Wednesday, 20 March 2013

Is there anything he could organize in a brewery? Comments on Minimum Unit Pricing

This post was written by Natasha Clarke, an MSc student at the University of Liverpool.

I recently attended the first annual Alcohol Research UK conference in London and wanted to focus this post on the fascinating day of talks that I was honoured to get the chance to listen to. I found the day engaging, all the talks were brilliant and inspiring and I just wanted to touch on an important issue that stuck with me on my journey home.

The most interesting for me related to MUP, Minimum Unit Pricing. Cheap alcohol is said to be a major reason for heavy drinking and talks of plans to increase the MUP to 40p or 45p have been long discussed. Its first mention of the day was by Professor Jonathan Chick and Dr Jan Gill in regards to Scotland. There it has been legislated but not yet implemented, despite the predictions of a 7.2% decrease in consumption and a reduction in hospital admissions. It was then discussed by Professor Keith Humphreys. He mentioned some facts about MUP that I must admit I wasn’t quite aware of. I know it’s a good idea but I’m never particularly good at defending its corner when my friends complain about more expensive drinks. I now have more evidence to throw back at them. It is not a taxation (it’s an increase in what the merchant charges on some beverages), and it’s not moderate drinkers who will be affected, it is heavy drinkers, because they generally buy cheaper drinks and therefore spend less per unit of alcohol. Furthermore, most beverages would not actually be affected by the change in price. Professor Humphreys interestingly mentioned that the cost to moderate drinkers would be greater with a lower MUP, due to NHS costs associated with heavy drinkers.

Evidence supporting its implementation from modelling data shows that the benefits of MUP are greater at 45p than 40p in terms of reducing consumption and health care costs in all population subgroups. Direct evidence from Canada shows that a 10% increase in average minimum price resulted in a 32% reduction in wholly alcohol attributable deaths between 2002 and 2009. This suggests the potential for great benefits, and shows promise for the future. So I go home, enlightened, and fall asleep dreaming of an improved world with a higher MUP, wake up and see an article on the BBC News discussing the uncertainty of whether Cameron will introduce the 45p per unit policy. He has now failed to commit on the pricing change, so it seems the plans may have been dropped…

Who knows what the future will hold: the evidence suggests MUP will be effective yet the government are having second thoughts. Moderate drinkers will hardly be affected, and nobody is trying to get all of us who do like a drink now and then to abstain completely. We enjoy ourselves and that’s what life is about. But the key word is moderation. Even if we don’t want to stop drinking ourselves, we should support any policy changes that might help heavier drinkers get back their enjoyment from life by cutting down on their alcohol.

The day ended with Professor the Baroness Finlay of Llandaff, who emphasised that even if public opinion is that alcoholics have made a choice and are therefore unwilling to take the steps to give them help, nobody can deny the secondary benefits that will come with reducing heavy drinking in the wider population. Maybe we can prevent innocent bystanders from being the victims of alcohol-related crimes, or free up NHS time from treating drunken injuries so they can focus on other illnesses and ailments. People think a rising MUP will punish the average drinker, but this is not the case. If we want to push change then public opinion needs to change. This can only happen when the public are informed properly about the benefits and understand the evidence. At the end of the day that is why research is conducted, to get the scientific evidence out to the public and ensure it has impact and promotes change.

See below some interesting posts from Keith Humphreys, one discussing MUP, the other on 24/7 sobriety for crime control.

Monday, 18 March 2013

A fine VINTAGE? The benefits and consequences of alcohol consumption in older adults

This article was written for the Mental Elf website by Matt Field, you can find the original post here.

We know a lot about the health consequences of drinking too much alcohol, but most of this research comes from studies of adults in their twenties, thirties and forties. But what about older adults? The European project VINTAGE reviewed and synthesised the available evidence relating to alcohol consumption in older people across many European countries. This project has now been published in two papers, one describing the methodology in detail, and the other summarizing the findings.
You might ask why we should be particularly concerned about alcohol consumption in older people. There are several reasons. Firstly, we know that when older people drink alcohol, their blood alcohol content rises more quickly and peaks at a higher rate, compared to younger people. The elderly may also show reduced tolerance to the effects of alcohol. Secondly, the authors make the point that the current generation of ‘baby boomers’ (those born in the years after the end of the Second World War) have more favourable attitudes to drinking, and more disposable income, than previous generations.  Both of these things are likely to be linked to increased consumption of alcohol. More generally, as life expectancy continues to increase and the proportion of elderly people making up the population of the European Union continues to rise, it is very important that we understand the influence of alcohol consumption on the health of older people.


