The Scottish Health Survey 2011: Volume 1 - Adults

CHAPTER 3 ALCOHOL CONSUMPTION

Clare Sharp

SUMMARY

• Weekly mean alcohol consumption in 2011 was 15.0 units for men and 7.4 units for women.
• Between 2003 and 2011 mean weekly alcohol consumption among adults aged 16 and over declined from 14.1 units to 11.1 units. For men, the mean units consumed per week fell from 19.8 units to 15.0 units in this period. The figures for women were 9.0 units in 2003 and 7.4 units in 2011.
• A quarter of men (25%) and just under a fifth of women (18%) were categorized as hazardous or harmful drinkers (men drinking more than 21 units per week and women drinking more than 14) in 2011.
• As with mean weekly alcohol consumption, the proportion of adults drinking in excess of recommended weekly limits also declined between 2003 and 2011 from 28% to 21% (from 33% to 25% for men and from 23% to 18% of women).
• Harmful/hazardous drinking was most common among those in living in higher income households and those living in less deprived areas. These associations with income and deprivation were stronger for women than for men. Women in the highest household income group were twice as likely as those living in the lowest income households to be harmful/hazardous drinkers (27% compared with 14%)
• Hazardous/harmful drinkers in low income households consumed more units of alcohol per week than those in higher income households. For example, male hazardous/harmful drinkers in the lowest income group consumed 61.6 units per week compared with the 38.6 to 44.3 consumed by those in the other income groups. Similarly, hazardous/harmful drinkers in areas of greater deprivation consumed more units per week than those living elsewhere.
• In terms of daily alcohol consumption in 2011, on their heaviest drinking day in the last week men drank an average of 5.5 units and women 3.2 units (the figure for all adults was 4.3 units).
• On their heaviest drinking day, 41% of men and 34% of women (37% of all adults) drank more than the recommended daily amount (no more than 4 units for men and 3 units for women). One in five adults drank more than twice the recommended daily amount (25% of men and 17% of women).
• Between 2003 and 2011 the proportion of men exceeding the recommended daily limits fell from 45% to 41%. For women there was a decline from 37% in 2003 to 33% in 2011.
• The proportion of people drinking more than twice the daily recommended units on their heaviest drinking day declined slightly between 2003 and 2011 (from 29% to 25% for men and from 19% to 17% for women).
• There was a drop in the proportion of adults drinking outwith the recommended government guidelines (weekly and/or daily), from 47% in 2003 to 42% in 2011. The decline was steeper for men than for women (from 53% to 46% compared with 42% to 38% for women) and was greatest among men aged under 45 and women aged 25-34.
• On average in 2011, men drank alcohol on 2.8 days in the last week and women drank on 2.5 days. One in ten adults (13% of men and 10% of women) drank on more than five days in the last week.
• The mean number of days on which adults drank in the previous week declined from 3.0 to 2.7 between 2003 and 2011 (among men, it fell from 3.3 to 2.8 days; for women it fell from 2.7 to 2.5 days). Over this same period there was also a decline in the proportion of adults who drank on more than five days in the last week from 17% to 12%.
• There was a strong association between the number of days on which alcohol was consumed in the last week and both household income and area deprivation level. As household income fell and area deprivation increased both the mean number of days drank in the previous week and the proportion drinking on more than five days in the last week decreased.

3.1 INTRODUCTION

Misuse of alcohol contributes to a wide range of health problems, including high blood pressure, chronic liver disease and cirrhosis, pancreatitis, some cancers, mental ill-health, and accidents, as well as social problems such as antisocial behaviour and violent crime. A report published in 2009 attributed 5% of deaths in Scotland to alcohol,¹ while the annual costs of excessive alcohol consumption are estimated to be £3.6 billion.² Alcohol-related morbidity and mortality is not evenly distributed throughout the population and the burden is greatest among those living in the most deprived areas.³ Its status as an issue of significant concern was underlined by its inclusion in the Scottish Government's 2007-11 National Performance Framework (NPF) via the following national indicator:⁴

Reduce alcohol related hospital admissions by 2011

Provisional estimates for 2010/11 show a 6% reduction in admissions, from 737 to 695 per 100,000 population, between 2006/7 and 2010/11, so this target was met.⁵ The revised NPF, published in December 2011 retains this indicator about alcohol related hospital admissions, but has removed the timeframe so it is now an ongoing indicator.⁶

Alcohol is also the subject of the following NHS Scotland HEAT targets:⁷

Achieve agreed number of screenings using the setting-appropriate screening tool and appropriate alcohol brief intervention, in line with SIGN 74 guidelines during 2011/12

By March 2013, 90 per cent of clients will wait no longer than 3 weeks from referral received to appropriate drug or alcohol treatment that supports their recovery.

