Types of Alcohol-related harm Common distinction: Health vs. crime/social –Relevant to who pays to clear up the mess –'Social' is flexible: public disorder through to workdays lost Alternatively: Short-term vs. long-term –Relevant to the kind of behaviour that causes the harm –Groups short-term health, e.g. hospital admissions for intoxication, with short-term crime, e.g. assault

Trends: A note on Survey Estimates of Quantity Consumed To calculate quantity consumed from answers to survey questions, we need to know how many units are in each of many kinds of drink In 2007, the numbers for these calculations were changed –This was a good thing, as they were very wrong at that time Wine was most affected, so women were most affected, as women drink more wine than men –Before: 1 glass of wine = 1 unit of alcohol –After: 1 glass of wine = 2 units of alcohol (or more if larger glass) This change makes it difficult to interpret trends from surveys

Trend: Quantity of Alcohol Consumed, GHS Changes mostly occurred in yr-olds. Other age groups were more stable

Trend: Quantity of Alcohol Consumed, GHS Changes mostly occurred in yr-olds. Other age groups were more stable

Trend: Convergence in Adolescent Drunkenness Emmanuel Kuntsche and colleagues Health Behaviour in School-aged Children survey: 80, year- olds in 24 countries; Europe and America Compare results from 1997/98 with 2005/06 How many times have you been drunk in your life? Results: Convergence between boys and girls, and between countries e.g. in the UK, both boys and girls reported less drunkenness in 2005/06 and the decrease was greater for boys In countries with lower levels of drunkenness, increases were found

Trend: Alcohol-related Hospital Admissions

Trend: Quantity of Alcohol Sold per Adult, HMRC

Affordability: Important, but not Straightforward Standard measure of affordability shows alcohol getting ever more affordable This is based on the price of alcohol relative to Retail Price Index BUT: If alcohol is cheap relative to a new TV, maybe youd go to the pub instead of getting a new telly If alcohol is cheap relative to food, maybe this means food has got expensive and you cant afford that bottle of wine in the weekly shop

Predicted Effects of a Minimum Price Petra Meier and colleagues Overall, a minimum price of 40p per unit of alcohol would reduce consumption by 2.6%, an average of 22 units per person per year Only the cheapest drinks are affected, so who buys these? Those who drink a lot: young, binge and harmful drinkers Reductions in consumption would be greatest for year-olds (4%) and harmful drinkers of all ages (4.5%) The impact would be less on year-old hazardous drinkers as they tend to drink in pubs, which would not be affected unless a two- tier minimum price was introduced

Polydrug use: Mixing Alcohol with Other Drugs Gillian Smith Moderate 39% Abstinent or very low 26% Heavy, memory loss 16% Mild, some 7% probs Heavy, many 6% probs Heavy, some 6% probs Multiple drugs 1.1% Some cannabis 5.4% No drug use 13.5% Multiple drug use 1.5% Increased risk of anxiety disorder Increased risk of suicide attempts Increased risk of suicide attempts

Some thoughts for discussion Consumption and binge drinking may be reducing, especially amongst young people Convergence? Immigration? Economics? Hospital admissions are still going up Most admissions are for long-term health consequences; maybe the result of drinking in previous years Drug use is an issue we need to be increasingly aware of Cannot be separated from alcohol use; need to look at the whole picture