Cheap Alcohol Research Articles

Off-premise alcohol purchasing in Australia: Variations by age group, income level and annual amount purchased.

To delineate what type and how much alcohol is purchased from different types of off-licence premises and how this varies across demographic sub-groups, as a basis for public debate and decisions on pricing and planning policies to reduce alcohol-related harm in Australia. The data on alcohol purchasing from off-licence premises are taken from the Australian Alcohol Consumption and Purchasing survey-a nationally representative landline and mobile telephone survey in 2013 on the experiences with alcohol consumption and purchasing of 2020 Australians aged 16+. The present analysis uses data from 1730 respondents who purchased alcohol from off-licence premises in the previous 6 months. The majority (54%) of alcohol purchased from off-licence premises was sold from liquor barns (large warehouse-style alcohol stores), with bottle shops (31%) the second most common outlet. Cask wine was the cheapest alcohol available at off-licence premises in Australia. Respondents in higher alcohol purchasing quintiles and with those with lower income purchased a higher percentage of cheaper alcohol in their total volume of purchasing than lower purchasing quintiles and those with middle and higher income, and younger respondents purchased more expensive alcohol than older age groups. A minimum unit price or increasing alcohol taxes may effectively reduce alcohol purchasing for lower income heavy alcohol purchasers and older age groups from off-licence premise sources, and may be less effective on younger age groups. [Jiang H, Callinan S, Livingston M, Room R. Off-premise alcohol purchasing in Australia: Variations by age group, income level and annual amount purchased. Drug Alcohol Rev 2017;36:210-219].

The effect of price increases on predicted alcohol purchasing decisions and choice to substitute

Introduction: Few studies have undertaken to explore whether people who consume particular alcoholic beverages have a greater tendency to substitute with cheaper alcohol in response to price increases. The aim of this study was to investigate the effect of price increases on alcohol purchasing decisions, specifically the influence on brand and cross-beverage substitution across demographic, drinking level and socio-economic factors.Method: Data on participants’ alcohol purchasing habits and consumption were collected via an online survey, including their reactions to three price increases to alcoholic beverages types previously purchased. Data were analysed using logistic regression, with substitution behaviour the dependent variable, controlling for demographic and socio-economic factors.Results: Responses to different price increases varied by drinking level, which was consistently and significantly associated with likelihood of substitution behaviour across beverage types. For a 50% increase in price, regardless of whether participants purchased beer, wine, bottled spirits or premixed spirits, drinking at levels which put participants at high risk of short-term harms was associated with a higher likelihood of substitution with cheaper brands or beverage types (OR: 1.729; OR: 1.787; OR: 1.729 and OR: 1.729, respectively).Conclusions: No consistent trends in responses occurred according to respondent characteristics, suggesting that increasing price may be an effective tool to influence purchasing behaviour across the population. Results also suggested that those who drink at levels which put them at high risk of short-term harms may be more likely to circumvent price increases by switching to a cheaper product.

Article Commentary: Ireland's financial crisis and its influence on alcohol and drug issues

Budget 2009 (announced in December 2008) increased tax on alcohol, resulting in a drop in consumption; Budget 2010 decreased tax and consumption increased; Budget 2013 increased tax and, again, consumption decreased. Prior to the crash of 2008, a shift in the pattern of alcohol purchasing, from pub or ‘on-premise’ to supermarket or ‘offlicence’ purchasing had already emerged; this was a shift which had been facilitated by the introduction in the year 2000 of more liberal licensing regulations (Hope, 2014). What this meant in practice was that the number of pubs declined while, between 2002 and 2009, the number of off-licence retail outlets doubled (Revenue Commissioners Annual Reports). One key influence on the expansion of the off-licence sector was the abolition in 2006 of the Groceries Order. This meant that, for the first time, Irish retailers could now sell alcohol at below-cost price; and supermarkets in particular, were quick to seize the advantage of using very cheap alcohol as a loss leader which would increase ‘footfall’, thereby increasing their customer bases