Data for the first of these targets were published in June 2012 and showed that 97,830 alcohol brief interventions were delivered during 2011/12, exceeding the target of 61,081.⁸ Data for the referrals target are published quarterly and the most recent figures (for January-March 2012) show that 87.7% of clients waited no longer than three weeks.⁹

The introductions to the alcohol chapters in the 2008,¹⁰ 2009¹¹ and 2010¹² Scottish Health Survey (SHeS) reports provided a detailed account of the costs and burdens harmful and excessive drinking places on Scottish society, as well as a number of key recent legislative and policy developments. These included:

• The Licensing (Scotland) Act 2005, which came into full force in September 2009.
• The 2009 publication Changing Scotland's Relationship with Alcohol: A Framework for Action.¹³
• The notable new powers contained within the Alcohol etc. (Scotland) Act 2010 passed by the Scottish Parliament in November 2010, which came into force in October 2011.¹⁴ The Act included new powers to: ban quantity discounts (such as '3 for 2') in off-sales (complementing the restrictions on irresponsible promotions in the Licensing Act for on-sales), limit price promotions and restrict the display of alcohol promotions in off-sales establishments, and introduce a mandatory Challenge 25 age verification scheme for all licensed premises.¹⁵

The February 2012 progress report on the Framework for Action⁶ provides a comprehensive overview of all the policies being pursued, and associated funds being invested, to support the 41 actions set out in the Framework. For example, it highlights the £155 million that has been committed to tackle alcohol misuse since 2008; the establishment of 30 Alcohol and Drug Partnerships that bring together representatives from local authorities, health boards, voluntary agencies and the police to develop strategies and commission services at the local level; the launch of new health behaviour change campaigns (including one targeted specifically at women); and the provision of refreshed advice for parents and carers to support them to talk to young people about alcohol consumption. These examples illustrate the wide range of actions being taken, and the extent of joint-working required to make progress on the Framework's actions.

In addition to the kinds of steps outlined above, significant new legislation has also been implemented. The Alcohol (Minimum Pricing) (Scotland) Bill was introduced to parliament in October 2011, was passed into law in May 2012, and is due to be implemented from April 2013.¹⁶ Following two amendments to the Bill, the Act contains a 'sunset clause' imposing a six year time limit on the policy, unless Ministers make further provisions to continue its operation, and a requirement to evaluate the effect of the bill after five years.¹⁷ Based on modelling evidence provided by the University of Sheffield¹⁸ - some of which draws on SHeS alcohol consumption data - Scottish Ministers have recommended a minimum unit price of 50p for the first two years (which will be reviewed biennially thereafter). The Act's provisions around evaluation, and the fact that SHeS data were used in the modelling that informed the unit pricing level, mean that the alcohol consumption estimates provided by the survey will continue to perform an important monitoring role once the policy is implemented.

The estimates of alcohol consumption discussed later in this chapter are based on self-reported data. However, it is important to note that surveys often obtain lower estimates of consumption than implied by alcohol sales data. The most recently available estimates of alcohol sales in Scotland show that 11.2 litres of pure alcohol per person aged 16 and over were sold in 2011 (the equivalent figure for England and Wales was 9.3 litres).¹⁹ This volume is sufficient for every adult aged 16 and over in Scotland to exceed the weekly recommended maximum consumption for men of 21 units. Although survey estimates are typically lower than sales estimates, surveys can provide information about the social patterning of individuals' alcohol consumption which sales data cannot. For example, the evaluation of the implementation of minimum pricing will use evidence from the survey to help assess the impact on consumption patterns across different social groups.

This chapter updates the key trend figures on weekly and daily alcohol consumption presented in the three previous SHeS reports.^10,11,12 It also provides, for the first time, trend data on the proportion of people who do not adhere to either the recommended weekly or daily drinking guidelines. The trend for the numbers of days in the previous week people reported drinking alcohol is also presented for the first time. Weekly drinking patterns, and the numbers of days on which alcohol was consumed, are also shown by household income and the Scottish Index of Multiple Deprivation (SIMD).

