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The Scottish Health Survey: Volume 1: Main Report

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3 ALCOHOL CONSUMPTION

Clare Sharp

  • Among men, mean units per week fell from 20.3 units in 2003 to 17.5 units in 2009, while among women mean weekly consumption fell from 9.1 to 7.8 units. Although there were small differences in mean units between 2008 and 2009, these were not statistically significant.
  • The proportions drinking in excess of recommended weekly limits also declined between 2003 and 2009, from 34% to 27% of men and from 23% to 19% of women.
  • Based on their usual weekly units, a majority of both men and women in 2008/2009 were moderate drinkers, drinking within the maximum recommended weekly limit (66% of women and 61% of men).
  • Women were more likely than men to be non-drinkers (14% compared with 10%). Conversely, women were less likely to be 'hazardous' drinkers - 16% of women drank over 14 up to 35 units a week, compared with 22% of men who drank over 21 up to 50 units per week.
  • A minority of men (7%) and women (4%) drank at levels that would be classed as 'harmful' (over 50 units for men and over 35 units for women).
  • Mean weekly alcohol consumption declined with age, with the proportions exceeding the recommended weekly limits highest among the youngest age group. Men and women aged 16-24 were also more likely than other age groups to be classed as harmful drinkers.
  • Those in the lowest income group were more likely than those on higher household incomes to be non-drinkers, while men and women in the highest income quintiles were more likely than those in the lowest quintiles to be hazardous drinkers. Harmful drinking was most prevalent among men and women in the lowest quintile.
  • In terms of daily consumption, on average men drank 5.9 units and women 3.2 units on their heaviest drinking day in the last week. 44% of men and 34% of women in 2009 drank more than the recommended regular daily limit (4 units for men or 3 units for women), while 26% of men and 17% of women drank more than twice the recommended daily limit (more than 8 units and more than 6 units respectively).
  • There have been small, but statistically significant declines from 2003 to 2009 in mean units consumed and the proportions drinking more than 8 (men) or more than 6 units (women) on their heaviest drinking days. However, the 2010 data is needed to confirm whether these are genuine downward trends or simply sample fluctuation.
  • Analysis of combined data for 2008 and 2009 shows that the amount of alcohol consumed on people's heaviest drinking day declines as age increases. Mean consumption among men fell from 7.9 units among those aged 16-24 to 1.8 units for those aged 75 and over. Similarly for women, mean units fell gradually from 5.7 units among those aged 16-24 to 0.7 units for women aged 75 and over.
  • The proportion of men drinking more than 4 units on their heaviest drinking day was fairly similar between the ages of 16 and 54 (48% - 53%), before falling to 43% of those aged 55-64, 32% of those aged 65-74 and 13% of men aged 75 or older. A similar pattern by age was apparent for women drinking more than 3 units on their heaviest drinking day.
  • Around a third (between 29% and 36%) of men aged 16-54 drank more than 8 units on their heaviest drinking day, falling to 22% of men aged 55-64, 12% of those aged 65-74 and 2% of those aged 75 and over. Younger women were more likely to have drunk 6 or more units on their heaviest drinking day - 34% of those aged 16-24 and 28% of those aged 25-34 had done so, with rates declining steadily with age to just 2% or less of those aged 65 and over.
  • Overall, 50% of men and 39% of women exceeded either the daily or the weekly guidelines on alcohol consumption, or both.
  • Current drinkers were presented with a number of statements designed to measure possible problem drinking. In 2008/2009, 14% of men and 10% of women agreed with two or more statements, indicating possible problem drinking. 11% of men and 6% of women agreed with one of three specific statements designed to indicate physical dependency on alcohol.
  • The proportion agreeing with two or more problem drinking statements fell with age - from 22% of men and 18% of women aged 16-24, to 6% of men and 2% of women aged 75 and over.
  • There has been an increase in the proportions of men and women aged 16-74 agreeing with two or more problem drinking indicators and a corresponding decrease in the proportions who said none of the indicators applied to them since 1998.
  • 20% of men and 12% of women had been drunk at least once a week in the last three weeks, while half (52%) of men and a third (36%) of women who currently drink had been drunk at least once in the last three months.
  • Prevalence of drunkenness was more common among young drinkers and declined steadily with age. Women in all age groups were less likely than men of the same age to say they had been drunk recently, although the differences between men and women in the proportions who had been drunk in the last three months were least pronounced among the youngest and the oldest age groups.

