There is ever-increasing concern in the UK about the rising tide of alcohol consumption and of alcohol-related health problems, particularly liver disease.

I mentioned this in this post on the Doorway Blog site in August, and showed two graphs, here shown with two others which are relevant.

Part of this debate has involved discussion of the pricing of alcohol, with respect as to whether there should be a minimum price per unit of alcohol* (the usual figure suggested is 50p per unit), and whether there should be extra taxation on ‘super strength lagers’* and removal of the tax breaks on ‘white cider’*.

A unit of alcohol is defined in the UK as 10ml of alcohol – that amount is contained in a half pint of fairly weak (3.5% ABV [alcohol by volume]) beer; a medium glass (175ml) of 12% ABV wine would contain about 2 units. The medical advice generally given is that men should not drink more than 3-4 units per day, and women no more than 2-3 units per day.

Superstrength lager (and other beer, but it’s mainly lager being discussed – the heavy drinkers tend not to be seeking out interesting expensive Belgian Trappist beers with odd glasses – they’re rather more likely to be buying cans of Carlsberg Special) is generally defined as those having an ABV of over 7.5% (incidentally, this excludes Stella Artois, which is 5% ABV, despite its nicknames of ‘Wifebeater’ and ‘Stella Actlikeatwat’) – certainly that was the definition used in the 2011 Budget, when it was announced there would be an extra duty on them of 25% over and above the general beer tax. Thus leaving in a stronger market position…….

“White cider” ‘is made by processing cider after the traditional brewing process is complete, resulting in a nearly white product. This processing allows the manufacturer to produce strong (typically 7-8% ABV) cider cheaply, quickly, and on an industrial scale, often from poor raw materials’. White cider has benefitted from the tax break which was given to cider to encourage the more traditional producers, mainly in the West Country and Herefordshire. This was to be ended in taxation measures announced in 2010, but the change was abandoned, as time ran out before the 2010 General Election.

At present it is possible to get a 3 litre bottle of Frosty Jack’s (probably the most popular white cider we see in Chippenham) for around £3.50 – that’s for a 7.5% ABV liquid, giving 22.5 units in the bottle. Not as cheap as this was, with the website’s admirably no-nonsense advertising – ‘this is the cheapest way to get drunk in the UK’ (the comments are fairly no-nonsense, as well…..).

A further wave of discussion broke recently when, in April, Alcohol Concern published their report ‘White Cider and street drinkers’. This attracted high profile pieces in the media, for example The Guardian. There are those who still speak as much, if not more, about the dangers of superstrength lagers, for example Thames Reach, extensively quoted in this piece from the BBC London News website. Some have speculated that some heavy drinkers avoid the white ciders because of the taste compared with the lagers. Our feeling at Doorway (certainly my feeling, anyway) had generally been that the driver for people choosing cider has been that of ‘value’, although we have certainly heard people blame some of their physical problems on it. We might have expected a slight local bias towards cider, as we ARE in the West Country, and ordinary strength cider is a mainstream drink here, in a way that it isn’t in London (I have some qualfications for saying this, being a Londoner) where cider had, until the Magner’s marketing phenomenon, a reputation of being a drink of tramps, punks, students and Goths. Here in the West Country, by contrast:

After Lisa, Jeremy Swain and I had spent part of an evening discussing this and other addiction-related issues on Twitter (in as much as one can have a detailed discussion within the confines of 140-character ‘tweets’), Lisa decided we should run a survey at the next drop-in session.

This was the afternoon session on Thursday 21st April, open to guests between 12:30 and 15:30 (food service stopping at 15:00, tea and coffee stopping at 15:15). The weather was warm and dry. It was the Thursday before the Easter weekend, so the next drop-in session was to be the next Thursday.

