The Alcohol Change Report

By Professor Alan Maryon-Davis FFPH FRCP FRCGP, Chair of Trustees

Looking at alcohol in the UK today, it is easy to think that the future looks bleak.

Every year thousands die as a direct result of their drinking. Despite our improving health as a nation, liver disease is one of the very few conditions that is increasing in prevalence, and the number of deaths as a result is rising.

There are an estimated 600,000 dependent drinkers in England alone – people who are in a relationship with alcohol that is bringing them and their families ill-health, conflict and pain. Four in five of them are receiving no treatment.

Much of the harm from alcohol – death, illness, violence, neglect – comes not from dependent drinkers, but from those drinking at high levels who would still be considered by many to be ‘normal’ drinkers.

Yet, looking to the future, I feel optimistic. So do all of us at Alcohol Change UK, the charity formed by the merger of Alcohol Research UK and Alcohol Concern – because we know that change is possible.

Many people see alcohol harm as something that happens to a small group of dependent drinkers who do not or cannot control their drinking, and who are mostly beyond help. But we at Alcohol Change UK know that that is not the case.

There is nothing inevitable about the way we drink, how we behave when drinking or how difficult it is to access the support that can help turn lives around. Research shows that the majority of dependent drinkers recover, that heavy drinkers can make new choices, and that the social and cultural environment in which people drink can and does change. Change is possible for individuals, and it is possible for society.

Alcohol Change UK is not anti-alcohol. We are against the harm caused by alcohol, and we are for alcohol change. We are working towards a future in which society has a healthier relationship with alcohol; where no-one feels they must drink; where the issues which exacerbate alcohol harm – like poverty, mental health problems, homelessness – are addressed; and where those who drink too much, and their loved ones, have access to high-quality support whenever they need it, without shame or stigma.

This report sets out our approach to alcohol harm and how we will work with Government, public bodies, organisations, charities and individuals to reduce it. But more than that, it looks at the UK today and makes the case for some key changes that we must all work towards if our society is to end serious alcohol harm.

If you are reading this report, we want to work with you. Get in touch. Support our work. Tell us your ideas. And spread the word. Together we can make change happen faster.

Alcohol is a part of many of our lives. We use it for celebration, for comfort, to socialise, to wind down, to cope. It’s legal, socially acceptable, even encouraged.

Yet every year in the UK alcohol-related harm leads to thousands of lives lost, and hundreds of thousands more damaged. The harm goes far beyond those who drink too much, affecting families, communities, and ultimately our whole society.

In 2017, 7,327 people in the UK died as a direct result of their drinking. This is the equivalent of 20 people per day, and is an increase of 11% since 2006. But this is only the tip of the iceberg. If we include every death in which alcohol was a factor, the figure is closer to 24,000. Alcohol is the biggest risk factor for all early deaths among 15-49 year olds.

The risk is not just to those we tend to think of as dependent drinkers, sometimes referred to as ‘alcoholics’. Those who end up on cancer, liver and stroke wards are often ‘normal’ heavy drinkers who might appear well on the outside but who have been unknowingly harming their bodies. Behind each death is a personal tragedy, not least because every one of these deaths is avoidable.

Even as thousands die each year as a result of alcohol and services creak under the pressure of caring for those with problems, dedicated alcohol support services are being cut. Less than 20% of people in need of treatment for alcohol dependence are getting the support they need. In the last few years, over two-thirds of local authorities have cut their funding for alcohol services, many by over 50%.

There are around 600,000 dependent drinkers in England, and around 200,000 children living with an alcohol dependent parent or carer. The pressures of caring for a family member who is drinking harmfully can be overwhelming and there can be lifelong effects on the children.

Support for people with a family member who drinks heavily improves outcomes for both the person drinking and their loved ones; yet these services are being cut along with services for those who drink.

Harm isn’t restricted to families of the heaviest drinkers. Drinking does not need to be at dependent levels in order to cause harm, conflict and pain in close relationships.

As well as causing enormous harm to individuals and families, alcohol has a significant impact on society, in part through the pressure it places on public services. In England alone, alcohol costs the NHS an estimated £3.5 billion every year. In 2017 there were 337,000 hospital admissions caused primarily by alcohol, which is 17% higher than in 2006. The total number of hospital admissions for which alcohol is a contributory factor is closer to one million: or about 7% of all hospital admissions. 82% of alcohol-related deaths in 2017 were caused by alcoholic liver disease: a preventable condition which is increasing significantly in the UK as it falls across the rest of Europe.

Alcohol is implicated in a wide range of social costs. In 2015, 167,000 years of working life were lost as a result of alcohol, and it has been estimated that the annual cost of alcohol to the economy is around £7 billion. In 2016, alcohol was linked to 39% of all violent crime in England and 49% in Wales (and a much higher proportion in the evening and at weekends), which equates to around 491,000 offences. The total social cost of alcohol to society is estimated to be at least £21 billion.

Reducing serious alcohol harm to individuals and society is far from easy as alcohol plays such a central role in our society. But the costs are too high to ignore; there are far too many personal tragedies and too much public resource spent in addressing the avoidable problems caused by harmful drinking.

We do not have to live in a society in which alcohol does this amount of harm. There is nothing inevitable about the way we drink, how we behave when drinking or how difficult it is to access support that can help turn lives around.

How we drink, and the amount of harm that alcohol causes, changes all the time.