3.1.1 Definitions used in this chapter

The recommended sensible drinking guideline in the UK is that women should not regularly drink more than 2-3 units of alcohol per day and men should not regularly exceed 3-4 units per day. In addition, the Scottish Government recommends that everyone aim to have at least 2 alcohol free days per week.

Over the course of a week, it is also recommended that women and men should not exceed 14 units and 21 units respectively. The term 'harmful drinking' is used to describe those who are drinking at a level which is already causing physical, social or psychological harm. People whose drinking is not currently causing clear evidence of harm, but which may cause harm in the future have been described as 'hazardous' drinkers.²⁰ In terms of units, men who consume over 21 and up to 50 units per week and women who consume over 14 and up to 35 units are usually classed as 'hazardous' drinkers, while those who consume above 50/35 units a week are considered to be drinking at 'harmful' levels.²¹

There is no standard definition of 'binge' drinking in the UK. To enable comparisons between other major surveys of alcohol consumption in Britain, SHeS uses the definition used by the Health Survey for England and the General Lifestyle Survey. These define binge drinking as more than 6 units on one occasion for women and more than 8 units for men.

An additional measure of people's adherence to the advice not to exceed the daily and weekly drinking levels set out above is reported in this chapter. The two key groups of interest are:

• People who adhere to the guidelines i.e.
  • women who drink no more than 14 units per week, and no more than 3 units on their heaviest drinking day
  • men who drink no more than 21 units per week, and no more than 4 units on their heaviest drinking day.
• People who do not adhere to the guidelines i.e.
  • women who drink more than 14 units per week, and/or more than 3 units on their heaviest drinking day
  • men who drink more than 21 units per week, and/or more than 4 units on their heaviest drinking day.

3.2 METHODS

3.2.1 Data collection in the 2008-2011 surveys

The way in which SHeS estimates alcohol consumption was changed significantly in 2008. The revisions are detailed extensively in the alcohol consumption chapter of the 2008 report¹⁰ so are not repeated here. The following instead outlines the methods now used to collect and analyse the alcohol consumption data.

Three aspects of alcohol consumption are measured: usual weekly consumption, daily consumption on the heaviest drinking day in the previous week, and indicators of potential problem drinking (including physical dependence).

To estimate weekly consumption, participants aged 16 and over were asked preliminary questions on whether they drank alcohol at all; followed by questions on how often during the past 12 months they had drunk each of six different types of alcoholic drink:

• normal beer, lager, cider and shandy
• strong beer, lager and cider
• sherry and martini
• spirits and liqueurs
• wine
• alcoholic soft drinks ("alcopops").

The average number of days a week the participant had drunk each type of drink was estimated from these questions. A follow-up question asked how much of each drink type they had usually drunk on each occasion. These data were converted into units of alcohol and multiplied by the amount they said they usually drank on any one day (see below for discussion of this process).²²

It is well known that surveys tend to underestimate adults' levels of alcohol consumption for a number of reasons, including problems of recall, social desirability, and the difficulties involved in assigning an average estimate to an activity that varies from day to day. It is also worth noting that medium to high alcohol consumption can often impair a person's ability to recall the volume consumed on that particular occasion. Also, as the questions ask about 'usual' behaviour, responses are unlikely to reflect occasions of heavier drinking. Nevertheless, survey estimates provide useful comparisons of the consumption of different population groups and enable change over time to be monitored.

Daily consumption was measured by asking about drinking in the week preceding the interview, and looked at actual consumption on the heaviest drinking day in that week. Participants aged 16 and over were asked whether they had drunk alcohol in the past seven days. If they had, they were asked on how many days and, if on more than one, whether they had drunk the same amount on each day or more on one day than others. If they had drunk more on one day than others, they were asked how much they drank on that day. If they had drunk the same on several days, they were asked how much they drank on the most recent of those days. If they had drunk on only one day, they were asked how much they had drunk on that day. In each case, the questions asked for details of the amounts consumed of each of the six types of drink listed above, rather than asking participants to give a direct estimate of units consumed. This part of the process was therefore similar to the one used to estimate weekly drinking.

The CAGE questionnaire was asked of participants aged 16 and over, and highlights up to six indicators of problem drinking, including three indicators of physical dependency on alcohol. Due to the sensitive nature of the questions, this questionnaire was administered in self-completion format

3.2.2 Unit calculations and conversion factors

In the UK, a standard unit of alcohol is 10 millilitres or around 8 grams of ethanol. As described above, the majority of advice given in relation to safe alcohol consumption refers to units. The need for accurate estimates of units consumed is therefore paramount. However, there are numerous difficulties associated with calculating units at a population level, not least of which are the variability of alcohol strengths and the fact that these have changed over time.

