Alcohol consumption Updated April 2014

Alcohol consumption Factsheet

Institute of Alcohol Studies Alliance House 12 Caxton Street London SW1H 0QS

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Tel: 01480 466766 Email: [email protected]

Website: www.ias.org.uk

Table of contents Alcohol consumption: Introduction

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Total consumption in the UK

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A good measure: Units and drinking guidelines

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Drinking patterns and trends

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Alcohol consumption in the European Union

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Alcohol consumption: Introduction Alcohol consumption in Great Britain has risen per head of the adult population during the post-war years, more than doubling between the mid-1950s and late 1990s, when it hit double fgures for the frst time. It has fallen slightly from a peak of 11.6 litres in 2004; periods of slow economic activity in recent years may have contributed to this relative decline. Men consume on average more than twice as much alcohol – mainly beer – on a weekly basis as women, although in terms of amounts drunk, women now consume more units of wine than men in total. There has also been a long-term increase in the proportion of alcohol purchased from offlicenced outlets and consumed at home rather than in pubs and bars; British Beer & Pub Association (BBPA) fgures estimate that twice as much alcohol is now bought from offlicenced premises as from pubs and other on-licenced premises. This is thought to be due to the increased affordability of alcoholic beverages from off-licence vendors, relative to the cost of purchasing drinks in pubs and bars.

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Total consumption in the UK Figure 1 below displays the long-term trends in UK alcohol consumption since 1980. The latest available data estimates total alcohol consumption in the UK at 9.4 litres per head for those aged 15 years and older and 7.7 litres per head on average throughout the entire population in 2013.1 This forms part of a recent downward trend from a peak of 11.6 and 9.5 litres per head respectively in 2004. Figure 1: UK Total Alcohol Consumption, litres per head, 1980 – 2013

Source: British Beer & Pub Association (BBPA)

Recorded UK alcohol consumption per head for drinkers 15 years of age and over frst hit double digits in 1997, rising to a peak of 11.5 litres in 2004. 2012 was the frst year in which recorded UK adult alcohol consumption fell below 10 litres per head since 1999. Recorded UK alcohol consumption in total has remained broadly in line with trends in adult consumption, also peaking in 2004 at a high of 9.5 litres per head, before declining to 8 litres in 2012. It is important to note that these fgures do not take into account the levels of unrecorded alcohol consumed. For instance, the National Audit Offce (NAO) estimates that the tax gap for beer duty accounted for up to 14% of the UK market in 2009-2010. 2 Unrecorded alcohol consumption in the UK includes the consumption of homemade or informally produced alcohol – legal or illegal – smuggled alcohol, alcohol intended for industrial or medical uses, alcohol obtained through cross-border shopping (which is recorded in a different jurisdiction), as well as consumption of alcohol by tourists. The World Health Organisation (WHO) estimates UK unrecorded alcohol consumption to be approximately 1.7 litres per head (for the population aged 15+ years). 3 Data on alcohol consumption comes from a variety of sources. Every year, the British Beer and Pub Association (BBPA) publishes a compilation of drinks industry statistics incorporating data from producers, retailers and other relevant sources on alcohol production, as well as government fgures on the revenue accrued from UK sales of alcoholic beverages, collected by HM Revenue and Customs (HMRC). The Offce for National Statistics (ONS) also provides data on alcohol consumption in the 4

UK, in conjunction with the Health & Social Care Information Centre (HSCIC). Alcohol consumption fgures were published in the annual General Lifestyle Survey (GLS) * until its discontinuation in 2012. Subsequent data appear in Opinions & Lifestyles Survey releases. Statistics on Alcohol publications also offer an insight into the demographic distribution of alcohol consumption throughout England, as do the Health Survey England reports. By its own admission, the ONS states that: Obtaining reliable information about drinking behaviour is diffcult, and social surveys consistently record lower levels of consumption than would be expected from data on alcohol sales. This is partly because people may consciously or unconsciously underestimate how much alcohol they consume. Drinking at home is particularly likely to be underestimated because the quantities consumed are not measured and are likely to be larger than those dispensed in licensed premises. 4 If this is the case, then it can be assumed that offcial statistics on the consumption of alcohol are conservative estimates. Data collected by HMRC can be seen as more robust than self-reporting via surveys in that it shows the actual volume of alcohol bought and sold. However, this too cannot be seen as wholly representative of UK alcohol consumption as it does not include unrecorded alcohol. 1 2 3 4

