Science and Technology Committee HC 1536 Alcohol GuidelinesWritten evidence submitted by Drinkaware (AG 18)

1. About Drinkaware

1.1 Drinkaware is an independent, UK-wide charity, which aims to equip people with the knowledge they need to make informed decisions about how much alcohol they drink. Drinkaware is entirely funded by voluntary donations from across the drinks industry, but operates completely independently from it. Our behaviour change campaigns are designed upon an evidence-based approach, and our work is informed by a panel of experts from across public health and industry.

2. Declaration of Interest

2.1 Drinkaware welcomes the opportunity to submit evidence to this inquiry. As the leading source of alcohol information for consumers in the UK with more than 225,000 visitors coming to its website every month, Drinkaware is one of the primary resources consumers turn to for evidence-based advice.

2.2 Unit guidelines are referenced in all of Drinkaware’s campaigns across all communication channels. We convey the guidance in practical everyday language so people can integrate recommendations into their everyday lifestyle.

2.3 Drinkaware has worked with the UK Government in communicating unit guidelines. This work has included coordinating campaigns and messages to reflect Government advice as well as practical partnerships including mail drops of a “unit and calorie calculator” (Annex 1) to more than 2.3 million households in support of the Change4Life January 2011 campaign activity.

2.4 This year also saw the launch of MyDrinkaware, an online drink diary and unit calculator. The tool allows consumers to better understand the number of units they consume and how it affects their health and wealth. More than 80,000 consumers now regularly use MyDrinkaware.(http://www.my.drinkaware.co.uk or http://bit.ly/px7va2)

2.5 Drinkaware works closely with the devolved administrations, most notably with the Scottish Government and its Alcohol Awareness Week activities in 2008, 2009 and 2010. Drinkaware provided almost 400,000 unit measure cups to help consumers in Scotland easily identify the number of units of alcohol in wine, beer and spirits and assist them to moderate their drinking behaviour.

2.6 In 2011 Drinkaware and the British Beer and Pub Association (BBPA) developed a new “2-2-2-1” unit campaign, providing a simple and quick way to gauge the number of units in the four most popular drinks—a pint of beer, a 175ml glass of wine, a 330ml bottle of 5% beer, and a 25ml pour of spirits. The campaign has started rolling out in pubs and restaurants across the UK and it is intended to become one of the most used “rules of thumb” for consumers.

2.7 Through a partnership with the Wine and Spirits Trade Association, Drinkaware has helped develop a similar “2-2-2-1” campaign for use in the off trade. Varying slightly from the BBPA version, the proposed version will replace the pint of beer with a 440ml can of 4% beer and a 330ml bottle of ready-to-drink (RTD) for the 330 ml bottle of 5% lager. When approved it is anticipated that it will be rolled out in every retail outlet across the UK.

3. Summary of Our Views

3.1 Our views can be summarised as follows:

It is essential that consumers view the scientific evidence that supports the unit guidelines as credible.

Any revised evidence base must be endorsed by the expert research community to avoid the current situation where consumers receive different opinions on low risk drinking.

Government and Drinkaware communications have both led to a raised awareness of unit guidelines and this should be continued.

We would recommend the Government maintain its use of current terminology on unit guidelines so as to continue progress in consumer awareness.

It is critical that consumer knowledge of unit guidelines is translated into real life drinking scenarios whereby consumers can learn to choose their drinks appropriately.

4. Question 1: What evidence are Government’s guidelines on alcohol intake based on, and how regularly is the evidence base reviewed?

We have no response to this question.

5. Question 2: Could the evidence base and sources of scientific advice to Government on alcohol be improved?

5.1 Drinkaware is one of the primary resources consumers turn to for evidence-based advice on low-risk drinking. It is essential that its advice is trusted and seen as credible by consumers, including the 225,000 unique users who come to our website every month looking for information about alcohol and the 80,000 who use MyDrinkaware to moderate their drinking.

5.2 The scientific evidence that supports the unit guidelines is thus critical to the effectiveness of our campaigns and for this reason we have recently commissioned research on consumer attitudes to units (Annex 2). This qualitative research highlighted how consumers aged 30–45 years and drinking to increasing risk levels, perceive there to be conflicting opinions and advice on unit guidelines. This has led to some consumers feeling the guidelines are unsubstantiated or inaccurate and therefore irrelevant.

