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Changing Scotland's relationship with alcohol: a discussion paper on our strategic approach



WEALTHIER & FAIRER - Enable businesses and people to increase their wealth and more people to share fairly in that wealth.

The scale of Scotland's problem: economic costs

189. Scotland has a successful history of alcohol production and export. Alcohol-related industries are responsible for around £3.3 billion 78 of exports and directly employ around 9,900 people in Scotland. 79 But alcohol misuse reduces the productive capacity of our economy and imposes significant costs to Scottish society. Alcohol misuse cost the Scottish economy an estimated £820m in lost productivity in 2006-7 through absenteeism, presenteeism (reduced activity/productivity while at work due to the effects of alcohol misuse), higher unemployment and premature death of younger people in the working population.

190. In addition, alcohol misuse imposes significant costs on the NHS (in terms of treating people damaged by excessive drinking); social work services (in supporting individuals and families); and the criminal justice system (for example, on police time), as well as having wider human and social costs. The total cost of alcohol misuse in Scotland in 2006-7 is estimated to be in the region of £2.2 billion. This equates to a cost of over £500 per year for every adult living in Scotland.

Table 1: Cost to society of alcohol misuse, 2006/71



Productivity / Economic


NHS Scotland


Social work


Criminal justice + emergency services


Human costs


Total cost


191. While the harm caused by alcohol misuse pervades all sections of Scottish society, it is those living in our most deprived communities who are disproportionately affected. We know that those living in the 20% most deprived communities are around six times more likely to be admitted to hospital (and to die) due to alcohol misuse than those from the most affluent areas 2.

SAFER & STRONGER - Help local communities to flourish, becoming stronger, safer places to live, offering improved opportunities and a better quality of life.

The scale of Scotland's problem: alcohol and crime

192. Alcohol can make people more aggressive and more willing to take risks they otherwise would not. We are only too aware of the role of alcohol in anti-social behaviour and public disorder, incidents of violence within and outside the home, and deaths and serious injuries caused by drunk driving.

193. We know there is a strong link between alcohol misuse and offending. Almost half (45%) of Scottish prisoners in 2007 said they were drunk at the time of the offence, while a similar number report that they would accept help for alcohol problems. 3 Victims' reports also provide an indication of the scale of the problem. Where respondents to the 2006 Scottish Crime and Victimisation Survey ( SCVS) were able to say anything about the person or people who committed the crime, 45% said that the person or one of the people responsible was under the influence of alcohol. In cases of assault, this figure rises to 67%. 5

194. Victims' perceptions appear well-founded. Analysis by Strathclyde Police shows that of the 5,000 prisoners processed by one Glasgow police station in 2006-7, over 60% were under the influence of alcohol and/or drugs. Of those detained for violence, two-thirds were under the influence of alcohol. 80

195. An audit of Scottish Emergency Departments ( EDs) suggested that at least 70% of assaults presenting to EDs may be alcohol-related (with the majority of these being concentrated at weekends and involving young men). 4 And in homicide cases, two-thirds of people accused (and whose drug status was known) were either drunk or drunk and on drugs at the time of the alleged offence. 6

196. The relationship between alcohol and domestic violence is complex, but where domestic violence exists, alcohol is often present. A 2003 Home Office study into domestic violence found that in 62% of cases alcohol was present, while almost half (48%) convicted for domestic violence were alcohol dependent. It concluded that alcohol may be a distinguishing factor in domestic violence offenders. 81

197. The link between pub closing times and criminal offences is shown graphically in Figure 3. The number of offences peak around closing time in both Strathclyde and Lothian and Borders. The slightly later peak (at around 1am) in Lothian and Borders could be explained by Edinburgh having later licensing hours. 82

Figure 3: Offences by time of day

Figure 3: Offences by time of day

Alcohol and Road safety

198. There were almost 12,000 drunk driving offences in Scotland in 2006-7. 83 Drink-driving remains one of the main causes of road deaths. In 2005 there were 30 fatalities on Scottish roads which involved accidents where the motor vehicle driver or rider was above the legal alcohol limit. Over 900 people were slightly or seriously injured. 7

Alcohol and Fire

199. Alcohol continues to be the single greatest contributory factor to people dying in accidental house fires in Scotland. Alcohol was a direct contributory factor in almost a third (30.8%) of fatal fire incidents and an indirect factor in a further 15.4% in Scotland in 2006/07. Given that 39 people died in domestic fires in 2006/7, these figures represent a significant number of potentially preventable deaths. 84

Fear and Quality of Life

200. It is well recognised that alcohol misuse also impacts on people's perceptions and fears. No fewer than 95% of respondents to the Scottish Crime and Victimisation Survey ( SCVS) 2006 saw alcohol abuse in Scotland as a problem (including two-thirds who saw it as a big problem). Scots put alcohol on a par with drugs and higher than crime, anti-social behaviour and unemployment. 5 The 2004 SCVS also found that almost half of respondents (46%) report drunken or rowdy behaviour as impacting on their quality of life. 85

Figure 4: Perceptions of social problems in Scotland, 2006

Figure 4: Perceptions of social problems in Scotland, 2006

HEALTHIER - Help people to sustain and improve their health, especially in disadvantaged communities, ensuring better, local and faster access to health care.

