Alcohol consumption and purchasing by ill drinkers in What might be the effect of a minimum price of 50p per unit? 2. “Strong cider in Scotland is all (or almost all) purchased by ill drinkers” ARUK 2016 Conference

6 months12 months18 months24 months Data collection Time-point 1 Time-point 2Time-point 3Time-point 4 MUPMUP Supplemented with Qualitative interviews Recruited: 639 (females = 181, males = 458) heavy drinkers, ‘harmed by alcohol’, recruited in Edinburgh and Glasgow. Data to be presented were collected at Time-point 1. MUPMUP Original study design

Inclusion criteria: Admitted to acute general hospital with an alcohol-related condition (n=190) Attending or admitted to an alcohol problems service (n= 449) Measures include: Drinks consumed in ‘last’ or ‘typical’ week: type, volume, price paid, location of purchase. Postcode -  SIMD (Scottish Index of Multiple Deprivation) (= approx socioeconomic group)

Data for wider Scottish population Alcohol purchasing Beeston et al (on behalf of the MESAS project team). Monitoring and Evaluating Scotland’s Alcohol Strategy. 3 rd Annual Report NHS Health Scotland; 2013 Alcohol-related hospital statistics Scotland for 2011/ Misuse/Publications/data-tables.asp?id=1493# Misuse/Publications/data-tables.asp?id=1493#1493 Prevalence of alcohol dependence (AUDIT score 20+) SHeS (2014) Scottish Health Survey. health-survey health-survey

Price distribution (%) of all drinks purchased as ‘Off sale’ by study group (data collected 2012). For comparison, population data from Robinson and Beeston (2013) (MESAS), produced from the Nielsen off-trade dataset (excluding discount retailers) are shown (% of all off-trade alcohol (L pure alcohol)) and sold in Scotland during Gill, J, Black, H, Chick J, Rush R et al (2015) Alcohol purchasing by ill heavy drinkers; cheap alcohol is no single commodity, Public Health (2015), Price band (ppu) Off sales purchases by price band: patients v. Scottish Population

What would be the effect of a minimum unit price of 50 pence/unit (according to the various patterns of purchasing among our patients)

SIMD % of quintile (n) Mean (SD) units per week Mean (SD) price currently paid (ppu) Potential impact of MUP on units (mean % reduction, range) % (215) (142.0) 33 (10)35.1 ( ) % (92)201.5 (118.3) 33 (10)34.5 ( ) 3 60% (60)270.1 (208.8) 34 (11)32.6 ( ) % (34)213.8 (141.5) 34 (11)32.9 ( ) % (31)181.3 (88.9) 36 (7)28.0 ( ) Drinkers purchasing exclusively from off-sale settings paying a mean price of less than 50ppu. (n=432)

White and strong amber cider (>6% ABV) In 2012 in Scotland 326,975 litres of pure alcohol were sold as strong cider off-license excluding unknown sales in discount supermarkets, Lidl and Aldi, whose share of total alcohol sales was thought to be 10%. What is the contribution made by dependent or ill drinkers’ purchases of strong cider to total purchases of strong cider in Scotland?

1. Acute hospital alcohol admissions In 2012, 24,742 unique patients age >19 were discharged from Scottish acute general hospitals with alcohol-related diagnoses. Our acute hospital patients ( n=190): averaged across all patients strong cider consumption was 42units/patient/week drink that for 1 week in 4 (13 weeks/year) =550units/year ** extrapolated 24,742 individual such patients admitted across Scotland =14,293,550u = 142,936L pure alcohol sold as strong cider. -accounts for 43.7% of sales of strong cider in that year (in press, Clinical Medicine, 2016)

2. Dependent drinkers Scottish Health Survey estimates that 1% of the population are ‘dependent’ drinkers (scoring 20+ on AUDIT). Using Scotland Census estimate for age group 30 to 65, that extrapolates to 55,410 individuals Our patients at alcohol treatment services n=449, Averaged across, 59units/patient/week as strong cider at 13 such weeks/year = 767u/year. ** extrapolated to 55,410 dependent drinkers in wider population = 424,994L pure alcohol sold as strong cider per annum -more than the reported national strong cider sales for that period 326,975 litres (in press, Clinical Medicine, 2016)

Conclusion Strong cider sales in Scotland is all (or almost all) accounted for by ill and dependent drinkers

Jan Gill Fiona O’May Robert Rush Barbara McPake Heather Black Cheryl Rees Jane Doogan Christine Galloway Lucie Michalova The Research Team Acknowledgements NHS Lothian Endowments Fund Scottish Mental Health Research Network Disclosure: J C is Medical Director, Castle Craig Hospital