Alcohol

Abstract

Alcohol has been used for thousands of years and, indeed, in very different ways. Two thousand years ago, the occupying Romans sipped wine regularly but reasonably moderately, and marvelled at the local English serfs who celebrated bringing in their crops with brief episodes of unrivalled drunkenness. The use of alcohol was not only tolerated but sometimes encouraged by the ruling classes as a way of subjugating the population and dulling their awareness of the conditions in which they had to live and work. The adverse impact of gin consumption was famously recorded by Hogarth’s painting of ‘Gin Lane’ but, at the same time, beer was reckoned a safer alternative to water for fluid intake and was linked to happiness and prosperity in the sister painting of ‘Beer Street’. It was against the ‘pernicious use of strong liquors’ and not beer that the president of the Royal College of Physicians, John Friend, petitioned Parliament in 1726. Some desultory attempts were made by Parliament in the eighteenth century to introduce legislation in order to tax and control alcohol production but they were eventually repealed. It was really the onset of the Industrial Revolution in nineteenth-century England that brought into sharp relief the wasted productivity and lost opportunity from excess consumption. England moved from a rural, relatively disorganized workforce to an urban, more closely scrutinized and supervised one—for instance, in factories, where men needed their wits about them to work heavy machinery, workers that were absent (in body or mind) were noticed. And, in Victorian Britain, there arose a greater social conscience—an awareness, for example, of the harm, through neglect, inflicted on the children of those who spent their wages and their days in an alcoholic stupor. Nonetheless, the per capita consumption of alcohol in the UK at the end of the nineteenth century was greater than it is today. It fell progressively through the first half of the twentieth century, with two marked dips. The first coincided with the introduction of licensing hours restrictions during the First World War, and the second with the economic depression of the 1930s. Following the Second World War, there was a doubling of alcohol consumption between 1950 and the present day, to about 10 l of pure alcohol per capita. There has been a small fall of 9% in the last 5 years; this may be, in part, related to the changing ethnic mix and increasing number of non-drinkers. There has always been a mismatch between the self-reported consumption in lifestyle questionnaires, and the data from customs and excise, with the latter being 40% greater. From the latter, it can be estimated that the average consumption of non-teetotal adults in England is 25 units (0.25 l of pure alcohol) per week, which is well above the recommended limits of 14 units for women, and 21 units for men. Of course, average figures hide population differences, and it is estimated that the heaviest-consuming 10% of the population account for 40% of that drunk. While men continue to drink, on average, about twice the amount that women do, the rate of rise of consumption in women has been steeper. Average consumption is comparable across socio-economic groups but there is evidence of both more teetotallers and more drinking in a harmful way in the poorest group. In 2007, 13% of those aged 11–15 admitted that they had drunk alcohol during the previous week. This figure is falling, but those who do drink are drinking more. The average weekly consumption of pupils who drink is 13 units/week. Binge drinking estimates are unreliable, as they depend on self-reporting in questionnaires. In the UK, they are taken as drinking twice the daily recommended limits of 4 units for men, and 3 units for women, on the heaviest drinking day in the previous week. In 2010, 19% of men, and 12% of women, admitted to binge drinking, with the figures being 24% and 17%, respectively, for those aged 16–24. The preferred venue for drinking in the UK has changed markedly, mainly in response to the availability of cheap supermarket drink. Thirty years ago, the vast majority of alcohol was consumed in pubs and restaurants, whereas, in 2009, the market share of off-licence outlets was 65%. However, drinkers under 24 years of age still drink predominantly away from home. The UK per capita consumption is close to the European average, but consumption has been falling in Mediterranean countries and rising in northern and eastern Europe. Europe has the highest consumption of all continents, but there is undoubtedly massive under-reporting in many countries, particularly because of local unregulated production and consumption. It is estimated that less than 10% of consumption is captured in statistics in parts of Africa.