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Minimum Unit Pricing for Alcohol - Scotland
The Scottish Government tasked Public Health Scotland to evaluate the impact of MUP. The University of Sheffield led on one project within the overall evaluation, investigating the impact of MUP on alcohol consumption and spending of people with alcohol dependence in treatment settings. Dr Wulf Livingston from Glyndwr University was a part of the first element collecting data from clinical settings and led on the second element in community settings.
MUP for alcohol was implemented in 2018 and is £0.50 per unit of alcohol. People who drink at harmful levels or are alcohol dependent are a group with complex needs, with many drinking the low-cost high-strength alcohol that the price change impacts. The research aimed to gather evidence on the impacts on alcohol purchasing and consumption patterns; strategies used to respond to MUP; health; on family and carers; on those living in rural Scotland; responses to MUP by alcohol treatment services; and additional factors unrelated to MUP that may have affected drinking at harmful levels.
First, the researchers revised a specific theory of change that described how MUP could affect people drinking alcohol at harmful levels. Three pathways were identified: stopping drinking for an extended period; adopting short-term coping strategies; or, continuing as usual.
For the first element, survey-based structured interviews were conducted with adults entering treatment services in Scotland and Northern England. A screening tool was used to identify participants likely to have alcohol dependence. Data were collected from different samples of people at three time points: before MUP was implemented, 3-9 months after MUP was implemented, and 18-22 months after MUP was implemented. Interviewees were asked questions about alcohol use, social and work life, and experiences of crime. Interviewees were also asked to complete a diary about alcohol they had purchased and consumed in the last typical drinking week before treatment. A sub sample, as well as some service providers were then invited to participate in a subsequent qualitative interview.
The second element involved interviewing people who were drinking at harmful levels and their families and carers. The participatory research included members of communities that are affected by the issues being studied and invited them to contribute and collaborate with the research team. The interviews explored previous alcohol and other drug use, price changes, the availability of alcohol products, change in drinking patterns, wider impacts of MUP, minimising harm from MUP, and other arising topics.
The third element used individual-level survey data that was collected over a decade across the United Kingdom, allowing for the detection of any changes after MUP was implemented in Scotland. A commercial market research company collected the data on behaviours, attitudes, and drinking diaries to detect the drinking behaviour of around 30,000 adults.
Findings from all projects were analysed together to assess key outcomes, and presented in a singular overarching report.
Prices paid and consumption
There was an increase in the prices paid for alcohol after MUP was implemented. No clear evidence was found of a reduction in alcohol consumption amongst people who were drinking at harmful levels after MUP was implemented. Researchers did detect a statistically significant decrease in the prevalence of ‘hazardous’ drinking after MUP was implemented, but not for those with ‘moderate’ or ‘harmful’ drinking. Interview data revealed that some individuals reduced their consumption after the implementation of MUP by switching to products that were higher in strength but sold in lower volumes.
Financial strain, products purchased, and drinking patterns
There was evidence of financial strain amongst some people drinking at harmful levels and their families. Participants found ways to obtain money for purchasing alcohol, which included reducing spending on food and utility bills. More generally, participants coped by adopting strategies they had previously used when alcohol was unaffordable to them. Reducing alcohol consumption was often viewed as a last resort. Some people drinking at harmful levels reported increased intoxication after they switched to consuming the higher-strength products and their family members were concerned about the potential for increased conflict.
Wider outcomes
There was little evidence of other negative outcomes following the MUP implementation, with few people resorting to crime to obtain money for alcohol and few people substituting alcohol for illicit drugs. However, the study did find that for some of those who lived close to the Scotland-England border, there was an increase in purchasing alcohol from England. This included moving the weekly grocery shop to England, buying alcohol when across the border for other reasons, and making a special trip to buy alcohol in bulk.
Awareness, support, and additional factors
It was found that people with alcohol dependence or harmful levels of drinking had limited awareness of MUP and its purpose and received no information about it from treatment services.
