Statistics on Alcohol, England 2021

Section 1 provides details of the data sources used in parts 1 to 3 of the report. Other key sources of data on alcohol use and misuse can be found in part 4 of the report. Section 2 provides links to further resources relating to alcohol use and misuse.

Data on the number of hospital admissions for diseases, injuries and conditions that can be attributed to alcohol consumption is taken from the Office for Health Improvement and Disparities (OHID) Local Alcohol Profiles for England, which use data from NHS Digital’s Hospital Episode Statistics.

Appendix B provides details on how alcohol-related hospital admissions have been calculated.

Data on the number of prescriptions for drugs used to treat alcohol dependence and the Net Ingredient Cost (NIC) of these prescriptions data is extracted from ePACT2, a data warehouse hosted by NHS Prescription Services. NHS Prescription Services process prescriptions in order to reimburse dispensers.

The number of prescriptions is not the same as the volume of drugs prescribed.  Each single item prescribed is counted as a prescription item and volume is not available within the prescribing data. There will be different practices locally on the duration of supply for a prescription.

The NIC is the basic cost of a drug as listed in the Drug Tariff or price lists; it does not include discounts, dispensing costs, prescription charges or fees.

The affordability of alcohol and expenditure on alcohol have been calculated using economic data published by the Office for National Statistics (ONS).

Affordability of alcohol uses two sources:

• Alcohol price and retail price indices data, which measure the rate of increase in prices for goods and services, taken from the Inflation and price indices. 
• Households’ disposable income data taken from the Economic and Labour Market Review. 

Expenditure on alcohol uses spending data on goods and services by members of UK households taken from Consumer trends, UK Statistical bulletins.

Appendix B provides details on how the affordability statistics have been calculated.

This report provided annual data for Great Britain on teetotalism, drinking in the week before survey interview, frequent drinking and units drunk, including analysis by sex, age and socioeconomic status. This series has been discontinued and the most recent available data is from 2017.

Adult drinking habits in Great Britain

The Adult Psychiatric Morbidity Survey (APMS) series includes prevalence estimates of hazardous and harmful drinking and of alcohol dependence in the adult general population. The survey is not run annually and the most recent available data is from 2014.

Adult Psychiatric Morbidity Survey

This charity seeks to help people through information and guidance and to help health professionals through training, projects and research. Their website contains statistics on alcohol and links to further reading.

Alcohol Change UK

Drinkaware is an independent charity supported by voluntary donations from the drinks industry and from major UK supermarkets. They work to reduce alcohol misuse and harm in the UK. Their website contains facts about alcohol including drinking habits and behaviours and the impact on health.

drinkaware

This is an online learning resource for healthcare and social care professionals working to reduce alcohol-related harm.

elearning for healthcare

The Home Office conducts research on alcohol, drugs, and antisocial behaviour to support policy development and operational activity.

Alcohol and drug research and analysis

The Infant Feeding Survey (IFS) covers the population of new mothers in the United Kingdom and includes information on the drinking behaviours of women before, during and after pregnancy.

This survey was last run in 2010 and the series has now been discontinued.

Infant Feeding Survey

The Mental Health of Children and Young People Survey provides data on the mental health of 6 to 23 year olds including alcohol use.

Mental Health of Children and Young People Survey

The National Institute for Health and Clinical Excellence (NICE) provide national guidance and advice to improve health and social care. This includes products on alcohol, including any guidance, NICE Pathways and quality standards.

NICE products on alcohol

This website provides information the effects of binge drinking and tips on reducing alcohol intake and the associated health benefits.

Alcohol support

The Sustainable Development Goals (SDGs) include an indicator on the harmful use of alcohol consumption.

Indicator 3.5.2: Alcohol per capita consumption (aged 15 years and older) within a calendar year in litres of pure alcohol

What About YOUth? is a survey aimed specifically at 15 year olds and includes questions on the drinking behaviours among children.

It was run for the first time in 2014 and it is hoped it will be repeated in the future.

What About YOUth? Survey

These notes help to explain some of the measurements used and presented in this report.

The number of hospital admissions, attributable to alcohol consumption, is estimated by applying alcohol-attributable fractions (AAFs) to Hospital Episode Statistics (HES) data. AAFs are the proportion of disease cases that can be attributable to alcohol. In 2020 new AAFs were calculated based on updated alcohol consumption rates and the latest evidence linking alcohol consumption to disease outcomes. 

Alcohol-attributable fractions for England: an update

The AAFs are dependent on the condition the patient is suffering from and their age and sex. Some conditions such as mental and behavioural disorders due to the use of alcohol have an AAF of 1 for all patients, i.e. all admissions are related to alcohol. Others have an AAF of less than 1 such as hypertensive disease which has a fraction of 0.17 for men aged 55-64. This means that 17 per cent of all admissions for men in that age group are estimated to be related to alcohol.

Hospital Episode Statistics (HES) is a data warehouse containing details of all admissions, outpatient appointments and A and E attendances at NHS hospitals in England.

Hospital Episode Statistics (HES)

Within this publication, two measures of alcohol-related hospital admissions are presented:

1. A “broad” measure is derived by summing the alcohol attributable fraction associated with each admission based on the diagnosis most strongly associated with alcohol out of all diagnoses (both primary and secondary).
2. A “narrow” measure which is constructed in a similar way but counts only the fraction associated with the diagnosis in the primary position or alcohol-related external causes recorded in secondary diagnosis fields.