5.3 Drinkaware believes that consumers would welcome a thorough examination of the evidence base for unit guidelines. A set of guidelines issued by the Chief Medical Officer with the underlying evidence would ensure Drinkaware and other organisations could continue to provide consumers with substantiated information. This endorsement, coupled with Drinkaware’s educational resources and tools could help reduce consumers’ confusion about what is good or bad for their health and be better able to take personal responsibility for their alcohol intake.

5.4 It is critical that any evidence base for unit guidelines is endorsed by the expert research community. Currently, as our consumer research shows, there are conflicting opinions being voiced over the number of units that may be consumed, the timeline in which they are consumed, and the impact on health if the guidelines are ignored. Without a reasonable level of agreement any revised evidence base would face significant challenges in achieving acceptance by consumers and ultimately in shaping their behaviour.

6. Question 3: How well does the Government communicate its guidelines and the risks of alcohol intake to the public?

6.1 Between 2007 and 2010, the UK Government carried out a series of unit guideline campaigns, spending about £4 million in 2008–09. The impact of these campaigns alongside those run by Drinkaware has led directly to an increased awareness and understanding of unit guidelines and how they translate to individual drinks. It is our belief that although there are still significant numbers of consumers to inform, we are certainly approaching a “tipping point” with consumers and that many more are beginning to understand units on a practical level. We would therefore caution against creating new terminology or presentation, which would set back the progress these communication programmes have achieved.

6.2 Drinkaware has found through its own research (Annex 3), that while the term “alcohol units” is well recognised among the general population (85% aware of the term), many fewer are able to translate this to actual drinks that they might consume. Just over a third of adults (38%) were able to select a drink from a list which correctly contained one unit of alcohol, but this only rises to 42% in those who were aware of the term “units”. For consumers who are unable to make a direct correlation between “units” and “drinks” the practical impact of guidelines will be limited.

6.3 Unit guidelines are an important reference point to those seeking to manage their drinking, particularly amongst certain key age groups. Drinkaware’s recent research amongst 30–45 year olds “increasing risk drinkers” found that 44% aimed to drink within the daily guidelines, 34% actively sought out information about the unit content of different drinks and the same proportion relied on information provided on drinks cans and bottles to help them moderate their drinking (Annex 4).

6.4 If the Government is able to recommend a widely endorsed set of guidelines we believe that both its own and Drinkaware’s abilities to communicate effectively with consumers will be improved. By coupling behaviour change campaigns with proven digital tools like MyDrinkaware and simple mnemonic devices like “2-2-2-1”, consumers will be able to have a clearer understanding of units and their equivalents and be better informed about the decisions they need to make about their own drinking behaviour.

7. Question 4: How do the UK Government’s guidelines compare to those provided in other countries?

We have no response to this question.

September 2011

Annex 1

“Unit and calorie counter” distributed to more than 2.3 million households in support of the Change4Life campaign activity.

January 2011

Annex 2

Summary of findings from research on consumer attitudes to units conducted by Penn Schoen Berland for Drinkaware and focusing on 30-45 year old increasing risk drinkers

August 2011

METHODOLOGY AND OBJECTIVES

Phase 1		Phase 2		Phase 3
6 Qualitative focus groups with Adults aged 30–45 who drink at least five times a week and exceed the daily guidelines across London, Manchester and Glasgow.		Quantitative online survey with Adults aged 30–45 who drink at least four times a week and exceed the daily guidelines.		4 Qualitative focus groups with Adults aged 30–45 who drink at least four times a week and exceed the daily guidelines across London and Birmingham.
1 Qualitative group with three couples in London		500 respondents.		Using the segments identified in phase 2, the audience was limited to those who were considering moderation
Key aims:		Key aims:		Key aims:
—	Explore key attitudes, motivations and barriers to moderating their drinking	—	To identify segments within the overall audience and understand what drives them to moderate	—	Understand which creatives best convey the messages
—	Understand how Drinkaware messaging can interact with current behaviour	—	Explore their relationship with alcohol	—	Identify which creative route is most successful for encouraging moderation
—	Identify key themes and tone for Drinkaware messaging	—	Identify most effective messaging for encouraging Adults to moderate	—	Explore possible improvements to strengthen creatives

Key Insights for Adult Audience

1. Adults are very set in their routine of drinking alcohol and see it as an enjoyable reward or moment of relaxation when they have a drink at home, either before with or after dinner.

