Scottish Health Survey 2015 - volume 1: main report

4 Alcohol

Linsay Gray and Alastair H Leyland

Summary

• Reported hazardous or harmful drinking for adults (based on revised guidelines of over 14 units per week for both men and women) declined significantly from 2003 (34%) to 2013 (25%) but has stayed at similar levels since (26% in 2015).
• Similar patterns were seen for the proportion of adults drinking above three units (women) or four units (men) on their heaviest drinking day (41% in 2003, 36% in 2015) and drinking above six units (men) or eight units (women) (24% in 2003, 20% in 2015).
• Non-drinking among adults has increased significantly from 11% in 2003 to 16% in 2013 and has remained at that level since.
• The mean number of units per week among drinkers has declined from 16.1 units in 2003 to 12.2 units in 2013 and remained at a similar level in 2015 (12.9 units).

• Mean unit consumption per week was around twice as high for male drinkers (17.2 units) than for female drinkers (8.7 units).
• Hazardous or harmful levels of drinking were reported for 36% of men and 17% of women.
• Drinking above the recommended maximum amount declined with age-standardised income for both men (46% in the highest income quintile to 25%-26% in the bottom two quintiles) and women (equivalent figures as 24% and 11%).
• Those aged 16-64 were more likely than those aged 65 and over both to drink above three units (women) or four units (men) on a single day (39-42% compared with 10-27%) and to drink above six units (women) or eight units (men) (18-28% compared with 2-10%).

• Using AUDIT scores, in 2014/2015, 82% of adults drank at low risk levels or were abstinent, 15% drank at hazardous levels, 2% at harmful levels and 1% had possible alcohol dependency.
• Prevalence of drinking at hazardous or harmful levels, or having a possible alcohol dependency, decreased with age from 35% of those aged 16-24 to 2% of those aged 75 and over.

4.1 Introduction

The misuse of alcohol is recognised as a major issue in Scotland, carrying a risk of physical and mental health problems, as well as potential negative social consequences. People who consume large quantities of alcohol have increased risks of high blood pressure, chronic liver disease and cirrhosis, pancreatitis, some cancers, mental ill-health and accidents. The World Health Organization ( WHO) cites alcohol as one of the largest risk factors for ill-health in wealthy countries, along with tobacco use, obesity and high blood pressure ^[1] . It also identifies higher levels of alcohol dependence and alcohol use disorders in the UK than across Europe as a whole ^[2] .

A report published in 2009 attributed 5% of deaths in Scotland to alcohol ^[3] . Alcohol-related mortality increased between 2012 and 2015, with 1,152 alcohol-related deaths in 2015. Whilst this remains lower than in any of the years from 1999 to 2011 ^[4] , it is nearly double the figures in the early 1980s. There are more than 94,500 GP consultations and around 35,000 hospital stays each year are for alcohol-related problems. Although the rate for alcohol-related hospital stays has declined in recent years ^[4,5] , it is still four times higher than in the early 1980s. Alcohol-related morbidity and mortality are not evenly distributed throughout the population and the burden is greatest among those living in the most deprived areas ^[6,7] .

The harms associated with alcohol misuse are not restricted to those consuming alcohol, with potential impacts on others of injury, neglect, abuse, crime, and from concern for or fear of family members. A report published by Alcohol Focus Scotland in 2015 estimated that 1 in 2 people in Scotland are harmed as a result of someone else's drinking ^[8] . The relationship between alcohol and crime is also well documented. In the 2015 Scottish Prisoner Survey, 41% of prisoners reported being drunk at the time of their offence, although this represents a fall from 45% in 2013 ^[9] . It is also thought that alcohol is involved in 70% of assaults requiring treatment at A&E ^[10] .

Misuse of alcohol also has a negative impact on children with an estimated 36,000 to 51,000 children living with a parent (or guardian) whose alcohol use is potentially problematic ^[11] . There are also economic impacts, with an estimated 1.5 million working days lost to reduced efficiency in the workplace due to the effects of alcohol, and a similar number lost due to alcohol-related absence ^[12] . In 2007, the total annual cost of excessive alcohol consumption was estimated to stand at around £3.6 billion ^[12] .Findings from the 2014 Scottish Social Attitudes survey showed that public awareness of the harmfulness of alcohol has increased, with 60% citing it as the drug causing most problems in Scotland ^[13] .

