Alcohol consumption

Updated August 2013

Alcohol consumption Factsheet

Institute of Alcohol Studies Alliance House 12 Caxton Street London SW1H 0QS Tel: 020 7222 4001 Email: info@ias.org.uk

Institute of Alcohol Studies Elmgren House

1 The Quay St Ives

Cambridgshire PE27 5AR

Tel: 01480 466766

Email: info@ias.org.uk

Website: www.ias.org.uk

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Table of contents Alcohol consumption: Introduction 3

Total consumption in the UK 4

A good measure: Units and drinking guidelines 6

Drinking patterns and trends 10

Alcohol consumption in the European Union 19

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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 figures for the first time. It has fallen slightly from a peak of 11.5 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 off-licenced outlets and consumed at home rather than in pubs and bars; British Beer & Pub Association (BBPA) figures estimate that twice as much alcohol is now bought from off-licenced 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 The latest available data estimates total alcohol consumption in the UK at 10 litres per capita for those aged 15 years and older and 8.3 litres per capita on average throughout the entire population in 2011.1 This forms part of a recent downward trend from a peak of 11.5 and 9.5 litres per capita respectively in 2004. However, Figure 1 below demonstrates the long-term increase in UK alcohol consumption since 1975, when average consumption per capita was 9 litres for the UK population older than 15 years and 6.9 litres on average as a whole. Figure 1: UK Total Alcohol Consumption, 1975 to 2011, litres per capita

Source: British Beer & Pub Association (BBPA), Statistical Handbook 2012 Recorded UK alcohol consumption per capita for drinkers 15 years of age and over first reached double figures in 1997, rising to a peak of 11.5 litres in 2004 and remaining above 10 litres per head since 1998. 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 capita, before declining to 8.3 litres in 2011. These figures do not, however, take into account the levels of unrecorded alcohol consumed. For instance, the National Audit Office (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 a country 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. 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

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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 figures on the revenue accrued from UK sales of alcoholic beverages, collected by HM Revenue and Customs (HMRC). The Office for National Statistics (ONS) also provides data on alcohol consumption in the annual General Lifestyle Survey (GLS), which provides a snapshot of the habits and attitudes of nearly 8,000 families and people living in private households in Great Britain. Statistics on Alcohol, produced in conjunction with the Health & Social Care Information Centre (HSCIC), offers an insight into the demographic distribution of alcohol consumption throughout England. The respondents to the 2010 GLS were asked questions about their drinking in the week prior to interview, in particular: “how often over the last year they have drunk normal strength beer; strong beer (6% or greater alcohol by volume (ABV)); wine; spirits; fortified wines and; alcopops, and how much they have usually drunk on any one day”. The answers to these criteria formed the basis for the statistics on average per capita alcohol consumption in the UK. By its own admission, the GLS states that:

Obtaining reliable information about drinking behaviour is difficult, 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, it can be assumed that the ONS statistics on the consumption of alcohol are conservative estimates, as 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 Sheen, David (August 2012), 'Statistical Handbook 2012', British Beer & Pub Association (BBPA),

London: Brewing Publications Limited, p. 36 2 National Audit Office (NAO) (January 2012), 'Renewed Alcohol Strategy: A Progress Report', p. 4 3 World Health Organisation (WHO) (2011), 'Global status report on alcohol and health', p. 277 4 Office for National Statistics (ONS) (March 2012), 'General Lifestyle Survey Overview Report 2010', p. 16

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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:

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 defined 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 defined 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 classified 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

Number of millilitres in drink x Alcohol By Volume (%) 1000

= Number of units

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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’, Sheffield Alcohol Research Group, School of Health and Related Research, University of Sheffield 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 “insufficient evidence to make completely confident 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 scientific evidence stating that small amounts of alcohol may have a protective effect against coronary heart disease. Despite this finding, 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',

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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 the health community, as they contradicted the evidence base and seemingly 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 first 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 Officer (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 sufficient 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 fifth 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:

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… 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 here when it becomes available. 1 BBC News Health (November 2011), 'Health Explained: What is a unit of alcohol?' 2 NHS Choices, 'Alcohol Units' 3 Patient.co.uk, 'Alcohol and Sensible Drinking' 4 Health & Social Care Information Centre (HSCIC) (May 2012), 'Statistics on Alcohol: England, 2012', p. 9 5 Royal College of Physicians (1987), 'The medical consequences of alcohol abuse, a great and growing

evil', Tavistock Publications Ltd 6 British Medical Association (BMA) (1995), 'Alcohol: guidelines on sensible drinking', BMA, London 7 Royal College of Physicians, Royal College of Psychiatrists, Royal College of General Practitioners

(1995), 'Alcohol and the Heart in Perspective, sensible limits reaffirmed', 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 Officer', 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

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Drinking patterns and trends Average weekly alcohol consumption, by age and sex Data from the 2010 General Lifestyle Survey (GLS)1 is used to illustrate the average number of units of alcohol consumed by persons aged 16 and over in the UK in the last week and the distribution of heavy drinkers' consumption habits, by age and by sex (see Figure 3). Figure 3: Average weekly alcohol consumption (units)