Alcohol purchasing by ill heavy drinkers; cheap alcohol is no single commodity

ObjectivesPotential strategies to address alcohol misuse remain contentious. We aim to characterise the drink purchases of one population group: heavy drinkers in contact with Scottish health services. We contrast our findings with national sales data and explore the impact of socio-economic status on purchasing behaviour. Study designCross-sectional study comparing alcohol purchasing and consumption by heavy drinkers in Edinburgh and Glasgow during 2012. Methods639 patients with serious health problems linked to alcohol (recruited within NHS hospital clinics (in- and out-patient settings) 345 in Glasgow, 294 in Edinburgh) responded to a questionnaire documenting demographic data and last week's or a ‘typical’ weekly consumption (type, brand, volume, price, place of purchase). Scottish Index of Multiple Deprivation quintile was derived as proxy of sociodemographic status. ResultsMedian consumption was 184.8 (IQR = 162.2) UK units/week paying a mean of 39.7 pence per alcohol unit (£0.397). Off-sales accounted for 95% of purchases with 85% of those <50 pence (£0.5 UK) per alcohol unit. Corresponding figures for the Scottish population are 69% and 60%. The most popular low-priced drinks were white cider, beer and vodka with the most common off-sales outlet being the corner shop, despite supermarkets offering cheaper options. Consumption levels of the cheapest drink (white cider) were similar across all quintiles apart from the least deprived. ConclusionsHeavy drinkers from all quintiles purchase the majority of their drinks from off-sale settings seeking the cheapest drinks, often favouring local suppliers. While beer was popular, recent legislation impacting on the sale of multibuys may prevent the heaviest drinkers benefiting from the lower beer prices available in supermarkets. Non-etheless, drinkers were able to offset higher unit prices with cheaper drink types and maintain high levels of consumption. Whilst price is key, heavy drinkers are influenced by other factors and adapt their purchasing as necessary.

Brands matter: Major findings from the Alcohol Brand Research Among Underage Drinkers (ABRAND) project

Background: Alcohol research focused on underage drinkers has not comprehensively assessed the landscape of brand-level drinking behaviours among youth. This information is needed to profile youth alcohol use accurately, explore its antecedents and develop appropriate interventions. Methods: We collected national data on the alcohol brand-level consumption of underage drinkers in the United States and then examined the association between those preferences and several factors including youth exposure to brand-specific alcohol advertising, corporate sponsorships, popular music lyrics, and social networking sites and alcohol pricing. This paper summarises our findings, plus the results of other published studies on alcohol branding and youth drinking. Results: Our findings revealed several interesting facts regarding youth drinking. For example, we found that: (1) youth are not drinking the cheapest alcohol brands; (2) youth brand preferences differ from those of adult drinkers; (3) underage drinkers are not opportunistic in their alcohol consumption, but instead consume a very specific set of brands; (4) the brands that youth are heavily exposed to in magazines and television advertising correspond to the brands they most often report consuming and (5) youth consume more of the alcohol brands to whose advertising they are most heavily exposed. Conclusion: The findings presented here suggests that brand-level alcohol research will provide important insight into youth drinking behaviours, the factors that contribute to youth alcohol consumption and potential avenues for effective public health surveillance and programming.