4.1.1 Policy background

One of the National Outcomes underpinning the Scottish Government's core purpose is for people living in Scotland to 'live longer, healthier lives' ^[14] . Tackling alcohol misuse is integral to ensuring that people in Scotland live longer and to reducing the significant inequalities that exist in society. The government's commitment to addressing alcohol misuse is evidenced by the inclusion of a National Performance Framework National Indicator to 'reduce alcohol related hospital admissions' ^[14] . Other related indicators include the reduction of premature mortality, reducing reconviction rates and crime victimisation, and reducing deaths on roads ^[14] .

The Scottish Government published its alcohol strategy Changing Scotland's Relationship with Alcohol: a Framework for Action in 2009 ^[15] . The strategy, which was accompanied by significant new investment in prevention and treatment services, builds on the Licensing (Scotland) Act 2005, which was implemented in September 2009. Further legislation includes the Alcohol etc. (Scotland) Act, which was implemented in October 2011 and, among other measures, included the banning of quantity discounts in off-sales, the introduction of restrictions on alcohol displays and promotions, and the introduction of the mandatory Challenge 25 age verification policy. The recently passed Air Weapons and Licensing (Scotland) Act 2015 creates offences of an adult supplying alcohol to someone underage in a public place, which will assist the Police to better address underage drinking in drinking dens.

The Alcohol (Minimum Pricing) (Scotland) Act 2012 allows for a price to be set for a unit of alcohol, below which it cannot be sold. Its implementation date is currently uncertain due to an ongoing legal challenge led by the Scotch Whisky Association, in conjunction with some other European alcohol producers ^[16] . Informed by modelling carried out by the University of Sheffield ^[17] , Scottish Ministers have indicated their preference for a minimum unit price of 50p for at least the first two years. It is estimated that twenty years after implementation of the policy, when it is considered to have reached full effectiveness, there would be around 120 fewer alcohol-related deaths per annum and around 2,000 fewer hospital admissions per annum ^[18] .

Evaluation of Scotland's alcohol strategy lies with NHS Health Scotland, through the Monitoring and Evaluating Scotland's Alcohol Strategy ( MESAS) work programme. The final annual MESAS report, published in March 2016, concluded that 'the declines in both mortality rates [since 2003] and hospitalisation rates [since 2007/08] were much steeper in Scotland than in England / England & Wales' ^[7] . However, 'Scotland continues to experience substantially higher levels of alcohol-related mortality and morbidity compared to the 1980s and compared to England & Wales. Inequalities in alcohol-related harm persist. Those living in the most deprived areas, especially men, continue to experience the highest levels of alcohol-related morbidity and mortality' ^[7] .

In January 2016, the UK Chief Medical Officers published new guidelines on alcohol consumption. This included advice that for both men and women, it is safest not to regularly consume more than 14 units of alcohol a week. This represents a reduction in the recommended safe amount for men. Advice was also included to spread the amount drunk over a number of days and limit the amount consumed in a single session ^[19] .

4.1.2 Measuring alcohol consumption in surveys

The alcohol consumption estimates discussed in this chapter are based on self-reported data collected during the survey interview. It is, however, important to note that surveys usually obtain lower consumption estimates than those implied by alcohol sales data. This disjuncture can largely be explained by participants' under-reporting of consumption, due in part to not accounting for atypical / special occasion drinking ^[20] , but there is also some evidence that survey non-responders are more likely than responders to engage in risky health behaviours, including hazardous alcohol use ^{[21,22,23,24]} . The most recently available annual estimates of alcohol sales in Scotland show that 10.8 litres (20.8 units per adult per week) of pure alcohol per person aged 16 and over were sold in 2015 (the equivalent figure for England and Wales was 9.1 litres (17.4 units per adult per week)) ^[25] .

While self-reported survey estimates of consumption are typically lower than estimates based on sales data, surveys provide valuable information about the social patterning of individuals' alcohol consumption. Findings from the Scottish Health Survey have been used in the evaluation of the implementation of minimum unit pricing to help assess the impact on consumption patterns across different groups in society.

