Alcohol pricing and purchasing among heavy drinkers in Edinburgh and Glasgow: Current trends and implications for pricing policies.

Executive summary This is a study of the alcohol purchasing behaviour of patients with alcohol-related conditions at NHS settings in Edinburgh and Glasgow. In 2011/12, 639 drinkers were recruited and invited to complete two questionnaires at baseline: one exploring consumption, and a second exploring experiences of alcohol-related problems. Participants completed further questionnaires during three follow up phases approximately six months apart. In addition, 20 individuals took part in face-to-face, semi-structured qualitative interviews before the final study phase. 227 participants were re-interviewed at the first follow-up, 165 at the second, and 145 at the third. Women accounted for 28% of the sample. Attrition (that is, the number of participants who dropped out) was an anticipated, but major, issue for this study. The reasons for this varied and maintaining contact with participants was challenging, due to fluctuating personal circumstances. Some participants who had adopted abstinence were unwilling to repeat the interviews. Another key factor was loss due to death: during the 2-3 years of the study, 105 (16.4%) participants died. The baseline sample had a mean age of 45.6 years, and 71.7% were male. Levels of alcohol consumption among participants were very high, with a median weekly consumption of 184.8 UK units. Participants generally bought alcohol cheaply, with a median price paid in the index week of 39.7pence per unit. 95% of all purchases were made in off-licences and the median weekly expenditure was £70. The most popular drinks were vodka and white cider. Comparison with pilot data collected in 2008/09 showed that a fall in the affordability of alcohol had been off-set by this type of very heavy drinkers switching to cheaper products. White cider was an important buffer: its cheap unit price (average £0.17 per unit) allowed it to be used as a fallback drink when finances were restricted. It is already recognised that very heavy drinkers tend to buy alcohol cheaply; our findings demonstrate that, as long as cheap alcohol is available, falling affordability is cushioned by trading down. Men drank significantly more than women in deprivation quintiles 1, 2 and 4, but not in quintiles 3 and 5 (5 being least deprived). Among women, the association between alcohol consumption and harm was influenced by two key factors: increased deprivation and being recruited in Glasgow rather than Edinburgh. In this, the study findings reflected a phenomenon sometimes referred to as the 'Glasgow effect’, in which health outcomes across a wide range of measures are worse for people living in Glasgow than elsewhere (Grey and Leyland, 2008). Women were half as likely as men to be a white cider drinker. Those in the least deprived group were one-fifth as likely to drink wite cider as those in the most deprived group. No evidence was identified which confirmed anecdotal reports in the literaure suggesting an enhanced health harm associated with white cider consumption in particular. Health risks are more likely to be associated with the high levels of ethanol consumption among white cider drinkers (which were 3 significantly higher than non-white cider drinkers). The health risk of the alcohol intake reported by participants (equivalent to 4-5 times the UK definition of harmful consumption) is likely to be compounded by smoking. 70% of participants smoked, with a median of 20 cigarettes (one pack) per day. In one-to-one interviews, participants were asked about the potential impact of alcohol policies, including miniumum unit pricing (MUP). Responses showed some misunderstanding of proposed alcohol policies, but also a concern that the removal of very cheap alcohol would compromise the budgets of addicted drinkers. However, there was no mention of an intention to steal or buy illicit alcohol were prices to rise.