Alcohol misuse: tackling the UK epidemic - London

BMA Board of Science
Executive summary
This report considers a range of evidence-based policies to tackle the problematic levels of alcohol
misuse in the UK and is not intended to assail those who enjoy consuming alcohol in moderation.
Alcohol consumption represents an integral part of modern culture in the UK and internationally.
Alcohol is a psychoactive substance and its consumption in moderation can lead to feelings of
relaxation and euphoria. It is also an addictive drug and its misuse is associated with a wide range
of dose-related adverse sequelae that can lead to significant harm to the individual and society.
Since 1950, alcohol consumption in the UK has risen from 3.9 litres pure alcohol per capita per
year to a peak of 9.4 litres in 2004. Despite a recent fall to 8.9 litres, per capita consumption in
the UK has remained consistently above 7 litres pure alcohol per year since 1980. The UK is among
the heaviest alcohol consuming countries in Europe. The vast majority of the UK adult population
consumes alcohol. The prevalence of alcohol consumption varies considerably by ethnic group.
Only nine per cent of the White British population are non-drinkers, whereas 48 per cent of Black
African origin and 90 per cent or more among those of Pakistani and Bangladeshi origin abstain
from alcohol. There are also differences in alcohol consumption between men and women with
men drinking twice as much alcohol as women on average per week. Individuals in employment
are more likely to drink frequently compared to those who are unemployed.
A similar pattern is also seen for socio-economic classification. Individuals in managerial and
professional occupations are more likely to drink more frequently than those in routine and
manual occupations.
A large majority of the individuals in the UK who consume alcohol, do so in moderation. Analysis of
the patterns of alcohol consumption, however, reveals that a significant proportion misuse alcohol by
drinking above the UK recommended guidelines. Of particular concern is the pattern of drinking
among adolescents, and the high level of binge drinking and heavy drinking among men and women
in the 16 to 24 and 25 to 44 age groups. UK teenagers are among the most likely in Europe to report
heavy consumption of alcohol, being intoxicated and experiencing adverse effects of drinking.
During the 1990s, the prevalence of alcohol misuse increased among both men and women, and in
particular in the 16 to 24 age group. This upward trend was particularly marked among young women
to the extent that consumption among this group is now the highest in Europe. The upward trend
may have peaked, however. In the 16 to 24 age group, there has been a downward trend since 2003
in the proportion of men drinking above recommended daily guidelines and drinking heavily. A similar
downward trend has occurred among women aged 16 to 24 since 2002. Data on average weekly
consumption show a similar downward trend in recent years. It is not yet possible to determine
whether these recent trends in alcohol consumption are genuine long-term changes in drinking habits.
Recent years have seen an increasing trend among UK adults toward home-based alcohol
consumption. This trend toward home-based alcohol consumption most likely reflects the lower cost
of alcohol in off-licences compared to licenced premises in the UK. Among younger adults, there is
also an increased tendency to consume alcohol at home prior to going out.
Alcohol consumption has been shown to be causally related to over 60 different medical
conditions and is a significant cause of morbidity and premature death worldwide. In the majority
of cases there is a dose-response relation, with risk increasing with the amount of alcohol
consumed. Moderate alcohol consumption is not usually harmful to health. Indeed, consumption
at moderate levels or below in older men and women is associated with a lower risk of coronary
heart disease (CHD), ischaemic stroke and diabetes mellitus, compared to individuals who abstain
from alcohol. Drinking heavily, however, can result in significant health problems through either
acute or chronic misuse. In the UK, the burden of alcohol-related morbidity and mortality is
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