An exploration of the lived experiences of people with alcohol related harm in Scotland

Background; Alcohol consumption has posed well documented problems for Scottish society, in terms of morbidity, mortality and wider societal costs. Objectives; To investigate the lived experiences and drinking behaviours of people with alcohol-related harm in Scotland, against a backdrop of recent economic downturn, falling incomes, welfare reform and changes to state benefits. Methods; As part of a larger Scottish study (2012-2014) of 639 individuals attending hospital or admitted, relating to an alcohol problem, 20 participants completed semi-structured interviews about their drinking and purchasing habits which were subjected to thematic analysis. Conclusions; Key themes elucidated participants' everyday drink-related behaviours within their local environment including drinking triggers, sourcing alcohol, resourcing alcohol purchase and views relating to substitution. The majority of participants had experienced reduced income, and adapted their alcohol purchasing behaviours accordingly, including 'trading down' to cheaper alcohol. A reduction in food purchasing and heating was a common outcome, as was falling into, or increasing current, debt. More attention should be paid to the prevalence and accessibility of alcohol within local communities. Ultimately, as long as there is highly visible and easily accessible cheap alcohol, heavy drinkers may struggle to undertake positive steps to reduce their damaging consumption levels.div_PaSAnderson, P., & Baumberg, B. (2006). Alcohol in Europe. A public health perspective: London: Institute of Alcohol Studies; 2006. Beeston, C., McAdams, R., Craig, N., Gordon, R., Graham, L., MacPherson, M., McAuley, A., McCartney, G., Robinson, M., Shipton, D., & Van Heelsum, A. (2016). Monitoring and Evaluating Scotland's Alcohol Strategy. Final Report. Edinburgh: NHS Health Scotland. Black, H., Gill, J., & Chick, J. (2011). The price of a drink: levels of consumption and price paid per unit of alcohol by Edinburgh's ill drinkers with a comparison to wider alcohol sales in Scotland. Addiction, 106(4), 729-736. BMA (2012). Reducing the affordability of alcohol. A briefing from the BMA Board of Science: British Medical Association, London: BMA; 2012. Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77-101. Cohn, S. (2016). Reconceptualising public acceptability: A study of the ways people respond to policies aimed to reduce alcohol consumption. Health, 20, 203-219. Cook, P., Phillips-Howard, P., Morleo, M., Harkins, C., Briant, L., & Bellis, M. (2011). The Big Drink Debate: perceptions of the impact of price on alcohol consumption form a large scale cross-sectional convenience survey in north west England. BMC Public Health, 11, 664. doi: 10.1186/1471-2458-11-664. 21 Duffy, J., & Snowdon, C. (2012). The minimal evidence for minimum pricing: London: ASI (Research) Ltd. Forsyth, A.J.M., Ellaway, A., & Davidson, N. (2014). How might the Alcohol Minimum Unit Pricing (MUP) impact upon local off-sales shops and the communities which they serve? Alcohol and Alcoholism, 49(1), 96-102. Foster, J., & Ferguson, C. (2012). Home drinking in the UK: trends and causes. Alcohol and Alcoholism, 47(3), 355-358. Gill, J., Chick, J., Black, H., Rees, C., O'May, F., Rush, R., & McPake, B.A. (2015). Alcohol purchasing by ill heavy drinkers; cheap alcohol is no single commodity. Public Health, 129(12), 1571-1578. Gmel, G., Holmes, J. & Studer, J. (2016). Are alcohol outlet densities strongly associated with alcohol-related outcomes? A critical review of recent evidence. Drug and Alcohol Review, 35, 40-54. HM Government (2012). Welfare Reform Act 2012. Retrieved from http://services.parliament.uk/bills/2010-11/welfarereform.html (last accessed 14 January 2016) ISD (2015). Alcohol-related Hospital Statistics Scotland 2014/15. Edinburgh: Information and Statistics Division. Retrieved from http://www.isdscotland.org/Health-Topics/Drugs-and- 22 Alcohol-Misuse/Publications/2015-10-13/2015-10-13-ARHS2014-15-Report.pdf (last accessed 14 January 2016) Ludbrook, A., Petrie, D., McKenzie, L., & Farrar, S. (2012). Tackling alcohol misuse purchasing patterns affected by minimum pricing for alcohol. Applied Health Economics and Health Policy, 10(1), 51-63. MacNaughton, P., & Gillan, E. (2011). Re-thinking alcohol licensing. Edinburgh: Alcohol Focus Scotland/Scottish Health Action on Alcohol Problems. Makela, P., Herttua, K., & Martikainen, P. (2015). The