I am very often one of the two volunteers on the front desk, so the guests are used to me greeting them and asking questions – we always ask in which town they had spent the previous night, whether they were rough-sleeping, sofa-surfing, own tenancy etc, and whether they are carrying any liquids or drugs (any liquids are kept locked away, and returned when the guest leaves). On this occasion, I was a ‘third person’ on the desk. The guests were asked the usual questions by the others, and then I explained that:

I then asked those who agreed to cooperate whether they currently drink either or both WC or SSL, or if they don’t, whether they had done in the past. This was not to imply that WC or SSL represented all of their alcoholic intake, just any. If there was doubt as to whether a drink fell into these categories, I ascertained (where it had not been volunteered by them already) which brands they were talking about. I also asked what influenced them in their choice of drink, or why they avoided such drinks. I then asked them for any further comments.

There were some times when the pressure of numbers entering the session was such that it was not possible for me to ask the questions on the guest’s way in. In these cases, I asked them on the way out. In one case, it was busy at the time he left also, and the chance was missed.

The co-operation received from guests was remarkably good, given the somewhat intrusive nature of the questions. It probably helped that I have been working as a volunteer at Doorway for 20 months, and am a familiar face to most of the guests.

37 guests attended the session (a slightly below average number – we have of late usually gone above the 40 mark). Of these, 31 took part in the survey, 3 declined (1 of these had just surrendered his Tennant’s Super cans at the desk!…), 1 (as mentioned above) was ‘missed out’ (we certainly knows he drinks WC as well as wine, as he has surrendered both at the door very recently), 1 was felt by me to be too upset to be asked to take part, and 1 was felt by me to be unsuitable as he has cognitive problems and is in supported housing (he uses the project sessions for historical reasons).

One of the current SSL drinkers used to drink WC but avoids it now (‘it’s gut-churning’).

The full spreadsheet of the results can be found here.

It should be stressed that this was a survey taken in only one session, but it was a nearly complete picture of the habits of the guests attending that session. The number of different guests in the drop-in sessions for the financial year 2010/11 was 253, so if the number remains around the same for 2011/12, we obtained responses from around 12% in that one session. In fact, most of our ‘regulars’ attended that session. However, we might consider repeating the survey to catch some that we missed.

It is notable that about half of the guests surveyed said they had never drunk either WC or SSL. Of those that have drunk or do drink them, there was a roughly 50:50 split between WC and SSL use. That surprised me a little, because, as stated before, I expected cider to dominate. It would seem that many of our heavy-drinking guests prefer cheap wine, Lambrini (a 7.5% ABV light perry, so akin to the white ciders in a way), or premium (5.0% ABV) lagers such as Stella Artois.

Where people stated reasons for avoiding superstrength lager and/or cider, their ‘chemical’ nature was quoted, as well as, in some cases, health problems (‘guts’, ulcers, fits) being attributed to their use. The Alcohol Concern paper quotes an un-named Gastroenterologist as saying:

The only guest mentioning taste as an issue in his choice generally avoids superstrength drinks of any sort.

Subjectively, I would observe that the guests who used SSL/WC were in most cases already known to us as having significant alcohol issues, in many of those cases, full alcohol dependence syndrome. It was also the case that none of the guests known to us to have active alcohol dependence syndrome were in the category of never consuming SSL/WC. Generally the driver for drinking SSL/WC was purely one of value for money – the cheapest price per unit of alcohol.

Clearly debate will continue over the benefits of minimum pricing, or at least a punitive tax rating on SSL/WC. I do have a fear that those with alcohol dependence syndrome will continue to prioritise obtaining alcohol over anything else, including food and paying bills, and will resort to more shoplifting than many of them do already. Minimum pricing may in due course lead to there being less people in society with alcohol problems, but I do not feel it is likely to help those already ‘caught in the trap’.

I am not claiming to have any easy answers to this thorny subject. I will however suggest that more resources need to put into helping people battle against alcohol dependence – if people aren’t drinking alcohol, its price is irrelevant to their management.

It is worth noting the figures from the 2004 Prime Minister’s Strategy Unit report ‘Alcohol Harm Reduction Strategy for England’:

Reducing the use of superstrength drinks may be very important for interim harm-reduction, but properly resourced help for people to tackle their alcohol problems radically is crucial.

I was going to ‘play us out’ with a You Tube clip of the Wurzels’ ‘I am a Cider Drinker’, but I’ve gone off the idea……

Article written by Martin, Doorway volunteer May 2011