Tackling binge-drinking in the UK, taken here to be drinking to get drunk, is an enormous challenge and there are no simple solutions. Good progress has been made in reducing binge drinking, which has been in decline since 2005. Huge efforts have been made by public health specialists, alcohol charities, local authorities, police, retailers, pubs and bars, the alcohol industry, local Primary Care Trusts (PCTs) and education authorities to bring this about, together with tougher legislation targeting irresponsible premises, underage sales, buying by proxy and drinking in public.
The UK has the reputation of being the binge drinking capital of Europe, unfairly now, perhaps. However, although UK consumers do not drink more than EU contemporaries, we have fewer BUT heavier drinking sessions - the amount consumed when we do binge is higher than most other countries. Together with Scandinavia and Denmark we embrace what might be called a ‘binge and purge’ culture rather than regular and moderate consumption.
Drinking trends are also changing, with many young people ‘pre–loading’, i.e. drinking with friends at home before going out ( approximately half of 18-34 year-olds).
Although binge drinking levels are falling, alcohol-related violence, criminality, and drunk and disorderly offences have risen over the last decade, particularly among women who, among the under 18s, are getting drunk more often and ending up in hospital more often than young males, although these levels too have fallen back over the last two or three years.
The final mix in the debate is public perception. 65% of the UK public agree with the statement ‘the amount people drink in this country is out of control’ although 71% agree it applies to only to a minority of drinkers. According to the 2008 Place Survey, 29% of those surveyed felt that drunk or rowdy behaviour was a problem in their area. One in four members of the public said they avoid parts of their neighbourhoods as a result.
So, how big is the problem in the UK?
Using the government definitions of binge drinking, 19% of men drink over 8 units (8g) in England and 12% of women drink over 6 units on at least one day in the week. Although drinking at this level regularly may lead to health problems, it is unlikely to lead to the antisocial consequences linked to binge drinking. Heavy drinking (exceeding 12 units for men and 9 units for women on an occasion) involves 16% of men aged 16-24 and 12% of young women. For ages 25-44 the figures are 15% for men and 11% for women. Hence 81% of men and 88% of women don’t binge by any definition, infact 17% of both 16-24 year old men and women say they never drink alcohol at all.
Smokers are the heaviest drinkers among the young. Average weekly consumption is 22.8 units among smokers and 7.8 units among non-smoking 16-24 year-olds. Among all ages, weekly consumption is 16.6 units versus 8.7 units for non-smokers.
Declining figures, especially among young age groups:
There has been a pronounced change in women’s drinking behaviour aged 16 to 24, with those drinking over 6 units falling rapidly from 24% in 2009 to 17% in 2010. Among young men (16-24) those drinking more than 21 units has fallen from 32% in 2005 to 21% in 2010. Even among very heavy drinkers, In England, in 2010, 6% of men reported drinking over 50 units a week on average and 3% of women reported drinking over 35 units in an average week – falling from 9% and 5% in 2005. Perhaps most promising is the fact that alcohol related hospital admissions for under 18s are at a 7 year low, falling from a high of 14,483 in 2006/7 to 12,332 in 2010/11. Shockingly there are more admissions for young women than men, who are also reporting being drunk more often, this may be partly due, as well as to their psychologically reduced ability to breakdown alcohol, to their more ‘promiscuous’ beverage choices of higher alcohol drinks, whereas young men drink predominantly beer.
In terms of drunkenness in comparison to our EU counterparts, England has fallen from having the fifth highest number of 15 year-olds who had been drunk at least twice in 2005/6 (50% of girls and 44% of boys) to 11th in the ranking to (42% girls and 38% boys). The table is led by Denmark, Lithuania and then Wales (50% girls and 47% boys).
The cost of binge drinking
The most widely cited figure is from the British Crime Survey, which estimated that there were 973,000 violent alcohol related incidents in 2008 – around half of all violent crimes costing the nation £8 billion. So, the evidence suggests that the excessive consumption of alcohol is falling and the number of those who are binge-drinking is falling, yet those who are drinking to excess, are drinking more and the costs associated with their behaviour continue to escalate.
As binge-drinking is at the heart of most public and media concerns related to alcohol misuse, the government has made it a core commitment of its alcohol strategy to tackle the anti social consequences of public drunkenness and binge drinking.
Core aims are to: reduce the frequency and intensity of binge-drinking episodes and associated behaviours; reduce costs that stem from binge-drinking to the community and Health service and encourage a more responsible attitude toward alcohol consumption over the long-term.
Evidence is beginning to suggest that as the number of binge drinkers fall, the need for increasingly targeted interventions towards deprived communities, binge drinking hot spots and focused on individuals being more effectively held accountable for their behaviours could combine to reduce ‘binge drinking’ further. A combination of carrot and stick elements may have helped contribute to the decline in binge drinking to date.