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. Its status as an area of significant concern is underlined by the Scottish Government's National Performance Framework national indicator about alcohol: 1

Reduce alcohol related hospital admissions by 2011

Alcohol is also the subject of a HEAT target 2 for NHS Scotland to:

Achieve agreed number of screenings using the setting-appropriate screening tool and appropriate alcohol brief intervention, in line with SIGN 74 guidelines by 2010/11

The introduction to the alcohol chapter in the 2008 report 3 provided a detailed account of the costs and burdens harmful and excessive drinking place on Scottish society, as well as a number of key recent legislative and policy developments. Rather than repeat this information, this introduction only focuses on major developments over the past year.

The most notable legislative development was the Alcohol Etc. (Scotland) Bill, introduced to the Scottish Parliament in November 2009. 4 This outlined a number of provisions to reduce alcohol-related harm, including: further restrictions to off-sale promotions and associated activities, a requirement for licensees to operate age verification policies, giving licensing boards the power to increase the age of buying alcohol from 18 to 21, an enabling power for the introduction of a new social responsibility levy, and, of most controversy to date, minimum pricing for alcohol. 5 The explanatory notes accompanying the Bill referenced the 2008 Scottish Health Survey findings to highlight concerns about the prevalence of excessive drinking in the population. The Bill passed its first stage in June 2010 but with significant questions raised throughout about the minimum pricing proposals. Coinciding with this, in the past year the debate about minimum pricing has extended beyond Scotland. The UK House of Commons Health Select Committee, the World Health Organisation and the National Institute for Health and Clinical Excellence have all announced their belief in the effectiveness of minimum pricing as a strategy to combat alcohol-related harm. 6 In addition to the Alcohol Bill, the Scottish Government also announced its intention to agree a new waiting times target for treatment for alcohol problems by November 2010, to be incorporated into a new HEAT target, covering both drugs and alcohol, by April 2011. 7

The estimates of alcohol consumption discussed later in this chapter are based on self-reported data. However, it is important to note that survey data often obtains lower estimates of consumption than implied by alcohol sales data. The most recent estimates of alcohol sales show that 50.9 million litres of pure alcohol were sold in Scotland in 2009. 8 This equates to 11.9 litres of pure alcohol sold per person aged 16 and over. The equivalent figure for England and Wales was lower, at 9.6 litres. It is estimated that 1,190 units of pure alcohol were sold per person aged 16 and over in Scotland in 2009 (see section 3.2.2 for an explanation of alcohol units). The average is estimated to be 22.9 units per person per week, which exceeds the recommended weekly allowance for men. For England and Wales the equivalent figure was lower at 18.4 units. In Scotland, sales of alcohol units have remained fairly stable from 2005 to 2009 (23.0 units on average per person aged 16 and over in 2005 to 22.9 units in 2009). However, the equivalent figures for England and Wales show a steady drop from 19.6 in 2005 to 18.4 in 2009 and suggest a widening gap between Scotland and England and Wales.

This chapter updates the information presented in the 2008 report and provides more detailed analysis of patterns that was not possible with just one year's worth of data. For example, it provides more robust estimates of alcohol consumption and potential problem drinking indicators by age and sex. It does not repeat the detailed socio-demographic analysis of alcohol consumption by National Statistics socio-economic classification, household income and Scottish Index of Multiple Deprivation presented last year. However, it does present some figures for weekly drinking by household income. In addition, the web tables published by the Scottish Government alongside this report include analysis of problem drinking by socio-demographic groups.

3.1.1 Sensible drinking guidelines and definitions of 'binge', 'hazardous' and 'harmful' drinking

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 Government recommends that everyone aim to have at least 2 alcohol free days per week.