Sheen, David (August 2013), ‘Statistical Handbook 2013’, British Beer & Pub Association (BBPA), London: Brewing Publications Limited, p. 28 National Audit Offce (NAO) (January 2012), ‘Renewed Alcohol Strategy: A Progress Report’, p. 4 World Health Organisation (WHO) (2011), ‘Global status report on alcohol and health’, p. 277 Offce for National Statistics (ONS), ‘Chapter 2 – Drinking (General Lifestyle Survey Overview – a report on the 2011 General Lifestyle Survey)’

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The General Lifestyle Surveys provided a snapshot of the habits and attitudes of nearly 8,000 families and people living in private households in Great Britain

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A good measure: Units and drinking guidelines What is a unit of alcohol? In the UK, consumption of alcoholic drinks is measured in units. Units are a simple way of expressing the quantity of pure alcohol in a drink, offering a standardised comparison of the volume of pure alcohol between alcoholic beverages. 1 They are calculated as follows:

Number of millilitres in drink x Alcohol By Volume (%) = Number of units 1,000 In the UK, 1 unit is equal to 8 grammes of pure alcohol, which is also equivalent to 10 millilitres of pure ethanol (alcohol). This takes approximately an hour for the average adult to process in the body (although there are many varying factors which mean all drinkers process alcohol differently).2 The number of grammes that make up a unit varies between countries. ** UK low risk drinking guidelines The current advice from the Department of Health regarding alcohol consumption is that, in order to minimise the risk of health harms associated with drinking: 3 • • • •

Men should drink no more than 21 units of alcohol per week, no more than 4 units in any given day, and have at least 2 alcohol-free days a week Women should drink no more than 14 units of alcohol per week, no more than 3 units in any given day, and have at least 2 alcohol-free days a week Pregnant women or women trying to conceive should not drink alcohol at all. If they do choose to drink, to minimise the risk to the baby, they should not drink more than 1–2 units of alcohol once or twice a week and should not get drunk Children should not drink alcohol at all, but if they do, they should be at least 15 years old, never drink more than once a week, supervised by a parent or carer, and never exceed the recommended adult daily limits (3–4 units of alcohol for men and 2–3 units for women)

Hazardous drinking is defned as a pattern of drinking which brings about the risk of physical or psychological harm. This occurs when a person regularly drinks over the recommended daily limit. The cumulative effect over a week's worth of drinking will most likely exceed 21 units for men and 14 units for women. Harmful drinking, a subset of hazardous drinking, is defned as a pattern of drinking which is likely to cause physical or psychological harm. 4 Men who drink more than 50 units in the course of a week are classifed as harmful drinkers, as are women who consume over 35 units. Figure 2 depicts the difference in consumption levels between moderate, hazardous and harmful drinkers.

** A comprehensive international roundup of drinking guidelines by nation is available on Wikipedia

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Figure 2: Alcohol consumption levels, in units, by sex

Source: Dr Holmes, John et al., ‘Minimum Unit Pricing & Banning Below Cost Selling: Estimated policy impacts in England 2014/15’, Sheffeld Alcohol Research Group, School of Health and Related Research, University of Sheffeld

History of UK drinking guidelines The current recommended drinking guidelines were originally based on evidence submitted in a report by the Royal College of Physicians (RCP) to the UK government in 1987. This report acknowledged that there was “insuffcient evidence to make completely confdent statements about how much alcohol is safe”. 5 However, in making the judgement that the public needed to be informed about the risks associated with drinking, it suggested the following guidelines for 'sensible limits of drinking': • • • •