Effective engagement – of different sectors of the community with different messages, approaches and methods
Many education programmes aim to reduce binge-drinking by emphasising the health risks. Research suggests however, that most young adults are aware of the health risks of excess alcohol – but do not worry about them in relation to binge-drinking. From a young age, it has been shown that ‘fear’ arousal and ‘guilt’ arousal messages lead to little behaviour change, but that campaigns that focus on positive behaviour change (a social norms and life skills based approached for up to age 14). For 15+ emphasising that most people go out to have a good time and not get drunk and non- preachy approaches focusing on being confident in your decisions, eating when drinking, pacing yourself, awareness of units, looking after mates, getting home safely or being a designated driver appear to make a difference and encourage more personal responsibility. Social media and apps are offering new fields to influence behaviour change. An app from Drinkaware that easily adds up units has led to an encouraging drop in consumption among heavy drinkers for example. These kinds of campaigns are based on a more realistic and accurate understanding of why people behave in particular ways and offer realistic tools for individuals to moderate their behaviour.
Enforcement of existing laws relating to public disorder
Police have very successfully targeted the selling of alcohol to under-18s, in partnership with the Trade’s Challenge 25 programme, Pub Watch, Best Bar None and under age prevention programme such as Community Alcohol Partnerships. However, greater use could be made of drinking banning orders; penalty notices for disorder; and enforcing the laws that forbid knowingly serving people who are already drunk. In 1989, there were almost 100,000 cases of public drunkenness handled by the police, compared to 71,000 in 2010. In 2008, only 574 Penalty Notices were issued for buying alcohol for an under 18, and only 28 people were actually convicted, Similarly, just 66 Penalty Notices for Disorder were issued in England and Wales for the sale of alcohol to a drunken person in 2008, and only one person was found guilty in a Magistrates Court of this offence in 2006-07.
In 2010 irresponsible promotions were banned such as ‘all you can drink’, ‘women drink free’ and ‘speed drinking competitions’ . Although it is too early to assess the effectiveness of these bans, the evidence suggests that the growth in irresponsible promotions played a significant role in incentivising and normalising speed drinking, drinking games and binge drinking. Other on trade regulatory measures introduced in April and October 2010 including free tap water for every customer; and offering smaller measures should also help moderate the environment. It is too soon to evaluate if these measures yet.
The regeneration of town-centres in the 1980s often saw streets with high concentrations of establishments that were tailored specifically for ‘vertical’ drinking (e.g. with promotional offers, few seats, a narrow demographic of young customers and loud music). This monoculture of age group and premise type may well have led to normalising of binge-drinking behaviour.
Joined up thinking and partnerships to tackle problem hotspots
Although nationally binge-drinking levels are falling, small-scale, localised research shows a steady growth in young people drinking with the express purpose of getting extremely drunk – what some academics call ‘extreme’ drinking.
The first ‘joined up partnership to improve behaviour was Manchester City Safe, which brought trade and local partners together to improve public transport, street lighting, door staff, police and private security patrols. Many schemes have followed suit, such as Purple Flag which continue to improve the on premise and street space to encourage better behaviour, clamp down on irresponsible premises and target anti social binge drinkers. Most drinkers go out to have a good time and socialise and not get drunk. They are equally threatened by anti social binge drinking behaviour.
The way that bar staff interact with customers and operate ‘host responsibility’ policies is another aspect of the drinking environment that can influence drinking behaviour as well as the lay-out or atmosphere of the premises.
Making sure that bar-staff are able to recognise those who are extremely drunk, and have the confidence to stop serving them, and conferring with other premises via schemes such as PubWatch to mutually ban troublemakers has had an effect.
On premise improvements such as better designed access to loos and the bar, more seating, better food offerings, staggered closing times, properly trained bar and door staff together with the more recent measures introducing free tap water, smaller measures and the banning of volume related promotions are combining to reduce binge drinking and associated problems.
The final environmental issue, is the lack of space and activities for teenagers that are under the age of 18. Under age drinkers cite the lack of other things to do and engaging spaces for them to safely ‘belong’ out of school time as a motivator for drinking, especially in deprived areas. Again huge investment has been ploughed into local clubs, skate parks and sports based activities for communities thanks to the National Lottery but more can still be done.
Antisocial behaviour is not excused by binge drinking
The main component of attitudes that is important for binge drinking is called ‘alcohol expectancy’: what a person expects to happen when he or she gets drunk. This is built up from unconsciously learned behaviour from our parents and peers as children and young adults. Therefore the role alcohol plays in situations: whether drinking with a meal or to escape difficulties; or whether inappropriate behaviour is considered normal when drunk, or is heavily disapproved of affects the next generation. Hence the way that parents drink around their children and social norms and life skill based alcohol education via the PSHE curriculum is crucial. We will never escape the need for a proportion of youngsters to push boundaries, thrill seek and see drinking as a rite of passage as part of their hedonistic, consumer culture but example and role models and indeed media portrayal of drinking can help make public drunkenness and using drink as an excuse for antisocial behaviours unacceptable.
