Changes in alcohol use

• 43% of the sample reported an increase in the frequency of drinking (25% a decrease) while 36% of the sample reported an increase in the amount of alcohol they drank on a typical day (22% a decrease) compared to before COVID-19.
• 30% reported starting drinking earlier in the day compared to before COVID-19 and 42% wanted to drink less in the next 30 days.
• Drinking alone at home while on video/audio calls, chats or ‘watch parties’ was more commonly reported during COVID-19 (40%) compared to pre-COVID-19 (16%).
• Of 75% who were drinking alone at the time of the survey, 41% reported that they were drinking alone more often compared to before COVID-19.
• 41% of people with a mental health or neuro-developmental condition reported they were drinking more due to increased stress about COVID-19 compared to 21% of people without mental health or neuro-developmental conditions.
• Those who increased drinking and reported a mental health or neuro-developmental condition were at least twice as likely to report feeling (more) depressed (36% vs. 13%) and/or lonely (30% vs. 15%).

Changes in the use of other drugs

• The drug types reportedly used in the past 30 days by this sample were THC containing cannabis products (28%), followed by CBD only cannabis products (9%), then cocaine (7%), MDMA (6%), prescription benzodiazepines (5%), amphetamine (4%), prescription opioids and LSD each at 3%.
• 39% of respondents who used cannabis in the past year reported increased use of THC containing cannabis products compared to before COVID-19 with the  biggest increases reported by respondents in Australia (49%) and the USA (46%).
• For other drugs, 37% reported having increased their use of prescription
  benzodiazepines, 26% CBD only cannabis products, 23% psilocybin, and 21% for cocaine, LSD and ketamine.
• The use of drugs that are commonly used in party settings saw the biggest decreases. More than one third of respondents who reported use of MDMA (41%), cocaine (38%), amphetamine (35%) and ketamine (34%) indicated that they used less frequently when compared to before COVID-19.

Drug markets

• While decreased availability of illegal drugs compared to before COVID-19 was reported by 56%, what is striking is that perceptions of purity and the range of drugs remained largely unchanged reflecting the resilience of the illicit drug trade and existing supplies being able to meet demand through a period of less international trade and travel.
• Over one third (36%) of respondents who used illegal/non-prescribed drugs reported that the price of illegal drugs in their country increased compared to before COVID-19.
• While over half (52%) reported that their last drug purchase was not impacted by the pandemic, some respondents reported signs of market scarcity, including paying a higher price (14%), taking longer to get the drugs than usual (10%), more difficulty finding a supplier (8%) and more difficulty finding their drug of choice (5%).
• At the last purchase between March and June 2020, 16% reported buying larger quantities compared with before COVID-19. Notably, stockpiling was reported as a reason for increased drug use, particularly for THC-containing cannabis (20%).

Conclusion

It will be interesting to see whether these changes in patterns of consumption are maintained, particularly if the country faces another extended period of lockdown as many fear. Overall, readers will have noticed that many, but far from all, regular users of cocaine and Ecstasy reduced their consumption, presumably because they would normally take these substances in a social situation on a night out. We must wait and see whether people who have been denied this part of their lifestyle return to using drugs on a night out if and when the night-time economy fully re-opens.

The main way that local authorities in England can reduce the negative impact of alcohol in their area is through the licensing system. Licensing legislation requires that all decisions are informed by evidence relating to the immediate local area or the specific outlets involve. Yet most published or usable data are available only for larger areas and thus cannot inform specific decisions, such as whether to revoke licenses or reduce trading hours.

The research

The researchers conducted three case studies from different regions in England which was selected and developed together with local licensing officers, public health teams and academic colleagues:

1. The closure of a large town centre pub and club with a nightclub in the basement following a licensing committee review. Following concerns about the amount of crime, anti-social behaviour and overt drunkenness at the premises over a period of months, during which the police tried to work with the license holder, the police decided to review the premises licence. The Director of Public Health provided evidence of ambulance call outs and the relationship between alcohol consumption and accidents, which was considered relevant as the premises is right on the river front. The designated premises supervisor (DPS) was removed and conditions placed on the licence. In effect the nightclub was closed in 2013.
2. The closure of a co-located restaurant and nightclub following review. Two premises co-located in the same street were closed down following a licence review brought by the police on the grounds of crime and disorder ceased trading in 2016.
3. The introduction of new local licensing guidance and increased inspections in a city centre. Following a change in central government regulations, local licensing authorities were permitted in 2012 to developed guidance specific to the local area. By enabling the local communities team to develop a relationship with local business, the new guidance in the case study area was intended to improve both the quality of licensing applications and local rates of alcohol-related crime. The developed guidance was in place for a period of about 12 months in 2013/14, during which there was active engagement by local Public Health teams. However, in 2013, local government was subjected to austerity measures put in place by the government, which led to restructuring and the loss of certain projects and teams.

The researchers were interested in the potential impact of these three events on reported numbers of calls for service from police records, alcohol -related hospital admissions and ambulance callouts to the immediate area. To evaluate the impact the licensing decisions, the research team developed the new statistical framework for each case study to create a counterfactual local area by combining the data from several other, comparable localities from the same urban areas. These counterfactuals strengthened the methodology by enabling the researchers to look at what would probably have happened had these decisions to close premises not taken place.

