Drinkaware, the industry funded alcohol awareness charity, has published new findings from its series of Monitor reports aiming to explore drinking behaviours, attitudes and other insights amongst drinkers in England.
The latest Monitor 2018 report [pdf] focuses on drinking behaviours, lifestyle and moderation. Whilst other national statistics and various research explores a range of drinking prevalence and attitudes, the 2018 Monitor report gathers insights based on an online sample of 8,906 UK adults aged 18 to 85, using segmentation and other measures not used elsewhere.
Drinkaware say the reports are used to inform their work to target and engage those drinking at risky or harmful levels, and its findings highlight the role of alcohol free days as the main moderation strategy for those seeking to cut down. A recent drink free days campaign was released earlier this year in partnership with Public Health England (PHE), resulting in widely publicised criticism of the national government body for partnering with an industry funded organisation. The decision led to Prof Ian Gilmore to quit his role in as a PHE advisor and an open letter of concern was signed by a large number of public health academics, though Drinkaware have emphasised they act entirely independently of their funders and that it is 'unequivocally committed to reducing alcohol harm'.
Consumption: more or less?
According to Monitor, 84% of adults report drinking at least once a year, and 12% say they never drink alcohol. Just over half (52%) of adults drink at least once a week, somewhat less than the 58% reported in the latest Opinions and Lifestyle Survey (OPN) data as used in the national alcohol statistics report. OPN also reports 20% of survey adults reported that they did not drink alcohol at all.
One fifth (20%) of Monitor respondents report exceeding the recommended guidelines of 14 units during the last week, with 17% drinking at increasing risk levels (15-49 units for men, and 15-34 units for women) and 3% drinking above these levels (higher risk). Drinking above the guidelines by gender was reported by 28% of men and 14% of women, also somewhat below the Health Survey England (HSE) figures of 31% of men and 16% of women.
However, the Monitor report also used AUDIT-C to assess risk level, finding significantly higher levels of alcohol misuse by this method. Based on AUDIT-C scores, 41% of respondents scored at a level indicating risky or harmful drinking (5 or more). Over a quarter (27%) fell within the ‘increasing risk’ category (scoring 5-7), and 15% scored 8-12 points, indicating harmful or possibly dependent alcohol use. Binge drinking (AUDIT-C question 3: drinking six or more units for women, or eight or more units for men) was reported by close to three-fifths (58%) of respondents who said they ever did, whilst 13% say that they typically do so weekly or more often.
Drinking perceptions: risk recognition?
A relatively unaddressed question relates to what proportion of alcohol misusers consider their drinking to be problematic in any way, or at least what they may say about it in response to survey questions about their drinking. In 2016 we reviewed several sources pertaining to this question, suggesting anywhere between 45% to 83% of at-risk drinkers not seeing their drinking as problematic or risky.
According to Monitor 2018 findings, nearly half (47%) of increasing/higher risk drinkers say their consumption is not above average when compared to other adults of similar age and gender, whilst 28% who say they drink more than their average demographic. One third of increasing/higher risk drinkers report they drink less than average, with 11% of this group reporting that they drink significantly less than average. The majority (63%) of all UK drinkers feel they drink less than average, whilst one in five (20%) believe themselves to drink about the same as similar others (of the same gender and age). Only a 14% of drinkers think they drink more than other people similar to them (11% believe they drink a bit more and 3% believe themselves to drink significantly more).
When it comes to future health risks, 76% of all drinkers believe that maintaining their current levels of alcohol consumption will be unlikely to cause increased health problems in the future, with a further 8% saying they do not know. However, 60% of increasing or higher risk drinkers say their current levels of consumption is unlikely to cause increased health problems, dropping only to 39% amongst higher risk drinkers. The majority (67%) of higher risk drinkers also felt that changing either their diet and/or exercise (or smoking if applicable) would have more positive impact on their health than changing their drinking.
Younger people are less likely to perceive themselves as drinking more than average, whilst drinkers with a high score for coping motivations for drinking are much more likely to. Alcohol purchasing behaviours such as buying on impulse, stocking up during a promotion or getting home deliveries were associated with recognition of drinking more than average
Ready to change?
Approximately one in six (16%) UK drinkers say they are currently changing their drinking habits. Men (17%) are only just slightly more like than women (15%) to be doing so. Middle aged drinkers (35-54) are most likely to say they sometimes think they should cut down their drinking (27% compared with 23% of those aged 18-34 and 24% of those aged 55+), though there is little difference by age in the proportion saying that they are actually changing their drinking.