Over the course of a week, it is 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 any harm, but which may cause harm in the future have been described as 'hazardous' drinkers. 9 In terms of units, men who consume over 21 and up to 50 units and women who consume over 14 and up to 35 units per week are usually classed as 'hazardous drinkers', while those who consume above 50/35 units a week are considered to be drinking at 'harmful' levels. 10

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

3.2 METHODS

3.2.1 Data collection in the 2008 and 2009 surveys

The way in which the survey estimates alcohol consumption was changed significantly in 2008. This is detailed extensively in the 2008 chapter so is 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 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").

From this question, the average number of days a 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 (see below for discussion of this process). 11

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. This questionnaire was administered in self-completion format due to the sensitive nature of the questions.

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).

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 Changes in usual weekly alcohol consumption since 2003

Trend comparisons in alcohol consumption have been made using data from the 2003, 2008 and 2009 surveys. The revised method of calculating units of alcohol consumed, noted above, was only applied to data from the 2003 and subsequent surveys. As a result, data from earlier surveys are not directly comparable and have been excluded from this analysis.

The general pattern shows a decline in weekly alcohol consumption between 2003 and 2009. Average weekly alcohol consumption for men aged 16 and over declined from 20.3 units in 2003 to 18.0 in 2008 and 17.5 in 2009. The figures for women also declined, from 9.1 units in 2003, to 8.6 in 2008 and 7.8 in 2009. The difference between the 2003 and 2009 figures were statistically significant for both men and women. However, the small decline in mean weekly consumption between 2008 and 2009 was not significant for men or women.

The proportions exceeding their recommended number of units per week have also declined significantly for both men and women since 2003. 34% of men drank over 21 units of alcohol per week in 2003, compared with 30% in 2008 and 27% in 2009. The proportion of women drinking more than 14 units per week declined from 23% in 2003, to 20% in 2008 and 19% in 2009 (note that the small drop from 2008 to 2009 was not statistically significant).

Given what is known about surveys underestimating alcohol consumption rates, it is worth remembering that although self-reported alcohol consumption appears to be declining, the actual prevalence of excessive alcohol consumption at any given point in time is likely to be greater than that suggested here.

The sample sizes for individual age groups are not considered large enough to draw robust conclusions about trends by age. However, it is evident that most age groups saw a decline between 2003 and 2009 in the proportions exceeding their recommended number of units per week. Although the pattern looks different for adults aged 16-24, with a rise in the proportions exceeding their recommended limits between 2003 and 2008, followed by a fall in 2009, these changes between survey years may be caused by random sampling fluctuation and are unlikely to reflect true patterns in the population. Sharp changes within short time spans such as this are relatively rare. Table 3.1, Figure 3A, Figure 3B

Figure 3A

Figure 3B

3.3.2 Usual weekly alcohol consumption by age and sex (2008/2009 combined)

This section presents patterns of alcohol consumption across age groups among men and women. Unlike the figures for each year presented above, it is based on combined data from 2008 and 2009 surveys. This provides a larger and therefore more robust sample size for looking at sub-groups in the population.

Based on the number of units of alcohol they usually consumed in a week, adults were assigned to one of the four categories listed in the table below.

Drinking category

Men

Women

Non-drinkers

No units

No units

Moderate

21 units or below

14 units or below

Hazardous

Over 21 units - 50 units

Over 14 units - 35

Harmful

Over 50 units

Over 35 units

Based on the combined data for 2008 and 2009, Table 3.2 and Figure 3.2 show that mean weekly alcohol consumption for men was significantly higher than for women (17.6 units compared with 8.2 units). Women were more likely than men to be non-drinkers (14% compared with 10%). The difference between men and women was particularly pronounced in the oldest age group; 31% of women aged 75 did not drink alcohol compared with 20% of men of the same age.

Mean weekly consumption levels declined with age for both sexes, though the patterns were not strictly linear. Among men, consumption was highest among those aged 16-24 (22.6 units), it then ranged from 17.0 to 19.5 units between the ages of 25 and 54, before declining steadily to 8.4 units for those aged 75 and over. The corresponding pattern for women was similar, consumption was highest among those aged 16-24 (13.9 units), was lower in the next three age groups, and declined further from 55 onwards to 2.6 units for those aged 75 and over.