4.1.3 Reporting on alcohol consumption in the Scottish Health Survey ( SHeS)

The key trends for weekly and daily alcohol consumption are updated and presented in this chapter. For weekly consumption, these are based on the revised guidelines; hence all weekly consumption figures for men, going back to 2003, have been revised. Figures for mean consumption are presented for drinkers only, a change from previous reports; hence all mean consumption figures, both weekly and on the highest drinking day, for both men and women, going back to 2003, have also been revised. Figures are also presented broken down by age and sex, and for the revised weekly guidance, by equivalised household income. Levels of alcohol dependency and high risk alcohol use, as measured by the Alcohol Use Disorders Identification Test ( AUDIT), by age and sex, are presented for the years 2014/2015 combined.

4.1.4 Comparability with other UK statistics

The Health Surveys for England, Wales and Northern Ireland all provide estimates for alcohol consumption. A report published by the Government Statistical Service advises that estimates from these surveys and / or those from SHeS are "not comparable" ^[26] . Mean weekly alcohol consumption statistics are not available for Wales, and estimates of consumption on the heaviest drinking day are not available for Northern Ireland. While questions are similar in each of the surveys, questions on alcohol consumption are delivered through self-completion in the Welsh Health Survey, complicating comparisons. Categorisation of drinkers and non-drinkers is inconsistent across the surveys. Differences also exist in the way some alcoholic drinks are categorised.

4.2 Methods And Definitions

4.2.1 Methods

Questions about drinking alcohol have been included in SHeS since its inception in 1995. Questions are asked either face-to-face via the interviewer or included in the self-completion questionnaire if they are deemed too sensitive for a face-to-face interview. All 16-17 year olds are asked about their consumption via the self-completion, as are some 18-19 year olds, at interviewers' discretion. The way in which alcohol consumption is estimated in the survey was changed significantly in 2008. A detailed discussion of those revisions can be found in the chapter on alcohol consumption in the 2008 report ^[27] .

In 2015, the SHeS questionnaire covered the following aspects of alcohol consumption:

• usual weekly consumption,
• daily consumption on the heaviest drinking day in the previous week, and
• indicators of potential problem drinking (including physical dependence).

Weekly consumption

Participants (aged 16 and over) were asked preliminary questions to determine whether they drank alcohol at all. For those who reported that they drank, these were followed by further questions on how often during the past 12 months they had drunk each of six different types of alcoholic drink:

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

From these questions, the average number of days per week the participant had drunk each type of drink was estimated. 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 ^[28] .

Daily consumption

Participants were asked about drinking in the week preceding the interview, with actual consumption on the heaviest drinking day in that week then examined in more detail ^[29] . Details on the amounts consumed for each of the six types of drink listed in the weekly consumption section above were collected, rather than direct estimates of units consumed.

Problem drinking

Since 2012 the AUDIT questionnaire has been used to assess problem drinking. AUDIT is widely considered to be the best screening tool for detecting problematic alcohol use. It comprises ten indicators of problem drinking: three indicators of consumption, four of use of alcohol considered harmful to oneself or others, and three of physical dependency on alcohol. Given the potentially sensitive nature of these questions, they were administered in self-completion format for all participants.

4.2.2 Calculating alcohol consumption in SHeS

The guidelines on sensible drinking are expressed in terms of units of alcohol consumed. As discussed above, detailed information on both the volume of alcohol drunk in a typical week and on the heaviest drinking day in the week preceding the survey was collected from participants. The volumes reported were not validated. In the UK, a standard unit of alcohol is 10 millilitres or around 8 grams of ethanol. In this chapter, alcohol consumption is reported in terms of units of alcohol.

Questions on the quantity of wine drunk were revised in 2008. Since then, participants reporting drinking any wine have been asked what size of glass they drank from: large (250ml), medium (175ml) and small (125ml). In addition, to help participants make more accurate judgements they are also shown a showcard depicting glasses with 125ml, 175ml and 250ml of liquid. Participants also had the option of specifying the quantity of wine drunk in bottles or fractions of a bottle; with a bottle treated as the equivalent of six small (125ml) glasses.

