Alcohol price hike may miss target

Policy-makers should not rely on rational decision-making to curb excess drinking among vulnerable young people

By Simon Moore

The level of alcohol consumption in the UK is not a problem. The problem is the harm that alcohol inflicts on drinkers, their families and their communities.

Practitioners across the NHS, the police and other areas are witness to alcohol-related harm’s increasing burden on our society: costs that are estimated to be as much as 2 to 5% of our Gross Domestic Product - and that figure does not include the harder-to-quantify misery that alcohol misuse can cause. More worryingly still, we might be seeing only the early symptoms of misuse. Many alcohol-related diseases take time to emerge: five to ten years in the case of some cancers.

But do these statistics justify increasing the price of alcohol as a means to reduce the burden of harm to our younger drinkers? To answer this question we have to think carefully about what the goal of such a policy would be. Is the goal to reduce the amount of alcohol consumed in the UK? Is it to reduce the amount of alcohol consumed by those who are drinking too much? Or is the goal to reduce the burden of harm generally?

Researchers who have looked at the relationship between price and alcohol consumption agree that when alcohol becomes less affordable, adult drinkers consume less. Putting up the price of alcohol should therefore reduce alcohol-related harm. But is it really that straightforward? Studies also suggest that heavier adult drinkers are less sensitive to increases in price compared to moderate drinkers; that heavier drinkers are more likely to switch drink type, for example from wine to spirits; and that heavier drinkers are more likely to change where they drink, for example from drinking in pubs to drinking at home.

One aspect of alcohol dependence is tolerance, which is characterised by the need for markedly increased amounts of alcohol to achieve intoxication, as well as a markedly diminished effect with continued use of the same amount of alcohol. Increasing the price of alcohol will reduce the amount of alcohol consumed across the whole adult population, but the effect on consumption is unlikely to be uniform, with heavy or dependent drinkers less affected. The greatest changes in drinking behaviour would be expected in those least at risk.

The picture gets more complicated when we consider youngsters who live in areas of low socio-economic status, who reside in urban areas, who have problems in their education, who are excluded from mainstream social life, who are bored and who engage in other kinds of sensation-seeking activities, including antisocial behaviour. It is these youths who are most likely to drink most heavily, develop health problems and engage in risky sex and criminality. They are also neglected in all of the research concerning alcohol and price, making it hard to gauge whether raising the price of alcohol would also deter them from drinking and reduce their risk of harming themselves and their communities. For these vulnerable young people, the effects of increases in the price of alcohol may have a very different impact compared to the adult population.

Although no one has really looked at the possible effects of policy on this group, there are very clear issues concerning substitution effects. Substitution is a term that describes switching from one consumable to another that meets the same need. For example, drinkers might switch between wine and vodka to get intoxicated and, similarly, youngsters might substitute illegal substances (marijuana or  cocaine, for instance, but possibly also solvents) for alcohol.  These alternatives to alcohol also have health risks and all of them can expose youngsters to criminal activities. If raising the price of alcohol reduces alcohol consumption in this group, would it also reduce the risk of harm? We know that young people with a penchant for delinquency tend to consume alcohol, drugs and tobacco routinely and that there has been speculation on possible “gateway” effects, such that moving to marijuana might encourage further experimentation with harder substances. The gateway effect of softer drugs is contentious, but substitution from alcohol to marijuana and vice versa has been observed. Increasing the price of alcohol may simply shift vulnerable youngsters’ consumption from alcohol to other substances.

Another important factor concerns how youngsters acquire alcohol. The debate over the price of alcohol is based on a rather simple idea that drinkers are rational consumers choosing how much to drink based on their wealth and the price of alcohol. The reality is that a growing number of youngsters have little or no regular income. To generalise rational economic theory to their decision making is beset by problems. For those that fund their consumption through illegal enterprise, either stealing alcohol or stealing to fund the purchase of alcohol, crime is a complement; increasing the price of alcohol would be expected to have either no effect or even the adverse effect of encouraging youngsters to steal more to fund their habit.

Moreover, sober consumption decisions made in supermarkets will be influenced by price. But in the context in which alcohol is consumed by these young people, other factors come into play. Youngsters are heavily influenced by their peers, social group norms and a need for inclusion, and when also intoxicated, consumption decisions will be far from rational.

Nevertheless, while increasing the price of alcohol is unlikely to have uniform effects across the population and may even have adverse consequences for marginalised youngsters, something clearly needs to be done. The current levels of alcohol-related harm pose major problems to society. A minimum unit price of alcohol is sensible and likely to be successful in at least addressing some of the growing problems with alcohol misuse in the UK.

But perhaps the most salient question we should be asking is not whether increasing the price of alcohol will stop youngsters from drinking, but why they are drinking in the first place? Ask youngsters about what they would like to do with their free time and you will get fairly typical answers: socialise with friends, go to the gym, visit the cinema, learn to rap, and so on. The reality is that for the price of two cinema tickets they can buy two litres of vodka. Even if youngsters can afford the cinema, getting there can often be difficult.

The relative price of alcohol is perhaps the most important factor driving consumption in younger drinkers. If all that is left for these youngsters is a street corner, then their desire for excitement and intoxication will remain.. We will need a bit more imagination than using the blunt instrument of policy to micro-manage individual behaviour.

9 November 2009

Simon Moore. Senior lecturer at Cardiff University,

Dr Moore is a member of the Youth Alcohol Research Network. He, Marainne van den Bree and Stephanie van Goozen will be presenting a seminar on “Preventing Alcohol Misuse” at the Annual Youth Justice Convention on November 12