As described above, information was collected about the volumes of alcohol participants had drunk in a typical week and also on their heaviest drinking day in the week preceding the survey. The volumes reported were not validated but in response to growing concerns about the reliability of consumption estimates from studies such as this, and the increasing consumption of wine - especially amongst women - extra efforts were made to measure wine glass sizes. This was done in two ways. Firstly, participants who reported drinking any wine were asked directly what size of glass they had been drinking from. Secondly, showcards depicting glasses with 125ml, 175ml and 250mls of liquid were used to help people make more accurate judgements.

The following table outlines how the volumes of alcohol reported in the survey were converted into units (the 2008 report provides full information about how this process has changed over time).¹⁰

Type of drink	Volume reported	Unit conversion factor
Normal strength beer, lager, stout, cider, shandy (less than 6% ABV)	Half pint	1.0
	Can or bottle	Amount in pints multiplied by 2.5
	Small can (size unknown)	1.5
	Large can/bottle (size unknown)	2.0
Strong beer, lager, stout, cider, shandy (6% ABV or more)	Half pint	2.0
	Can or bottle	Amount in pints multiplied by 4
	Small can (size unknown)	2.0
	Large can/bottle (size unknown)	3.0
Wine	250ml glass	3.0
	175ml glass	2.0
	125ml glass	1.5
	750ml bottle	1.5 x 6
Sherry, vermouth and other fortified wines	Glass	1.0
Spirits	Glass (single measure)	1.0
Alcopops	Small can or bottle	1.5
	Large (700ml) bottle	3.5

3.3 WEEKLY ALCOHOL CONSUMPTION LEVELS

3.3.1 Trends in weekly alcohol consumption since 2003

Trends in weekly consumption levels are presented using the following categories: non-drinkers, moderate, and hazardous or harmful drinkers. Men who drank some alcohol, but no more than 21 units in a typical week, and women who drank but did not exceed 14 units, were classified as moderate drinkers. Consumption in excess of these thresholds was classified as hazardous or harmful. The trend figures for these three categories, and the mean units consumed, for men, women and all adults are presented in Table 3.1.

There was an overall downward trend in usual weekly alcohol consumption in adults aged 16 and over between 2003 and 2011. The mean weekly units consumed by all adults declined steadily, from 14.1 in 2003 to 11.1 in 2011. This decline was more sustained among men than women. Men consumed 19.8 mean units in 2003, and 18.0 in 2008, and consumption then fell by 0.5-1.0 units each year thereafter to 15.0 units in 2011. In contrast, women's consumption declined most between 2003 and 2009 (from 9.0 to 7.8 mean units), and while the decline has continued (to 7.4 units in 2011), it has been much less steep in recent years. As has been discussed in previous SHeS chapters on alcohol consumption,¹² commenting on change over time among age sub-groups is difficult due to the small sample sizes and the greater likelihood of sample fluctuation. However, the general pattern emerging across the years is that the decline in unit consumption has tended to be more apparent among those aged under 65, which is unsurprising as alcohol consumption was higher in this age group to start with.

The proportion of adults classified as hazardous or harmful drinkers has also declined, from 28% in 2003 to 21% in 2011. As with mean unit consumption, the decline was a little steeper for men (from 33% to 25%) than for women (from 23% to 18%). As Figure 3A illustrates, the greatest decline occurred between 2003 and 2009, with only smaller drops occurring thereafter. There has been no change for women since 2009 suggesting that there may be some levelling off in the proportions engaging in harmful or hazardous drinking. Again, the general patterns suggest that the decline in harmful or hazardous drinking was greatest among men under 65 and women under 55. Figure 3A, Table 3.1

3.3.2 Weekly alcohol consumption by age and sex, 2011

As illustrated in the discussion above, in 2011 weekly mean alcohol consumption was higher among men (15.0 units) than women (7.4 units). For both sexes, mean consumption varied by age, with men aged 75 and over (9.9 units), and women aged 65 and above (3.4-5.9 units) consuming less units than younger people.