There are numerous challenges 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. Table 4A below 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) ^[27] . Those who drank bottled or canned beer, lager, stout or cider were asked in detail about what they drank, and this information was used to estimate the amount in pints.

4.2.3 Age-standardised estimates for weekly alcohol consumption

Equivalised annual household income is a measure of household income that takes account of the number of persons in the household. The income data presented for weekly alcohol consumption are presented in quintiles. To ensure that the comparisons presented are not confounded by the different age profiles of the quintiles, the data have been age-standardised (see the Glossary at the end of this Volume for a detailed description of both age-standardisation and equivalised household income).

Table 4A Alcohol unit conversion factors

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

4.2.4 Definitions

The new UK alcohol guidelines consist of three recommendations:

• A weekly guideline on regular drinking;
• Advice on single episodes of drinking; and
• A guideline on pregnancy and drinking.

According to the weekly guideline, you are safest not to regularly drink more than 14 units per week, to keep health risks from drinking alcohol to a low level. This applies to both men and women. If you do drink as much as 14 units a week, it is best to spread this evenly over three days or more. On a single episode of drinking, advice is to limit the total amount drunk on any occasion, drink more slowly, drink with food and alternate with water. The guideline on drinking and pregnancy, or planning a pregnancy, advises that the safest approach is not to drink alcohol at all ^[19] .

Those who drink within the revised weekly guidelines of 14 units a week are described within this report as 'moderate' drinkers, while drinking above this level is described as 'hazardous or harmful' ^[30] .

'Hazardous' / 'harmful' drinking can also be defined according to scores on the AUDIT questionnaire. Guidance on the tool, which is primarily intended to screen respondents for levels of alcohol dependency or high-risk use, has been published by the World Health Organization ( WHO). Section 4.2.5 includes a fuller description of the tool ^[31] .

4.2.5 Consumption of more than three units (women) or four units (men) on a single day is also reported in this chapter. This allows comparison with previous SHeS reports although these volumes of alcohol are no longer included in the most recent guidance from the UK Chief Medical Officers. Consumption of double this amount (six units for women and eight for men) is also reported.Alcohol Use Disorders Identification Test ( AUDIT) scale.

The AUDIT questionnaire was primarily designed to screen for levels of alcohol dependency or high-risk use. In line with the WHO guidelines on using the tool, responses to each of the ten AUDIT questions were assigned values of between 0 and 4 ^[32] . Scores for the ten questions were summed to form a scale, from 0 to 40, of alcohol use.

The WHO guidelines ^[31] for interpreting AUDIT scale scores are as follows:

Score	Category description
0 to 7	low-risk drinking behaviour, or abstinence
8 to 15	medium level of alcohol problems, with increased risk of developing alcohol-related health or social problems (sometimes described as hazardous drinking behaviour)
16-19	high level of alcohol problems, for which counselling is recommended (harmful drinking behaviour)
20 or above	warrants further investigation for possible alcohol dependence.

4.3 Trends In Alcohol Consumption Since 2003

4.3.1 Trends in usual weekly alcohol consumption

Trends from 2003 to 2015 in self-reported usual weekly alcohol consumption are presented in Table 4.1 by sex for adults aged 16 and over. These take into account the revised guidelines for all years. As outlined in Section 4.2.4, moderate weekly alcohol consumption is now defined as no more than 14 units for both men and women, with those exceeding this amount classified as hazardous or harmful drinkers.

As shown in Figure 4A and Table 4.1, reported hazardous or harmful drinking declined significantly for adults aged 16 and over from 2003 (34%) to 2013 (25%) but has stayed at similar levels since (26% in 2015). Hazardous or harmful drinking levels were more than twice as high for men (36%) as for women (17%) in 2015, with this having been the case in each survey year from 2003 onwards. The trend for men showed a significant decline from 47% in 2003 to 34% in 2013 and then remained at a similar level in 2014 and 2015 (35% and 36% respectively), with the trend for women following a similar pattern (23% in 2003, 16% in 2013, 17% in 2015).

