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CHAPTER ONE: INTRODUCTION
Introduction
1.1 This report presents findings from a module of questions in the 2007 Scottish Social Attitudes survey on public attitudes towards drinking alcohol. The module was funded by the Scottish Government Alcohol Misuse Team. Its main aim is to provide a robust baseline of evidence on attitudes towards alcohol in Scotland in 2007, against which progress in attempts to change Scotland's 'drinking culture' can be measured in future years.
Research and policy context
1.2 This research was commissioned against a background of extremely high levels of concern among policy makers and health professionals about the social and health impacts of Scotland's 'drinking culture'. Health statistics on the impact of alcohol misuse in Scotland are stark. Alcohol-related deaths in Scotland have more than doubled since 1990, with alcohol-related death rates for both men and women now around double the rates for the UK as a whole ( ONS, 2007). Fifteen of the twenty UK local areas with the highest male alcohol-related death rates in 1998-2004 were located in Scotland, while 22 out of 29 areas in Scotland had female alcohol-related death rates at least 25% higher than the UK average ( ONS, 2007). Mortality rates from chronic liver disease and cirrhosis among middle-aged men rose exponentially during the 1990s - by 2004, death rates in Scotland were around twice as high as those for men in England and Wales. Deaths among women from chronic liver disease and cirrhosis also rose dramatically (Scottish Government, 2008).
1.3 The social impacts of alcohol misuse are more difficult to quantify, but available evidence suggests a similarly bleak picture. For example, while it is not possible to show a simple causal relation between crime and alcohol misuse there is a strong correlation between the two. In homicide cases in 2006-7, 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 (Scottish Government, 2007c), while almost half of Scottish prisoners in 2007 said they were drunk at the time of their offence (10 th Prisoner Survey 2007). There were over 11,500 drink driving offences in 2006-7 (Scottish Government, 2007a), with 30 fatalities on Scottish roads in 2005 involving accidents where the driver or rider was above the legal limit and almost a further thousand cases where someone was injured (Scottish Government, 2007b). Numerous media reports have highlighted the impact of drunken anti-social behaviour on Scottish cities and towns, and the Scottish Crime and Victimisation Survey 2004 found that 46% say drunken or rowdy behaviour impacts on their quality of life (Hope, 2007).
1.4 Recently published figures updating figures on alcohol consumption from the 2003 Scottish Health Survey to take account of the increased strength of some drinks indicates that 40% of men and 33% of women drank more than twice the recommended upper daily limit or more 2 on their heaviest drinking day in the previous week (Scottish Government, 2008). Figures on alcohol sales in Scotland support this picture of heavy consumption. Combined figures for on-trade and off-trade sales for 2007 equate to an average of 1,182 units of alcohol sold for each person in Scotland aged over 16 - equivalent to 22.7 units per week per person, which is more than the recommended weekly limit for men (21 units). 3 Drinking above both daily and weekly limits is more common among younger people - 60% of both 16-24 year-old men women reported drinking more than double the daily limit or more on at least one day in the last week, compared with just 9% of men and 1% of women aged 75+ (Scottish Government, 2008). Underage drinking is also common in Scotland, with 36% of 15 year-olds and 14% of all 13 year-olds reporting drinking in the past week according to the 2006 Scottish Schools Adolescent Lifestyles and Substance Use Survey (Maxwell et al, 2007).
1.5 The survey evidence on the relationship between deprivation and consumption suggests that this is not straightforward. For example, data from the 2003 Scottish Health Survey (Bromley et al, 2008) show that in fact it is men and women in the least deprived areas who are most likely to exceed weekly limits, but those in the most deprived areas drank the most on their heaviest drinking day in the previous week. However, it is very clear that those in deprived communities suffer the most harm from alcohol misuse - in 2005, nearly two thirds of alcohol-related deaths were amongst people who lived in the most deprived areas of Scotland ( SIMD deprivation quintiles 4 and 5 4, ISD Scotland, 2007). These patterns are not always clearly reflected in survey data on alcohol consumption.
1.6 Problems associated with both underage drinking and binge drinking among young people have been the focus of both media and government attention in Scotland and the UK for some years now. However, more recently, groups whose alcohol consumption was not previously considered especially problematic have begun to attract concern. In particular, recent research and government campaigns have highlighted excessive drinking among women and among the middle-classes. While men continue to drink more, and more often, than women across all age groups, there is some evidence that women's consumption of alcohol has increased in recent decades. More concrete evidence of the increased impact of alcohol on women is the large increase in numbers of Scottish women with alcoholic liver disease, as discussed above (Leon and McCambridge, 2006). Recent research on alcohol consumption in England by the North West Public Health Observatory found that the percentage of adults drinking at 'hazardous' levels (15-35 units a week for women or 22-50 units for men 5) was particularly high in some of England's wealthiest areas ( APHO, 2007). This research was accompanied by a flurry of media articles in 2007 on the health problems faced by 'middle-class wine drinkers' (Times, 5 June 2007, Guardian, 16 October 2007).