Fifty years ago, for example, adults in the UK drank an average of 7.4 litres of pure alcohol every year. By 2004 this had risen to 11.6 litres, before falling to 9.5 litres in 2016. Thirty years ago, most of the alcohol consumed in the UK was drunk as beer – and it was drunk in the pub, mostly by men. Now most of our alcohol is consumed as wine, and most of what we buy is drunk in the home.

Far more women drink than in the past. This is a reflection of greater social equality, but it comes with costs as the number of women experiencing alcohol-related health problems has increased.

Twenty years ago, much of the most harmful consumption was among younger drinkers. Rates of overall consumption were at a record high, and there was widespread concern over public drunkenness and disorder in town and city centres at night. Those problems have not yet been resolved, as police, accident and emergency staff, or those working in supervised recovery facilities in town centres (sometimes called ‘safe havens’ or ‘safe spaces’) across the country will confirm. But consumption among young people has fallen considerably – more evidence of how cultural attitudes can change over time.

Now, many of the problems we face are among older drinkers, who have carried their drinking behaviours into middle age and beyond. It is here that we are seeing particular increases in the rates of liver disease, as well higher recorded levels of heavy and dependent drinking.

Other countries show us that the alcohol harms we experience in the UK are not inevitable. In the UK, liver disease rates have been rising significantly, while they have fallen across most of Europe. In the UK the peak liver disease mortality age for women is around 55, twenty years younger than in France, where rates have fallen steeply in recent decades.

The prevalence of liver disease is closely related to levels of alcohol consumption: as consumption has increased, so have incidences of liver diseases. If consumption falls, we can expect the number of people whose lives are devastated by this avoidable condition to fall as well. Change won’t happen overnight, as liver disease is a condition that develops over a long period of time, but if consumption shifts downwards, it will happen.

It is not only the amount that people consume that can change. Both policy and shifting attitudes can create reductions in specific harms. Drink-driving, for example, has become increasingly socially unacceptable. The number of people killed and injured in drink-driving incidents is still far too high, but has seen a long-term decline. A combination of much stronger enforcement of the law, including the widespread use of breathalysers, and campaigns to change attitudes have worked to create a positive social shift which has saved hundreds of lives.

When support for people who drink too much improves it saves money and harm is avoided. It is estimated that for every additional £1 spent on treatment, at least £3 in wider healthcare costs can be saved, and if targeted at people with complex needs the savings can be higher.

But even greater savings can be achieved if we prevent people falling into problematic consumption in the first place. This means introducing policies that reduce harmful drinking; regulating the price, accessibility and marketing of alcohol; intervening to provide advice for people whose drinking is becoming risky, and providing accurate information on the risks of drinking at all levels to allow people to make the choices necessary to reduce harm in the population at large.

It also means being sensitive to the enormous role that social inequalities play in alcohol harms, ensuring that actions reduce these inequalities and help the most vulnerable to reduce the risks to themselves and their families.

Social and individual change is unpredictable. Countless factors influence attitudes and behaviours, not all of which are fully understood. There are no magic wands which can transform people’s lives overnight. There are, however, powerful elements of change that can be influenced.

These are the areas across which charities, public bodies, policy-makers and individuals must work together for change. These are the areas in which we work.

Reducing the harm caused by alcohol is not easy. But there are reasons to be positive.

Across the country, charities, local authorities, service providers and other organisations are working for change. Policy-makers are showing increasing interest in and understanding of alcohol harm as an urgent problem that requires an evidence-based response.

We are living in a society with increasingly diverse drinking cultures, in which new freedom from restrictive traditions can be achieved. We are also living at a time when new norms and technologies are revolutionising the ways we think about our health. The time is ripe for serious change.

What is the role of Alcohol Change UK?

We seek to understand the nature of the problems that we face. We focus on where harms occur, and support and enable actions based on the best available knowledge. We approach change with honesty, determination and compassion.

We commit to undertaking, supporting and communicating the best research. We will fund new research activities, collate and curate the wealth of knowledge already available, and work to ensure that this knowledge informs the work of policy-makers and practitioners at all levels.

We will actively promote the use of evidence in policy-making, and advocate for policies based on that evidence. We will work across the UK, and at both national and local level, to ensure this is the case. That means not only seeking to influence the policies at Westminster and the devolved administrations, but in local authorities, among clinical commissioning groups, in licensing committees, with police and crime commissioners and all other stakeholders engaged in the reduction of alcohol harms.

We will support positive changes in social attitudes towards drinking; both those that widen choice for drinkers and non-drinkers, and those that reduce the stigma associated with drinking problems. We will seek to promote a more mature, considerate and caring culture around alcohol, with compassion and understanding at its heart.

We will help people to gain the motivation, confidence and ability to exert control over their drinking, providing the knowledge and information needed for people to make positive choices. We will provide leadership on campaigns such as Dry January, which create the empowering, collective environment in which individuals can explore the changes they wish to make. We will also continue to invest in the latest research on behaviour change, an area which is making significant strides in relation to alcohol.

We will work with others to champion the alcohol treatment sector, and other organisations and networks whose purpose is to help those with the greatest level of need. We do not take a one-size-fits-all approach and so will work actively to support any organisation engaged in evidence-based work to help individuals on their road to recovery, or to support families and communities affected by alcohol.

All this will take time, investment and effort. But change is essential, and it is possible. The work of our predecessor charities has shown what can be achieved; building on that, we are confident that even more can be done to reduce the harm caused by alcohol.