Men – no more than 21 units per week Women – no more than 14 units per week Both men and women should have 2 or 3 alcohol-free days The total number of weekly units should not be drunk in 1 or 2 bouts

These guidelines were based on the underlying assumption that they did not apply to children and adolescents, to adults who had particular health problems or a family history of alcohol problems or to women during pregnancy. In 1995, the recommendations were reviewed by an inter-departmental government working group, following the publication of scientifc evidence stating that small amounts of alcohol may have a protective effect against coronary heart disease. Despite this fnding, leading health experts – including the British Medical Association (BMA) 6 and the RCP – came to the conclusion that the 1987 guidelines were still the most appropriate means of communicating to the public the risks associated with drinking. 7 However, it was agreed that further clauses could be added to take account of short term episodes of heavy drinking which was argued to often correlate strongly with both medical and social harm. The Sensible Drinking report called for the establishment of daily benchmarks to help individuals ‘decide how much to drink on single occasions and to avoid excessive drinking with its attendant health and social risks’. 8 These new guidelines recommended that 'men should not regularly drink more than 3–4 units of alcohol a day and women should not regularly drink more than 2–3 units a day', and advised against the consumption of alcohol for at least 48 hours after an episode of heavy drinking, in order to allow affected parts of the body to recover fully. The transition from weekly to daily guidelines effectively increased the weekly limit for men by 33% and women 50%, exceeding the previous threshold for low risk drinking as presented by the medical profession. These changes were met with concern by members of the health community, as they contradicted the evidence base and seemingly 7

recommended 'safe' levels of drinking that were in fact over and above what was deemed a 'low risk' threshold. The 1995 report also extended the reach of the original recommendations to include guidance for pregnant women. They were warned against drinking alcohol – especially in the frst three months of the pregnancy to lower the risk of miscarriage – but that if they did still drink, to consume not more than 1–2 units of alcohol once or twice a week and not to become intoxicated. In 2009 the Chief Medical Offcer (CMO) for England introduced a new guideline, that no children under the age of 15 years should consume alcohol, after evidence indicated that drinking before this age increased the risk of alcohol dependency in later life and also affected cognitive development. The CMO guidance recommended: An alcohol-free childhood is the healthiest and best option, but; 9 • • •

If children do drink alcohol, they should not do so until at least 15 years old; If 15 to 17 year-olds drink alcohol, it should be rarely, and never more than once a week. They should always be supervised by a parent or carer; and If 15 to 17 year-olds drink alcohol, they should never exceed the recommended adult daily limits (3–4 units of alcohol for men and 2–3 units for women)

In December 2011, the House of Commons Science and Technology Committee launched an inquiry into the current UK drinking guidelines, calling for a review of the evidence that had emerged since 1995 on the health risks associated with drinking, and also on levels of public understanding of the guidelines. The Committee received evidence from a number of organisations, including public health interest groups and the alcohol industry. The Science and Technology Committee report, published in January 2012, concluded: There are suffcient concerns about the current drinking guidelines to suggest that a thorough review of the evidence concerning alcohol and health risks is due. The Department of Health and devolved health departments should establish a working group to review the evidence and advise whether the guidelines should be changed. In the meantime, the evidence suggests that (i) in the context of the current daily guidelines, the public should be advised to take at least two alcohol-free days a week; and (ii) the sensible drinking limits should not be increased. 10 The Coalition Government's Alcohol Strategy, published in March 2012, accepted a need to improve the UK public's poor understanding of and adherence to the current drinking guidelines, with around a third of adult men and a ffth of adult women drinking above the recommended limits. In order to tackle this problem, the Government has tasked the CMO with overseeing a review of the drinking guidelines, which will: … take account of available science on how we can best communicate the risks from alcohol, improving the public's understanding of both personal risks and societal harms. This will include whether separate advice is desirable for the maximum amount of alcohol to be drunk in one occasion and for people over 65. This could complement the existing guidelines for young people and women who are pregnant or trying to conceive. 11 The CMO review is ongoing and more information will be published on the issue when it becomes available. 1 2 3 4 5