Rite of passage
Joseph Rowntree Foundation research shows that drinking cultures have changed over the last five to ten years, even as binge drinking levels have fallen. Binge-drinking has become more extreme, with visible displays of drunkenness viewed as normal and as forming personal narratives and myths. Binge drinking is a rite of passage into full adulthood (between ages of 18-25 years old). And many young drinkers see it as a ‘normative pathway’ – it being something you do when you are young but give up when more mature (into your late twenties). The prevalence of local drinking cultures means binge-drinking behaviour is affected by a host of specific factors such as socio-economic class, ethnicity, and random local and transient social norms.
A recent report by DEMOS on Binge Drinking found that affordability of alcohol does correlate to levels of consumption, but only accounts for 22 % of the variation in demand: countries where excise tax on alcohol is very high also have very high levels of consumption, and the UK already has the third least affordable alcohol in Europe. More problematic is that there appears to be no correlation between affordability and alcohol-related harm. In other words, even if alcohol is made less affordable, the behaviours associated with binge-drinking would not necessarily change, because they are a complex mix of cultural and social forces. Demos suggest that price sometimes reduces the amount drunk in binge drinking sessions, and sometimes the way alcohol is consumed (e.g. encouraging more ‘pre-loading’), but does not necessarily reduce the motivation to binge drink.
The 1980s and 1990s saw the growth of ‘monocultures’ of many premises of one type in town centres encouraging a ‘vertical drinking culture’ which re-enforced perceived social norms that binge drinking was a majority pass time. Coupled with on trade drinks promotions such as ‘all you can drink for £10’, shots and many irresponsible drink promotions which, in addition to other drinking trends such as high-strength lagers, higher strength wines, shots, and larger measures (doubles and large glasses of wine) all conspired to make binge drinking more likely in public. Over the last decade, as discussed above, huge changes have been made in improving the on trade environment (both voluntary and legally). However, the disparity in cost in alcohol now in the on trade versus off trade sales has led to the growth of drinking at home before going out, or preloading.
The rising price of on-licence alcohol sales may have made preloading more attractive and emerging studies suggest it is an important component of binge-drinking behaviour. Lancashire Drug & Alcohol Action Team found 73% of respondents in the 21-24 age group stated that they do drink at home before a night out. A North West survey of young adults (aged 18-35) found that 25% of female and 15% of male alcohol consumption occurred at home before going out. Moreover, participants who drank before going out were more likely to have been involved in alcohol-related crime and disorder, being two and a half times more likely to have engaged in fighting during nights out within the previous 12 months.
Pre-loading may be done largely for economic reasons but there is research suggesting young people see it as an ‘enjoyable activity’ in terms of social bonding, a short period of ‘controlled loss of control’ and hedonism and one of the ‘rituals’ of binge-drinking. It is of particular concern, because those who do it are considerably more likely to end up being involved in an alcohol related incident.
Evaluating the effectiveness of schemes aimed at tackling binge drinking and its associations is of prime importance, not only to ensure they work, but for public confidence and to ensure buy in from businesses and local authorities who can see cost savings from less crime, disorder and accidents. A good example of measured evaluation is the work of the Community Alcohol Partnership (launched 2007) with the objective of reducing harm to society and victims (including young drinkers); deliver a cultural change and to challenging and changing public perceptions. There are 36 CAPS active in the UK.
St Neots CAP was led by Cambridgeshire County Council Trading Standards. Three main approaches were used providing greater Education about the law in relation to underage sales. Increase enforcement with more patrols of hotspot areas, confiscating alcohol from under 18s. Retailers working closes with trading standards on enforcement issues and Public perception was changed by working with local media to provided regular CAP news stories that built community confidence and helped alter public perception of underage drinking.
Overall the scheme saw a reduction in anti-social behaviour of 40% and the amount of alcohol related litter dropped by 90%. In the longer term, the scheme allowed for a better relationship between retailers and enforcers and for cleaner public spaces with incidents of group drinking reduce. Due to the structure of Community Alcohol Partnerships, this came at no extra costs to the police or local authority. Similarly in Kent, CAP pilot areas saw a decline in offences of criminal damage of 6% greater than in non-pilot areas.
So what more can be done?
In short, as the binge drinking community becomes smaller, more targeted programmes should be aimed at problem areas and populations. The police should use the powers already at their disposal to ensure individuals are held accountable for their actions when drunk and disorderly. The focus should be on the provision of fun and imaginative mixed on trade environments with well trained staff working together with the wider community to ensure a safe and profitable environment. Finally, while not forgetting that young people will always need to thrill seek , seek hedonism and have a good time one hopes, this doesn’t excuse violence, disorder, mess, noise and the cost imposed on society by a minority who should be held more personally accountable for their actions.