multiple Deprivation quintile was derived as proxy of sociodemographic status. Results Median consumption was 184.8 (IQR = 162.2) UK units/week paying a mean of 39.7 pence per alcohol unit (£0.397). Off-sales accounted for 95% of purchases with 85% of those <50 pence (£0.5 UK) per alcohol unit. Corresponding figures for the Scottish population are 69% and 60%. The most popular low-priced drinks were white cider, beer and vodka with the most common off-sales outlet being the corner shop, despite supermarkets offering cheaper options. Consumption levels of the cheapest drink (white cider) were similar across all quintiles apart from the least deprived. Conclusions Heavy drinkers from all quintiles purchase the majority of their drinks from off-sale settings seeking the cheapest drinks, often favouring local suppliers. While beer was popular, recent legislation impacting on the sale of multibuys may prevent the heaviest drinkers benefiting from the lower beer prices available in supermarkets. Non-etheless, drinkers were able to offset higher unit prices with cheaper drink types and maintain high levels of consumption. Whilst price is key, heavy drinkers are influenced by other factors and adapt their purchasing as necessary.

The enigma of 'harmful' alcohol consumption: evidence from a mixed methods study involving female drinkers in Scotland

The irrefutable consequence of Scottish excessive alcohol consumption has prompted implementation and proposal of alcohol policy measures. The purpose of this study is to explore with heavy drinkers their awareness of and identify potential implications of policy introducing alcohol minimum unit pricing (MUP). Face-to-face semi-structured interviews were conducted with drinkers with alcohol-related harm (n = 20; 15 males, five females; aged 34 to 67 years old) in Scotland’s two largest cities (drinkers were participants within a larger quantitative study, through attendance for treatment for alcohol-related harms at National Health Service [NHS] centers). Median weekly consumption among participants was 130.7 units (range: 28-256.3 U.K. units). Views regarding the impact of increased alcohol prices, through MUP, were mixed. While some drinkers indicated potential reduction in intake, thus possibly reducing alcohol harms in the long term, the expected, or even desired, from a public health perspective, effects on consumption and associated harms might not be fully realized in this group. To mitigate possible unintended short-term detrimental effects of MUP on the most vulnerable, careful planning and appropriate resourcing may be required prior to implementation.

An exploration of the lived experiences of people with alcohol-related harm in Scotland

Background/aims: An appreciation of the drinking patterns of population subgroups may usefully inform tailored interventions. For this purpose, research has highlighted a need to better describe the drinking behaviour of UK women. This study aims to characterise the purchasing and consumption behaviour of female heavy, harmed, drinkers in contact with Scottish health services in two cities and to explore the factors that influence the link to harm. Methods: Mixed methods study involving cross-sectional survey questionnaires and one-to-one interviews (5). The questionnaires documented (1) demographic data (including derived deprivation score), last week’s (or ‘typical’ weekly) consumption (type, brand, volume, price, place of purchase), self-reported illnesses, and (2) Alcohol-Related Problem Questionnaire score. A total of 181 patients with serious health problems linked to alcohol were recruited within National Health Service (NHS) hospital clinics (in- and outpatient settings), in two Scottish cities during 2012. Results: Median consumption was 157.6 UK units for the recorded week, with almost exclusive purchase from ‘off-sale’ retail outlets. Preferred drinks were white cider, vodka and white wine. Increasing problems was positively associated with drinking more in the week, being younger and belonging to Glasgow. Conclusion: For Scottish women, the current definition of ‘harmful’ consumption likely captures a fourfold variation in alcohol intake, with gender differences less apparent. While current alcohol-related harm is positively associated with dose and being younger, there is clear evidence of an influence of the less tangible ‘Glasgow effect’. Future harm concerns are warranted by data relating to pattern, alcohol dose and cigarette use.

Strong cider sold in scotland appears to be almost exclusively for dependent drinkers

ABSTRACT Background: Alcohol consumption has posed well-documented problems for Scottish society in terms of morbidity, mortality, and wider societal costs. Objectives: To investigate the lived experiences and drinking behaviors of people with alcohol-related harm in Scotland against a backdrop of recent economic downturn, falling incomes, welfare reform, and changes to state benefits. Methods: As part of a larger Scottish study (2012–2014) of 639 individuals attending hospital or admitted, relating to an alcohol problem, 20 participants completed semistructured interviews about their drinking and purchasing habits that were subjected to thematic analysis. Conclusions: Key themes elucidated participants’ everyday drink-related behaviors within their local environment including drinking triggers, sourcing alcohol, resourcing alcohol purchase, and views relating to substitution. The majority of participants had experienced reduced income and adapted their alcohol-purchasing behaviors accordingly, including “trading down” to cheaper alcohol. A reduction in food purchasing and heating was a common outcome, as was falling into, or increasing current, debt. More attention should be paid to the prevalence and accessibility of alcohol within local communities. Ultimately, as long as there is highly visible and easily accessible cheap alcohol, heavy drinkers may struggle to undertake positive steps to reduce their damaging consumption levels.

White Cider Consumption and Heavy Drinkers: A Low-Cost Option but an Unknown Price

Sheron et al [1][1] suggested strong cider (>6.0% alcohol by volume) in the UK was particularly associated with alcohol-related illnesses. Beeston et al 2reported that in 2012 in Scotland 326,975 litres of pure alcohol were sold as strong cider off-licence, excluding unknown sales in discount