BBC News Health (November 2011), ‘Health Explained: What is a unit of alcohol?’ NHS Choices, ‘Alcohol Units’ Patient.co.uk, ‘Alcohol and Sensible Drinking’ Health & Social Care Information Centre (HSCIC) (May 2012), ‘Statistics on Alcohol: England, 2012’, p. 9 Royal College of Physicians (1987), ‘The medical consequences of alcohol abuse, a great and growing

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evil’, Tavistock Publications Ltd British Medical Association (BMA) (1995), ‘Alcohol: guidelines on sensible drinking’, BMA, London Royal College of Physicians, Royal College of Psychiatrists, Royal College of General Practitioners (1995), ‘Alcohol and the Heart in Perspective, sensible limits reaffrmed’, Oxprint, Oxford 8 Department of Health (December 1995), ‘Sensible Drinking – The report of an Inter-Departmental Working Group’, DH, London, p. 24 9 Donaldson, Liam, (Sir) (December 2009), ‘Guidance on the consumption of alcohol by children and young people. A report by the Chief Medical Offcer’, Department of Health, pp. 13–29 10 House of Commons Science and Technology Committee (December 2011), ‘Alcohol guidelines: eleventh report of session 2010-12’, p. 3 11 Secretary of State for the Home Department (March 2012), ‘The Government's Alcohol Strategy’, p. 24 6 7

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Drinking patterns and trends Average weekly alcohol consumption by age and sex On the 2011 GLS, respondents were asked 2 sets of questions about their drinking behaviour resulting in the following 2 measures of alcohol consumption: • •

maximum amount drunk on any one day in the previous seven days; average weekly alcohol consumption

Questions to establish average weekly alcohol consumption were included on the GLS from 2008. These questions ask respondents about their drinking behaviour in the 12 months before interview. The measure was developed in response to earlier medical guidelines suggesting maximum recommended weekly amounts of alcohol of 21 units for men and 14 units for women.1 In 2012, the survey vehicle for collecting drinking data changed from the GLS to the Opinions and Lifestyle Survey (OPN). This was accompanied by a reduction in questions asked on topics covered by the GLS, including some of the questions required in order to establish average weekly alcohol consumption. OPN data answers questions regarding the number of units consumed on a person’s heaviest drinking day in the last week, to allow for an easier comparison with offcial daily alcohol limit guidance. Health Survey England reports continue to publish average weekly alcohol consumption statistics for England. These show (see Figure 3 below) that in 2012, men consumed a mean average of 17 units in the last week, compared with 10.2 units for women. Men aged 55–64 years of age consumed the most number of alcohol units of all age groups. For women, the age group that consumed the most units was aged 45–54 years. For both sexes, the age group consuming fewest units on average were aged the over 75s. Figure 3: Estimated weekly alcohol consumption, by age and sex, units, 2012

Source: Adapted from Health & Social Care Information Centre (HSCIC) (December 2013), Health Survey England 2012, Table 6.12, p. 28

OPN data also highlight the differences in the drinking habits of those who consume above the recommended guidelines on the heaviest drinking day of the week. Figure 4 depicts this variation by age and sex between 2005 and 2012.