The “broad” measure is a better indicator of the total burden that alcohol has on health services as it takes more account of secondary diagnoses than the “narrow” measure. However, since secondary diagnosis fields have become better populated over time, this impacts upon time series comparisons for the “broad” measure as increases can be partly due to an improvement in data quality rather than a real effect. Consequently, the “narrow” measure is a better indicator of changes over time.

Within each of these measures, the data is broken down into admissions that are wholly and partially attributable to alcohol.

The number of admissions per 100,000 head of population has been calculated by using direct standardisation and the European Standard population . This removes the impact of different age/gender compositions within local authorities and allows for more meaningful comparisons between local authorities.

Affordability of alcohol gives a measure of the relative affordability of alcohol, by comparing the relative changes in the price of alcohol, with changes in households’ disposable income per capita over the same period (with both allowing for inflation).

Relative changes in the price of alcohol are calculated using the relative alcohol price index (RAPI) which shows how the average price of alcohol has changed compared with the price of all other items and is calculated as follows:

RAPI = (alcohol price index / Retail Prices Index)*100

Changes in households’ disposable income are calculated using the Adjusted Real Households’ Disposable Income (ARHDI) index which tracks changes in real disposable income per capita.

The Relative Affordability index of alcohol is calculated as follows:

RAAI = (ARHDI/RAPI)*100

If the affordability index is above 100, then alcohol is relatively more affordable than in the base year, January 1987.

The two main drugs prescribed for the treatment of alcohol dependence are Acamprosate Calcium (Campral) and Disulfiram (Antabuse). In May 2013 a new drug Nalmefene (Selincro) was launched. Details of how these drugs work is provided below:

Acamprosate Calcium (Campral) – helps restore chemical balance in the brain and prevents the feelings of discomfort associated with not drinking, therefore reducing the desire or craving to consume alcohol.

Disulfiram (Antabuse) – produces an acute sensitivity to alcohol resulting in a highly unpleasant reaction when the patient under treatment ingests even small amounts of alcohol.

Nalmefene (Selincro) – is the first medicine to be granted a licence for the reduction of alcohol consumption in people with alcohol dependence. It helps reduce the urge to drink in people accustomed to large amounts of alcohol but does not prevent the intoxicating effects of alcohol.

Naltrexone is also prescribed for alcohol dependence. It is not included in this report however, as it can also be used to treat drug dependence and the condition that Naltrexone is prescribed to treat is not available within the prescribing data.

In 2016, the UK chief medical officers issued new guidelines on how to keep health risks from drinking alcohol to a low level.

UK chief medical officers’ low risk drinking guidelines

In 2017 guidance was published setting out how the UK chief medical officers' advice on alcohol and its health risks can be communicated to the public on product labels.

Communicating the UK chief medical officers’ alcohol guidelines

The Policing and Crime Act includes alcohol licensing provisions.

Policing and Crime Act: alcohol licensing

The modern crime prevention strategy builds on new research, techniques and technology to update the way we think about crime prevention. The strategy includes research on the links between alcohol and crime.

Modern crime prevention strategy

NHS Health Check programme includes an alcohol risk assessment to provide support where needed ranging from brief advice to a referral to specialist alcohol service.

NHS Health Check

The Commissioning for Quality and Innovation (CQUIN) framework supports improvements in the quality of services and the creation of new, improved patterns of care. This includes the delivery of advice to hospital patients on alcohol consumption and where appropriate referral to treatment.

Commissioning for Quality and Innovation

Making every contact count (MECC) is an approach to behaviour change that utilises the millions of day to day interactions that organisations and people have with other people to encourage changes in behaviour that have a positive effect on the health and wellbeing of individuals, communities and populations. This includes reducing alcohol consumption.

Making Every Contact Count

Better Health provides free tools and support to encourage people to make healthy changes, including drinking less.

Better Health: Drink less

From our engagement with customers, we have many known users of Statistics on Alcohol. However, since this publication is free to access through the NHS Digital website, there are also many unknown users of these statistics. We are continually aiming to improve our understanding of who our users are in order to enhance our knowledge on how they use our data. This is carried out via consultations and feedback forms available online.

In 2015 a consultation was carried out to gain feedback on how to make the report more user-friendly and accessible while also producing it in the most cost-effective way.

Findings of the Consultation

In response to the feedback received, the format of the report was changed for the 2016 report.

Below is listed our current understanding of the known users and uses of these statistics. Also included are the methods we use to attempt to engage with the unknown users.

Known Users and Uses

Department of Health and Social Care (DHSC) use these statistics to inform policy and planning as shown in Appendix C.

NHS use the reports and tables for analyses, benchmarking and to inform decision making.

Office for Health Improvement and Disparities (OHID) use these data for secondary analyses.

Media - these data are used to underpin articles in newspapers, journals and other articles.

Public Health Campaign Groups - data are used to inform policy and decision making and to examine trends and behaviours.

Public - all information is accessible for general public use for any particular purpose.

Ad-hoc requests – the statistics are used by NHS Digital to answer Parliamentary Questions (PQs), Freedom of Information (FOI) request and ad-hoc queries. Ad-hoc requests are received from health professionals; research companies; public sector organisations, and members of the public, showing the statistics are widely used and not solely within the profession.

Unknown Users

This publication is free to access via the NHS Digital website:

Statistics on Alcohol

Consequently, the majority of users will access the report without being known to us. Therefore, it is important to put mechanisms in place to try to understand how these additional users are using the statistics and to gain feedback on how we can make these data more useful to them. On the webpage where the publication appears there is a Contact us link at the bottom of the page. Any feedback is passed to the team responsible for the report to consider.