This team of researchers from a number of European countries searched the research literature for articles that examined alcohol consumption in older adults, and assessed the consequences of drinking for health and well-being. The focus was on alcohol consumption in the general population, it is not a review of medical complications arising from alcohol dependence in older people. They only included systematic reviews or original research papers that had not been included in a previous systematic review, so this paper was a review of reviews. They then completed a narrative review, with some meta-analyses, based on a total of 78 papers.


This is what they found:
Senior couple drinking alcohol
Older people with low to moderate alcohol consumption have improved general health, well-being and cognitive function, relative to those who drink heavily, or abstainers
  • Compared to younger adults, adults in the 50-65 age bracket do not drink significantly less, or drink less frequently, than younger adults
  • However in people aged 75 or above, fewer people ever drink alcohol, and rates of heavy drinking are very low
  • Older people with low to moderate alcohol consumption have improved general health, well-being and cognitive function, relative to those who drink heavily, or abstainers
  • The relationships between alcohol intake and incidence of dementiaAlzheimer’s disease, cardiovascular disease and some types of stroke were best described by U-shaped or J-shaped curves, meaning that low to moderate alcohol consumption was associated with reduced incidence, but heavy drinking was associated with increased incidence of these diseases.
  • The relationship between alcohol use and injuries, all cause mortality and some other health problems was a little unclear (meta-analyses would have been very useful here)


  • Overall, we see that older adults (those aged 75 or above) drink less often and drink lower amounts of alcohol compared to younger adults. Their rates of alcohol-related harm are correspondingly low.
  • Consumption of low to moderate amounts of alcohol in older age is associated with improved health. We don’t know the optimum amount of alcohol that people should drink, but we have to be very careful before recommending that older people should drink more, because:
for those who do drink, there is certainly no evidence that those who consume 20g alcohol per day are any worse or any better off than those who drink less. Of course, this may just mean that those who are healthier, wealthier and better socially adjusted are more likely to be light drinkers than abstainers or heavy drinkers
It is important to note that the authors reported a mix of meta-analyses and narrative reviews of the literature. For example, when discussing the link between alcohol use and some types of injuries, they reported that five of the available studies found a statistically significant association whereas the remaining five studies did not. If a meta-analysis had been conducted, this would have revealed the ‘bigger picture’ (for example, it might show a small but robust association between alcohol use and injuries).
The authors conclude by acknowledging that cumulative alcohol exposure over the lifetime is likely to be strongly associated with poor health, particularly as people get older. So even if somebody doesn’t drink very much at the moment, if they were a heavy drinker for most of their life then problems may be brewing.


Galluzzo L, Scafato S, Martire S, Anderson P, Colom J, Segura L et al for the VINTAGE project working group. Alcohol and older people. The European project VINTAGE: good Health Into Older Age. Design, methods and major results. Ann. Ist. Super. Sanità 2012  Jan: 48(3): 221-231. DOI: 10.4415/ANN_12_03_03
Anderson P, Scafato E, Galluzzo L for the VINTAGE project working group. Alcohol and older people from a public health perspective. Ann. Ist. Super. Sanità. 2012  Jan: 48(3): 232-247. DOI: 10.4415/ANN_12_03_04

Matt Field

Thursday, 7 March 2013

Sippin’ on Gin and Juice! The effect of music on alcohol consumption

This post was written by Lisa Di Lemma and Andy Jones, who are researchers at the University of Liverpool.

In the previous fortnight we have both been to music gigs and this got us thinking about the effects of music on behaviour, particularly alcohol use. Music and drinking alcohol seem to go hand-in-hand, for example songs about drinking or the culture of gigs and music festivals (until fairly recently, Leeds and Reading music festivals were sponsored by Carling, and called the Carling Weekender). Our discussion coincided with the publication of an interesting piece of research examining how different music genres can directly influence  alcohol consumption, and we discuss this paper here.

We often listen to music to alter our mood states or to stimulate behaviours. For example, how many times have we reached for a certain CD when we feel bad? Or created a playlist of high intensity tracks for our gym session in order to push ourselves that little bit further? These anecdotes are backed up by scientific research showing that certain characteristics of music can influence mood and exercise performance.