Men were also more likely than women to be categorized as hazardous or harmful drinkers (25% compared with 18%). Those aged 75 and over were the least likely to be classified as hazardous or harmful drinkers (14% of men and 8% of women), whereas the figures for those aged 16-74 ranged, with no obvious pattern, between 22% and 29% for men and 16% and 23% for women. The low level of hazardous or harmful drinking among men aged 25-34 (22%) in 2011 may well be a blip as the equivalent figure in previous years was consistently higher than this (28%-29% between 2008 and 2010).

Women were more likely than men to be non-drinkers (17% and 11%, respectively). Among men, those aged 25-64 were the least likely to be non-drinkers (8%-11%), compared with 15%-18% of the remaining age groups. The pattern for women was clearer, 12%-16% of those aged 16-64 were non-drinkers, this increased to 26% of those aged 65-74, and to 36% of those aged 75 and over. Table 3.1

3.3.3 Weekly alcohol consumption, 2008-2011 combined, by equivalised household income and Scottish Index of Multiple Deprivation (SIMD)

Weekly alcohol consumption levels by equivalised household income and the Scottish Index of Multiple Deprivation are presented in Tables 3.2 and 3.3 respectively (descriptions of each of these measures are available in the Glossary at the end of this volume). Four years of data (2008-2011) have been combined to enable more robust estimates of drinking patterns in each of the sub-groups to be made. Due to space constraints, an equivalent table by socio-economic classification has been omitted.

To ensure that the comparisons presented in this section are not confounded by the different age profiles of the sub-groups, the data have been age-standardised (age-standardisation is also described in the Glossary). On the whole, the differences between observed and age-standardised percentages are small. Therefore, the percentages and means presented are the standardised ones only

Equivalised household income

The proportions of men and women in each household income quintile classified as hazardous or harmful drinkers (and moderate and non-drinkers) are shown in Table 3.2. The mean weekly units consumed by moderate and hazardous or harmful drinkers, by income quintile are also presented in this table.

The proportion of men classed as hazardous/harmful drinkers generally declined in line with income - from 35% for those in the highest income quintile, to 28% for those in the 2^nd and 3^rd quintiles, and further still to 22%-24% for those in the two lowest income quintiles. The pattern was similar for women, but the decline was a little steeper, from 27% in the highest quintile to 14% in the lowest. Moderate drinking levels were fairly similar across the quintiles so the decline of hazardous/harmful drinking in line with household income was largely accounted for by a linear increase, as income decreased, in the proportion of non-drinkers. 5% of men and 8% of women in the highest income households were non-drinkers, compared with 21% of men and 24% of women in the lowest.

However, while non-drinking was most common in low income households, and hazardous/harmful drinking less common, Figure 3B illustrates that hazardous/harmful drinkers in the lowest income households consumed more units than hazardous/harmful drinkers in the other income groups. Men in the lowest income households who were hazardous/harmful drinkers consumed 61.6 units per week, compared with the 38.6-44.3 units consumed by men in the other income quintiles. The corresponding figures for women were 37.2 units and 26.0-26.4, respectively. Figure 3B, Table 3.2

Scottish Index of Multiple Deprivation (SIMD)

Two measures of SIMD are being used throughout this report. The first, which uses quintiles, enables comparisons to be drawn between the most and least deprived 20% of areas and the intermediate quintiles. The second contrasts the most deprived 15% of areas with the rest of Scotland (described in the tables as the "85% least deprived areas").

The general patterns seen for household income were also seen for SIMD, but with some notable differences. For men, the prevalence of hazardous/harmful drinking did not vary greatly by SIMD quintile (ranging between 26% and 29%). For women however, as deprivation level increased the proportion of hazardous/harmful drinkers steadily decreased (from 24% in the least deprived quintile to 15%-16% in the most deprived two quintiles). As seen with income, levels of moderate drinking were broadly similar across the SIMD quintiles, whereas non-drinking increased in line with deprivation, from 7% to 16% in men, and from 10% to 24% in women.

Although the prevalence of hazardous/harmful drinking varied little by SIMD for men, mean weekly consumption among male hazardous/harmful drinkers increased steadily in line with deprivation, from 36.7 units in the least deprived quintile to 52.8 units in the most deprived quintile. There was a particularly pronounced increase between the most deprived and the second most deprived quintiles (difference of 9.2 units). There was a corresponding, but less pronounced, increase in mean weekly consumption as deprivation increases among female hazardous/harmful drinkers from 24.9 units in the least deprived quintile to 30.6 units in the most deprived.

