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Chapter 4: Alcohol and health

Chapter aims

This chapter addresses the following key questions:

• How harmful do people think alcohol is to individual users by comparison to other drugs?
• Do people believe it is possible to recover from serious drink problems?
• How do people rate the long-term health impacts of binge drinking and chronic drinking?
• Do different groups of people take the health risks of drinking more or less seriously?
• What types of services do people think are most helpful for people with different drinking problems?
• How easy do people think it would be to access help with alcohol problems?

Introduction

The health risks associated with excessive alcohol consumption are well-documented. Some of the more recent statistics on alcohol-related death and illness were highlighted in the introduction to this report. However, while the health risks of problem drinking are well understood by policy makers and health professionals, it is not clear whether this knowledge is shared or accepted by the general public.

The SSA included a series of questions designed to measure Scottish people's views of the health risks associated with alcohol misuse. These questions again attempted to distinguish attitudes towards binge and chronic drinking, and the analysis examines differences in attitudes between different groups in society. The survey also examined views of the services available to people with drinking problems.

How harmful do people think alcohol is?

In addition to asking respondents about which drug they thought caused most problems for 'Scotland as a whole', reported in Chapter 2, the survey asked which drug they thought caused most and least harm to 'frequent users'. While alcohol was the drug most commonly identified as causing most problems for Scotland (42% of respondents thought this), a much smaller proportion of respondents (9%) see it as the drug which causes most harm to individual users (Table 4.1). Alcohol is, however, more commonly viewed as harmful than several illegal drugs (cannabis, cocaine and ecstasy).

Table 4.1 Views on which drug causes most and least harm to frequent users

The proportion of respondents who think alcohol is the drug most harmful to frequent users is similar across men and women, different age groups, different occupational groups, and among respondents with different levels of educational qualifications. The only group significantly more likely to rate alcohol as the most harmful drug were respondents who never drink, among whom 18% thought alcohol causes most harm to individuals.

A quarter of respondents think alcohol is the drug which causes least harm to frequent users, while a fifth think tobacco causes least harm. These findings are interesting given the high level of publicity surrounding alcohol and tobacco as major causes of ill health and death in Scotland. However, it is possible that while people know that more people overall die from tobacco-related illness, they still think an individual person would be more likely to suffer harm from taking 'hard drugs' than from alcohol or tobacco use. Alternatively, it may be that people attach a much higher risk to the act of taking heroin or other hard drugs on even a one-off basis (e.g. the risk of overdose). In comparison, the risks people attach to alcohol and tobacco may be associated with longer-term ill-health, rather than immediate risk of death or serious harm.

Figure 4.1 shows how strongly respondents agreed or disagreed that a person with a serious drinking problem can never fully recover. Responses were fairly evenly split, with a little over a third (37%) agreeing that most serious drinkers cannot make full recoveries, and around two fifths (39%) disagreeing with this statement. Men were slightly more likely than women to agree that serious drinkers cannot recover. However, there were no other particularly significant or striking differences in by age, occupational group or educational attainment, suggesting that people across different social groups are genuinely divided over the chances of recovering from a serious alcohol problem.

Figure 4.1 'Most people with serious drinking problems can never fully recover' (% agree/disagree)

Base: 1,514

Differences in attitudes towards chronic and binge drinking

Figure 4.2 shows how likely people thought the two drinkers described in Chapter 3 were to seriously damage their long term health. Chronic drinking is viewed as much more likely than binge drinking to cause serious long-term damage - the vast majority of respondents (94%) think the chronic drinker is 'very likely' to damage their long-term health, compared with 43% who think this about the binge drinker. However, the majority of respondents (86%) think that binge drinking is at least 'fairly likely' to have negative long-term health effects.

Figure 4.2 Likelihood of drinker seriously damaging their long-term health

Base: 1,637

There were clear age differences in attitudes towards the health risks of binge drinking (Figure 4.3). Sixty-nine per cent of 18-24 year-olds think the binge drinker is likely to damage their long-term health, compared with 79% of 25-39 year-olds and 90% of 40-64 year-olds. These age differences were not present in attitudes towards the health risks of chronic drinking.

Figure 4.3 Likelihood of binge drinker seriously damaging their long-term health by age of respondent

Base: 1,637

Aside from age, logistic regression shows that the main factor associated with attitudes towards the health impact of binge drinking is gender - women were more likely than men to say that the binge drinker is very likely to damage their long-term health (46% compared with 38%).

It is also worth noting the gap between the proportion of 18-24 year-olds who think the binge drinker is likely to seriously damage their health (69%) and the proportion who think they have a serious problem (58%). This shows that some respondents accept that there are long-term health risks attached to binge drinking, but still do not see this type of drinking as constituting a 'serious problem'. In fact, 28% of all respondents who think the binge drinker is 'very likely' to damage their long-term health only rate the binge drinker as having a 'fairly serious' problem, while 2% say their drinking is 'not very serious'. It may be that some younger people in particular view the 'seriousness' of a drink problem in terms of its immediate social and health impacts and that future health problems are seen as too distant to be taken into account in judgements about current behaviour.

Attitudes towards services

Table 4.2 shows what sources of help or advice respondents would recommend to the binge drinker and the chronic drinker. In Chapter 3, it was suggested that findings on the extent to which different drinkers should be 'embarrassed' about their drinking could be explained by the fact that chronic drinking is likely to be viewed within a 'medical model' of drinking as a 'disease' and something that requires medical treatment, while binge drinking is more likely to be viewed as a 'social' problem, which the individual drinker could control if they chose to. This hypothesis is supported by the fact that 42% of respondents think the chronic drinker should go to a doctor or GP first for help, compared with just 28% who think the binge drinker should see a doctor. The most common suggested source of help for the binge drinker was friends and family (33%), which again suggest that binge drinking is seen as more of a 'social' problem, for which medical or professional help may be less appropriate.

Table 4.2 Who would advise person to turn to first for help

Figure 4.4 shows that three quarters of respondents think that it would be very or fairly easy for someone with an alcohol problem to find help in the respondents area. This figure did not vary significantly between respondents in urban and rural areas or accessible and remote areas. However, respondents in the least deprived areas (as measured by the Scottish Index of Multiple Deprivation) were more likely (79%) than respondents in the most deprived areas of Scotland (67%) to think it would be easy to find help.

Figure 4.4 How easy it would be for someone in respondent's area with an alcohol problem to find help

Base: 1,637

Key points from this chapter

• Respondents were more likely to identify alcohol and tobacco than cannabis, cocaine and ecstasy as causing 'most harm to frequent users'. However, a much lower proportion of respondents thought alcohol was the drug which cause most harm to users (9%) compared with the proportion who thought it caused most problems for Scotland (42%).
• Opinions are divided over the possibility of someone with a serious drink problem ever being able to make a full recovery.
• The hypothetical chronic drinker was viewed as much more likely than the binge drinker to cause themselves serious long-term health damage, although a majority of respondents (86%) also thought the binge drinker was at least 'fairly likely' to damage their health.
• Younger people are less likely than older people to think binge drinking will have long-term health effects.
• People are most likely to recommend that a chronic drinker see a doctor for help, while they are most likely to recommend that a binge drinker talk to family and friends. This provides support for the view that chronic drinking is more likely to be viewed within a 'medical model', while binge drinking may be seen as more of a social problem.
• Three-quarters of respondents think that it would be very or fairly easy for someone in their area to find help with alcohol problems, suggesting that in general people think services are readily available. However, respondents in the most deprived areas of Scotland were less likely than respondents in the least deprived areas to think it would be easy to find help.

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