(i) The definition of hazardous drinkers is confused and essentially meaningless
Let’s get harmful drinking out of the way first – it’s defined as “A pattern of drinking alcohol that causes harm to a person’s health or wellbeing. The harm may be physical, psychological or social.” When no harm is visible, the proxy used is drinking 50 units a week for men, 35 for women. Those limits may be high or low, but let’s accept them for now. The real problem is with ‘hazardous’ drinking. The Select Committee Report uses the BMA definition of harmful drinking: “A pattern of drinking alcohol that increases the risk of harmful consequences for the person. This term is used for males who regularly consume more than 21 units per week and females who regularly consume more than 14 units per week.” However, to arrive at their data, they then use ONS data. The question ONS asks if you’ve exceeded the daily recommendation (4 units for men, 3 for women) on any one day in the last week. The BMA has taken people who have exceeded the limit on one day, and claimed that these people regularly exceed the limit on most days – thus, if you drink 4+ units on a Friday, and are teetotal the rest of the week, you are counted as someone who drinks 4+ units most days. Even having done this, hidden in the body of the text, the BMA and the Report state that “In contrast to harmful use, hazardous drinking refers to patterns of use that are of public health significance despite the absence of any current disorder in the individual user.” (My italics) This is incredible – what they’re saying is that hazardous drinking is still hazardous, despite the absence of any ill effects of drinking in the individual. I can understand that while effects in the individual may be negligible, if you gross it up to a societal level you may see a statistical effect. But that is quite different from the overall implication that drinking at this level is likely to cause harm. Sorry, did I say implication? I meant assertion. Because after having quite specifically said that ‘hazardous drinking’ is defined as there being an “absence of any current disorder in the individual user”, the BMA then goes on to say: “The 2004 Alcohol Needs Assessment Research Project (ANARP) estimated that, for adults in England aged 16-64:
- 38 per cent of men and 16 per cent of women have an alcohol use disorder, corresponding to 26 per cent overall (8.2 million people)
- Of the 26 per cent with an alcohol use disorder, 23 per cent (7.1 million) consume alcohol at hazardous or harmful levels (32% of men and 15% of women)”
This terminology is then repeated throughout various documents. Yes, if you’re a hazardous drinker – that’s consuming more than 4 units a day for men and 3 for women remember, (equivalent to 1.5 pints of strong lager or one drop more than one large glass of wine) you now officially suffer from an ‘alcohol use disorder’ – even though their own definition of hazardous drinking specifies an absence of any disorder. The BMA also admits that: “The effects of alcohol on an individual are dependent on various factors including age, weight, type of drink, level of dehydration, previous exposure to alcohol, level and timing of food intake, and gender of the drinker.” Having acknowledged all this, they are still content to count anyone who drinks more than 4 units a day as a ‘hazardous drinker’ – irrespective of any of the above factors which, by their own admission, have an impact on the effect of alcohol. This definition of hazardous drinking is incoherent, self-contradictory, and makes profound errors in how the figure is calculated. And yet it libels a good proportion of 25% of the population as suffering from an ‘alcohol use disorder’.
(ii) Even if you accept the definition (which you really shouldn’t) harmful and hazardous drinking are conflated by the report – and they’re quite different.
The only thing to say here is that throughout most of its content, and as shown above, the Report refers to the two groups in one breath as ‘hazardous and harmful drinkers’. Having drawn a clear distinction between the definitions of the two groups, in terms of recommendations they are discussed as one – to the extent that ‘interventions’ are proposed for hazardous drinkers to warn them about their drinking! In fact, only 9% of the UK population are ‘harmful’ drinkers – surely it would be more useful to focus on them.
(iii) Even when you take all that into account – ‘hazardous’ drinking as it’s defined – to the best we can measure it – is either static or declining.
The report claims that “the latest ONS figures show that hazardous drinking had in fact increased between 2000–2008 from 24% to 28% in men, and from 15% to 17% in women. Remember what the ONS said about making comparisons like that? That’s right: “It should be noted, however, that changing the way in which alcohol consumption estimates are derived [in 2006] does not in itself reflect a real change in drinking among the adult population.” The Report here is quite deliberately and consciously ignoring the advice of the people who gathered the data it uses. Even if we were to pretend that the definition of hazardous drinking had any merit whatsoever, if look at that data in more detail:
Among men, even taking into account the revision upwards in 2006, ‘hazardous’ drinking is at worst static over the last ten years. If you were to disregard the recalculation, it would be falling. The fall is more pronounced for that ‘problem’ group, 16-24 year old men. It shows a decline – even a year-on-year decline – even taking into account the recalculation: The figure for women shows a marked increase, but this is clearly due to the recalculation of the units in a glass of wine:
So what’s the truth?
Well, according to the NHS, if we put aside the definitions of hazardous and harmful and look at some other data: “Among adults aged 16 to 74, 9% of men and 4% of women showed some signs of alcohol dependence. The prevalence of alcohol dependence is slightly lower for men than it was in 2000 when 11.5% of men showed some signs of dependence. There was no significant change for women between 2000 and 2007.” Alcohol dependence is a different measure. But I’d argue, given the above, that it’s a more useful one. It’s much lower than 25%. And overall, it’s declining.