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CHAPTER FIVE: CONCLUSIONS

What are public attitudes towards the role of alcohol in Scottish culture?

5.1 Many people in Scotland believe that drinking plays a major part in Scottish culture - two-thirds agree that 'drinking is a major part of the Scottish way of life'. At the same time, people also recognise that alcohol misuse is something that causes problems for this country, with nearly half agreeing that the amount of alcohol people in Scotland drink is something to be ashamed of. Moreover, alcohol is the drug most commonly identified as causing the most problems for Scotland as a whole. That said, it is not clear that Scotland's drinking culture is viewed as marking it out from its UK neighbours - only a quarter agree that adults in other parts of the UK drink more sensibly than those in Scotland. In 2004, however, almost two-thirds agreed that adults in other parts of Europe drink more sensibly.

5.2 However, while alcohol misuse as a whole is viewed as impacting on wider society, it is less clear whether people believe wider society shares any responsibility for tackling the problems of alcohol misuse. For example, half believe that someone with a drinking problem has 'only themselves' to blame. Moreover, there is fairly low support for alcohol price increases, which could represent a 'shared measure' to try and address excessive drinking. That said, people are more likely to agree they would feel some responsibility if a friend got drunk and got into trouble, although around 3 in 10 still disagree they would feel responsible in this situation.

5.3 Alcohol is still commonly viewed as a 'social lubricant'. Although 8 in 10 believe it is possible to enjoy a night out without drinking, 4 in 10 believe it is easier to enjoy social events where alcohol is involved. Moreover, the decision not to drink at all is still associated with some stigma, although most people would not think it strange if a friend decided to abstain on a particular occasion where others were drinking.

5.4 While many of these attitudes are widespread across different social groups in Scotland, there are some differences, including:

• Older people are more likely than young people to express concern about the level of drinking in Scotland
• Men are more likely than women to see alcohol as a 'social lubricant'
• Those who drink more often are more likely to think that alcohol plays an important role in Scottish life, but less likely to see this as problematic.

What are public perceptions of the harm caused by different patterns of drinking?

5.5 There is clear variation in how serious different patterns of drinking are viewed as being. While almost everyone sees 'chronic' drinking as 'very serious', the figures are lower for 'binge' drinking and lower still for 'hazardous' drinking behaviours. People are also less likely to think that 'binge' and 'hazardous' drinking are 'very likely' to seriously damage health if continued long-term (47% and 35% respectively, compared with 94% for 'chronic' drinking).

5.6 Slightly fewer people think a 'chronic' drinker should be embarrassed about their behaviour compared with a 'binge' drinker, which may reflect the notion that the former is a 'medical' condition, while the latter is a 'social problem', over which drinkers should be able to exert more control.

5.7 While very few people agree that 'getting drunk', either at weekends or 'regularly', is completely acceptable, a significant minority 'neither agree nor disagree' with these propositions. This may suggest that attitudes to alcohol are not fixed, and vary depending on the person or context being discussed. It may also reflect some concern about admitting holding attitudes which may be deemed unacceptably 'permissive' with respect to drinking and getting drunk.

5.8 Attitudes towards the harm caused by different drinking patterns vary between different groups in Scotland, for example:

• Young people (aged 18-29) are least likely to see a problem with binge drinking and getting drunk
• However, the 30-39 year-old age group also hold relatively permissive views in relation to 'hazardous' drinking compared with older age groups
• Women are slightly more likely than men to be concerned about the health impacts of 'binge' and 'hazardous' drinking
• Those in managerial and professional households are slightly less likely than those in routine and semi-routine employment to dismiss hazardous drinking as 'not very' or 'not at all' serious, or to think it is unlikely to impact on health if continued long-term.

How well informed are the Scottish public about safe drinking limits and the alcohol content of different drinks?

5.9 Awareness of the term 'units of alcohol' and of the fact the government advises people not to drink more than a certain number of units a day is extremely high. However, more detailed knowledge of both the actual upper recommended daily limits and the numbers of units in specific drinks is much lower. Just a third are able to correctly identify recommended limits for men and 4 in 10 for women. Knowledge of the number of units in a normal bottle of wine is particularly low, with just 15% correctly identifying this as in the range of 8-10 units, while almost 4 in 10 underestimate the unit content and a further 4 in 10 simply do not know.

5.10 In terms of key variations in knowledge between different groups:

• Those in the youngest and oldest age groups are least likely to identify the correct answers
• Knowledge of both unit content and recommended limits is higher among those on high incomes and in managerial and professional households compared with those on lower incomes and in routine and semi-routine occupations.