Alcohol, Young People and Urban Life

AbstractMoving beyond the current academic pre‐occupation with the night‐time economy and drinking venues, this paper highlights the specificities of outdoor drinking cultures in streets and parks. Instead of viewing outdoor drinking as morally transgressive – as promoted in the popular press – it is contended that outdoor drinkscapes are distinctly appealing over commercial premises for some young urbanites. Streets and parks enable young people to feel socially and physically unrestricted whilst consuming alcohol; provide a space where young people can drink with friends who are not old enough to consume alcohol in commercial premises; and allow drinkers a chance to consume relatively cheap alcohol. Accounts of young people in urban public spaces are typically one of intergenerational conflict, whereby adults seek to exclude or marginalise young people or, at least, try to control their presence and activities. However, in attempting to understand young people's alcohol consumption experiences in outdoor urban spaces, a series of complex personal geographies emerge in which not only adult–young people relations but also young people–young people relations play an important role. Whilst some progress has been made in exposing the diversity of young people's drinkscapes, it is argued that much of the existing literature renders young people's drinking spaces static, bounded terrains. This paper turns to suggest that the ‘new mobilities paradigm’ can be drawn upon to develop and enrich the geographies of young urbanites' outdoor alcohol consumption experiences. It is argued that the extant literature on alcohol‐related mobilities is predominantly concerned with a ‘pointillist’ understanding of mobility. It is contended that Bissell's () alternative conceptualisation of mobility as a ‘loop’ is a more apt means of capturing the more pointless every night mobilities of many young people; particularly the mobilities of those who are not old enough/choose not to consume alcohol in commercial premises, and choose instead to spend their evenings traversing outdoor drinkscapes. It is also asserted that the embodied, emotional and affective elements of young people's alcohol‐related im/mobilities need to be much more prominent if understandings of the lived experiences of young urbanites' drinking geographies are to be unearthed.

I don’t Think there’s Anything Else the Politicians can do: Alcohol Policy in Scotland from the Perspective of People with Alcohol-Related Harm

Damage at a national level is an irrefutable consequence of excessive alcohol consumption in Scotland. In light of recent alcohol policy measures implemented, and proposed, by the Scottish Government, this study interviewed heavy drinkers in order to explore level of awareness of recent alcohol legislation and perceptions of any impact personally; and to elicit views regarding the cost of alcohol in Scotland, increases in alcohol price and the potential implications of Minimum Unit Pricing (MUP) should it be implemented, at a personal and general population level. We conducted semi structured interviews face-to-face with people with alcohol related harm (n=20) in Scotland’s two largest cities. The interviews revealed several themes. Recent alcohol policy has not greatly impacted drinkers with alcohol related harm in Scotland, arguably because cheap alcohol is still readily accessible. Proposed policy to introduce (MUP) for alcohol, designed to reduce consumption and associated harms at a population level by increasing the price of the cheapest alcohol, may perhaps not have the desired effect in those who are drinking large volumes of alcohol. It may initially cause further adverse effects to those who are alcohol dependent by removing abruptly the source of cheap alcohol with associated health risks, and requiring an increase in the funds needed to be paid to maintain high levels of consumption, with financial and potentially social impacts. The unique pattern of drinking described by this group underscores the need for a more accurate modeling of the ramifications of MUP. To mitigate some negative short-term effects of the Act on those most affected by it, health and social resources will be required.

Commentary on Ally et al. (2014): Increasing the price of cheap alcohol would contribute to decreasing health inequalities.