2. Adults view their behaviour as normal and do not consider themselves in any way at risk because of their level of drinking. They feel they are in control of their drinking and already exert a level of moderation easily in their lives as they do not tend to get drunk. They see little need to further limit themselves and reject the idea of daily guidelines as too restrictive. They struggle to equate units with their own drinking as they drink at home and therefore are less aware of measures. They appreciate simple, general examples of drinks that feel relevant.

3. This audience need to realise they are drinking too much and there are risks associated with this, to prompt them to reassess their behaviour and consider moderation within daily guidelines.

4. Many Adult drinkers are open to the idea of moderating their alcohol consumption—underpinned by a growing anxiety around the health harms. Also many feel pulled in many directions—wanting to be successful, family oriented, healthy and look good. This opens the door to the idea of moderation to provide a way of achieving their aspirations—providing a clear benefit that taps into their desires.

5. While there are few substitutions for alcohol as a reward or for relaxation some are moderating their alcohol, employing avoidance or limitation techniques, eg avoiding having alcohol at home, drinking smaller volumes of drinks or trying to make alcohol last longer.

6. There is a need to highlight that messaging around risks associated with alcohol is relevant to them by demonstrating empathy with the benefits they derive from drinking, targeting their behaviour to make it feel it speaks to them. The risks that hold most relevance are weight gain (calories), cancer and liver disease.

7. Highlighting the excuses adults make for having a drink works well as it is empathetic and resonates with the reasons they give themselves, for example, Monday/Friday or a good/bad day at work. This helps messaging feel targeted at them and illustrates how risks are relevant.

8. This audience like to feel they are in control and many already are. Any demonstrations that they are drinking at a high-risk level needs to be done carefully as they do not like to be told what to do. They prefer to be provided with the facts to make their own informed decisions.

Relaxation and Reward are Key Motivations for Drinking

Adults are very set in their routine of drinking alcohol and see it as an enjoyable reward or moment of relaxation when they have a drink at home, either before with or after dinner.

Selected quotations:

“After a hard day at work you want to unwind.” (Male, London)

“It’s slightly ritualistic, it’s 7pm, I watch the clock and wait for the sweet release of the cork opening.” (Male, London)

“I certainly think of it as a reward. You feel like you deserve it.” (Female, London)

“It’s exciting, you’ve finished your day, you’re at home, it’s your reward.” (Female, Manchester)

Many Feel no Desire to Moderate their Drinking

Strong lack of self-realisation in how much they are drinking and most feel that they are already “moderating”—particularly when they think back to past behaviours.

They have built up a tolerance for drinking and subsequently don’t feel hung-over the next day (again they use their 20’s hangovers as a frame of reference).

But a small minority are reappraising their drinking—and some moderating is occurring:

Monday/Tuesday nights off.

Have a cup of tea instead.

Nonetheless this is a particularly difficult group to prompt a behavioural change. Many messages struggled to connect, in part because they were anchored in the guidelines, which they quickly dismissed as unrealistic and/or unfounded.

Selected quotation:

“I personally don’t see a significant effect on my life from drinking alcohol. Maybe 10 years down the line it will come back to hit me in the face.” 34. Male, London

They Feel they Already Exert Enough Control and Drink in Moderation

Adults do not consider themselves in any way at risk. They feel in control and already moderating so there is little need to limit further. They struggle to equate units with their own drinking as they drink at home and therefore are less aware of measures.

Selected quotations:

“I can come home and think ‘oh I don’t want one [a drink] tonight’. I can control myself like that.” (Female, Manchester)

“When it is pre-measured like pints it makes sense but as you’re pouring your own glass of wine or spirits, it isn’t measure.” (Male, Glasgow)

High Awareness of Units, but Daily Guidelines Lack Credibility

Attitudes towards the unit guidelines were mixed. While there was a high awareness of the term units and could rank drinks in order of unit content, most had little knowledge of exact unit content in drinks. Few could link guidelines to their own behaviour and daily guidelines were largely seen as restrictive and unrealistic.

Selected quotations:

“I’d have two small glasses of wine and still drive. I shouldn’t have any more than that if I was driving. I think that’s like logically how I think about units.” (Male, Manchester)

“If drink was measured in units it would sound silly. I wouldn’t go ‘four units of lager please.’” (Male, Manchester)

“I think it used to be 14 and 21 units for a week, two small glasses of wine or a pint a day.” (Female, Glasgow)

“Because it’s so restrictive you just think if I’m going over I might as well go over properly.” (Female, London)

Annex 3

Selection of results from research involving 4,164 participants conducted by IPSOS Mori on behalf of Drinkaware.