Young people were also the most likely to exceed the recommended number of weekly units for their sex. Among men, 36% of those aged 16-24 drank more than 21 units, compared with 25% to 32% of those aged 25 to 74 and 13% of those aged 75 and over. The pattern among women was similar, 32% of those aged 16-24 drank more than 14 units a week, the figures for those aged 25 to 64 were lower and ranged between 18% and 23%, before dropping further to 11% and just 3% in the oldest two groups. The equivalent findings presented in the 2008 Report, based on a smaller sample size, suggested that young people's consumption was considerably higher than the rest of the population's. While these more robust figures confirm this general pattern, they show that the magnitude of the difference between age groups is not quite as large as it previously appeared. Table 3.2, Figure 3C

Figure 3C

Looking at the drinking categories set out above, 12% of all adults were non-drinkers, 64% were moderate drinkers (drinking within the weekly guidelines for their sex), 19% were hazardous drinkers and a small minority, 5%, were harmful drinkers. Women were more likely than men to be non-drinkers (14% versus 10%), and to be moderate drinkers (66% versus 61%). Conversely, women were less likely than men to be hazardous drinkers (16% versus 22%) or harmful drinkers (4% versus 7%).

Men and women aged 16-24 were less likely to be moderate drinkers than their older counterparts. Rates of hazardous drinking were broadly similar among men aged 16 to 64 (21-25%), were marginally lower for those aged 65-74 (19%) and were lower still for those aged 75 and over (13%). Between 16% and 23% of women aged 16 to 64 were hazardous drinkers, compared with 9% of those aged 65-74 and just 3% of those aged 75 and over.

As noted above, a small proportion of men (7%) and women (4%) fell into the 'harmful drinking' group. Those aged 16-24 were more likely than other age groups to be harmful drinkers - 11% of men in this age group compared with 5% to 7% of those aged 25 to 74, and only 1% of those aged 75 and over. The same pattern was evident among women, 9% of those aged 16-24 were harmful drinkers compared with 2% to 4% of those aged 25-74 and 1% of those aged 75 and over. Table 3.2

3.3.3 Usual weekly alcohol consumption, by household income and sex (2008/2009 combined)

This section considers the relationship between weekly alcohol consumption and equivalised household income (a description of this measure is available in the Glossary at the end of this volume). To ensure that the comparisons presented in this section are not confounded by the different age profiles of the income groups, the data have been age-standardised (a description of age-standardisation is also available in the Glossary). Unlike the reports in previous years, only the age-standardised data are presented in the table in this section. A discussion of how alcohol consumption relates to a range of other socio-demographic factors including socio-economic classification and SIMD can be found in the 2008 Report.

Table 3.3, Figure 3D and Figure 3E show the four weekly drinking categories described in Section 3.3.2 by equivalised household income quintiles. Those in the lowest income group were the most likely to be non-drinkers. Around one in twenty (4%-6%) men in the highest two income quintiles were non-drinkers compared with one in five (20%) in the lowest quintile. The equivalent figures for women were marginally higher: 7%-9% in the two highest income quintiles were non-drinkers rising to 23% in the lowest quintile.

As Figures 3D and 3E illustrate, for both sexes the majority of each income group were moderate drinkers. Moderate drinking did not show such notable differences by income. The proportion of moderate drinkers across income groups ranged from 56% to 65% among men with no obvious pattern. Among women, 61% of those in the lowest income quintile were moderate drinkers compared with 66% to 69% of those in the other groups.

Men and women in the highest income quintiles were more likely to be hazardous drinkers than to be non-drinkers. The prevalence of hazardous drinking was 30% among men in the highest income quintile compared with around a quarter of those in the second and third quintiles, and 16% to 17% of those in the lowest two income quintiles. The equivalent figures for women were lower but showed a similar pattern, declining steadily across the groups as income declined, from 22% in the highest quintile to 10% in the lowest.

