Ian Hamilton: Alcohol related deaths are on the rise, but we remain a nation in denial

The UK is stuck in a deadly catch-22 where access to help for alcohol addiction is harder, while people drinking at hazardous levels have increased their consumption, writes Ian Hamilton

We are a nation in denial when it comes to the harms of alcohol. Even the recent report from the Office for National Statistics showing a new record in the number of alcohol related deaths is unlikely to shift our long held love affair with this drug. From January to September 2020, 5460 people lost their lives to this substance, an increase of 16.4% on the same period the year before. Although this covers the start of the pandemic, most of these deaths would have been triggered by years of excess drinking as three quarters were due to liver disease rather than acute poisoning. 

The UK had problems with harmful levels of alcohol consumption before the pandemic, but unfortunately covid has amplified these risks for some groups. Surveys show that many people who were drinking at harmful levels before the pandemic have further increased their intake. This contrasts with those who were abstinent or drinking at low levels before the pandemic, who are more likely to have reduced their alcohol use still more.

All the factors that before this pandemic contributed to people developing a problem with alcohol have only intensified. Unemployment, poverty, lack of housing, stress, and insecurity have not been spread equally in our society—as always, it is those who already had the least in the way of resources who are feeling the greatest impact during covid. Unless you’re in that situation, it can be hard to truly understand how this feels and the limited “choices” that such inequality leaves someone with. Stigmatising attitudes that view those who develop a problem with alcohol as having a “self-inflicted” injury persist, but this is an easy belief to hold when you have a stable well paid job, adequate housing, and a secure future. 

It’s this lack of collective empathy that has permitted specialist treatment services for addiction to be incrementally shrunk over a decade in which deaths and harmful drinking levels have only risen—a truly twisted and cruel policy position. Not only has this specialist help reduced, but the covid-19 pandemic has made it harder for some to access services. Restrictions mean that in person consultations have been replaced by virtual appointments, which are hardly the best way to build a relationship at a critical time. It’s difficult to know how much this will have contributed to the rise in alcohol related deaths recorded between January and September 2020, but we do know that timely access to treatment is critical if harm is to be minimised. This leaves us in a deadly catch-22 where access to help is harder at a time when people already drinking at hazardous levels have further increased their consumption.

Although we may not fully understand all the reasons behind why a record number of people are dying as a result of alcohol, we do know how to reduce alcohol related harm. One example of how this can be done is the policy of minimum unit pricing, where a minimum cost is placed on a unit of alcohol. The interesting and depressing aspect of minimum unit pricing is the apathy of the Westminster government to adopt the policy. Early evaluation of the introduction of minimum unit pricing in Scotland looks promising, although it’s worth noting how hard the alcohol industry fought for this policy not to be introduced—something they are no doubt replicating with English policy makers.

The only time alcohol has been mentioned by government ministers during the pandemic is in relation to maintaining access to the drug, such as placing off-licences in the same category as pharmacies by deeming them to be “essential retailers.” This tells you all you need to know about this government’s approach to alcohol policy. Their ideal of prizing libertarian, free individual choice appears harmless but it’s built on the assumption that we all have an equal menu from which to make our “choices,” which we clearly don’t. 

The last Labour government had the courage to act ahead of public opinion by banning smoking in public places—a policy shift that has become publicly accepted, as well as proving to be an effective way of reducing the harm caused by cigarettes. While banning alcohol would clearly not be desirable, there is a need for assertive and bold policy intervention. This is unlikely to happen until we and our government accept that we are in a state of denial about the harm alcohol continues to cause.

Ian Hamilton is an academic at the University of York with an interest in addiction and mental health. He previously worked as a mental health nurse with people who had combined mental health and substance use problems. Twitter: @ian_hamilton_

Competing interests: None declared.