Alcohol prices are a powerful instrument for alcohol policymakers for impacting alcohol consumption and related harms 1. In the policymaker's toolkit, the main tool for increasing alcohol prices has been taxation, with the implicit assumption that taxes are passed through to prices. The conditions and boundaries of this assumption have been studied surprisingly little, and the study by Ally et al. 2 is a welcome contribution. In the study, the pass-through rates are examined by product type and price category in the United Kingdom, and the results show that in connection with tax increases, the prices of cheaper—higher–selling—products are raised less than the prices of more expensive products. This has implications for how an increase in alcohol excise duties may be expected to affect consumption, and hence harms, in various consumer groups. This is particularly relevant from the viewpoint of addressing increasing socio-economic disparities in alcohol-related harm. Socio-economic disparities in overall mortality and morbidity are large whether measured by educational, occupational or income differences 3, 4, and in many countries in Europe and the United States these disparities have grown considerably over the past decades 5, 6. For example, in the United Kingdom, men in the highest occupational category were, at the beginning of the 2000s, expected to live 5.8 years and women 3.5 years longer than men and women in the lowest occupational category, which is a considerable increase from the difference of 4.9 years and 2.3 years observed 20 years earlier 7. Closing these gaps has been identified as one key health challenge within the European Union 8. Socio-economic disparities in alcohol-related mortality are also high, and often even higher than those for overall mortality 9, 10. This has not always been the case, however. In England and Wales the relative index of inequality in male liver cirrhosis mortality by social class rose from 0.88 [lower mortality in lower socio-economic status (SES) categories] in 1961 to 1.4 (higher mortality in lower SES categories) in 1981, and an even stronger shift was reported for men in Scotland (from 0.6 to 1.67) 11. Since then, alcohol-related mortality in the United Kingdom has increased even further 12, and at the beginning of the 2000s, alcohol-related mortality was reported to be 3.5 greater in the routine occupational class compared to the higher and managerial occupations among men, and 5.7 times greater among women 10. In this same period, with increasing alcohol-related mortality and mortality differentials, the price of alcohol has fallen relative to personal disposable income 13, 14, which has meant that consumption habits leading to liver cirrhosis and other alcohol-related diseases are increasingly within the reach of everyone. From Finland, there is more direct evidence that alcohol has played a central role in the increasing inequalities in overall mortality 9. It is extremely important to prevent severe alcohol-related harm in the lower socio-economic groups, where the burden is the greatest. The price of alcohol is particularly relevant in this group, making it a useful tool. Against this background, Ally et al.'s results are highly important. It is known that heavier drinkers and particularly heavy drinkers with lower incomes tend to purchase cheaper alcohol 15. Ally et al. show that it is exactly in this cheapest price category where increased taxes are not passed through to prices. In other words, commercially operated companies are unwilling to increase the price of the alcoholic beverages for which this would be most important from a public health viewpoint, i.e. the cheapest alcohol which is bought and consumed in greatest quantities, by the heaviest drinkers, and hence lead to most harm. This renders tax increases less efficient from the public health viewpoint than they would be with an evenly distributed tax pass-through. Minimum unit pricing would in this case be an ideal supplement, a targeted measure, which would have little impact on moderate drinkers, even those with low incomes 15. Minimum unit pricing would therefore be highly justified as an efficient method to combat harmful drinking and to reduce alcohol-related harm and its high socio-economic disparities. None.

Impact of minimum price per unit of alcohol on patients with liver disease in the UK

The slow epidemic of liver disease in the UK over the past 30 years is a result of increased consumption of strong cheap alcohol. When we examined alcohol consumption in 404 subjects with a range of liver disease, we confirmed that patients with alcohol-related cirrhosis drank huge amounts of cheap alcohol, with a mean weekly consumption of 146 units in men and 142 in women at a median price of 33p/unit compared with £1.10 for low-risk drinkers. For the patients in our study, the impact of a minimum unit price of 50p/unit on spending on alcohol would be 200 times higher for patients with liver disease who were drinking at harmful levels than for low-risk drinkers. As a health policy, a minimum unit price for alcohol is exquisitely targeted at the heaviest drinkers, for whom the impact of alcohol-related illness is most devastating.

Alcohol tax pass-through across the product and price range: do retailers treat cheap alcohol differently?

Effective use of alcohol duty to reduce consumption and harm depends partly on retailers passing duty increases on to consumers via price increases, also known as 'pass-through'. The aim of this analysis is to provide evidence of UK excise duty and sales tax (VAT) pass-through rates for alcohol products at different price points. March 2008 to August 2011, United Kingdom. Panel data quantile regression estimating the effects of three duty changes, two VAT changes and one combined duty and VAT change on UK alcohol prices, using product-level supermarket price data for 254 alcohol products available weekly. Products were analysed in four categories: beers, ciders/ready to drink (RTDs), spirits and wines. Within all four categories there exists considerable heterogeneity in the level of duty pass-through for cheaper versus expensive products. Price increases for the cheapest 15% of products fall below duty rises (undershifting), while products sold above the median price are overshifted (price increases are higher than duty increases). The level of undershifting is greatest for beer [0.85 (0.79, 0.92)] and spirits [0.86 (0.83, 0.89)]. Undershifting affects approximately 67% of total beer sales and 38% of total spirits sales. Alcohol retailers in the United Kingdom appear to respond to increases in alcohol tax by undershifting their cheaper products (raising prices below the level of the tax increase) and overshifting their more expensive products (raising prices beyond the level of the tax increase). This is likely to impact negatively on tax policy effectiveness, because high-risk groups favour cheaper alcohol and undershifting is likely to produce smaller consumption reductions.