These patterns were confirmed when the weekly consumption of those living in the 15% most deprived areas in Scotland was compared with those living elsewhere. Men and women in the 15% most deprived areas were more likely to be non-drinkers than those in the rest of Scotland (17% for men and 24% for women compared with 10% and 14% respectively for those living in the 85% least deprived areas). Levels of moderate drinking were similar in both areas, and while the prevalence of hazardous/harmful drinking in both areas was also similar for men, women in the 15% most deprived areas were less likely than those living elsewhere to be hazardous/harmful drinkers (14% and 19%, respectively).

Mean unit consumption among harmful/hazardous drinkers was higher in the 15% most deprived areas than in the rest of Scotland and this was true for both men (54.9 compared with 41.1 units) and women (30.6 compared with 26.9 units). Table 3.3

3.4 ESTIMATED DAILY CONSUMPTION

3.4.1 Trends in alcohol consumption on the heaviest drinking day since 2003

Data on alcohol consumption on the heaviest drinking day in the last week for adults aged 16 is presented in Table 3.4 for 2003 onwards.

The mean number of units consumed by adults on their heaviest drinking day in the past week has declined gradually from 4.9 units in 2003 to 4.3 units in 2011. The latest figures suggest that decline is perhaps more apparent among men than women. To illustrate, in 2003, men consumed 6.5 mean units on their heaviest drinking day, between 2008 and 2010 it was a little lower (5.9-6.2 units), and then fell to 5.5 in 2011. In contrast, for women mean units fell between 2003 and 2009 for women (from 3.6 to 3.2 units) and has remained stable since then (3.1 in 2010 and 3.2 in 2011). The half a unit decrease in men's daily consumption between 2010 and 2011 is the largest in the series to date, so evidence from future years will be needed before we can establish more conclusively whether this has been a sustained decline rather than a single year's sampling variation. It is worth noting that the decline was most notable in men aged 25-34 (whose consumption fell by 1.6 units between 2010 and 2011), so it is possible that it does not represent a meaningful trend. As was the case with weekly drinking, the general pattern of decline since 2003 tended to be due to reductions in the consumption of men aged under 65, and women aged 16-34.

The proportion of adults exceeding their recommended daily limits (more than 4 units for men, more than 3 for women), has declined by one percentage point in each survey year, from 41% in 2003 to 37% in 2011. As highlighted in the alcohol consumption chapter in the 2010 SHeS report,¹² between 2003 and 2010 there was little change in the proportion of men exceeding their recommended daily limits (43%-45%). At 41%, the 2011 figure was clearly lower than the 2003 high of 45%, indicating an overall downward trend for men between 2003 and 2011. However, it is worth noting that the decline from 2010 to 2011 was largely confined to men aged 25-34. A steady decline in the proportion of women exceeding their recommended daily limits (from 37% in 2003 to 33% in 2010) was reported in the 2010 chapter¹² and there was little change in 2011 (34%). Men aged 16-54, and women aged 16-34 have generally seen the largest declines over time in the proportions exceeding the daily limits.

Between 2003 and 2011, there was also an overall decrease in the prevalence of drinking more than twice the recommended daily limits (more than 8 units for men and more than 6 units for women) from 24% to 20%. As with the other measures discussed here, this decline was more pronounced and consistent among men (from 29% in 2003 to 25% in 2011), while recent figures for women have fluctuated between 16% and 17% (compared with 19% in 2003). Figure 3C, Figure 3D, Table 3.4

3.4.2 Alcohol consumption on the heaviest drinking day by age and sex, 2011

In 2011, men consumed more units on their heaviest drinking day in the last week than women (5.5 and 3.2 respectively). They were also more likely than women to exceed their recommended daily limits (41% compared with 34%) and to consume twice their recommended daily limits (25% compared with 17%).

Daily drinking showed variations with age. Mean units consumed decreased as age increased (from 5.9 in those aged 16-24 down to 2.9 in those aged 75 and above). This pattern was observed for both men and women. The proportion exceeding their daily limits was similar for those aged 16 to 54, and dropped quite sharply for each successive age group thereafter. For example, the proportion of men aged 16-54 that drank more than 8 units on their heaviest drinking day ranged from 28% to 32%, this then dropped to 20% at age 55-64, 12% at age 65-74, and to just 3% for men aged 75 and over. Table 3.4

3.5 ADHERENCE TO WEEKLY AND DAILY DRINKING ADVICE

3.5.1 Trends in adherence to weekly and daily drinking advice since 2003

As noted in Section 3.1.1, the recommended daily drinking guidelines are that men should not regularly exceed 3-4 units and women should not regularly drink more than 2-3 units. In addition, the recommended weekly drinking guidelines are that men and women should not exceed 21 units and 14 units respectively.