socioeconomic differences in alcohol-related harm and the effects of alcohol prices on them: a summary of evidence from Finland. Alcohol and Alcoholism, 50(6), 661-669. Nakamura, R., Suhrcke, M., Pechey, R., Morciano, M., Roland, M., & Marteau, T.M. (2014a). Impact on alcohol purchasing of a ban on multi-buy promotions: a quasi-experimental evaluation comparing Scotland with England and Wales. Addiction 109(4): 558-567. Nakamura, R., Pechey, R., Suhrcke, M., Jebb, S., & Marteau, T. (2014b). Sales impact of displaying alcoholic and no-alcoholic beverages in end-of-aisle locations: an observational study. Social Science & Medicine 108: 68-73. ONS (2014). Office for National Statistics. Statistical Bulletin: Alcohol-related deaths in the United Kingdom, registered in 2012. Retrieved from http://www.ons.gov.uk/ons/dcp171778_353201.pdf (last accessed 14 January 2016). 23 O'May, F., Black, H., Gill, J., Rees, C., Chick, J., & McPake, B. (2016) Dependent drinkers' perspectives on minimum unit pricing for alcohol in Scotland: a qualitative interview study. SAGEOpen, DOI: 10.1177/2158244016657141. O'May F, Whittaker A, Black H and Gill J. (2016) The families and friends of heavy drinkers; caught in the cross fire of policy change? Drug and Alcohol Review 2016 Apr 13. doi: 10.1111/dar.12403. Orford, J., Velleman, R., Copello, A., Templeton, L. & Ibanga, A. (2010). The experiences of affected family members: a summary of two decades of qualitative research. Drug Education Prevention and Policy, 17, 44-62. Orford, J., Velleman, R., Natera, G., Templeton, L. & Coppello, A. (2013). Addiction in the family is a major but neglected contributor to the global burden of adult ill-health. Social Science & Medicine, 78, 70-77. Rice, P. (2014). Why do the health professions want minimum unit price in Scotland? In Proceedings of Scotland the Brave! - Alcohol Policy in Scotland, 5 September, 2014, Brussels. Retrieved from http://www.shaap.org.uk/images/mup-event-summary.pdf (last accessed 14 January 2016). Richardson, E.A., Hill, S.E., Mitchell,R., Pearce, J., & Shortt, N.K. (2015). Is local alcohol outlet density related to alcohol-related morbidity and mortality in Scottish cities? Health & Place, 33, 172-180. 24 Riessman, C. (1993). Narrative Analysis. London: Sage. Robinson, M., Geue, C., Lewsey, J., Mackay, D., McCartney, G., Curnock, E., Beeston, C. (2013). Monitoring and Evaluating Scotland's Alcohol Strategy: The impact of the Alcohol Act on off-trade alcohol sales in Scotland: Edinburgh: NHS Health Scotland. Robinson, M., Beeston, C., McCartney, G., Craig, N. (2015). Monitoring and Evaluating Scotland's Alcohol Strategy: Annual update of alcohol sales and price band analyses. Edinburgh: NHS Health Scotland. Scottish Government (2009). Changing Scotland's relationship with alcohol: a framework for action: Edinburgh: Health and Social Care Directorate. Scottish Government (2012). Introduction to SIMD. Edinburgh: Scottish Government. Retrieved from http://simd.scotland.gov.uk/publication-2012/ (last accessed 14 January 2016). Scottish Government (2015a). Minimum unit pricing. Retrieved from http://www.scotland.gov.uk/Topics/Health/Services/Alcohol/minimum-pricing (last accessed 12 January 2016(. Scottish Government (2015b). Scottish Liquor Licensing Statistics 2014-2015. Retrieved from http://www.gov.scot/Topics/Statistics/Browse/Crime-Justice/PubLiquor (last accessed 14 January 2016). 25 Scottish Parliament (2005). Licensing (Scotland) Act 2005. Edinburgh: Scottish Parliament. Scottish Parliament (2010). Alcohol etc. (Scotland) Act 2010. Edinburgh: Scottish Parliament. Scottish Parliament (2012). Alcohol (Minimum Pricing) (Scotland) Act. Edinburgh: Scottish Parliament. Scottish Parliament (2015). Welfare Reform Committee 1st Report, 2015 (Session 4): The Cumulative Impact of Welfare Reform on Households in Scotland. Edinburgh: Scottish Parliament. Sheron, N. (2014). Alcohol and Liver Disease in Europe. In Proceedings of Scotland the Brave! - Alcohol Policy in Scotland, 5 September, 2014, Brussels. Retrieved from http://www.shaap.org.uk/images/mup-event-summary.pdf (last accessed 14 January 2016). Shipton, D., & Whyte, B. (2011). Mental Health in Focus: a profile of mental health and wellbeing in Greater Glasgow & Clyde. Glasgow: Glasgow Centre for Population Health. Retrieved from http://www.gcph.co.uk/assets/0000/2748/Mental_Health_in_Focus_15_11_11.pdf (last accessed 14 January 2016).pub4623pu