Prevalence of non-drinking for adults aged 16 and over increased significantly from 11% in 2003 to 16% in 2013, remaining at this level since. Significant increases over this period were seen for both men and women. For men, the proportion saying they did not drink alcohol rose from 8% in 2003 to 14% in 2014 and 2015. In total, 13% of women reported being non-drinkers in both 2003 and 2008, rising to 18-20% from 2013 to 2015 (18% in 2015).

The estimated mean number of units of alcohol consumed per week for adult drinkers aged 16 and over fell from 16.1 units in 2003 to 12.2 in 2013 and has subsequently stayed at similar levels (12.9 in 2015). Comparable trends were seen for both men and women. The mean number of units declined for male drinkers from 21.8 units in 2003 to 15.7 in 2013 and was at a similar level (17.2) in 2015. Women's consumption decreased from 10.6 units per week in 2003 to 8.6 in 2013 and has remained relatively static since (8.7 in 2015).

Figure 4A, Table 4.1

4.3.2 Trends in alcohol consumption on the heaviest drinking day in last week

The estimates for the mean units consumed on the heaviest drinking day,the proportions of the population drinking more than three units (women) or four units (men), and the proportions drinking more than six units (women) or eight units men on a single day in the week prior to interview are presented separately for men, women and all adults aged 16 and over in the years 2003 to 2015 in Table 4.2.

The proportion of all adults aged 16 and over drinking more than three units (women) or four units (men) on their heaviest drinking day declined from 41% in 2003 to 35% in 2013 and has maintained approximately this level in 2015 (36%). Similar patterns were seen by sex. For men, the proportion drinking more than four units on their heaviest drinking day declined from 45% in 2003 to 40% in 2013 and is currently at 41% in 2015. For women, the proportion drinking more than three units on their heaviest drinking day decreased from 37% in 2003 to 30% in 2012 before stabilising (32% in 2015).

Drinking more than eight units for men and six units for women on the heaviest drinking day fell from 24% in 2003 to 19% in 2013 and has been at 20% in the two subsequent survey years of 2014 and 2015. Again, figures for men and women showed similar patterns of long-term decline although with relatively stable figures in the most recent years. For men, prevalence was 29% in 2003 before declining to 24% in 2014 (26% in 2015). For women, there was a decline from 19% in 2003 to 15% in both 2012 and 2013 and was at 14% in 2015.

The mean unit alcohol consumption on the heaviest drinking day of those who had consumed alcohol in the previous week declined from 7.7 units in 2003 to 6.9 in 2013. The 2015 figure of 7.2 units was not significantly different from either the 2003 or 2013 figures. Similar patterns were seen for both men and women. There was a significant decline for men who had consumed alcohol during the previous week from a mean of 9.0 units on the heaviest drinking day in 2003 to 8.0 in 2013, with a figure of 8.6 units in 2015 that was not significantly different from either of these. For women, the mean number of units of alcohol consumed on the heaviest drinking day fell from 6.2 units in 2003 to 5.6 in 2012 and 2013, with a figure of 5.7 units in 2015.

Table 4.2

4.3.3 Number of days alcohol was consumed in the past week

Table 4.3 presents the reported number of days on which adult drinkers (men and women aged 16 and over) consumed alcohol during the week prior to interview for the period 2003 through to 2015. The mean number of drinking days in the past week dropped steadily over time for all adult drinkers from 3.0 days in 2003 to 2.6 in 2013, 2014 and 2015. Numbers fell overall for both men and women but there were distinct patterns: among male drinkers there was a steady decline from 3.3 days in 2003 to 2.8 in 2011, after which time the number generally plateaued (2.8 in 2015). For female drinkers, on the other hand, there was a steadier decline over time from 2.7 days in 2003 to 2.3 in 2015.

The prevalence of drinking alcohol on more than five days in the past week among adult drinkers fell from 17% in 2003 to 11% in 2009 and was also 11% in 2015. This pattern was similar for both sexes, with a fall for men from 20% in 2003 to 14% in both 2009 and 2015. For women, the proportion fell from 13% in 2003 to 9% in 2009 and was at a similar level (8%) in 2015.

Table 4.3

4.4 Alcohol Consumption In 2015

4.4.1 Weekly alcohol consumption

Self-reported usual weekly alcohol consumption in 2015 is shown by age and sex for adults aged 16 and over in Table 4.4. Figures are shown for mean weekly consumption in units, as well as percentage breakdowns of moderate and hazardous or harmful consumption levels (revised guidelines as defined in Section 4.2.4) and non-drinkers.

