1 INTRODUCTION
Overview
1.1 Although alcohol is widely recognised as a major generator of employment and income from exports in Scotland, a considerable (and increasing) amount of harm is associated with its misuse. The effects of this misuse - which are considered in this paper - are wide, and generate substantial costs not only for the health service, but also for criminal justice, communities, employers, and the wider Scottish economy.
1.2 A significant report by Catalyst Health Economics Consultants was published in 2001 by the (then) Scottish Executive (Scottish Executive, 2001) on the trends and costs associated with alcohol misuse in Scotland, with relatively minor internal updates in 2004 (Scottish Executive, 2004) and 2008 (Scottish Government, 2008a). The Scottish Government commissioned this research (by York Health Economics Consortium at the University of York) to review the existing literature and approaches used in recent costing studies and other relevant publications and to examine the current cost of alcohol misuse in Scotland across a range of appropriate domains, including health, criminal justice and wider economic costs.
Recent Policies Relating to Alcohol
1.3 In recent years the Scottish Executive and, latterly, the Scottish Government has published a number of policy documents and introduced a series of initiatives relating to alcohol use and misuse 1. The Scottish Government published Changing Scotland's Relationship with Alcohol: A Framework for Action (Scottish Government, 2009), on 2 March 2009, following a public consultation on the proposals in a 2008 discussion paper (Scottish Government, 2008b). The Framework sets out a package of measures to address issues around reducing alcohol consumption; tackling the damaging impact alcohol misuse has on Scottish families and communities; encouraging positive attitudes and positive choices; and improving the support and treatment available.
1.4 A number of new actions are already underway. Significant investment to tackle alcohol misuse was announced in March 2008, with the majority of funding being routed through NHS Scotland to deliver increased screening for alcohol problems, access to early intervention, and enhanced treatment and support services. A new programme target for the delivery of alcohol brief interventions (150,000 interventions over three years from 2008) by NHS Boards has been established. This is being supported by a comprehensive national training programme for staff involved in delivering brief interventions. The Licensing (Scotland) Act 2005 came fully into force in September 2009 and is based on five key licensing objectives, including protecting and improving public health; protecting children from harm; and securing public safety. Amongst a package of measures, the Act imposes limits on irresponsible alcohol promotions in licensed premises.
1.5 The Scottish Government brought the new regulatory measures set out in the Framework together in the Alcohol, etc (Scotland) Bill introduced to Parliament in November 2009. The Bill includes proposals to introduce a minimum price per unit of alcohol; further restrictions on the supply of alcoholic drinks free of charge or at a reduced price in off-sales; restrictions on the location of drink promotions within off-sales premises; and local provisions for raising the purchase age of alcohol in off-sales to 21.
Aim and Objective of Study
1.6 The specific aim of the project is to derive estimates of the cost of alcohol misuse in Scotland for 2007 (the latest year for which the majority of data are available). The objectives required to achieve this aim include:
- Reviewing the existing literature and approaches used in other costing studies, particularly those related to alcohol misuse;
- Identifying new research studies or data that will enable more robust estimates of the costs of alcohol misuse to be derived;
- Deriving estimates of the economic and social costs associated with alcohol misuse in Scotland.
Defining Alcohol Misuse
1.7 Alcohol consumption can be classified in many ways. One of the most helpful approaches is to categorise use of alcohol for the purpose of assessing the need for treatment. This is done by applying the World Health Organisation's International Classification of Mental Disorders (10th revision, 1992). Alcohol Use Disorders ( AUDs) are classified according to three categories reflecting increasing levels of risk and harm associated with alcohol consumption:
- Hazardous Alcohol Use;
- Harmful Alcohol Use;
- Alcohol Dependence.
1.8 Drinkers not meeting the criteria for an AUD are described variously as 'sensible drinkers' or 'low risk drinkers' (Drummond et al., 2009). Further information about the numbers of people misusing alcohol in Scotland is provided in Section 2.
Structure of Report
1.9 This report considers some recent data on weekly alcohol consumption in Scotland by age and gender in Section 2. The adopted methodology, which is based around that for cost-of-illness studies, is outlined in Section 3. Section 4 briefly summarises some recent studies of the costs of alcohol misuse in Scotland and elsewhere.
1.10 The subsequent sections focus on the five broad aspects associated with alcohol misuse covered in this study - costs relating to healthcare services ( Section 5); social care costs ( Section 6); costs relating to crime ( Section 7); costs to the Scottish economy due to lost productive capacity ( Section 8); and the wider costs (including intangible costs) of alcohol misuse to Scottish society ( Section 9). The findings are discussed in Section 10.