Because of the large and varied effects that music can have on individuals, our exposure to music is now becoming more and more ubiquitous in commercial environments, and this is no coincidence. Research has shown that Classical music can increase spending in restaurants, and songs referring to alcohol in the lyrics can increase spending on alcohol in bars. Importantly, the effects of music on our purchasing behaviour may occur outside our awareness. A simple, but interesting, correspondence published in Nature demonstrated that playing French Music increased purchases of French wine, whilst playing German Music increased purchases of German Wine. When asked about the reasons for their purchase only 6 of 44 shoppers alluded to music influencing their choice. It is important to note however, that larger scale studies have failed to replicate these effects!

Specific genres of music are also more likely to be associated with the use of different substances, for example illegal drugs versus alcohol. Dance music and raves are associated with the use of stimulants and hallucinogens, which are taken to amplify sensory experiences and increase energy. Rap and Rock music lyrics often glorify drug and alcohol use, and videos for these songs are often party themed. Finally, artists often associate themselves with drug and alcohol use, which is very ‘rock n’ roll’.

However, these studies do not identify causality. Do particular types of music actually influence our consumption of alcohol, or of particular alcoholic drinks? A recent Dutch study looked at this issue. They recruited 249 young adults, who were tested in groups of their peers. A total of 32 groups of friends visited the ‘bar lab’ (a laboratory which is decorated to look like a bar) to take part in the study. On the day they visited, participants were asked to complete some questionnaires and, after a 50-minute break, to perform some group tasks. The purpose of the questionnaires and group tasks was to disguise the true aims of the study from the participants.

Critically, during the break participants were exposed to one of four different types of music: Pop, Hard Rock, Rap or Classical. While the music was played they were allowed to order alcoholic and non-alcoholic drinks (which they didn’t have to pay for and weren’t forced to order). The researchers predicted that individuals who were exposed to Rap and Hard Rock would order the most alcoholic drinks, those exposed to classical music would order fewer alcoholic drinks, with those exposed to Pop music somewhere in the middle. However, this is what they found:

  • Participants who listened to Classical music ordered and consumed significantly more alcohol than those who heard Hard Rock or Rap, with an almost significant difference with Pop music (p = .07).
  • Looking at individual drinks, participants who listened to Pop and Classical Music drank more beer than those exposed to Hard Rock, whereas those who listened to Classical music drank significantly more wine compared to those who heard Pop or Hard Rock. Finally, Hard Rock music led to increased consumption of mixed drinks (e.g. rum and coke) compared to Pop and Classical music.
  • Importantly, individual music preferences, importance of music to the individual and susceptibility for exposure to specific genres did not influence these results, which suggests relatively uncomplicated effects of music on consumption of different types of drinks.  

Now, we don’t think that students associate Classical music with wild parties and binge drinking, so this result was a surprise to us. The authors also acknowledge this and suggest that the increased alcohol consumption may be due to a ‘prediction error’ mechanism. It is probably fair to say that Classical music is not the music of choice in bars that students frequent. Therefore, they suggest that ‘people might deviate more from what their habitual drinking is in a bar when they are exposed to atypical music for that context’.

There are some other caveats to this research that should be taken into account before people throw out their symphony and concerto CDs. Firstly, the musical preference ratings given by participants may have been influenced by recent exposure to that music. Secondly, the authors did not control for the lyrical content of their music, and as we have discussed this has been shown to influence alcohol consumption. We suggest that future research should also attempt to examine not only consumption of alcohol but also purchases of alcohol after exposure to different types of music. Would people still drink more alcohol after hearing Classical music, if they have to pay for their own drinks?

These findings suggest that music can have a subtle influence on our alcohol consumption. A recent, well-publicised study shows that that the shape of glasses can influence the rate at which beer is consumed.  Although background music and glass shape are very different issues, if we take these findings together they show that subtle cues in our drinking environments may drive us to drink, and we might not be aware that our behaviour is being ‘nudged’ in this way!

Target paper:
Engels, R.C., Poelen, E.A., Spijkerman, R., Ter Bogt, T. (2012). The effects of music genre on young people's alcohol consumption: an experimental observational study. Substance Use and Misuse 47, 180-188.