Harmful drinking is much less common than hazardous drinking in men and women across all income quintiles. However, it was significantly associated with household income, with the highest prevalence amongst the lowest income quintile. Among men, the prevalence was 9% in the lowest income quintile and ranged between 5% and 7% in the other four with no clear pattern. There was a similar pattern for women, 6% in the lowest quintile were harmful drinkers compared with 3% to 4% of the other income groups. The mean number of units consumed per week was also higher among harmful drinkers in the lowest income quintile compared to harmful drinkers in the highest income quintile (92.8 units for men and 68.7 for women harmful drinkers in the lowest quintile, compared with 68.6 units for men and 52.0 for women in the highest quintile). Table 3.3, Figure 3D, Figure 3E

Figure 3D

Figure 3E

3.4 ESTIMATED DAILY CONSUMPTION

3.4.1 Trends in alcohol consumption on the heaviest drinking day in the last week by age and sex

The survey also collected information about how much alcohol people had drunk on their heaviest drinking day in the previous week. The survey data are not sufficient to fully determine whether current advice on sensible drinking is being followed (as described in Section 3.1), since the advice refers to 'regular' drinking patterns rather than this snapshot of consumption on one day. However, it is a useful measure of very heavy consumption levels.

'Binge' drinking, that is drinking an excessive amount on a single occasion, often has more harmful immediate consequences for health and wider society than drinking smaller amounts more regularly (for example consumption that adheres to the recommended daily limits). Although there is no medically-specified criterion to define binge drinking, in common with other UK surveys, more than 8 units for men and more than 6 for women are used as proxies here.

Table 3.4 presents trend data from 2003, 2008 and 2009 for all adults aged 16 and over. The mean number of units consumed by men on their heaviest drinking day in the last week decreased from 6.5 units in 2003 to 6.2 in 2008 and 5.9 in 2009. This 0.6 mean unit fall between 2003 and 2009 was statistically significant, however the confidence interval around it is fairly wide suggesting that the true decline in the population could have been very small. A very minor change in the other direction in 2010 would remove the suggestion that there has been a genuine decline since 2003.

There has been no change in the proportion of men drinking more than 4 units of alcohol on their heaviest drinking day in the previous week (45% in 2003 and 44% in both 2008 and 2009). The proportion drinking over 8 units dropped slightly from 29% in 2003 to 27% in 2008 and 26% in 2009. Although this 3 percentage point decline between 2003 and 2009 was statistically significant, the difference between 2003 and 2008 was not. The stability over time in the proportion drinking more than four units, coupled with the fact that the differences in mean unit consumption and drinking more than 8 units were recent and very small, suggests that these patterns do not yet reflect any notable shift in daily consumption since 2003.

The patterns for women are somewhat different but need to be treated with similar caution. As with men, there has been a very slight but statistically significant decline in the mean units consumed by women on their heaviest drinking day from 3.6 units in 2003, to 3.5 units in 2008 and 3.2 units in 2009. As the 2003 and 2008 figures are very similar it will also be necessary to look at the 2010 data to confirm whether this represents a real downward trend or just sample fluctuation in 2009. There have been statistically significant declines in the proportion of women drinking more than 3 and more than 6 units of alcohol on their heaviest drinking day in the previous week. However, as with the mean unit data, the decline has only occurred in the past year so the 2009 figures could be atypical in the series. For example, 37% of women in 2003 and 36% in 2008 drank more than 3 units on their heaviest drinking day compared with 34% in 2009. The decline in the proportion drinking more than 6 units was very small; the figures for each of the survey years were 19%, 18% and 17%, respectively. Table 3.4

The sample for each individual year is not large enough to draw robust conclusions about trends for individual age groups. To enable more detailed analysis of the patterns in daily drinking by age the next section looks at the combined data from the 2008 and 2009 surveys.

