For many adults, alcohol has positive associations, often intertwined with socialising with friends and family. However, Public Health England (PHE) says that over 10 million people drink at levels which increase their risk of health harm. And among those aged 15-49 in England, alcohol is now the leading risk factor for ill-health, early mortality and disability, as well as being the fifth highest risk factor for ill-health across all ages.
To keep health risks to a low level, the latest guidelines from the Government’s chief medical officer recommend that men and women should drink no more than 14 units of alcohol a week. Yet women are more vulnerable to the harmful effects of alcohol than men for a number of reasons, including the fact that it takes longer for their bodies to break down alcohol.
Despite this, it seems that women are now drinking as much alcohol as men – a trend that has been dubbed ‘sex convergence’, in a British Medical Journal (BMJ) report, which analysed evidence from studies across the last century. Researchers from Australia and the USA looked at 68 studies of people born between 1891 and 2000 across the world and examined trends in alcohol use among men and women. They found that in the early 1900s, men were twice as likely as women to drink alcohol and three times more likely to experience alcohol-related problems. But nowadays, there is far less of a difference between the amount that men and women drink, and women born after 1981 may actually be drinking more than their male peers.
One reason for the increase in women drinking alcohol is that more women now work and therefore have an independent income and are more free to socialise. The cost and ease of access to alcohol is another factor, says Joanna Simons, CEO at Alcohol Concern. “Since the 1950s, we’ve seen women’s drinking rise,” she says. “Drinking at home has continued to increase and because alcohol is so cheap and easily available, it’s become an everyday grocery item. We’ve also seen a concerted effort by the alcohol industry to market products and brands specifically to women.”
PHE figures show that levels of alcohol consumption vary with age. Among men, the prevalence of drinking more than 14 units a week is most common among those aged 65-74 years, with 39 per cent of men in this age group drinking at this level. Among women, the proportion who drink more than 14 units a week declines among those aged 25-44, and is highest among women aged 55-64, with 21 per cent of this age group drinking at this level. For men and women, binge drinking, defined as exceeding eight units in one day for men and six units for women, is highest in the youngest age groups, peaking between 25 and 34 years and then reducing with age.
So what does all this mean for women’s health? Although PHE figures say that in 2014 the rate of alcohol-related mortality for men (65.4 per 100,000) was more than double the rate for women (28.8 per 100,000), all major body systems in both men and women are affected by alcohol consumption. According to the Institute of Alcohol Studies, the adverse effects of alcohol pose a greater risk to women’s physical health at lower consumption levels than men, with notable impacts including fertility disorders and breast cancer.
Most people are aware that drinking too much too often can store up future health problems, so what can be done to combat the rise in women’s drinking?
Joanna suggests there should be mandatory health warnings on alcohol products to educate the public about the risks associated with drinking alcohol, such as cancer and high blood pressure. She also advocates a mass media campaign “to make sure the chief medical officer’s guidelines are widely known and understood”.
But while many people understand that alcohol is measured in units, Ben Butler, director of marketing and communications at Drinkaware, says: “Identifying the number of units in different types of drinks and how they compare to the guidelines can be confusing.”
Ben says it is too early to speculate about what the impact of the revised 2016 guidelines may be, but adds that early research suggests awareness of the guidelines requires sustained promotion. He believes that one way in which pharmacy staff could help customers moderate their drinking is by signposting them to download the free Drinkaware app, which tracks alcohol consumption over time, calculates units and calories and allows users to set goals to improve their drinking habits.
Another popular way of raising awareness of alcohol consumption is Alcohol Concern’s “Dry January” initiative, which encourages people to abstain from alcohol for the first month of the year. But do campaigns such as this actually work, or do they promote an “all or nothing” approach to drinking and thus have the opposite effect?
Joanna says that Dry January is primarily a behaviour change campaign, rather than being about never drinking again. She says: “With the support and information we give people, we aim to get participants thinking about their drinking. The focus is all about getting in control and reducing risky drinking beyond the end of the campaign. And it really works – 65 per cent of participants had cut down or stopped drinking altogether six months after last year’s campaign.”
At the very least, Ben says that taking a break from alcohol can be a good opportunity to reflect on how much and how often someone drinks and the impact it has on their health, family and relationships. “We encourage people who do take a break from alcohol to use this as an opportunity to change their behaviour,” he says.
However, he stresses that it is important not to assume that having a break from alcohol means it’s okay to drink in excess for the rest of the year. “It is also important,” he says, “to recognise that just because a person can stop drinking for a period of time, it does not mean they don’t need to continue to moderate their drinking in the long term.”
The Government issued its revised alcohol consumption guidelines in January 2016. It recommended:
Fourteen units is equivalent to six pints of four per cent beer or six 175ml glasses of 13 per cent wine.
Health interventions aimed at drinkers who are already at risk, and specialist treatment for people with harmful drinking patterns and dependence, are effective approaches to reducing consumption and harm. Typically, these interventions are considered a good investment, but success depends on large-scale implementation and dedicated funding and staff, without which the Department of Health (DH) says they are less effective.
When it comes to interventions in community pharmacy, the DH recommended that pharmacy-based Identification and Brief Advice (IBA) should be piloted and evaluated as part of pharmacy’s developing public health function. However, a recent pilot in London found little evidence for the effectiveness of IBA in community pharmacies in terms of reducing hazardous or harmful alcohol consumption. This may have been because the pharmacists were under-trained in the delivery of IBA, having had only a single 3.5-hour training session.
Nevertheless, community pharmacy still has a role to play in alcohol awareness, and specifically in identifying and helping women with alcohol problems. In 2009, NHS County Durham and Darlington launched an Alcohol Harm Reduction Strategy. One strand of its objectives related to the delivery of IBA interventions for alcohol in community pharmacies to women presenting for emergency contraception.
Eileen Kaner, professor of public health and primary care research at Newcastle University, advised on the project. She says: “Alcohol use is linked to a wide range of reasons that require a pharmacy visit, including emergency and prescribed contraception, which are typically required by women. It is clear that many staff and also their customers feel that it can be helpful if alcohol information and advice is available in this setting.
“Alcohol can also interact with many prescribed and over-the-counter medications, so simple, timely advice is likely to be helpful to many pharmacy customers.”
However, she cautions: “It’s currently not clear what the best form of advice should be or which staff are best placed to deliver this information.”
As trusted providers of health information, community pharmacy staff have the potential to play a significant role in providing information and guidance to women as well as men about how to moderate their alcohol consumption. This being the start of a new year, it is a great time to get people thinking about how they can improve the habits that will benefit their health, rather than damage it. Joanna explains: “Pharmacy staff can recognise people who are drinking above the recommended levels. So, for example, if they’ve got a prescription for a medicine they can’t drink alcohol with, then it’s an ideal way to bring up their drinking habits. Dry January offers a great opportunity to have an open conversation with people about alcohol – it’s a non-threatening way to bring up a potentially sensitive subject.”
There are currently over 10 million people drinking at levels which increase their risk of health harm