Has minimum unit pricing failed? Why the picture is not black and white

The study, led by the University of Sheffield on behalf of Public Health Scotland, found "some evidence" that problem drinkers had switched from strong ciders - which were among the products whose price increased most steeply as a result of minimum pricing - to spirits instead, particularly vodka.

READ MORE: 'Drinkers cut back on food' to fund alcohol after minimum pricing, finds study

There was "no clear evidence that MUP [minimum unit pricing] led to an overall reduction in alcohol consumption among people drinking at harmful levels"; in fact, "reducing alcohol consumption was a last resort".

Instead, the "substantial minority" of harmful drinkers dependent on alcohol coped with the price hikes though "reduced spending on food and utility bills, increased borrowing from family, friends or pawnbrokers, running down savings or other capital, and using foodbanks or other forms of charity".

Some harmful drinkers living within an hour's drive of the border with England travelled there "specifically to make bulk purchases of alcohol".

Researchers noted that the introduction of MUP in Scotland had also coincided with the rollout by the UK Government of Universal Credit which "made it difficult to manage household budgets that were already strained by increased spending on alcohol".

What the study did not find, despite warnings, was any clear evidence that MUP had led to increased criminality, illicit substance use or acute withdrawal.

Overall, however, the report paints a grim picture of the desperate grip alcohol has on a minority of drinkers.

READ MORE: Push to increase cost of alcohol 30 per cent after 'devastating' spike in deaths

Harmful alcohol consumption is defined as more than 35 units a week for women (for example, three and a half bottles of wine) or more than 50 units a week for men (equivalent to around 17 pints of lager).

Within this group, around one in five have alcohol dependence - a chronic disease which means they crave alcohol and would suffer withdrawal symptoms if they suddenly stopped drinking.

It is a mistake, therefore, to imagine that minimum unit pricing could ever be - or even aimed to be - a silver bullet for alcoholism.

Evaluations of the policy are ongoing, and take into account a much wider context.

This is important since the legislation behind MUP in Scotland includes a sunset clause, which means that it will automatically expire six years from implementation - that is, in May 2024 - unless the Scottish Parliament votes for it to continue.

The legislation was trailblazing when it first took effect in May 2018, following a decade of legal challenges.

Since then, similar models have been adopted in Australia's Northern Territory, Wales, and Ireland.

The lessons learned in Scotland will feed into how MUP legislation is designed and reformed worldwide.

Advocates of the policy here insist that it should not only continue, but - in light of inflation - be hiked from the current threshold of 50 pence per unit to 65 per unit.

This is based on evidence of the policy's impact when considered on a population-wide basis.

This includes an overall decrease in alcohol purchasing and consumption, and early signs of reductions in hospital admissions for alcohol-related liver disease and, pre-pandemic, deaths.

In the first full year after MUP, total alcohol consumption in Scotland was the lowest in 26 years.

Research published in the Lancet in May last year found that - based on retail data - alcohol sales in Scotland overall fell by almost 8% after minimum pricing took effect.

The biggest impact in purchasing habits occurred in the highest-consuming households where there was a "sustained drop in units bought".

READ MORE: Making sense of Scotland's alcohol death and suicide rates during Covid 

Notably, however, given this week's findings, there was a worrying exception: high-purchasing, low-income households.

The Lancet study noted: "The amount of money spent on alcohol after introduction of MUP increased faster for low-income than for high-income households.

"In the quintile of households that bought the most alcohol, following the introduction of MUP, the lowest income households did not seem to reduce the amount of alcohol they purchased, and their expenditure on alcohol increased."

Modelling by Sheffield University estimated that in the first five years of MUP in Scotland, 400 alcohol-related deaths and 8000 alcohol-related hospital admissions would be avoided.

The same analysis also forecast that an MUP of 60 pence would save twice as many lives and reduce hospital admissions by twice the level of 50 pence per unit, while 70p per unit would have three times the effect.

So far, real world evidence has been somewhat mixed.

Source: National Records of Scotland

In 2019, the first full-year after minimum pricing, Scotland's alcohol-specific death rate fell to 18.6 per 100,000 - a 7% dip compared to the average for the five years pre-MUP.

In 2020, however, it rebounded 15.6% to 21.5 per 100,000 - the highest rate since 2011 - with 1,190 lives lost.

There were four times as many alcohol deaths in the most deprived communities compared to the most affluent, with the spike almost solely driven by deaths among men and coinciding with periods of lockdown when pubs closed and alcohol consumption at home increased.

The pandemic is known to have “polarised” drinking habits, leading moderate drinkers to stop or reduce consumption while already heavy drinkers spiralled.

(Source: Public Health Scotland)

In contrast, however, alcohol-related hospital admission rates in 2020/21 fell 10% year-on-year - the steepest drop on record - returning to levels last seen in the mid-1990s.

What happens post-pandemic will be key.

But if the case is made to increase MUP in future, the challenge will be balancing population-wide benefits against the risks faced by the poorest and those most beholden to alcohol.