Close to a third (29%) of higher risk drinkers say they are actually changing their drinking habits at present. In comparison, 22% of increasing risk drinkers and 8% of low risk drinkers are changing their drinking. Over one third (35%) of higher risk drinkers think they do not drink too much, rising to 68% of increasing risk drinkers. Drinkers with higher coping motivations for drinking are significantly more likely to sometimes think they should cut down their drinking (47%), versus those with lower coping motivations (21%). Increasing or higher risk scores are more likely to have sought advice from a GP or nurse (13% compared with five percent of low risk drinkers).
Moderation
The most common motivation for cutting down drinking is for a healthier lifestyle or to cut down on calories/lose weight (both 55%). Older drinkers are more motivated by general and physical health reasons, whilst younger drinkers were more likely to be motivated by mental wellbeing, to be more in control or to improve concentration.
Over half of drinkers who have recently considered or attempted to reduce their drinking do not cite a particular trigger. The most common trigger for thinking about decreasing alcohol consumption is advice from a doctor or other health professional (13%), followed by a spouse or partner (10%). The most popular techniques to cut down on drinking are to choose certain days in the week to avoid alcohol, with close to three quarters (72%) of those having attempted to change their drinking using alcohol free days. Just over half of those attempting to cut down have used other techniques such as sticking to the guidelines, swapping to non-alcoholic drinks, or avoided alcohol for a set period. Drinking at home was seen as the best opportunity to cut down drinking whilst going out for a meal was considered the least best, although older drinkers were less willing to cut down home drinking.
Proponents of brief interventions will note that most common behaviour change trigger was advice from a health professional, albeit that concerns exist over the levels of alcohol brief intervention in Primary Care as 'extremely low'.
Health problems
Two-thirds of UK drinkers (68%) were able to identify liver disease or damage as a condition linked to alcohol when unprompted; the only condition spontaneously mentioned by the majority of drinkers. Three in ten (29%) mentioned heart disease, and a close to a quarter (24%) mentioned cancer. Other conditions such as obesity, diabetes and mental health problems, were mentioned by approximately one in ten or fewer.
Once prompted, 92% of UK drinkers recognise liver disease as linked to alcohol. Three quarters associated alcohol with obesity (74%), and over two-thirds with mental health problems (71%), high blood pressure (70%), heart problems (69%) and erectile dysfunction (68%). When prompted, 54% of respondents recognised cancer as a condition linked to alcohol consumption.
Being of older age, higher socio-economic group and female was associated with higher recognition of links to health conditions, although younger and middle age groups are more likely than older drinkers to recognise the link to cancer. Higher risk drinkers were more likely to recognise the link between certain conditions such as stroke and high blood pressure, but not heart or mental health problems.
Non-drinkers
Of the 12% of adults who stated they never drink, 53% say they used to drink alcohol, while 43% have never drunk. Amongst former drinkers, around a third say they gave up either to improve their health generally (33%), or because they don’t like the physical effects that alcohol has on them (32%). Twenty-one percent say they gave up because it wasn’t fitting into their lifestyle anymore, or that they didn’t like the behavioural consequences. Close to a fifth (18%) say they gave up drinking as they felt their drinking was problematic.
Monitor insights & the broader context of alcohol policy
Drinkaware's Monitor reports undoubtedly offer a detailed level of insight into the attitudes and behaviours of drinkers in the UK, and Drinkware remains the most well-resourced and widely accessed source of information for drinkers. Many public health roles however fundamentally object to its existence as a largely industry funded body, and the debate is likely to be played out for as long as it exists. Others though claim to take what they see as a pragmatic stance, including PHE representatives who defended their decision to partner with Drinkaware partly on the basis that they must “deal with the world as we find it, not as we would like it to be”, despite "the potential dangers of engagement with industries, such as the alcohol industry, that profit from the sale of harmful products".
This purportedly pragmatic line of argument may also be further considered in the context of ever-diminishing government funded alcohol-related resources and support. Earlier this year, the last OPN data on alcohol consumption was released and follows ongoing cuts to the Office for National Statistics (ONS). This means an end to ONS drinking data across England, Wales and Scotland, making it harder to compare drinking between countries and removing a significant source of national survey data.
Perhaps in a similar vane, online NHS alcohol resources have also been boiled down to what may be argued as a bare bones and poorly worded web page, albeit that the One You and Drink Free Days campaign are the main government led alcohol communication. Others will point out that the reported crisis in treatment services is far more of an issue, with only one in five dependent drinkers people accessing help and numbers declining.
Whether the ever-diminishing status of publicly funded alcohol support is seen as a reason to accept or further reject resources derived from other funding sources will continue to feed into arguments over the role of industry funded bodies and public body partnerships. If the new national alcohol strategy follows in the steps of recent government policy, it is likely that an emphasis on such partnerships will continue to be a central theme.
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