Source: ONS, 'Table 2.5a: Average weekly alcohol consumption (units), by sex and age', in GLS 2010 Men consumed on average more than twice as much alcohol on a weekly basis as women, with the 16-24 age group being the exception to the trend and having the narrowest gap in consumption levels between the sexes. The GLS data also illuminates the variation in each age cohort's drinking patterns, making a distinction between moderate and heavy drinkers. The Medical Students' Handbook places heavy drinkers into two categories, hazardous and harmful (please see the previous section of this factsheet for the full definitions).2 Figure 4 depicts the variation among excessive drinkers of both sexes at different ages.

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Figure 4: Proportion of hazardous and harmful drinkers in Great Britain, by age and sex (%), 2010

Source: Adapted from ONS, 'Table 2.2: Weekly alcohol consumption level: percentage exceeding specified amounts by sex and age, 2005–2010', in GLS 2010 The highest proportion of respondents surveyed in the 2010 GLS who consumed alcohol to a hazardous level in the last week for both sexes were between the ages of 45 and 64 years. 30% of men in this age group consumed more than 21 units of alcohol in the last week, with 7% of them qualifying as having drunk to a harmful level (50 units and over). 20% of women in the same age group drank more than the recommended limit (14 units), with 4% of 45 to 64 year-olds drinking to a harmful level (at least 35 units) in the last week. The lowest proportion of hazardous alcohol drinkers were aged 65 and over. 9% of women and 20% of men in this cohort were in this category.

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Frequency The GLS also shows the frequency at which drinkers consume alcoholic beverages over the course of a week (Figure 5). Figure 5: Average frequency of alcohol consumption in last year3

Source: ONS, 'Table 2.5b: Average frequency of alcohol consumption in last year', in GLS 2010 In England, in 2010, 87% of men were reported to have had an alcoholic drink at least once in the last year. 16% of drinkers claimed to have done so on 5 or more days in the week. Men aged 65 and over exceeded this average (27%), compared to only 4% of all male respondents aged between 16 and 24 years claiming to have done the same. Across all age groups, most male drinkers did so once or twice a week (30%). From the 81% of women who were reported to have consumed alcohol in the last year, 10% consisted of women who had a drink on 5 or more days in the week. A greater

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proportion of women aged 45 and over consumed alcohol on this basis (14% for those aged 65 and over), compared to the proportion of 16-24 year-olds who did the same (1%), even though the older age group accounted for the lowest proportion of hazardous drinkers. Like their male counterparts, most female drinkers claimed to have done so once or twice a week (26%). This average is largely reflected in the younger cohorts of female drinkers, of whom 28% of respondents aged 16-24 and 29% of those aged between 25-44 consume alcohol on this basis. Binge drinking Researchers usually define “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 classification does not apply in practice to everyone because the tolerance and the speed of drinking in a session varies from person to person.4 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 6 compares the proportion of binge drinkers in England between 2000 and 2010, by sex.

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Figure 6: Binge drinkers in England, 2000-2010**

Source: Adapted from Health & Social Care Information Centre (HSCIC), 'Drinking in the week prior to interview among adults, by age and gender, 1998 to 2010' in Chapter 2: Drinking behaviour among adults and children, Statistics on Alcohol England, Table 2.2 There has been a slight downward trend in binge drinking levels in England over the last four years; from 2007 highs of 25% and 16%, the percentage of both male and female consumers who binge drink has fallen to 19% and 12%, respectively.

** Measure = The method used for calculating the number of units drunk was updated for the 2006 survey.

The change is designed to take into account changes in the way drinks are served and the changing strength of drinks. Two sets of data are included in the table for 2006; one is calculated using the original method and one with the improved method of calculating units. The earlier method is presented to allow for comparisons with 2006 data to previous years, and the improved method is our best estimate of current alcohol consumption. The resulting difference in 2006 in reported alcohol consumption between the old and new method does not reflect an increase in drinking. More info needed here about the change in methodology – and perhaps a link to the survey itself (See (8) for the relevant dataset).

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Type of drink consumed Official 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):5

The data is calculated by recording how many pints, glasses, measures or bottles/cans of different types of alcoholic drink a respondent would usually consume on any one day in the past 12 months and how often each type of drink is usually consumed. From this information average weekly alcohol consumption is broken down into the number of units consumed by alcohol type for both sexes.6

Figure 7: Average weekly consumption of different types of drink, by gender and age, 2009, Great Britain

Source: HSCIC and ONS The most recent unit-specific dataset – published in 2009 – shows that beer was the most popular drink among men of all ages (60%) and that it was most popular with young male drinkers; beer contributed to 68% of alcohol consumed by 16 to 24 year-olds (see Figure 8a). This age group also consumed a greater amount of spirits as a proportion of total male consumption (3.3 units per head), followed by those aged 65 and over (2.3 units). The amount of wine drunk as a proportion of total consumption was highest among men aged 45 and over, making up roughly a third of the consumption levels of both 45 to 64 year olds (32%) and those aged 65 and over (35%).

