Director of Public Health Annual Report 2019: Alcohol and us

Understanding what affects the amount of alcohol we drink at an individual level and a population level is important to help improve our health and limit the harms caused by alcohol. The amount we drink is influenced by the society we live in, cultural norms around alcohol and personal factors.

At a societal level, the level and pattern of drinking are influenced by economic and social factors. There are three main factors that have been shown to influence the level of alcohol consumption in a society according to a comprehensive evidence review by Public Health England:

● How cheap alcohol is (affordability)

● How easy alcohol is to purchase and consume (availability)

● The cultural and social norms around alcohol (acceptability).

The price of alcohol, particularly relative to income, is a key influence on consumption levels and the level of alcohol harm. Broadly speaking, when alcohol is more affordable levels of consumption and harm increase.

Since 1980 alcohol has become 64% more affordable. The graph below shows the affordability index of alcohol since 1980. The greater the alcohol affordability index, the more affordable alcohol is.

UK household expenditure on alcohol has almost doubled from £9.7 billion in 1987 to £19.3 billion in 2017.

Alcohol sold in off-licences and supermarkets has been found to be more affordable compared to pubs and restaurants.

The availability of alcohol is a key determinant of alcohol consumption. Where alcohol is easily accessible, the population is more likely to consume alcohol in greater quantities. In areas where alcohol licensing is used to reduce the density of alcohol outlets, to regulate the hours alcohol is sold and/or to ensure that the alcohol trade is well managed, it has been shown that alcohol harms are reduced.

The cultural and social norms around alcohol are also very important. These norms influence how acceptable alcohol is for our society and culture.

Alcohol is an acquired taste, which means for alcohol consumption to continue each generation of young people have to learn to like the taste and acquire the desire to drink. Other people’s behaviour influences our drinking behaviour, first as children and young people observing parental and family drinking patterns and then as adults the drinking behaviour of our peers influences our consumption.

Alcohol marketing can encourage new generations of drinkers to take up alcohol. Through advertising and sponsorship, alcohol producers associate their products with a wide range of activities from watching sport to celebrating holidays to relaxing after work. There is also evidence that young people are particularly influenced by alcohol marketing. Exposure to alcohol marketing increases the risk that children will start to drink alcohol, or if they already drink, will consume greater quantities.

A local Buckinghamshire resident in their 30s discusses his binge drinking and how social settings influence his behaviour. This resident is not in alcohol treatment.

During childhood, the home and family are often where a child learns what is normal or acceptable drinking. Parents exert a powerful influence on drinking behaviour in their children. Research suggests that parents have an influence on their children’s drinking behaviour particularly children aged 5 to 12, but also older teenagers. This influence can be positive or negative depending on the parents’ behaviour.

Certain styles of parenting are associated with lower risks of harmful drinking in adolescence. Parents who set clear boundaries for behaviour, who discuss why those boundaries exist and what the difficulties in sticking to them might be, help to protect their children from developing harmful drinking behaviours. Parents who are aware of where their children go, what kinds of things they get up to, and who their friends are also help reduce the risks of harmful drinking in their children.

Research shows that clear messages from parents that underage drinking is unacceptable delays drinking in teenagers.

The drinking behaviour and attitudes of parents or others in the household can affect children’s subsequent drinking behaviour. The likelihood of the child drinking increases the greater the number of adults the child lives with who are drinking alcohol. Children with one parent who misuses alcohol are 2.5 times more likely to also misuse alcohol, compared to children whose parent does not misuse alcohol. The drinking behaviours of children mirror those of the people with whom they live, not just their parents. The more people who drank in the household, the more likely it was that the child drank alcohol in the last week.

Some parents choose to give their children alcohol with the view that it will increase their child’s resistance to peer influence and protect them from alcohol-related problems later in life. Data from the 2016 Smoking, Drinking and Drug Use survey of school aged children in England shows that the most common way (70%) children obtain alcohol is from their parents.

Parental supply of alcohol has been shown to be associated with alcohol use, intentions to drink and risky drinking in adolescents. Children who start drinking early are more likely to become more frequent and binge drinkers. Underage drinking is also associated with school and educational problems, risky behaviours and consumption of illegal drugs.

Alcohol use disorder is a term used to describe when people are drinking at hazardous levels, as well as those who are dependent on alcohol.

Children who live with parents or family members with alcohol use disorder are more likely to develop alcohol use disorder later in life.

The likelihood of someone becoming dependent on alcohol and developing alcohol-related diseases (e.g. liver cirrhosis) has an inherited component. This is partly due to genetics but the family and social environment also play an important role.

People who have experienced child maltreatment or childhood trauma are also more likely to misuse alcohol in later life, as well as develop a range of other problem.

The teenage years are a time of experimentation and risk taking. Research shows that some teenagers start to drink because they wrongly think “everyone is doing it!” Most teenagers only experiment with alcohol or use it for ‘fun’. However, some may use alcohol in a way that is problematic. Drinking is also linked to self-harm and suicide in young people.

The relationship between alcohol and mental health is complex. Alcohol has been described as ‘the UK’s favourite coping mechanism’, and some people drink as they think it will help manage stress, anxiety, depression or other mental health issues. Unfortunately, although alcohol may help us relax the effects are short-lived and the long-term negative consequences of using alcohol in this way can be harmful.

Overuse of alcohol can worsen the symptoms of many mental health problems. In particular, it can lead to low mood and anxiety. Depression is one of the most common mental health problems, with around one in ten people suffering in the UK in any year. Depression and heavy drinking have a close relationship in that either condition increases a person’s chances of experiencing the other.

Life events - marriage, having children, grief, illness or change in life role as we age often mark a change in people’s drinking practices.

About a third of older people with drinking problems develop them for the first time in later life. Drinking alcohol may be used to cope with bereavement, physical ill-health and social isolation. Drinking alcohol may then become part of daily routine and difficult to give up.

A study found that older people are more likely to drink too much when they are more affluent, engage in more social activities and have friends who approve of drinking.