1.7 The current Scottish Government has broadened the focus of its efforts on tackling alcohol misuse still further. A record £85 million funding package to tackle alcohol misuse was announced in 2007, much of this additional resource being directed towards the early identification and treatment of alcohol problems. However, there is also a recognition that the scale and nature of the problems caused by alcohol misuse in Scotland require that government and others challenge the shared attitudes, beliefs, values and customs which underlie excessive drinking in this country. Cabinet Secretary for Justice Kenny MacAskill recently described Scotland as having a 'cultural problem with alcohol' and labelled alcohol misuse 'as the problem of our time'. 6 Highlighting the widespread and pervasive nature of excessive drinking across Scotland, the Government's current focus, as outlined in Changing Scotland's relationship with alcohol: a discussion paper on our strategic approach (Scottish Government, 2008), is on achieving a step change in both culture and drinking behaviour across the whole Scottish population.
Research aims
1.8 While there is a wealth of quantitative data on alcohol consumption and alcohol-related ill-health, much less is known about the nature and distribution of the attitudes and values which underpin drinking behaviour. The 2004 Scottish Social Attitude survey report on attitudes to drinking and smoking (Bromley and Ormston, 2005) began to bridge this gap, providing robust data on attitudes towards: alcohol and health, underage drinking, alcohol and crime, controlling the sale and purchase of alcohol, 'binge' and 'chronic' drinking, and the role of alcohol in Scottish culture. The 2007 survey repeated some key measures from 2004 to allow analysis of whether there has been any change in attitudes over this relatively short period of time. However, it also included new questions to explore perceptions of the role of alcohol in Scottish culture in more detail, to examine attitudes to 'hazardous' drinking, and to assess how well informed the Scottish public is about safe drinking limits and the alcohol content of different drinks. This report is thus intended to provide robust baseline data on attitudes towards alcohol in 2007 to coincide with consultation on the Scottish Government's long-term strategic approach to tackling alcohol problems (Scottish Government, 2008). The Scottish Government intends to replicate these questions in future years to enable it to measure progress in achieving the goals around 'culture change' set out in that strategy.
1.9 In particular, the report addresses the following key questions:
Key questions:
- What are public attitudes towards the role of alcohol in Scottish culture?
- What are public perceptions of the harm caused by different patterns of drinking?
- How well informed are the Scottish public about safe drinking limits and the alcohol content of different drinks?
The data
1.10 This report is based on data from the Scottish Social Attitudes survey ( SSA). SSA was established by the Scottish Centre for Social Research in 1999 and has run annually ever since. It provides robust data on changing social and political attitudes to inform both public policy and academic study. Around 1,500 face-to-face interviews are conducted annually (1,508 in 2007) with a representative probability sample of the Scottish population. Interviews are conducted in respondents' homes, using computer assisted personal interviewing technology. Around 9 in 10 respondents also complete a paper self-completion questionnaire. The survey has achieved a response of between 55% and 65% in each year since 1999 (in 2007, the response was between 55% and 58% 7.). Further technical details about the survey are included in Annex B.
1.11 While the analysis in this report focuses primarily on the 2007 data, it also uses data from a module on attitudes to drinking and smoking included in the 2004 survey. It thus builds on the findings discussed in Bromley and Ormston (2005).
Structure of the report
1.12 The remainder of this report is divided into four chapters.
- Chapter two explores perceptions of the role of alcohol in Scottish culture. It examines: the social context of drinking; beliefs about whether alcohol is integral to a Scottish 'way of life'; perceptions of the harm alcohol causes, for Scotland as a whole and for individuals; beliefs about who is responsible for alcohol misuse; support for price increases to discourage excessive drinking; and attitudes to the role of alcohol as a 'social lubricant'.
- Chapter three looks at attitudes towards different kinds of alcohol misuse. It compares views of 'chronic', 'binge' and 'hazardous' drinking in terms of how serious a problem these are seen to pose for individuals, beliefs about their health impacts, and the level of stigma attached to these different drinking behaviours. It examines who (if anyone) respondents think people should seek help from for different kinds of 'drink problems'. Attitudes towards 'getting drunk' are also explored.
- Chapter four explores awareness and knowledge of both government advice about daily limits on consumption of alcohol, and the actual alcohol content of different kinds of drinks.
- Chapter five draws together key findings from across the report and discusses possible implications for alcohol policy in Scotland.
1.13 Chapters two to four each begin by presenting overall findings for the Scottish population, before exploring key differences between sub-groups - for example, men and women, younger and older people, and those who drink more and less often.
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