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Figure 4: Amount of alcohol drank on heaviest drinking day in the last week, by age and sex, 2005–2012

Source: Adapted from Offce for National Statistics (ONS) (December 2013), ‘Opinions and Lifestyle Survey, Drinking Habits Amongst Adults, 2012’, Table 2

Trend data from the OPN survey show that the proportion of people who exceeded 4/3 units on their heaviest drinking day of the week declined between 2005 and 2012. 7% fewer men (41% – 34%) and 8% fewer women (34% – 26%) drank above recommended guidelines on at least one day in the last week over the period. The highest proportion of male respondents surveyed who consumed alcohol above the recommended guidelines in the last week were between 25–44 years of age. 4 out of every 10 males (40%) did so in 2012, 8 percentage points down on 2005–2007 (48%). The largest decline over the 7-year period occurred among 16–24 year-old males; the proportion of those who exceeded 4/3 units on their heaviest drinking day of the week was 16 percentage points down on 2005 (from 46% to 30%). The proportion of female respondents surveyed who consumed alcohol above the recommended guidelines in the last week in 2012 are similar for all working age groups (30% for 16–24 and 45–64 year-olds; 29% for 25–44 year-olds). The largest decline over the period occurred among 25–44 year-old women; the proportion of those who exceeded 4/3 units on their heaviest drinking day of the week was 12 percentage points down on 2005 (from 42% to 29%). Binge drinking Researchers usually defne “binge drinking” or “heavy episodic drinking” as men consuming at least 8 – and women at least 6 – standard units of alcohol in 24 hours, that is, double the maximum recommended ‘low risk limits’. It must be noted however, that this classifcation does not apply in practice to everyone because the tolerance and the speed of drinking in a session varies from person to person. 2 It is still possible to drink hazardously this way, even if people drink only once or twice a week and keep within the recommended weekly limit. Figure 5 compares the proportion of binge drinkers in Great Britain between 2005 and 2012, by age and sex.

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Figure 5: Amount of alcohol drank on heaviest drinking day in the last week, by age and sex, 2005–2012

Source: Adapted from ONS, ‘Opinions and Lifestyle Survey, Drinking Habits Amongst Adults, 2012’, Table 2

OPN survey trend data show that the proportion of people who exceeded 8/6 units on their heaviest drinking day of the week declined between 2005 and 2012. Over this period, 4% fewer men (23% – 19%) and 4% fewer women (15% – 11%) drank at least twice above recommended guidelines on at least one day in the last week. For both sexes, the steepest decline in over the period occurred among 16–24 year-olds; 10% fewer people in this age group binge drank on their heaviest drinking day in the last week compared with 7 years ago. Of all age categories and for both sexes, the proportion of 65+ year-olds who drank above recommended guidelines was consistently below average. Frequency The Drinking Habits Amongst Adults tables in the OPN survey also show the frequency with which alcoholic beverages are consumed over the course of a week in Great Britain (Figure 6).

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Figure 6: Proportion who Drank Alcohol in the Last Week, by Age and Gender, 2005– 2012

Source: Adapted from ONS, ‘Opinions and Lifestyle Survey, Drinking Habits Amongst Adults, 2012’, Table 1

In 2012, 64% of British men and 52% of British women were reported to have had an alcoholic drink in the last week. 14% of men and 9% of women claimed to have done so on 5 or more days in the week. Older drinkers (45–64 and 65+ year-olds) were most likely to consume alcohol most frequently. In 2012, 45–64 year-olds were most likely to have drunk alcohol in the last week (71% men; 59% women) and 65+ year-olds were most likely to have done so on at least 5 days in the last week (23% men; 14% women). 2012’s fgures represent a continuation of the trend in consumption frequency that sees older people drinking most often of all age groups. Since 2006, 45–64 year-olds have been most likely to consume alcohol in the last week, and 65+ year-olds have been most likely to do so on 5 or more days over the same time period. Type of drink consumed Offcial survey data provides a comprehensive breakdown of the average weekly consumption of alcohol by drink type, under the categories of sex and age (see Figure 7 below).