The proportion of adults who drank within these recommended government guidelines remained fairly stable between 2003 and 2011 (ranging from 42% - 44%). Similarly, there was little change when the trends for men and women were looked at separately (although there was a slight increase for men from 39% in 2010 to 42% in 2011 but the figures have fluctuated each year). However when examining variations by age there was an overall increase in adherence to the guidelines among men aged 16-54 and 75 and above, and women aged 25 to 34. Among men aged 65-74 and women aged 65 and above the proportion adhering to the guidelines decreased between 2003 and 2011.

Between 2003 and 2011 there was a decline in the proportion of people drinking outwith the guidelines (47% and 42% respectively), although there was no significant change between 2009 and 2011. The drop was steepest among men (from 53% in 2003 to 46% in 2011) and was largely explained by a decline among younger men (aged 16-44). The decline among women (from 42% to 38%) was mainly driven by a decrease among those aged 25-34 (from 55% to 42%).

Over this same period (2003-2011) the proportion of ex-drinkers increased from 5% to 8% (for men it increased from 4% to 6%, the equivalent figures for women were 5% and 9%). The increase was greatest in the older age groups, with little change among those aged under 45.

While there was little change in the overall proportion of adults reporting that they had never drunk alcohol between 2003 and 2011, there was a notable increase in the proportion of 16-24 year olds reporting this (from 8% to 13% in men and from 9 to 12% in women). Most of this change occurred between 2009 and 2010. Table 3.5

3.5.2 Adherence to weekly and daily drinking advice by age and sex, 2011

In 2011, 43% of adults drank within the recommended guidelines (42% of men and 44% of women). As would be expected, the patterning by age was similar to that described above for weekly and daily drinking: 37%-43% of those aged 16-54 drank within the guidelines, this increased to 46%-47% of those aged 55-74, and further still to 57% of those aged 75 and over. This was true for men and women, with the increase occurring slightly later among men (aged 75 and over compared with aged 55-64 for women).

The proportion drinking outwith the guidelines (42%) was similar to the proportion that adhered to them (43%). Men were more likely than women to drink outwith the weekly and daily guidelines (46% compared with 38%). As Figure 3E illustrates, the age-related pattern for drinking outwith the guidelines was the reverse of that seen for drinking within them, with prevalence declining from the age of 65-74 among men and 55-64 among women. Figure 3E, Table 3.5

3.6 NUMBER OF DAYS ALCOHOL WAS CONSUMED IN PAST WEEK

3.6.1 Trends in number of days alcohol was consumed in past week since 1998

The trend for the number of days in the previous week that people said they had consumed alcohol is presented in Table 3.6. The figures presented are based only on those who said they had drunk alcohol in the past week. While the changes made to the alcohol estimates from 2003 onwards (detailed in the 2008 SHeS chapter on alcohol consumption)¹⁰ mean that consumption volumes cannot be compared, the question about the number of drinking days was unaffected, so the trend figures in the table extend back to 1998 when the question was first asked. Adults aged 75 and over were not included in the 1998 survey therefore the discussion on trends since 1998 is based on adults aged 16 to 74 (totals for this age group are also presented in Table 3.6). Figures for all adults (aged 16 and over) from 2003 onwards are also presented.

These figures provide useful contextual information about people's drinking patterns, and help to illustrate whether changes over time in overall consumption levels are the result of people drinking on fewer occasions over the week, or whether they are drinking less on the same number of occasions. In addition, people are advised to have at least two alcohol-free days per week so the trend in the proportion who drank on more than five days in the previous week helps show the extent to which this advice has been adhered to.

Between 1998 and 2008 there was little change in the mean number of days on which adults aged 16-74 consumed alcohol (ranging from 2.8 to 3.0 days) though it has been a little lower since then (2.6 days). The figures for men aged 16-74 followed a similar pattern to this (3.1-3.2 days between 1998 and 2008 and 2.8 days since 2009). For women, with the exception of 2003 (2.7 days), the figure remained unchanged from 1998 (2.4 days in 1998 and 2011).

