Every month for three years, researchers knocked on doors across England and asked more than 60,000 people how much they drink, when they try to cut down, and whether their doctor ever brings up the subject. The Alcohol Toolkit Study fills a gap left by less frequent national surveys. Alcohol harm costs the NHS billions each year, but policymakers lacked detailed, month-by-month data on who drinks, who tries to stop, and what actually helps. The survey revealed stark mismatches: fewer than 10% of heavy drinkers who visit their GP report receiving advice on alcohol, compared with roughly 50% of smokers. Only 14.8% of high-risk drinkers use aids to reduce intake, versus 60.3% of smokers trying to quit. January brings many attempts to cut down, but little evidence those attempts succeed. If these findings change practice, the impact would be felt in GP surgeries and public health campaigns. Doctors could be prompted to raise alcohol more routinely, and better support tools—already common for smoking—could be offered to drinkers. The ongoing survey also allows future evaluation of how new alcohol policies affect different social groups and local authorities, helping target resources where they are needed most.
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Background: A detailed monthly national survey is needed to understand population-wide influences on alcohol use, and to inform and evaluate policies aimed at reducing alcohol-related harm. The Alcohol Toolkit Study (ATS) was established in 2014 with SPHR1 funding and involved monthly household surveys of representative samples of the adult population in England. The survey collected detailed information across 36 consecutive months from over 60,000 people on alcohol consumption and harm (AUDIT), which was contextualised by data on a range of alcohol-related behaviour and socio-demographic characteristics. The ATS has several advantages over other large-scale surveys on alcohol use in the United Kingdom (1). These include the frequency of data collection and detailed contextual information relating to alcohol consumption. Findings: Key findings include that less than 10% of those who drink excessively and visit their GP in England report having received advice on their alcohol consumption whereas for smokers it is ~50% (2); January is associated with increased attempts to cut down alcohol intake but there is little evidence that these attempts translate into reduced consumption (3); the established paradox that lower socioeconomic status groups consume less alcohol but experience more alcohol-related problems appears to be influenced by the particular measure socioeconomic status and to be concentrated in men and younger people (4); just 14.8% of high-risk drinkers use aids to help them reduce their alcohol intake compared to 60.3% of smokers attempting to quit (5); at any one time around 1/5th of high-risk drinkers in England are attempting to cut down (6); smoking and high-risk drinking appear less common in ‘central England’ than in the rest of the country (7); and that the publication of revised lower risk drinking guidelines can improve drinkers’ knowledge of these guidelines within all sociodemographic groups (9). Conclusions & implications: The wide variety of questions on alcohol use and key-related behaviours has resulted in several important findings which have implications for policy and identify ways in which high-risk alcohol consumption may be reduced. For example, there is a clear need to increase the uptake of aids and behavioural support, to encourage GPs to broach the subject of excessive alcohol use and to decrease social-inequalities. In the future, the long-running nature of the ATS will allow for the evaluation of population level polices on health inequalities and the impact across different social groups and types of local authorities.
NIHR School for Public Health Research - Public Health
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