Main findings

The researchers run the data through the then new statistical model and made the following findings:

• The closure of the nightclub (case study 1) had resulted in a temporary, 4-month, reduction in anti-social behaviour of about 60 incidents averted, but a return to ‘normal’ afterwards.
• Closure of the restaurant and nightclub (case study 2) did not result in any measurable changes in outcomes in the 12 months after closure.
• The new licensing guidance (case study 3) led to small reductions in drunk and disorderly behaviour (9 of a predicted 21 events averted), and the unplanned end of the LLG coincided with an increase in domestic violence of 2 incidents per month (an 11% increase).

Conclusion

This study was the first attempt to evaluate the effects of these kind of small-scale licensing interventions, at the levels of individual premises in two of the case studies. The researchers conclude from this work that:

1. The impact of local alcohol policy, even at the level of individual premises, can be evaluated using this methodology, and importantly,
2. That local government actions such as closure or restriction of venues and licensing can have a positive impact on health and crime in the immediate surrounding area.

The research team argue that this approach can potentially bridge the gap between the predominantly data-oriented approach by public health teams and the need for contextualised evidence for presentation to councillors. They hope to build a database of such individual evaluations over time which will increase and understanding of the possible impact of a range of different licensing decisions.

This post is heavily based on an original blog post by Frank de Vocht on the Institute of Alcohol Studies website.

This Safer Nightlife update simply highlights some of the key findings and trends.

Alcohol consumption

Adults

The proportion of men and women usually drinking over 14 units in a week varied across age groups and was most common among men and women aged 55 to 64 (38% and 19% respectively). Proportions drinking at these levels then declined among both sexes from the age of 65. Across all age groups, men were more likely than women to drink at increasing and higher risk levels.

The proportions of men and women who had not drunk alcohol varied across regions. Among both men and women, the highest proportions of non-drinkers were in London (28%) and the lowest proportions in the East of England (9%).

Children

It seems that the recent trend for many young people to be less interested in alcohol may be bottoming out. Between 2003 and 2014 there was a decline in the proportion of pupils who had ever had an alcoholic drink. In 2018, 44% (confidence interval 41-46%) of pupils said they had ever had an alcoholic drink, the same as in 2016. As always, the prevalence rate increases with age with 14% of 11-year-olds saying that they have had an alcoholic drink at least once with the equivalent figure for 15-year-olds being 70%.

Schoolchildren who drink consumed an average (mean) of 10.3 units that week. 21% of pupils who drank in the last week were estimated to have drunk more than 15 units. Again, younger pupils who drank in the last week were more likely to have drunk fewer units than older pupils.

The Smoking, Drinking and Drug use among Young People in England survey, from which this information comes, also asked respondents about being drunk in the last four week period. 9% of children said they been drunk in the last month, including 6% of pupils who had been drunk once or twice and 2% who said they had been drunk more often.

There is also helpful information on where young people who drink usually buy their alcohol. 24% of current drinkers said they usually bought alcohol from friends or relatives, the most common source. 19% said they usually bought alcohol from any retailer or licenced premises, though this was higher for older pupils; 26% of 15 year olds, compared to 12% of 11 to 13 year olds (see the graphic below). 61% of current drinkers said they never buy alcohol, the proportion being higher for younger pupils; 76% of 11 to 13 year olds  (not shown on graphic).

Alcohol-related hospital admissions

Two measures for alcohol-related hospital admissions are used:

• Narrow measure – where the main reason for admission to hospital was attributable to alcohol.
• Broad measure – where the primary reason for hospital admission or a secondary diagnosis was linked to alcohol.

The narrow measure estimates the number of hospital admissions which are primarily due to alcohol consumption and provides the best indication of trends in alcohol-related hospital admissions. The broad measure gives an indication of the full impact of alcohol on hospital admissions and the burden placed on the NHS.

In 2018/19 there were 358 thousand estimated admissions where the main reason for admission to hospital was attributable to alcohol (narrow measure). This is 6% higher than 2017/18 and 19% higher than 2008/09.

There were almost 1.3 million estimated admissions where the primary reason for hospital admission or a secondary diagnosis was linked to alcohol, which is 8% higher than 2017/18 (broad measure). Changes over a longer time period will partly reflect improvements in recording of secondary diagnoses. This represents 7.4% of all hospital admissions.

In England in 2018, there were 5,698 alcohol-specific deaths which  is 2% lower than 2017 and an increase of 7% on 2008. Just over twice as many men as women died from alcohol-specific causes.

Alcohol treatment

In 2018/19, 76 thousand were treated for problematic drinking alone which was similar to the previous year ; 29,000 were treated for non-opiate and alcohol problems.

Expenditure on  alcohol

UK household expenditure on alcohol has almost doubled to £20.0 billion in 2018, from £10.4 billion in 1987.

However, alcohol expenditure as a proportion of total household expenditure has fallen to 1.5% over the same period, from 3.4% in 1987.

Average weekly household expenditure on alcohol was £8.70 in 2017/18.​ People in the 65-74 age group spent the most, with an average of £10.60 a week. ​