As shown in Figure 3F, among adults aged 16-74 the prevalence of drinking on more than five days a week declined between 1998 and 2011 (from 14% to 10%) but has been largely static since 2009. As seen with the trend in mean days, the decline since 1998 was greater for men (from 17% to 12% in 2011), than for women for whom the figures have decreased from 10% in 1998 to 8% in 2011.

The decline is slightly greater when the figures for all adults aged 16 and over are considered. Between 2003 and 2009 the mean number of days on which alcohol was consumed in the previous week declined from 3.0 to 2.7 and has remained at this level since then. Again, the decline was more evident for men (from 3.3 days in 2003 to 2.8 days in 2011) than for women (from 2.7 days in 2003 to 2.5 days each year since 2008). The downward trend was evident for men of all ages but for women was more consistent among those aged 25-54.

For all adults aged 16 and over, the trend (since 2003) in drinking on more than five days a week has also been downward. In 2003, 17% drank on more than five days a week. The equivalent figure in 2011 was 12%. This too was largely confined to men (down from 20% in 2003 to 13% in 2011) with the equivalent figures for women showing a much smaller decline (13% to 10%). The change over time was evident for almost all age groups, with the exception of the youngest age group and women aged 75 and over. Figure 3F, Table 3.6

3.6.2 Number of days alcohol was consumed in past week, by age and sex, 2011

In 2011, the mean number of days on which adults who drank consumed alcohol was 2.7 (2.8 days for men and 2.5 for women). Just over one in ten (12%) drank on more than five days in the previous week (13% of men and 10% of women). Both the mean number of days, and the proportion drinking on more than five days, increased in line with age with similar patterns for men and women (see Figure 3G). Just 4%-6% of people aged 16-44 who had drunk alcohol in the previous week did so on more than five days, this increased with each successive age group to 37% of those aged 75 and over. These figures, in combination with the daily alcohol consumption figures presented in Table 3.4, suggest that the way in which people consume their alcohol differs notably across the lifecycle, with older people drinking less alcohol overall, spread across more days of the week, and younger age groups drinking higher volumes of alcohol on fewer occasions. Figure 3G, Table 3.6

3.6.3 Number of days alcohol was consumed in past week, 2008-2011 combined, (age-standardised), by equivalised household income and Scottish Index of Multiple Deprivation (SIMD)

Equivalised household income

Both the mean number of days on which drinkers drank in the previous week, and the proportions drinking on more than five days are presented by household income in Table 3.7. As the figures are based only on people who drank, the table is based on the combined 2008-2011 data.

The prevalence of drinking on more than five days a week varied significantly by household income for men but with no clear pattern. Those in the highest income households were most likely to drink on more than five days (18%) while prevalence was lowest among those in the 2^nd and 4^th income quintiles (13% and 14% respectively). In contrast, the pattern for women was much clearer with a decline from 15% of those in the highest income households to 8%-9% in the three lowest income quintiles.

For both men and women the mean number of days on which drinkers consumed alcohol in the previous week declined fairly consistently in line with household income. Among men it declined from 3.2 days for those the highest income households to 2.7-2.8 days for those in the bottom two quintiles; for women it declined steadily from 3.0 to 2.1 days between those in the highest and lowest quintiles. Table 3.7

Scottish Index of Multiple Deprivation (SIMD)

The patterns by SIMD (Table 3.8) are similar to those for household income discussed above. There was a clear association between area level deprivation and drinking on more than five days a week for both sexes although the pattern was more pronounced for women. Women living in the least deprived quintile were almost three times as likely as those in the most deprived to drink on more than five days in the previous week (13% and 5%, respectively). For men, it was those living in the 4^th and 3^rd quintiles that were most likely to drink this frequently (16% and 17% respectively).

The mean number of days on which female drinkers had drunk in the previous week declined as area level deprivation increased (2.8 days for those living in the least deprived quintile compared with 2.0 days for those in the most deprived). The pattern for men was similar to that for prevalence of drinking on more than five days: with a mean of 2.7 drinking days for those in the two most deprived quintiles compared with 3.0-3.1 days for those living elsewhere.

Comparing the 15% most deprived areas with the rest of Scotland shows similar patterns, with bigger differences evident for women than for men. For example, 5% of women in the 15% most deprived areas drank on five or more days compared with 10% of women in the rest of Scotland. The equivalent figures for men were 14% and 15%. Similarly, the difference in the mean days figure for women in both groups was 0.6 days compared a difference of 0.3 days for men. Table 3.8