2010

Awareness of Measuring Alcohol by Units

The large majority of people (85%) say they have heard of the term “alcohol units”. As might be expected, 95% of regular drinkers are aware of units, compared to only 58% of those who do not drink. There are no significant differences in awareness between those who drink regularly within guidelines, and those who drink to increasing risk or higher risk levels. However, there is a difference between non drinkers and those who drink even rarely (58% vs. 89% have heard of units), suggesting that any level of alcohol consumption at all appears to make a difference.

There are no differences by gender in awareness of the term units. Those aged under 45 are less likely to be aware of the term than those aged 45 and over. (82% compared to 88% aware). Those in the highest social grades are more likely to be aware of units than those in the lowest social grades—more than nine in ten (93%) ABs are aware compared to less than three quarters (73%) of Des.

Knowledge of the term “alcohol units” is much lower among BMEs compared to white respondents with only four in ten (40%) non-white respondents being aware of this term compared to nine in ten (89%) white respondents. This is likely to reflect the much higher proportion of non-drinkers in the non-white group.

Those living in the South are more aware of the term units than those who live in the North or the Midlands (94% aware compared to 88% and 86% respectively). London respondents stand out as especially unlikely to be aware of the term units—only half (51%) say they have heard of this term. This difference is likely to be explained by the higher proportion of non drinkers and BME residents in London than in other regions. The gap between London and other regions has widened since last year—with awareness in the South rising from 89% and falling in London from 64%. This may also be linked to a persistent trend for adults in London to be less likely to drink than the England average.

Applying Unit Measures to Actual Drinks

A new question was added to the survey in 2010, to explore whether awareness of units as a concept was able to be applied by respondents to actual drinks that they might consume. Respondents were given a list of different drinks, from which they were asked to select the drink which best matched one unit of alcohol.

Although the large majority of adults have heard of the term alcohol units, many fewer are able to translate this to actual drinks that they might consume. Just over a third of adults (38%) were able to select a drink from a list which correctly contained one unit of alcohol, this only rises to 42% in those who were aware of the term units before taking the survey.

However, it is reassuring that very few people selected drinks which are equal to 2 or more units as a proxy for one unit—less than 1% selected double shots or cocktails, and only 3% thought a large glass of wine represents one unit of alcohol. One in eight adults (13%) say they didn’t know—a greater proportion of non drinkers than drinkers fall into this group (19% of non drinkers say don’t know compared to 4% of increasing risk drinkers).

Men were significantly more likely than women to be able to select a drink which contained one unit (46% of men were correct compared to only 30% of women). This may be linked to a higher proportion of men choosing a half pint of lager (which contains 1 unit) and a higher proportion of women choosing a small (125ml) glass of wine (which contains 1.5 units).

Differences between age groups in terms of their ability to recognise a drink containing one unit of alcohol were not significant. However, those in higher social grades were more likely than those in lower social grades to recognise a unit (42% of ABs got the proxy measure correct compared to 33% of DEs). Those from white backgrounds were much more likely to recognise a drink containing a unit than BME respondents (40% compared to 16%).

The difference between white and BME respondents on this measure is likely to be linked to the finding that only a quarter (24%) of those who do not drink are able to recognise a drink which contains one unit, compared to 46% of regular drinkers. Interestingly, understanding of how to relate units to actual drinks increases the more alcohol one consumes—52% of increasing risk drinkers and 58% of higher risk drinkers select correctly compared to 41% of those who drink less than the recommended consumption limits. The following chart shows the breakdown of correct and incorrect responses according to level of drinking.

There are also some broad patterns which emerge when we analyse responses to this question by the types of drinks that respondents typically drink. For instance, those who drink lager are more likely to select “half a pint of lager” as a proxy measure—48% of those who say they typically drink pints of lager select this option, compared to 30% of adults overall. Similarly, those who list a medium glass of wine (175ml) among the drinks which they consume over the course of a typical week are more likely to select the “small glass or wine (125ml)” as their proxy measure (33%, compared to 21% overall). This may indicate that people are more likely to choose a proxy measure based on the types of drink that they themselves are familiar with, or that respondents’ choice of proxy measure may reflect the personal rules of thumb that they themselves employ.

Awareness of Recommended Unit Consumption Guidelines

As in 2009, respondents were also asked how many units of alcohol they thought was the safe guideline amount for alcohol consumption per day, for each gender. When it comes to knowing the recommended daily number of alcohol units adults are advised to limit themselves to, less than a third are able to correctly identify this. 29% of women got the limit for their own gender correct, compared to 32% of men getting their own limit correct. One in six (16%) say they don’t know what the recommended limit is. The proportion getting the daily limits correct has fallen slightly since 2009—for example last year 36% of all adults correctly stated the limit for women compared to 31% in 2010.

