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2. Our challenge
Introduction
2.1 Alcohol has always played an important part in Scottish society. Whisky is exported all over the world, whilst here at home, we enjoy alcohol on a broad range of social occasions and are proud of our reputation for the quality of our hospitality. However, although the majority of people in Scotland enjoy alcohol without causing harm to themselves or to others, alcohol continues to cause short and longer term health problems. Excessive drinking is increasingly common and is often associated with a range of antisocial behaviours and risks to public health.
2.2 There is also a clear social inclusion aspect to problematic alcohol consumption, with excessive drinking contributing to the persistent health inequalities within Scottish society. For the individuals concerned, alcohol misuse can lead to relationship breakdown, loss of employment and a fall into poverty, mental ill-health, social isolation and a range of other related negative impacts. This update to the original action plan must therefore be seen within the context of our Closing the Opportunity Gap approach to tackling poverty and disadvantage, which seeks to tackle health inequalities, break the inter-generational cycles of deprivation and ensure that support targets those most in need.
Alcohol consumption
2.3 Alcohol consumption is continuing to increase across Scotland, with alcohol estimated to have been 54% more affordable in 2003 than in 1980 because of increased disposable income ( Alcohol Statistics England 2004). Between 1980 and 2004, the number of liquor licences in Scotland has increased by 23% and we have seen the emergence of the 'superpub' which can accommodate 300-400 people under one licence. Off-sales have also grown steadily with an increase of 25% in off-sales licences between 1980 and 2004 ( Liquor Licensing in Scotland, 1999-2004).
2.4 In 2003, in Scotland 29% of men and 17% of women aged 16-74 years reported exceeding weekly sensible drinking limits (Scottish Health Survey 2003). There has been a 54% increase in reported drinking by 15 year olds and a 100% rise in drinking by 13 year olds since 1990. The most commonly reported sources of alcohol among pupils who reported that they usually drank alcohol at least once a week were shops (35%) and off licences (29%), ( Scottish Schools Adolescent Lifestyle and Substance Use Survey, 2004).
Economic impact
2.5 Alcohol-related industries are estimated to employ around 155,000 people (6% of total employment in Scotland) though not all of these jobs are directly reliant on alcohol revenue. Of these, 10,000 people are directly employed in alcohol production and the remaining numbers are located in secondary alcohol enterprises. In 2003, alcohol exports from Scotland were worth £3.3 billion, with £2.6 billion being exported outside of the United Kingdom. At UK level, alcohol taxes account for 7% of total Customs and Excise revenue ( Alcohol: Costs and Contributions to Enterprise in Scotland, 2005).
2.6 However, alcohol can also have a negative impact on the Scottish economy. The 2004 update to the Executive's 2001 report, Alcohol Misuse in Scotland Trends and Costs, estimated an economic cost of £418 million from a reduction in output and productivity if people are prevented from working and if people of working age die prematurely from alcohol-related illnesses; and a further £484 million pa in public services. It has been further estimated that "presenteeism", a reduction in work performance as a consequence of alcohol problems, might represent a cost of £154 million to the Scottish economy.
Health impact
Alcohol-related disease
2.7 Although there is evidence to suggest that moderate alcohol consumption is compatible with a healthy lifestyle, over 31,000 people in 2004/05 were admitted to a general hospital with an alcohol-related diagnosis. This represented 4% of all general hospital patients in that year. Alcohol problems cut across all social groups, but there are clear links with inequality. People from the most deprived areas are five and a half times more likely to be admitted to hospital with an alcohol-related diagnosis than those from the most affluent areas (using the Scottish Index of Multiple Deprivation). There was a 52% increase in the number of people discharged from general hospitals for alcohol-related liver disease between 1997/98 and 2004/05 whilst in 2001/02 almost one in six patients discharged from psychiatric units had an alcohol-related diagnosis ( figures have been updated from Alcohol Statistics Scotland, 2005).
Figure 2.1 Admissions due to alcohol-related liver disease in Scotland, 1997-2005p
Source: Scottish Morbidity Record 01 p = provisional
2.8 There were 2,372 alcohol-related deaths in Scotland in 2005, an increase of 72% since 1995. Men living in the most deprived areas are six times more likely to die an alcohol-related death than those in the least deprived areas.
Figure 2.2 Alcohol-related deaths by gender in Scotland, 1980-2005
Source: General Register Office for Scotland
Alcohol and mental health
2.9 There are significant links also between reported alcohol use and mental illness.As many as 65% of suicides have been linked to excessive drinking; whilst 70% of men who take their own lives have drunk alcohol before doing so and almost a third of suicides amongst young people are committed while the person is intoxicated. Evidence also shows that anxiety and depressive symptoms are more common in heavy drinkers and also that heavy drinking is more common in those with anxiety and depression. There is also evidence that abusing alcohol results in a greater risk of developing acute, severe and enduring mental illness. ( Cheers - understanding the relationship between alcohol and mental heath: Mental Health Foundation, April 2006).
2.10 There is also a difference between social drinking and the use of alcohol as a coping mechanism. There is evidence that people use alcohol as a means of trying to escape from day to day problems and stresses instead of dealing with the underlying causes. This puts people's mental health and well-being at risk ( Cheers - understanding the relationship between alcohol and mental heath: Mental Health Foundation, April 2006).
Social impact
2.11 Many of us will have witnessed or been caught up in the antisocial behaviour which can follow from the worst excesses of Scotland's drinking culture. In 2003, 4 out of 5 people in Scotland thought that "alcohol abuse" was a serious issue (Scottish Crime Survey). There is an association between alcohol and domestic abuse, whilst in 1999, almost two thirds (72%) of the victims of assault who could tell, thought that the perpetrator was under the influence of alcohol ( Alcohol Statistics Scotland, 2005).
2.12 Although there has been no clear trend in drink drive offences over the past decade, in both 2002 and 2003 there were an estimated 50 people killed as a result of drink driving in Scotland. An estimated 750 accidents with 1,130 casualties resulted from drink driving in Scotland in 2003, an increase in serious casualties and a decrease in slight casualties from 2002. It should be noted however that the 2002 figures represented the highest estimated number of drink drive accidents and casualties since 1993 ( Alcohol Statistics Scotland, 2005).
Figure 2.3 Accidents which involved motor vehicle drivers or riders with illegal alcohol levels by severity of accidents in Scotland, 1992-2003.
Source: Road Accidents Scotland 2003
2.13 Alcohol has been a major factor in fatal fires in recent years. In 2002/03, of the 84 people who died in Scotland as a result of fire, excessive alcohol consumption contributed directly in 32 (38%) and indirectly in a further five (6%), ( Alcohol Statistics Scotland, 2005).
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