"It's the population, stupid": why changing the policy frame should help Scotland tackle its problem with cheap alcohol.

"It's the population, stupid": why changing the policy frame should help Scotland tackle its problem with cheap alcohol.

The ebb and flow of attitudes and policies on alcohol in Ireland 2002–2010

This paper examines the level of public support for alcohol control policies during a period of policy evolution in Ireland. A comparison of attitudes to alcohol policy at three points in time was undertaken. The first survey took place in 2002 and was repeated in 2006 and 2010 using a national quota sample of 1000 adults with face-to-face interviews. Policy areas examined were drunk-driving, price, availability and promotion. In 2002, the highest level of public support was for drink-driving countermeasures (84% favoured random breath testing) and measures to restrict alcohol promotions (67% favoured restrictions). Support for stricter measures on price and availability was lower. Trends showed a decline in support for tax increases and for early closing time, whereas support for fewer outlets (off-trade) increased. When public concerns (level of support) for stricter alcohol policies were seen to be meet, as occurred with price and hours through increased tax and reversal of opening hours, public concern/support declined. When concerns were not met, as with outlets, support continued to rise most likely influenced by greater number of off-trade outlets and cheaper alcohol. Support for liberal alcohol policies was low and the majority favoured the status quo on price and availability. Public support for policy is one element of the complexity of policymaking along with consensus building across government and management of vested interests, so that the policy outcome is seldom assured.

Putting a price on alcohol

Medical students are renowned for their love of cheap alcohol, and rates of alcohol abuse in the medical professionals are well documented. Students and doctors aren’t alone in this—Britain, like many countries in Europe, faces a public health crisis over the widespread overconsumption of alcohol. An issue that the UK government has flip-flopped over is the introduction of minimum unit pricing to try and drive up the cost of alcohol. In their feature on p 16 , Alice Buchan and Sally Marlow look at the evidence behind …

Harms to ‘others’ from alcohol consumption in the minimum unit pricing policy debate: a qualitative content analysis of UK newspapers (2005–12)

Background and aimsMinimum unit pricing is a fiscal intervention intended to tackle the social and health harms from alcohol to individual drinkers and wider society. This paper presents the first large-scale qualitative examination of how newsprint media framed the debate around the harms of alcohol consumption to ‘others’ during the development and passing of minimum unit pricing legislation in Scotland.MethodsQualitative content analysis was conducted on seven UK and three Scottish national newspapers between 1 January 2005 and 30 June 2012. Relevant articles were identified using the electronic databases Nexis UK and Newsbank. A total of 403 articles focused on the harms of alcohol consumption to ‘others’ and were eligible for detailed coding and analysis.ResultsAlcohol harms to wider society and communities were identified as being a worsening issue increasingly affecting everyone through shared economic costs, social disorder, crime and violence. The availability of cheap alcohol was blamed, alongside a minority of ‘problem’ youth binge drinkers. The harm caused to families was less widely reported.ConclusionsIf news reporting encourages the public to perceive the harms caused by alcohol to wider society as having reached crisis point, a population-based intervention may be deemed necessary and acceptable. However, the current focus in news reports on youth binge drinkers may be masking the wider issue of overconsumption across the broader population.

Are there more positive alternative celebration opportunities to Schoolies Week?

Schoolies week is purported to have started in 1979 on the Gold Coast by graduates of private single-sex schools.* During the early 1980s the Gold Coast attracted schoolies from all over Australia, with this phenomena spreading to many popular tourist spots around the country, and more recently to overseas destinations, especially Bali. Over the years schoolies week has become synonymous with beaches, sun, alcohol, drugs and sex – and also community concern, thanks to the high media presence it attracts.

Implications for alcohol minimum unit pricing advocacy: What can we learn for public health from UK newsprint coverage of key claim-makers in the policy debate?