Alcohol consumption differed significantly by age in 2015. Among all adult drinkers, the mean units per week was highest for those aged 16-24 and those aged 55-64 (14.7 and 14.9 units respectively) and lowest for those aged 75 and over (8.3). The lowest consumption for both male and female drinkers was among those aged 75 and over (11.6 units for men, 5.4 for women), with the highest levels for men being among those aged 55-64 (20.6 units) and for women among those aged 16-24 (10.8).

The hazardous or harmful drinking prevalence in men was more than twice that of women (36% compared with 17%), with levels for men compared to women within each age group also around twice as high. The prevalence of moderate drinking (i.e. within the recommended weekly limit of 14 units) was between 13 and 24 percentage points lower for men than for women in each age group, with the exception of those aged 75 and older where there was only a 1 percentage point gap (54% for men compared with 55% for women).

Overall, women were significantly more likely than men to report being non-drinkers (18% compared with 14%) in 2015. Prevalence of non-drinkers was higher among those aged 65 and over than those aged 16-64, both for men (17-24% compared with 10-13%) and women (25-38% compared with 7-17%).

Table 4.4

4.4.2 Weekly alcohol consumption, by household income

The age-standardised estimates for usual weekly alcohol consumption levels (according to the revised guidelines) are given by household income for 2015 in Figures 4B, 4C, and 4D and Table 4.5 (see section 4.2.3 for more information on age-standardisation).

For both men and women, there was a clear association between household income and the propensity to exceed the recommended limit of 14 units per week and thus be classified as a hazardous / harmful drinker (revised guidelines). Among women the age-standardised prevalence of hazardous / harmful drinking declined gradually from 24% of those in the highest income quintile drinking at hazardous / harmful levels to 11% of those in the two lowest income quintiles. For men, levels of hazardous / harmful drinking were similar among the three quintiles with the highest income (40-46%) with a significantly lower level among the two lowest income quintiles (25% and 26%).

Figure 4B, Table 4.5

Age-standardised non-drinking prevalence had a clear association with household income in 2015. The age-standardised prevalence of non-drinking was consistently lower with higher household income, for both men (ranging from 3% non-drinkers in the highest income quintile to 28% in the lowest income quintile) and women (10% and 27% respectively).

Age-standardised mean self-reported levels of weekly alcohol consumption among male drinkers in 2015 were significantly higher in the lowest income quintile (a mean of 23.1 units per week) than in the other four income quintiles (mean levels between 14.4 and 17.2 units per week). Among female drinkers, there was no clear association between consumption and household income, with consumption at between 7.6 and 10.0 units per week across all five income quintiles.

The equivalent figures for hazardous and harmful drinkers only show a much clearer pattern of high consumption among some drinkers in the lower income bands. Among male hazardous or harmful drinkers (those who consumed more than 14 units per week), mean levels of consumption were 54.8 units per week in the lowest income quintile, compared with 28.3 to 34.7 units per week in the other income quintiles. Female hazardous or harmful drinkers in the lowest two income quintiles consumed a mean of 33.3 to 39.1 units, compared with 22.9 to 24.4 in the top three quintiles. While these differences were statistically significant, the figures on prevalence of hazardous and harmful drinking in the lower income quintiles demonstrate that such levels of consumption, particularly among women in the lower income bands, are not common.

Figure 4C, Figure 4D, Table 4.5

4.4.3 Alcohol consumption on the heaviest drinking day in last week

Table 4.6 shows reported alcohol consumption on the heaviest drinking day during the week prior to interview in 2015, by age and sex. Figures are shown for mean units consumed, as well as the percentage consuming more than three units (women) or four units (men) and the percentage consuming over six units (women) or eight units (men) on the heaviest drinking day.

As in previous survey years, ^[33] the proportion of men drinking more than four units (41%) was higher than the proportion of women drinking more than three units (32%). The proportion having at least double this number of units was also higher among men (26%) than women (14%) both at a total level and among all age groups.

