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WRITER, CONSULTANT AND BROADCASTER SPECIALISING IN BEER, PUBS AND CIDER. BEER WRITER OF THE YEAR 2009 AND 2012

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Monday, 11 January 2010

Answering the neo prohibitionists, 3 of 10: "25% of the UK population is drinking at hazardous or harmful levels"

First, a disclaimer – I have no intention or desire to suggest that there is no such thing as a harmful level of alcohol consumption, or that some people in the UK drink to a level that presents a danger to themselves and/or others. We know that’s true. What I’m objecting to is the deliberate alarmism at the scale of the problem, and the attempt to define so many people as problem drinkers when the majority are patently not.

OK, this is where we have to start getting a bit more technical and detailed. But to sum it up briefly:

(i) The definition of hazardous drinkers is confused and essentially meaningless

(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.

(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.


(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:

It’ll be interesting to see what happens to this figure over the next few years – before the recalculation, levels are static.

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.

7 comments:

Brad said...

Brilliant deconstruction, Pete. I'm only observing this as an American, but for the sake of sensible drinks patrons everywhere, I hope you and/or many other people will succeed in bringing this reckless data-manipulating to light lest the public and government be snookered into installing drastic and unnecessary measures.

Keep up the good work.

Anonymous said...

well done Pete, what we need now is to get this information published and debated in the wider media

Cooking Lager said...

is there really gonna be 10 of these things? How about more pictures of Myleene Klass ?

Professor Pie-Tin said...

I'm confused.
Can I get pissed this weekend or do I have a problem as I was pissed last night ?

Curmudgeon said...

So a man who drinks two pints of Pedigree (which is just over 5 units) on ONE DAY a week is classed as a hazardous drinker???!!! God help us.

David Strange said...

Excellent article, really demonstrates how some organisations will twist data in order to justify their interfering agenda. It is sad when most people have a perfectly healthy relationship with drink that the control freaks seek to demonise us all for no good reason. So much of the neo-prohibitionist propaganda is reported totally uncritically. I worry that some people will be worn down by the constant stories about the evils of booze and end up worrying they are damaging themselves when they are, most likely, in perfect control of what is largely a healthy and enjoyable pursuit .

BeerMatt said...

Been enjoying your 'Answering the Neopros series' Pete. Wasn't sure whether to post this comment in your 16 January post or here, where it seems more relevant.

The one thing that has occurred to me through the whole series is that you come very close to lumping anybody who suggests that as a society we could drink less into the same neopro basket. There is undoubtably an element who fits this bill, but not everyone.

Doesn't your disclaimer heading this post and your January abstinence essentially acknowledge that there is a point at which alcohol consumption can be harmful? That too much regular consumption can have ill affects, whether through something fairly mild such as unwanted weight gain to something more serious?

I don't know where the safe level is...and I pray that it's not the two standard drinks that medical opinion wants holds out, but I still hesitate to dismiss all discussion about moderation as being part of a neo-prohibitionist plot. In addition to drinking less, medical opinion (at least in Australia) contends that we should wear a hat amd sunscreen when we venture outside to avoid the risk of skin cancer. No one suggests that this is a part of an anti-sun plot, or that to fail to do it on any particular occasion will kill you, just as a general rule you should cover up.

There are lots of similar recommendations: we should eat five serves of vegetables and three serves of fruit a day, be sun safe out of doors, eat less red meat, eat more fibre...or aim for X units of alcohol a day, they are not rules - they are guidelines to aim for. I don't think I manage to adhere to any of them, but it's being aware of them that gives me a sense of where north is...