Drinking age

This year marks the tenth anniversary of Dry January. But are those who are least likely to take part – older people – the ones who would most benefit? DDN reports. 

older drinkersAccording to research published by Alcohol Change UK at the end of December, around 8.8m people – roughly one in seven UK adults – were planning to take part in Dry January this year. How many actually made it to the end of the month without a drink is of course a different matter, but the figure shows how firmly established the campaign – now in its tenth year – has become. 

It comes as alcohol-related deaths and hospital admissions continue their upward trajectory. There were 280,000 alcohol-specific hospital admissions in England in 2019-20, while the broader measure that includes a secondary diagnosis linked to alcohol saw almost 980,000 – one in 20 of all admissions.

According to the latest ONS figures, meanwhile, 2021 saw alcohol-specific deaths across the UK reach their highest-ever level at more than 9,600 – a 7 per cent increase on 2020 and almost 30 per cent higher than 2019. Again it’s worth remembering that these figures only include deaths that are the result of conditions ‘wholly attributable’ to alcohol – primarily alcoholic liver disease – and according to ONS are therefore likely to account for only a third of all deaths that could be considered alcohol-related.

As usual, the alcohol-related death rate for men was far higher than for women, but what has changed in recent years is the age of those likely to be drinking the most. While the popular perception of ‘binge drinkers’ still tends to be of groups of people in their teens and twenties stumbling around town and city centres, according to the latest Health survey for England the people most likely to drink more than the weekly guidelines are now men aged between 55 and 74 and women aged 45 to 64.

Generational shift

One key reason for this generational shift in drinking patterns is that these are people who grew up at a time when excessive drinking was seen as the norm, with habits long-since becoming ingrained – especially as most of their friends are likely to drink at similar levels. ‘It’s those influences that the baby boomer generation had – that whole alcogenic environment,’ consultant old-age psychiatrist and visiting research fellow at South London and Maudsley NHS Foundation Trust, Dr Tony Rao, tells DDN. ‘It’s a combination of peer pressure, habit and lifestyle, and if you put all those into the mix you’ve got a generation that’s not ready to look at anything beyond that.’

Covid impact

COVID has also had a significant impact on drinking patterns, with research from a range of organisations coming to essentially the same conclusion – that while many moderate drinkers reduced their consumption during lockdowns and the pandemic as a whole, many of those who were already drinking too much began drinking even more. Researchers have warned that this is likely to cast a ‘long shadow’ on health, with a report from the University of Sheffield stating that it could lead to 25,000 additional deaths and almost 1m hospital admissions over the next 20 years. And again, it’s often older people who are most affected. ‘During that period of lockdown, the percentage change in people drinking over 50 units a week was consistently higher among 65 to 74-year-olds, which is very surprising,’ says Rao. 

Tony raoWhile public health campaigners consistently urge the government to tighten up what are seen as the toothless regulations around alcohol marketing, most proposals to do so tend to focus on young people – as is reflected in the consultation being carried out by the Scottish Government at the moment, with its plans to tackle sports and events sponsorship and statement that marketing is ‘associated with an increased likelihood that children and young people will start to drink alcohol’. Given this ongoing generational shift in drinking patterns, are they maybe barking up the wrong tree?

‘Definitely,’ Rao states. ‘We had the Drink Wise, Age Well project that lasted for seven years, but what I think we urgently need now is a nationwide public health campaign to show older people not only the extent of the problem but also how they can play a part in their own harm reduction.’ 

While Dry January is very much based around people who are already health-aware, what’s needed with older people is something to raise that awareness of harm, he stresses. ‘I think older people still see this kind of mind shift among younger people as very woke, very nanny state, because they don’t appreciate the true extent [of the harm] – “It’s not my problem, it’s someone else’s problem.” There’s all this ONS data and the media stories around it saying that younger people are drinking less – and that’s all well and good – but what they’re not saying is that older people are drinking far more compared to the same generation 50 years ago.’

It’s an issue that has to be tackled on two fronts, he believes. ‘We need a public health campaign on alcohol-related harm, but we also need to develop clinical services so there’s better screening and brief intervention. Not just because it would help to catch things early, but it would help to give addiction services a better understanding of the extent of the problem.’ And within those services there needs to be a multi-disciplinary approach, he adds. ‘You need the medical side to look at mental health disorders, the nursing and psychology side to engage people in reducing stigma and opening up about their drink problem, and then you need the social focus on community integration and recovery. It can take decades to achieve that kind of thing.’ 

Does Dry January Work?

dry januarySo does Dry January itself work, or is it just a way for people to think ‘I’ve done that, now I can go back to bingeing on 1 February?’ ‘There’s always this misconception with alcohol, because it’s such a stigmatising subject, that either you drink or you’re abstinent,’ he states. ‘But I think the longer-term impact for a large number of people is that it’s given them the chance to reflect on having healthier lifestyles and really looking at the part that alcohol plays in their lives.’ Alcohol Change UK, however, found that just 10 per cent of over-55s were planning to take part, a missed opportunity given they’ve often ‘been quite hedonistic, and are quite health-naïve’, he says. 

While there’s obviously still large numbers of young people who drink heavily, it’s looking as though this overall shift in drinking patterns may well turn out to be permanent. One factor may be something as simple as alcohol not being seen as cool anymore among a growing proportion of younger people – for a generation whose every action is scrutinised on social media, getting drunk and losing control perhaps isn’t something particularly attractive. ‘I think there are three components,’ says Rao. ‘There’s seeing parents and grandparents who’ve suffered from alcohol problems, there’s the health aspect – they’re a much more health-aware population – and then there’s the cost of living. They can’t afford to – they’re probably more likely to go and have a craft beer every month than drink every week.’

Loud and consistent

In terms of where alcohol health campaigns should now be turning their focus, it doesn’t help of course that there’s been no alcohol strategy for a decade. And when one does finally come it’s highly likely to focus on young people, Rao points out. ‘So we need louder and more consistent voices for the older population, who are suffering. I really don’t think that at a political level, or a clinical level or a public health level, it’s really been taken seriously enough. I think the other reason is that there’s probably an attitude – not just among older people that they don’t want to change their habits – but among society as a whole of “why shouldn’t older people be allowed to enjoy themselves?”’ But what we know from definitive and robust reviews is that older people tend to do much better in terms of treatment and recovery than younger people. So it’s never too late.’  DDN

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