On May 24th 2012, Scotland passed the Alcohol (Minimum Pricing) Bill. Minimum unit pricing (MUP) is an intervention that raises the price of the cheapest alcohol to reduce alcohol consumption and related harms. There is a growing literature on industry's influence in policymaking and media representations of policies, but relatively little about frames used by key claim-makers in the public MUP policy debate. This study elucidates the dynamic interplay between key claim-makers to identify lessons for policy advocacy in the media in the UK and internationally. Content analysis was conducted on 262 articles from seven UK and three Scottish national newspapers between 1st May 2011 and 31st May 2012, retrieved from electronic databases. Advocates' and critics' constructions of the alcohol problem and MUP were examined. Advocates depicted the problem as primarily driven by cheap alcohol and marketing, while critics' constructions focused on youth binge drinkers and dependent drinkers. Advocates justified support by citing the intervention's targeted design, but critics denounced the policy as illegal, likely to encourage illicit trade, unsupported by evidence and likely to be ineffective, while harming the responsible majority, low-income consumers and businesses. Critics' arguments were consistent over time, and single statements often encompassed multiple rationales. This study presents advocates with several important lessons for promoting policies in the media. Firstly, it may be useful to shift focus away from young binge drinkers and heavy drinkers, towards population-level over-consumption. Secondly, advocates might focus on presenting the policy as part of a wider package of alcohol policies. Thirdly, emphasis on the success of recent public health policies could help portray the UK and Scotland as world leaders in tackling culturally embedded health and social problems through policy; highlighting past successes when presenting future policies may be a valuable tactic both within the UK and internationally.

Tackling Alcohol Misuse

Alcohol consumption is associated with a range of health and social harms that increase with the level of consumption. Policy makers are interested in effective and cost-effective interventions to reduce alcohol consumption and associated harms. Economic theory and research evidence demonstrate that increasing price is effective at the population level. Price interventions that target heavier consumers of alcohol may be more effective at reducing alcohol-related harms with less impact on moderate consumers. Minimum pricing per unit of alcohol has been proposed on this basis but concerns have been expressed that 'moderate drinkers of modest means' will be unfairly penalized. If those on low incomes are disproportionately affected by a policy that removes very cheap alcohol from the market, the policy could be regressive. The effect on households' budgets will depend on who currently purchases cheaper products and the extent to which the resulting changes in prices will impact on their demand for alcohol. This paper focuses on the first of these points. This paper aims to identify patterns of purchasing of cheap off-trade alcohol products, focusing on income and the level of all alcohol purchased. Three years (2006-08) of UK household survey data were used. The Expenditure and Food Survey provides comprehensive 2-week data on household expenditure. Regression analyses were used to investigate the relationships between the purchase of cheap off-trade alcohol, household income levels and whether the household level of alcohol purchasing is categorized as moderate, hazardous or harmful, while controlling for other household and non-household characteristics. Predicted probabilities and quantities for cheap alcohol purchasing patterns were generated for all households. The descriptive statistics and regression analyses indicate that low-income households are not the predominant purchasers of any alcohol or even of cheap alcohol. Of those who do purchase off-trade alcohol, the lowest income households are the most likely to purchase cheap alcohol. However, when combined with the fact that the lowest income households are the least likely to purchase any off-trade alcohol, they have the lowest probability of purchasing cheap off-trade alcohol at the population level. Moderate purchasing households in all income quintiles are the group predicted as least likely to purchase cheap alcohol. The predicted average quantity of low-cost off-trade alcohol reveals similar patterns. The results suggest that heavier household purchasers of alcohol are most likely to be affected by the introduction of a 'minimum price per unit of alcohol' policy. When we focus only on those households that purchase off-trade alcohol, lower income households are the most likely to be affected. However, minimum pricing in the UK is unlikely to be significantly regressive when the effects are considered for the whole population, including those households that do not purchase any off-trade alcohol. Minimum pricing will affect the minority of low-income households that purchase off-trade alcohol and, within this group, those most likely to be affected are households purchasing at a harmful level.