However, people are generally more likely to under, rather than overestimate guideline amounts—43% selected less than the actual guideline amount for women, and 42% selected a lower amount for men. Only 10% overestimate the limit for women, and 13% overestimate the mens’ limit. The proportion underestimating the guideline amounts has increased significantly since last year—from 30% underestimating for women and 26% underestimating for men.

18–24 year olds are more likely than other age groups to get the recommended amounts correct (39% on both men and women’s guidelines, compared to 31% of those aged 25–44 and 30% of those aged 45+). Those from white backgrounds are more likely to get the guidelines correct than BME respondents (32% compared to 22% for women’s guidelines, and 31% vs. 18% for men’s guidelines). There are no significant differences between social grades on women’s guidelines, but ABs are slightly more likely than DEs to get the guidelines correct for men (32% vs. 27%).

Awareness of guidelines is clearly related to one’s level of alcohol consumption—for example, 35% of regular drinkers get the guideline limit for women correct, compared to 23% of those who say they do not drink. Ability to select the correct guideline amount for women rises to 38% among increasing risk drinkers and 43% in higher risk drinkers. However, awareness of the recommended limits has fallen slightly since last year—in 2009, 41% of regular drinkers got the limits for women correct, as did 44% of increasing risk drinkers.

Information Provided to Understand Units

Less than a third of adults who drink regularly (30%) feel that the information provided on cans and bottles of alcoholic drinks helps them to monitor how much they are drinking. This view is fairly uniformly held, with no significant differences by age or gender. However, the more one drinks the more likely one is to feel that the information is not helpful—48% of regular drinkers who drink below guidelines think that the information provided on bottles/cans does not help them to monitor how much they drink, compared to 50% of increasing risk drinkers and 61% of higher risk drinkers.

Annex 4

Summary of findings from research on consumer attitudes to units conducted by Penn Schoen Berland for Drinkaware and focusing on 30–45 year old increasing risk drinkers

August 2011

METHODOLOGY AND OBJECTIVES

Phase 1		Phase 2		Phase 3
6 Qualitative focus groups with Adults aged 30-45 who drink at least 5 times a week and exceed the daily guidelines across London, Manchester and Glasgow.		Quantitative online survey with Adults aged 30-45 who drink at least four times a week and exceed the daily guidelines.		4 Qualitative focus groups with Adults aged 30-45 who drink at least four times a week and exceed the daily guidelines across London and Birmingham.
1 Qualitative group with 3 couples in London		500 respondents.		Using the segments identified in phase 2, the audience was limited to those who were considering moderation
Key aims:		Key aims:		Key aims:
—	Explore key attitudes, motivations and barriers to moderating their drinking	—	To identify segments within the overall audience and understand what drives them to moderate	—	Understand which creatives best convey the messages
—	Understand how Drinkaware messaging can interact with current behaviour	—	Explore their relationship with alcohol	—	Identify which creative route is most successful for encouraging moderation
—	Identify key themes and tone for Drinkaware messaging	—	Identify most effective messaging for encouraging Adults to moderate	—	Explore possible improvements to strengthen creatives

Many Already Adopting Moderating Techniques

The following table illustrates the percentage of people (from a sample of 500, 30-45 year old increasing risk drinkers) who replied “often do” or “do from time to time” to each suggestion in response to the request:

Here are some things people have said they do to moderate their drinking. Using the following scale please tell us whether you have ever tried any of these.

	% Agreeing often do/dofrom time to time
Avoid drinking at lunchtime during the week	72%
Make a bottle of wine last for a few days (by buying a screw top or having a stopper)	46%
Have a cup of tea instead	46%
Drink within the daily guidelines	44%
Drink smaller glasses of wine or smaller bottles of beer	44%
Avoid drinking on a “school night”	44%
Try alternative ways to unwind eg taking a bath, reading a magazine, watched a film, etc.	43%
Limit myself to just one drink	42%
Look at the information provided on drinks cans and bottles to help me monitor how much I drink	35%
Find out about the unit content of different drinks to help monitor how much I am drinking	34%
Avoid always having wine and beer in the house	32%
Drink lower alcoholic drinks	28%
Keep a drink diary to monitor how much I am drinking	19%