Alcohol consumption and health harm

201. There is clear evidence that as alcohol use increases so does the risk of a range of physical and mental health harms. Alcohol misuse has been shown to damage the brain and nervous system, affect the immune system, harm bones, skin and muscles, cause fertility problems and impair fetal development. In the short term it can result in accidental injury or alcohol poisoning. In the long term, it can lead to a range of alcohol related conditions, including cancer, chronic liver disease and cirrhosis and high blood pressure, and even to death. Taken together this represents a significant risk to health. The World Health Organisation identifies alcohol as the third highest risk factor for ill health in developed countries, behind only tobacco and high blood pressure. 13

202. As shown in figure 5a, as alcohol intake increases so does the relative risk of death from all causes. Figure 5b shows the increased risk of breast cancer among women regularly drinking above as little as seven units per week. 86

Figure 5: Alcohol intake and relative risk

a) Relative risk of all-cause mortality

Figure 5: Alcohol intake and relative risk

b) Relative risk of breast cancer

Figure 5: Alcohol intake and relative risk

Note: 8g of pure alcohol = 1 unit

The scale of Scotland's problem: alcohol and health harm

203. As alcohol-related death and illness often result from longer-term exposure to high levels of alcohol intake, the full impact of the increase in consumption since the 1950s and 1960s is only recently becoming evident. Alcohol-related attendances in Scottish general hospitals have increased by almost 50% over the last decade 10 and alcohol-related death rates have more than doubled. Mortality rates in Scotland are now twice that of the rest of the UK, with one Scot dying every 6 hours as a direct result of alcohol misuse. The alcohol-related mortality rate among Scottish women is now higher than that of English men, as shown in Figure 6. 9

Figure 6: Alcohol-related mortality in the UK, 1991-2006

Figure 6: Alcohol-related mortality in the UK, 1991-2006

204. Scotland's chronic liver disease and cirrhosis death rates among 45-64 year old men have increased dramatically in the last decade and are now twice as high as in England and Wales. Scotland has one of the fastest growing chronic liver disease and cirrhosis death rates in the world at a time when rates in most of Western Europe are falling. Evidence shows that the majority of chronic liver disease and cirrhosis deaths are alcohol related. 87 The fall in death rates in many European countries closely mirrors falls in their alcohol consumption levels since the 1970s whereas in Scotland, as alcohol consumption has risen, so have chronic liver disease and cirrhosis mortality rates.

Figure 7: Chronic liver disease and cirrhosis mortality rates per 100,000 population, 1950-200688

Figure 7: Chronic liver disease and cirrhosis mortality rates per 100,000 population, 1950-2006

205. The effects of alcohol misuse are not limited to chronic illness. An audit of Scottish Emergency Departments ( EDs) found that over a 10 day period there were 2,228 alcohol-related attendances to 15 of Scotland's 25 EDs (representing 11% of all ED attendances). 89 A large proportion of attendances involved young men with a significant number occurring at the weekend around or shortly after pub closing time.

206. As well as physical harms, we know there is a strong link between alcohol and mental health problems. Half of the consultations for alcohol problems relate to either mood or anxiety disorders (as opposed to one-fifth of those patients not misusing alcohol). 90 And about 50% of people committing suicide since 1997 have had a history of alcohol misuse, while 20% had a primary diagnosis of alcohol dependence. 12

207. Alcohol can also have serious side effects such as unwanted weight gain. A pint of lager typically contains around 200 calories, as can a large glass of wine. Many of us are now drinking the equivalent of a day's average recommended daily calorie intake every week. Being overweight or obese contributes to a range of serious health problems, including diabetes, high blood pressure, cancers and arthritis.

SMARTER - Expand opportunities for people in Scotland to succeed from nurture through to life long learning, ensuring higher and more widely shared achievements.

The scale of Scotland's problem: alcohol and life chances

208. Our young people are drinking too much, putting themselves and others at risk of harm. In a 2006 survey 40% of 15 year olds and 15% of 13 year olds had drunk alcohol in the previous week. Figure 6 below sets out the associated harms experienced by 15 year olds who had drunk in the previous year. Notably 1 in 6 reported trying drugs and 1 in 7 reported having unprotected sex. 15

Figure 8: Consequences of alcohol consumption among 15 year olds, 2006

Figure 8: Consequences of alcohol consumption among 15 year olds, 2006

209. But it is not just young people's own drinking that is the problem. Children whose parents drink at problematic levels have been found to have higher levels of behavioural difficulty, school-related problems and emotional disturbance than children of non-problem drinking parents. 91 There were an estimated 65,000 children under the age of 16 living with parents defined as problem drinkers in 2003. 16

210. In 2003, it was estimated that 25% of children on child protection registers in the UK were there because of parental alcohol or drug use. 17 Parental alcohol problems were the most frequent concern raised about the health and well-being of parents and significant others by children calling Childline Scotland. In 40% of cases children were calling because they were being physically abused. 92

Relationships and Families

211. Heavy drinking is also a common factor in family break-up. Research has shown that marriages where one or both partners have an alcohol problem are twice as likely to end in divorce as marriages where alcohol problems are absent, while one in three divorce petitions in the UK cite excessive drinking by a partner as a contributory factor. 18