I drink, therefore I am: A brief look at alcohol dependence in Great Britain

Alcohol dependence is often viewed as a cluster of behavioural, cognitive, and physiological phenomena that in most affected people includes a strong desire to consume alcohol, and have difficulties in controlling their drinking. According to a 2013 report by Alcoholics Anonymous, alcoholism kills more people in the UK than any other drug apart from nicotine. Based on Government statistics, they claim one adult in every 13 is alcohol-dependent (although this is much higher than data collected from the most methodologically robust studies – see below). The General Household Survey (GHS) and the General Lifestyle Survey (GLF) have been measuring drinking behaviour for over 30 years. In relation to alcohol use, the latest 2013 Office for National Statistics (ONS) report notes that:

“The Department of Health estimates that the harmful use of alcohol costs the National Health Service around £2.7bn a year and 7% of all hospital admissions are alcohol related. Drinking can lead to over 40 medical conditions, including cancer, stroke, hypertension, liver disease and heart disease. Reducing the harm caused by alcohol is therefore a priority for the Government and the devolved administrations. Excessive consumption of alcohol is a major preventable cause of premature mortality with alcohol-related deaths accounting for almost 1.5% of all deaths in England and Wales in 2011”.

The ONS notes that obtaining reliable data on drinking behaviour is difficult. Compared to national alcohol sales, surveys carried out by social scientists consistently record lower levels of how much alcohol they consume because participants may consciously and/or unconsciously be underestimating alcohol consumption (e.g., alcohol use in the home may be based on the number of glasses of wine drunk with the amount poured into the glass being much greater than a standard unit of alcohol). In the most recent 2013 report (based on data collected in 2011), participants were asked two questions about their alcohol consumption. These were (i) maximum amount of alcohol drunk on any one day in the previous seven days, and (ii) average weekly alcohol consumption. The survey also obtained three measures of maximum daily alcohol consumption.

• Exceeding the recommended daily alcohol limit. This measure assessed the proportion of men and women exceeding the recommended units of alcohol on their heaviest drinking day (i.e. 4 units for men, 3 units for women).
• Engaging in binge drinking (i.e., intoxication). This measure assessed the proportion of men and women who exceeded the number of daily units considered as intoxicating (i.e., 8 units for men, 6 units for women).
• Engaging in heavy drinking. This measure assessed the proportion of men and women who drank more than three times the recommended daily units of alcohol (i.e., more than 12 units for men and more than 9 units for women).

The results indicated that:

• Over half of all adults (59%) reported that they had consumed alcohol in the week prior to the survey.
• Men (66%) were more likely than women (54%) to have had an alcoholic drink in the week before the survey
• More men (16%) drank on at least five out of seven days than women (9%) in the week prior to the survey.
• Almost one in ten men (9%) drank alcohol every day in the week prior to the survey compared to only one in twenty women (5%).
• More men (34%) exceeded the daily recommended units of alcohol than women (28%).
• More men (18%) were binge alcohol drinkers than women (12%)
• More men (9%) were heavy drinkers than women (6%)
• Heavy drinking was most prevalent in those aged 16 to 44 years
• Drinking alcohol was also associated with smoking nicotine with smokers being more likely to be binge drinkers and heavy drinkers.

Another major report on alcohol use in England was recently published by the Lifestyle Statistics, Health and Social Care Information Centre (in 2013). Their analyses were mainly obtained from the Health and Social Care Information Centre (HSCIC), Hospital Episodes Statistics (HES), and prescribing data. They reported that:

• 61% of men and 72% of women had either drunk no alcohol in the last week, or had drunk within the recommended levels on the day they drank the most alcohol.
• 64% of men drank no more than 21 units weekly, and 63% of women drank no more than 14 units weekly.
• 12% of school pupils had drunk alcohol in the last week. This continues a decline from 26% in 2001, and is at a similar level to 2010, when 13% of pupils reported drinking in the last week.
• In 2011/12, there were 200,900 admissions to English hospitals where the primary diagnosis was attributable to alcohol consumption (a 1% increase on the previous year).
• In 2011/12, there were an estimated 1,220,300 admissions to English hospitals related to alcohol consumption where an alcohol-related disease, injury or condition was the primary reason for hospital admission or a secondary diagnosis (an increase of 4% on the previous year).
• In 2012, there were 178,247 prescription items prescribed for the treatment of alcohol dependence in primary care settings or NHS hospitals and dispensed in the community (an increase of 6% on the previous year).

Arguably the most robust data on alcohol dependence in the UK comes from the 2009 Adult Psychiatric Morbidity Survey (APMS) carried out by the National Centre for Social Research and University of Leicester. Alcohol problems (including alcohol dependence) were measured using the AUDIT (Alcohol Use Disorders Identification Test) and the SADQ-C (Severity of Alcohol Dependence Questionnaire, community version). An AUDIT score of eight or more indicated hazardous drinking, and 16 or more indicated harmful drinking. SADQ-C scores of 4-19 indicated mild dependence; 20-34, moderate dependence; 35 or more, severe dependence.

Using the AUDIT, the prevalence of hazardous drinking was 24.2% (33.2% males, 15.7% females). A total of 3.8% of adults (5.8% males, 1.9% females) drank alcohol at harmful levels, i.e., around 1 in 25 adults. Among males, the highest prevalence of both hazardous and harmful drinking was in 25-34 year olds, whereas in females it was in 16 -24 year olds. Using the SADQ-C, the prevalence of alcohol dependence was 5.9% (8.7% males, 3.3% females), i.e., around 1 in 16 adults. For males, the highest levels of dependence were identified in those between the ages of 25-34 years (16.8%), whereas for females it was between the ages of 16-24 years (9.8%). Most of the recorded dependence levels were mild (5.4%), with relatively few adults showing symptoms of moderate or severe dependence (0.4% and 0.1% respectively). Compared to the previous APMS survey in 2000, the prevalence of alcohol dependence was lower for males in 2007, whereas it remained at a similar level for females.

Dr Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Lifestyle Statistics, Health and Social Care Information Centre (2013). Statistics on Alcohol: England, 2013. Located at: https://catalogue.ic.nhs.uk/publications/public-health/alcohol/alco-eng-2013/alc-eng-2013-rep.pdf

National Centre for Social Research/University of Leicester (2009). Adult Psychiatric Morbidity in England, 2007: Results of a Household Survey. London: NHS Information Centre

Office for National Statistics (2012). The 2010 General Lifestyle Survey. London: Office for National Statistics.

Office for National Statistics (2013). The 2011 General Lifestyle Survey. London: Office for National Statistics.

Sussman, S., Lisha, N. & Griffiths, M.D. (2011). Prevalence of the addictions: A problem of the majority or the minority? Evaluation and the Health Professions, 34, 3-56.