Generally, both exceeding three / four units and exceeding six / eight units were less common for the older age groups. More than three units (women) or four units (men) were consumed on the heaviest drinking day by 39-42% of those aged 16-64, with this being less prevalent for those aged 65-74 (27%) and 75 and over (10%). A similar pattern was seen for those drinking in excess of six (women) and eight (men) units, declining from 18-28% for those aged 16-64 to 10% for those aged 65-74 and 2% for those aged 75 and older. Similar patterns were seen for both men and women.

Male drinkers drank significantly more units of alcohol on their heaviest drinking day than female drinkers (8.6 and 5.7 units on average respectively) in 2015, with higher levels seen for men than women among each individual age group. Average units consumed tended to decline with age for both sexes. The mean number of units consumed on the heaviest drinking day was 12.6 units for male drinkers aged 16-24 compared with 3.5 units for male drinkers aged 75 and over, with the corresponding figures for female drinkers being 8.8 and 2.6 units, respectively.

Table 4.6

4.4.4 Number of days alcohol was consumed in past week

Data on the reported number of days on which drinkers consumed alcohol in the week prior to interview in 2015 are presented by age and sex in Table 4.7. As reported for previous surveys ^[33] , in 2015 male drinkers consumed alcohol on more days per week than female drinkers (2.8 days compared with 2.3 days). The mean number of drinking days in the past week was higher with older age: from 2.2 days for male drinkers aged 16-24 to 3.9 for those aged 75 and over, with the figures for women being 1.7 and 3.4 days respectively. The average number of days that alcohol was consumed was between 0.4 and 0.7 days higher for men than women for each age group.

Male drinkers had a significantly higher prevalence of drinking alcohol on more than five days in the past week than female drinkers (14% and 8% respectively) in 2015. Drinking on five days or more increased from 3% for drinkers aged 16-24 to 32% for those aged 75 and over, with similar patterns seen both for men (3% to 37% respectively) and women (2% to 26% respectively).

As in previous years ^[33] , in 2015, those aged 75 and over had the highest number of days on which alcohol was consumed in the past week and the lowest weekly consumption levels. In combination, the data suggest that younger drinkers tend to consume a greater volume of alcohol in fewer drinking sessions, while older drinkers consume less at one time but with greater frequency.

Table 4.7

4.5 Problem Drinking In 2014/2015 (Combined)

Table 4.8 presents AUDIT scores by age (16 and over) and sex based on data from the 2014 and 2015 surveys combined. As well as volume of alcohol consumption-based categorisation, scores calculated from responses to the AUDIT questionnaire can also be used to determine hazardous and harmful drinking behaviour (see Section 4.2.4 for further details).

Among all adults, 82% drank at a low risk level or were abstinent ( AUDIT score of 0-7), 15% drank at hazardous levels ( AUDIT score of 8-15), 2% at harmful levels ( AUDIT score of 16-19) and 1% had possible alcohol dependence ( AUDIT score of 20 or more). Women were significantly more likely to drink at a low risk level or be abstinent than men (88% compared with 75%) and less likely to drink at hazardous levels (10% compared with 21%), harmful levels (1% compared with 2%) or to have possible alcohol dependency (also 1% compared with 2%) according to their AUDIT scores.

Drinking at low risk levels or abstinence increased with age from 65% for those aged 16-24 to 98% for those aged 75 and over, with levels of hazardous drinking decreasing from (28% to 2% across the same age groups). Harmful drinking and possible alcohol dependence prevalence also decreased with age from those aged 16-24 (4% and 2% respectively) to those aged 75 and over (0% for both).

AUDIT scores varied significantly by age for both men and women (Figures 4D and 4E) in 2014/2015. For men, the proportion classified as either abstinent or low-risk drinkers was 60% of those aged 16-24 compared with 95% of those aged 75 and over. The equivalent figures for women were 71% and 99% respectively. Prevalence of harmful or possibly dependent drinking behaviour (an AUDIT score of 16 or above) was highest for men aged 16-24 (7%) and was lower for those who were oldest (1% for those aged 75 and over). A similar pattern was seen for women, with equivalent figures of 5% and 0% respectively.

Figure 4E, Figure 4F, Table 4.8