Implications for future research

5.11 A key aim of this research was to map the nature and distribution of attitudes towards the role of alcohol in Scottish culture as a baseline against which future cultural change can be measured. In terms of effecting a positive change in the role of alcohol in Scottish culture, it might be hoped that if these questions are repeated in future years:

• People will be less likely to view alcohol as a 'social lubricant'
• People will be less concerned that the decision not to drink (at all, or on particular occasions) will be seen as odd
• Even more people will feel that they share some responsibility for their friends when drinking
• Fewer people will think that someone with a serious drinking problem has only themselves to blame (since this view can be seen as at odds with policies that attempt to minimise the stigma attached to admitting and seeking help for an alcohol problem)
• More people will believe that 'binge' and 'hazardous' drinking are 'very likely' to damage health if continued long-term
• More people will be aware of sensible drinking guidelines and the unit content of different alcoholic drinks.

5.12 However, clearly many changes in attitudes require to be accompanied by a corresponding change in behaviour in order for such a shift to be considered 'positive'. For example:

• A decrease in the proportion thinking that 'the amount of alcohol people in Scotland drink is something we should all be ashamed of' would need to be accompanied by a decrease in alcohol-related ill-health and social effects for such a shift in attitudes to be considered a step in the right direction. In the absence of such a shift in health and social trends, it might be considered a more helpful step if more people started to express concern with respect to levels of drinking in Scotland.
• Similarly, a fall in the proportion who consider alcohol the drug which causes most problems for Scotland as a whole would only be positive if accompanied by an actual decrease in the problems caused by alcohol misuse in Scotland.

5.13 While it might be hoped that people will be less likely to agree that 'drinking is a major part of the Scottish way of life' in future years, in fact the more important issue is what part drinking is seen to play in Scottish society. It seems perfectly possible that agreement with this statement could remain the same, but that the problems associated with negative consumption patterns could decline as people adopt more balanced attitudes and behaviours with respect to drinking alcohol.

5.14 Repeating these questions in future years will also enable researchers to explore whether some of the differences in attitudes between groups persist. For example, repeating the module in future years will reveal whether the attitudes of the current group of 18-29 year-olds reflect 'cohort' or 'life-stage' effects - will they carry their more 'permissive' attitudes forward into their 30s and 40s, or will they become more concerned about the effects of excessive drinking as they get older? Will the gender divide in attitudes towards alcohol as a 'social lubricant' remain? Will differences in levels of knowledge of sensible drinking guidelines between those in higher and lower income groups narrow?

Implications for alcohol policy

5.15 The findings on attitudes to alcohol discussed in this report raise a variety of issues and challenges for policies designed to effect changes in Scotland's 'drinking culture'. First, many of the findings suggest that problematic attitudes towards alcohol are widespread and are not simply confined to a small minority of young or chronic drinkers. For example:

• Just 20% think a 'hazardous' drinker has a 'very serious' problem, while 28% think this is 'not very' or 'not at all' serious.
• Knowledge of sensible drinking guidelines and the unit content of different drinks is low among a significant proportion of the population. Fewer than half of even the most highly educated Scots are able to correctly identify recommended daily limits for men.
• While young people's attitudes towards binge drinking are more 'permissive' than those of older people, with respect to 'hazardous' drinking 30-39 year-olds also express relatively low levels of concern, highlighting the fact that problematic attitudes towards drinking do not necessarily stop at 30.
• Although older people do tend to drink less than younger drinkers, there is evidence from elsewhere that consumption may be increasing among the over 65s ( NHS Health Scotland, 2007). From this perspective, the lower levels of knowledge of the unit content of drinks and recommended limits may be seen as worrying.

5.16 Although it is important not to lose sight of the fact that awareness of units, for example, is lowest amongst those most at risk from alcohol-related harm in the short and long-term (young people, those from deprived backgrounds), the research supports the need for a wider, 'whole population' focus to policies aimed at shifting attitudes towards alcohol.

5.17 Second, although many people appear to recognise that alcohol causes problems for Scotland as a whole, it is less clear that people view this as a 'shared social problem', to be tackled together, rather than simply an issue for individuals who develop problems with alcohol. Encouraging a greater sense of 'shared responsibility' for shifting the culture around drinking in Scotland may be something that those developing campaigns to promote 'cultural change' could focus on.

5.18 Third, the fact that most people disagree that they would find it odd if someone else refused a drink may also have implications for future campaigns. It may provide evidence for challenging the belief that people will 'stick out' or be viewed with suspicion if they choose not to drink at social events, and thus encouraging people to consider the option of choosing not to drink at individual social events more seriously.

5.19 Finally, findings on low levels of awareness across social groups of the unit content of specific drinks and of recommended daily limits suggest a need to build on Scotland's first 'Alcohol Awareness Week' (see para 4.1, above). In particular, the research suggests a need to increase awareness of the alcohol content of specific drinks (including wine, where knowledge appears particularly low) and of the potential health impacts of 'hazardous' drinking, given that excessive drinking that falls into this category appears to be taken less seriously than either 'chronic' or 'binge' drinking.

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