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Figure 7: Types of Alcoholic Drink Consumed on Heaviest Drinking Day in the Last Week, by Age and Gender

Source: Adapted from ONS, ‘Opinions and Lifestyle Survey, Drinking Habits Amongst Adults, 2012’, Table 5

In 2012, beer and wine were the most popular alcoholic drinks chosen for consumption by British drinkers on their heaviest drinking day in the last week. Men were most likely to drink beer on their heaviest drinking day in the week (59%), almost twice that of the next most popular alcoholic beverage of choice (wine, 30%). Of all beer drinkers, 16–24 yearold males were most likely to consume the drink at both normal and strong alcoholic strengths. Women were most likely to drink wine on their heaviest drinking day in the last week (64%), more than twice that of the next most commonly consumed alcoholic beverage (spirits or liqueurs). This was best exemplifed in the 45–64 year-old age group, where 70% of women drank wine on their heaviest drinking day of the week compared with 19% who drank spirits or liqueurs and 15% who drank regular strength beers and ciders. 16–24 year-olds were an exception; women in this age category were most likely to drink spirits or liqueurs on their heaviest drinking day in the last week (47%), compared with 42% who consumed wine. It is important to note that even offcial fgures underestimate the actual level of UK alcohol consumption, as they do not account for unrecorded levels of consumption. The World Health Organisation (WHO) describes unrecorded alcohol as: … alcohol that is not taxed and is outside the usual system of governmental control, because it is produced, distributed and sold outside formal channels. Unrecorded alcohol consumption... includes consumption of homemade or informally produced alcohol (legal or illegal), smuggled alcohol, alcohol intended for industrial or medical uses, alcohol obtained through cross-border shopping (which is recorded in a different jurisdiction), as well as consumption of alcohol by tourists. 3 As a result, it is diffcult to calculate the actual amount of alcohol consumed. The most recent WHO estimates believe UK unrecorded alcohol consumption to amount to approximately 1.7 litres per head for the population aged 15+ years. 4

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On-trade versus off-trade consumption Figure 8 demonstrates the increasing disparity between on and off-trade consumption that has occurred in recent years. On-trade consumption among adults in the UK – drinking alcohol purchased from venues such as pubs, nightclubs and hotels – has declined by 1.8 litres since 2002, from 5 to 3.2 litres per person 15 years and older in 2012. In contrast, off-trade consumption – drinking alcohol purchased from retailers in a domestic capacity – increased slightly over the same period, from 6.2 to 6.4 litres per head. Off-trade consumption reached a peak in 2007 at 7.2 litres per person aged 15 years and older, and now stands at approximately twice the level of alcohol consumed in the ontrade. 2011 also marks the joint biggest difference (with 2008) between on- and off-trade consumption levels in the last decade, as the average Briton 15 years and older consumed 3.4 litres more alcohol inside than outside the home, although fewer litres of alcohol were consumed per person in total compared with 2008 fgures. Figure 8: On versus off-trade consumption in UK, litres per person (15 years and older) of 100% alcohol consumed, 2002–2012

Source: Sheen, David (August 2012), 'Statistical Handbook 2013', British Beer & Pub Association (BBPA), London: Brewing Publications Limited, pp. 37–38 1 2 3 4

Offce for National Statistics (ONS), ‘Chapter 2 – Drinking (General Lifestyle Survey Overview – a report on the 2011 General Lifestyle Survey)’ NHS Choices, ‘Alcohol misuse – Defnition’ WHO (2011), ‘Global status report on alcohol and health’, p. 5 WHO, p. 277

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Alcohol consumption in the European Union According to international data, the average Briton consumed 10.2 litres of alcohol (defned as beer, wine or spirits) per head in 2010. Leaving aside Luxembourg – because of the high volume of purchases by non-residents in this country – Austria, France, Latvia, Lithuania and Romania reported the highest consumption of alcohol, with 12 litres or more per adult in 2010. At the other end of the scale, mainly southern European countries (Cyprus, Greece, Italy, Malta) have relatively low levels of consumption, in the region of 7– 8 litres of pure alcohol per adult. Figure 9: Alcohol consumption in the EU, litres per head, 2010

Source: Organisation for Economic Co-operation and Development (OECD), Health Data 2012; WHO Global Information System on Alcohol and Health

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