Eight in ten at-risk drinkers in England are not trying to cut down, and this fellowship aims to change that. Over 10 million adults in England drink at levels that harm their health, yet 80% make no attempt to reduce. Of the 20% who do try, only 14% use any evidence-based support. The problem is not a lack of will—it is a lack of effective, accessible strategies that match what people actually want. This five-year fellowship uses four work packages to tackle both sides of the gap. Focus groups with the public—including homeless people—will co-produce reduction strategies and goals. An online trial will test which strategies appeal to drinkers who have never tried to cut back. Causal inference methods will analyse national survey data to estimate what actually works. Finally, a mass media campaign co-designed with underserved groups will aim to nudge more people to attempt reduction, while the digital app *Drink Less* will be refined and tested in a within-app randomised trial. If successful, the research could shift the population’s drinking curve downward through small, individual reductions—without requiring abstinence or clinical treatment. That would reduce alcohol-related illness and early death across the UK.
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Research question How can we increase the proportion of at-risk drinkers in the UK making alcohol reduction attempts and the success of these attempts? Background Alcohol consumption is a leading risk factor for early mortality, ill health and disability and is a leading contributor to disease burden in the UK; over 10 million adults in England are at-risk drinkers, meaning they consume alcohol at levels that pose a risk to their health. However, 80% of these drinkers are not attempting to reduce their consumption, and of the 20% that are, only 14% use any evidence-based support. Reducing the harm from alcohol can be achieved at a population-level through small individual reductions in consumption. It is important to incorporate the individuals' drinking goals and needs, and provide evidence-based public health interventions that are easy to access. Aims The overarching aims of this fellowship are to use a mixed-methods approach to increase the: proportion of at-risk drinkers making alcohol reduction attempts; success of these attempts. Methods Work Package (WP) 1: Focus groups to understand alcohol reduction attempts A series of focus groups conducted remotely with members of the public, including under-served groups such as people experiencing homelessness, with a semi-structured discussion on their experiences of alcohol reduction attempts to create a list of co-produced alcohol reduction strategies and desired goals, and an understanding of what might persuade those who have not made an alcohol reduction attempt to do so. WP2: Acceptability of alcohol reduction strategies to drinkers who have not made a reduction attempt An experimental online trial with drinkers who have not previously made an alcohol reduction attempt where participants are randomised to an alcohol reduction strategy and a suggested goal to understand which strategies and goals are most acceptable. WP3: Causal inference methods to evaluate alcohol reduction strategies Population-level data collected on alcohol reduction characteristics from a nationally representative survey of adults in England and causal inference methods used to estimate the total causal effect of alcohol reduction strategies on the success of alcohol reduction attempts. WP4: Interventions to increase the proportion and success of attempts being made A population-level mass media campaign co-designed with members of the public, including those from under-served groups, to increase the proportion of drinkers making alcohol reduction attempts and evaluated using a time series analysis of population-level data. Refinement of the individual-level digital intervention, Drink Less, using the person-based approach to increase the success of attempts being made, and evaluated in a within-app randomised trial. Timelines for delivery WP1 conducted in years 1-2 of the fellowship, WP2 in year 2, WP3 in years 2-4, and WP4 in years 4-5. Anticipated impact and dissemination This fellowship will have a positive impact on population health in the UK by increasing both the proportion of at-risk drinkers making an alcohol reduction attempt and success of these attempts. The research findings will be widely disseminated including via press releases, academic publications, social media, and a stakeholder workshop.
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