3.4.2 Alcohol consumption levels on heaviest drinking day in last week by age and sex (2008/2009 combined)

Based on the combined samples from 2008 and 2009, 44% of men drank more than 4 units of alcohol on their heaviest drinking day in the previous week, whilst 26% drank more than 8 units. Men's mean consumption on their heaviest drinking day was 6.0 units. The equivalent figures based only on those men who drank in the past week were 63%, 39% and 8.6 units (data not shown). Among women, 35% drank over 3 units, 17% over 6 units, and the mean number of units consumed was 3.3. The equivalent figures based only on women who drank alcohol in the last week were 62%, 30% and 5.8 units (data not shown).

Table 3.5 and Figure 3F illustrate the steady decline in daily alcohol consumption as age increases for both sexes. Looking first at men, mean consumption declined from 7.9 units among those aged 16-24 to 1.8 units for those aged 75 and over. The proportion consuming more than 4 units was fairly similar between the ages of 16 and 54 (48%-53%), was lower for those aged 55-64 (43%) and then declined sharply to 32% of men aged 65-74 and 13% of men aged 75 and over. Consumption of over 8 units followed a similar pattern with around a third (29% to 36%) of those aged 16 to 54 drinking twice the recommended limits on their heaviest drinking day. This then fell to 22% of those aged 55-64, 12% of those aged 65-74, and to only 2% of those aged 75 and over.

Although the overall prevalence of exceeding daily limits and binge drinking on their heaviest drinking day was lower in women than men, the pattern across age groups was similar. The mean units consumed tended to fall gradually with age from 5.7 units among those aged 16-24 to just 0.7 units for those aged 75 and over. The proportion who had drunk more than 3 units ranged between 42% and 47% for women aged 16 to 54, before declining sharply in each subsequent age group (from 32% of those aged 55-64 to just 5% of those aged 75 and over). The difference in consumption across age groups was more pronounced for binge drinking. Women aged 16-24 (34%) and 25-34 (28%) were the most likely to have drunk more than 6 units on their heaviest day, with rates declining steadily with age to 10% for the 55-64 age group, and to just 2% or less of those aged 65 and over. Table 3.5, Figure 3F, Figure 3G

Figure 3F

Figure 3G

3.5 ADHERENCE TO WEEKLY AND DAILY DRINKING ADVICE

As noted in the introduction, the Government provides advice about both sensible weekly and sensible daily alcohol consumption. Men are advised not to regularly consume more than 3-4 units a day, and not to consume more than 21 units a week. The equivalent advice for women is no more than 2-3 daily units and no more than 14 weekly units. Figure 3H shows the proportions of adults who drink outwith each of these recommended amounts, as well as the total proportions who exceed one or both of the daily and weekly guidelines. Overall, 1 in 2 men (50%) and 2 in 5 (39%) women exceeded either the daily or the weekly guidelines or both. This is higher than the proportions who exceeded each of these individually - 44% of men and 35% of women had drunk more than the recommended daily maximum on their heaviest drinking day in the last week, while 29% of men and 19% of women exceeded recommended weekly limits. Figure 3H

Figure 3H

3.6 PROBLEM DRINKING AND PHYSICAL DEPENDENCY ON ALCOHOL

3.6.1 Problem drinking

People identified as current drinkers in the main interview were asked to answer some self-completion questions about problem drinking. They were presented with the following six statements about problem drinking. For each one they had to indicate whether it had applied to them in the previous three months:

  • I have felt that I ought to cut down on my drinking
  • I have felt ashamed or guilty about my drinking
  • People have annoyed me by criticising my drinking
  • I have found that my hands were shaking in the morning after drinking the previous night
  • I have had a drink first thing in the morning to steady my nerves or get rid of a hangover
  • There have been occasions when I felt that I was unable to stop drinking

The final three statements are measures of possible physical dependency on alcohol. Agreement with two or more of the six items is an indicator of possible 'problem drinking'.

3.6.2 Trends in problem drinking

Table 3.6 presents the proportions of men and women aged 16 to 74 who agreed with 0, 1 or 2 or more problem indicators in 1998, 2003, 2008 and 2009 (the 1998 survey did not include people aged 75 and over so this group is excluded from the trend analysis). The proportion of men aged 16-74 agreeing with two or more of the problem indicators increased from 12% in 1998 to 17% in 2008, and was 15% in 2009. The pattern was the same for women, from 5% in 1998 to 11% and 10% in 2008 and 2009, respectively.