Environmental factors in drinking venues and alcohol‐related harm: the evidence base for European intervention

Reducing alcohol-related harm in young people is a major priority across Europe. Much alcohol use and associated harm in young people occurs in public drinking environments. This review aims to identity environmental factors in drinking establishements that are associated with increased alcohol consumption and associated harm and to understand the extent of study in this area across Europe. A systematic literature search identified studies that had explored associations between physical, staffing and social factors in drinking environments and increased alcohol use or alcohol-related harm. Fifty-three papers were identified, covering 34 studies implemented in nine countries. Most studies had been implemented in non-European countries and many had collected data more than a decade prior to the review. The majority had used observational research techniques. Throughout the studies, a wide range of physical, staffing and social factors had been associated with higher levels of alcohol use and related harm in drinking environments. Factors that appeared particularly important in contributing to alcohol-related problems included a permissive environment, cheap alcohol availability, poor cleanliness, crowding, loud music, a focus on dancing and poor staff practice. However, findings were not always consistent across studies. Drinking establishments, their management and the behaviours of the young people who use them vary widely across Europe. While international research shows that environmental factors in drinking settings can have an important influence on alcohol-related harm, there is currently a scarcity of knowledge on the relevance and impacts of such factors in modern European settings. Developing this knowledge will support the implementation of strategies to create drinking environments in Europe that are less conducive to risky drinking and alcohol-related harm.

The price of a drink: levels of consumption and price paid per unit of alcohol by Edinburgh's ill drinkers with a comparison to wider alcohol sales in Scotland

AimTo compare alcohol purchasing and consumption by ill drinkers in Edinburgh with wider alcohol sales in Scotland.DesignCross-sectional.SettingTwo hospitals in Edinburgh in 2008/09.ParticipantsA total of 377 patients with serious alcohol problems; two-thirds were in-patients with medical, surgical or psychiatric problems due to alcohol; one-third were out-patients.MeasurementsLast week's or typical weekly consumption of alcohol: type, brand, units (1 UK unit 8 g ethanol), purchase place and price.FindingsPatients consumed mean 197.7 UK units/week. The mean price paid per unit was £0.43 (lowest £0.09/unit) (£1 = 1.6 US$ or 1.2€), which is below the mean unit price, £0.71 paid in Scotland in 2008. Of units consumed, 70.3% were sold at or below £0.40/unit (mid-range of price models proposed for minimum pricing legislation by the Scottish Government), and 83% at or below £0.50/unit proposed by the Chief Medical Officer of England. The lower the price paid per unit, the more units a patient consumed. A continuous increase in unit price from lower to higher social status, ranked according to the Scottish Index of Multiple Deprivation (based on postcode), was not seen; patients residing in postcodes in the mid-quintile paid the highest price per unit. Cheapness was quoted commonly as a reason for beverage choice; ciders, especially ‘white’ cider, and vodka were, at off-sales, cheapest per unit. Stealing alcohol or drinking alcohol substitutes was only very rarely reported.ConclusionsBecause patients with serious alcohol problems tend to purchase very cheap alcohol, elimination of the cheapest sales by minimum price or other legislation might reduce their consumption. It is unknown whether proposed price legislation in Scotland will encourage patients with serious alcohol problems to start stealing alcohol or drinking substitutes or will reduce the recruitment of new drinkers with serious alcohol problems and produce predicted longer-term gains in health and social wellbeing.

Change and Stability?

Over the past two decades, alcohol consumption in Sweden has grown by 20 per cent as a result of an increasing consumption of wine and strong beer. The rise is driven by a combination of factors such as the higher physical availability and lower real prices of alcohol, which suggests that alcohol has become much more affordable. In addition, the possibilities to bring back cheaper alcohol from other EU countries have been greatly extended during the Swedish EU membership. No definite patterns were found with respect to certain social and demographic changes during the study period. Despite the significant increase in consumption, indicators of alcohol-related harms did not show consistently increasing trends. It is not evident why the increasing availability should have such different effects on various population sub-groups, and there are obviously other relevant factors at play. Widespread political concern at the implications of the rising availability of alcohol has led Sweden to spend more per capita than any other European country on alcohol policy and prevention initiatives. It will be a continuous challenge for policy makers to find measures that limit the harms caused by alcohol in the Swedish society.