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Figure 8a: Proportion of average weekly units accounted for by each type of drink among men, 2009

Source: HSCIC, Proportion of average weekly units accounted for by each type of drink, 2009 in 'Statistics on Alcohol England', Table 2.9, pp. 19–20. Extract from Drinking: Adults' behaviour and knowledge, 2009 Omnibus Survey Compared to men, women were proportionately less likely to drink beers (19%) and more likely to drink wine (59%) (see Figure 8b). In terms of amounts drunk, they drank more units of wine than men, despite consuming less alcohol in total; 5.4 units on average compared to 4.0 units for men. Women’s beer consumption was much lower than men’s, an average of 1.9 units compared with 9.3 units. Among women aged 16 to 24, spirits were the most popular type of drink, followed by wine. Among older women, wine was at least three times more popular than the next alcoholic beverage, accounting for up to 70% of average weekly alcohol consumption for 45-64 year-olds. The amount of fortified wine as a proportion of women’s total consumption was highest among those aged 65 and over. They consumed approximately 0.5 units of fortified wine a head, which made for 9% of total alcohol consumption for that age group. The consumption of alcopops was greatest with young women; at 1.7 units a head, it accounted for 16% of the alcohol consumption of women aged 16-24 years.

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Figure 8b: Proportion of average weekly units accounted for by each type of drink among women, 2009

Source: HSCIC, Proportion of average weekly units accounted for by each type of drink, 2009 in 'Statistics on Alcohol England', Table 2.9, pp. 19–20. Extract from Drinking: Adults' behaviour and knowledge, 2009 Omnibus Survey However, both sources underestimate the actual level of UK alcohol consumption, as they do not factor in 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.7

As a result, it is difficult to calculate the actual amount of alcohol consumed. The WHO estimates that UK unrecorded alcohol consumption is around 1.7 litres per capita for the population aged 15+ years.8

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On-trade versus off-trade consumption BBPA figures highlight an increasing disparity between on and off-trade consumption in Great Britain over the last decade. Figure 9 shows that since 2001, on-trade consumption – drinking alcohol purchased from venues such as pubs, nightclubs and hotels – has declined by 1.7 litres, from 5 to 3.3 litres per person in 2011. In contrast, off-trade consumption – drinking alcohol purchased from retailers in a domestic capacity – increased by 0.9 litres over the same period, from 5.8 to 6.7 litres per person. Off-trade consumption reached a peak in 2007 at 7.2 litres per capita. It is now more than twice the level of alcohol consumed in the on-trade. 2011 also marks the joint biggest difference (with 2008) between on- and off-trade consumption levels in the last decade, as the average Briton over the age of 15 consumed 3.4 litres more of alcohol inside than outside the home, although fewer litres of alcohol were consumed per person in total compared with 2008 figures. Figure 9: On versus off-trade consumption in UK, litres per person (15 years and older) of 100% alcohol consumed, 2001–2011

Source: Sheen, David (August 2012), 'Statistical Handbook 2012', British Beer & Pub Association (BBPA), London: Brewing Publications Limited, pp. 37–38 1 ONS (March 2012), Drinking Tables in 'General Lifestyle Survey (GLS) 2010' 2 The Medical Council on Alcoholism (1998), 'The Medical Students' Handbook: ALCOHOL AND HEALTH',

3rd ed, London: Artfriends, glossary 3 ONS, 'Table 2.5b: Average frequency of alcohol consumption in last year' 4 NHS Choices, 'Alcohol misuse – Definition' 5 HSCIC, 'Proportion of average weekly units accounted for by each type of drink, 2009' in Statistics on

Alcohol England, Table 2.9, pp. 19–20. Extract from Drinking: Adults' behaviour and knowledge, 2009 Omnibus Survey

6 HSCIC, Statistics on Alcohol England, p. 19 7 WHO (2011), 'Global status report on alcohol and health', p. 5 8 WHO, p. 277

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Alcohol consumption in the European Union Figure 10: Alcohol consumption per head in the EU

Source: BBPA, Statistical Handbook 2012 According to BBPA figures, the average Briton consumed 7.5 litres of alcohol (defined as beer, wine or spirits) per head in 2009.*** This places the country in Category B of consumer countries in the EU region (A being the lowest and E being the highest; see Figure 12). The countries with the highest number of litres of alcohol consumed per capita in the EU that year were Austria (AT, 10.2), Czech Republic (CZ, 12.8) and Romania (RO, 10.5). The countries with the lowest amounts consumed per head were Italy (IT) and Sweden (SE), drinking an average of 6.8 and 6.1 litres respectively. *** Excluding cider; when added UK increases to 8.4 litres per capita

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Figure 11: Alcohol consumption per head in the EU, graphical interpretation, by category

Source: BBPA, Statistical Handbook 2012