There has been a corresponding decline in the proportion aged 16-74 who did not report any of the problem drinking indicators since 1998, from 70% in 1998 to 63% and 64% among men in 2008 and 2009 respectively, and from 85% in 1998 to 70% and 75% in 2008 and 2009 for women. Table 3.6

The 2008 Report noted that the relatively small samples sizes for the individual age groups, particularly for younger people, make it difficult to draw firm conclusions about trends across age groups. However, Table 3.7 is based on combined data from the 2008 and 2009 surveys so has a larger sample. The proportionately greater increase over time in the reporting of problem drinking behaviours among men and women aged 16-24 noted last year does appear to be confirmed by 2009 figures. In 1998 16% of men and 8% of women aged 16-24 reported two or more problems compared with 22% of men and 18% of women in 2008/2009. Table 3.6, Table 3.7

3.6.3 Problem drinking by age and sex (2008/2009 combined)

This section looks in more detail at the patterns in problem drinking behaviours across age groups (drawing on the larger sample from the combined 2008 and 2009 surveys, and including adults aged 75 and over). The overall proportion of 'problem drinkers' (defined as agreement with two or more of the statements) was 14% among men and 10% among women in 2008/2009. These combined 2008/2009 figures for men and women differ very slightly from those discussed in section 3.6.2, above, because they include drinkers aged 75 and over. Agreement with two or more statements declined gradually with age. For men this dropped from 22% of those aged 16-24 to 6% of those aged 75 and over. The corresponding figures for women were 18% and 2%.

The proportions of current drinkers who agreed with each of the statements from the CAGE questionnaire are presented below in Figure 3I and Table 3.7. Whilst just over a quarter of men (28%) and about a fifth of women (21%) aged 16 and over agreed with the first statement about cutting down their drinking, agreement with the other statements was much lower (4% to 9% of men and 1% to 8% of women). For men, looking across age groups there appears to be little difference between those aged 16 to 64 years in the proportion who agreed with the first statement (ranging from 26% to 33%). However, agreement was lower among those aged 65-74 (21%) and 75 and over (15%). A similar pattern was found for women (19% to 26% of those aged 16 to 64 agreed, compared with 11% of those aged 65-74 and 5% of those aged 75 and over). For the other statements, agreement gradually declined with age.

The last three statements in the CAGE questionnaire are potential measures of 'physical dependency'. The overall proportion of drinkers aged 16 and over who agreed with at least one of the physical dependency statements was 8% (11% of men and 6% of women). Agreement declined with age (for men, from 23% of those aged 16-24 to 3% of those aged 75 and over; and for women, from 17% of those aged 16-24 to 2% or fewer of those aged 55 and over). Table 3.7, Figure 3I

Figure 3I

3.6.4 Drunkenness by age and sex (2008/2009 combined)

Current drinkers were also asked how often they had been drunk recently. 20% of men and 12% of women had been drunk at least once a week in the previous three weeks. Those who had not been drunk this often were asked if they had been drunk at least once in the last three months. In combination, responses to these two questions show that around half (52%) of men and just over a third (36%) of women who drink alcohol had been drunk at least once in the last three months.

As with some of the self-reported consumption patterns presented in this chapter, the prevalence of recent and regular drunkenness among current drinkers was more common among young people and declined steadily with age in both sexes. 41% of men and 29% of women aged 16-24, compared with just 2% of men and women aged 75 and over, were drunk at least once a week in the previous three weeks. Around three quarters (74%-78%) of men aged 16 to 34 had at least one incidence of being drunk in the previous three months, this declined steadily with age from 63% of those aged 35-44 to just 17% and 5% in the two oldest age groups. A similar pattern by age was found for women (from 71% of those aged 16-24 to 2% of those aged 75 and over). It is also notable that women in all age groups were less likely than men of the same age to have been drunk. The differences between sexes were at their narrowest in the youngest and oldest two groups. Table 3.7