Deaths from drinking are at a record high: does England need a new alcohol strategy?

Drinking alcohol is a part of most adults’ lives in England, even though it carries risks for both individuals and society. Alcohol consumption is directly associated with debilitating and sometimes fatal health issues like liver disease, cancer, cardiovascular problems, and a higher risk of dangerous accidents. The last government alcohol strategy was published in 2012, and introduced key health-related measures, such as monitoring alcohol-related admissions, deaths and consumption trends. A substantial focus was placed on tackling anti-social drinking and reducing harm among younger people.

This blog looks at current trends in drinking and alcohol-related harm, and explores whether the 2012 strategy needs updating to reflect the new government’s focus on prevention.

Sobriety is gaining traction in England, but the amount people drink has not changed much

There is some evidence that abstaining from or reducing alcohol intake has gained popularity in England. Sales of non-alcoholic drinks are up, over a quarter of 16–24-year-olds do not currently drink alcohol, and hospital admissions for alcohol poisoning have recently fallen.

Despite this, the average number of units consumed per week has changed relatively little over the past 10 years. The latest data, illustrated in the chart below, shows that the average adult in England in 2022 consumed around 13 units (the equivalent of six pints of beer) per week. The chart also illustrates that men’s alcohol consumption has recently climbed up to 17.6 units per week – the highest average in 10 years.

But deaths from alcohol are up – substantially

In 2023 there were 8,274 deaths in England from conditions caused entirely by alcohol consumption, which include alcoholic liver disease and accidental poisoning. This represents an increase of over 60% since records began in 2006. A further 14,370 deaths in 2023 were from conditions caused partially by alcohol.

The chart below shows that 2020 was the beginning of the current upward trend in deaths. Evidence from the Alcohol Toolkit Study suggests that heavy drinking spiked at the start of the pandemic before steadily falling again. Troublingly, deaths from alcohol continued to rise, as heavy drinking nonetheless fell. 

The average heavy drinker in England is now older

Heavy drinkers are defined here as men who drink more than 50 units per week, and women who drink more than 35 units per week on average. In the past 10 years, the percentage of adults in England who are heavy drinkers has increased slightly, from 4% in 2012 to 5% in 2022. During this time, the profile of heavy drinkers has also changed substantially, as the chart below shows. In 2012, people aged 65+ made up just 12% of all heavy drinkers, and by 2022 this had risen to 21%.

When heavy drinkers are older, we can underestimate the impact on health systems in a few ways:

1. Older heavy drinkers are more likely to have drunk heavily in the long term, meaning a higher risk of cumulative alcohol-related damage.
2. Older people metabolise alcohol slower, and we underestimate the impact of alcohol on their body when we look at units alone without considering age.
3. Heavy drinking can worsen conditions associated with age, such as osteoporosis, diabetes, blood pressure, stroke and memory loss – making people’s care more complex and expensive.

Older, heavy drinkers are also more likely to have accidents. The ageing profile of drinkers in England may help to at least partially explain that, in the most recent years of data, the rate of hospital admissions per 100,000 for alcohol-related injuries increased significantly from 49.7 in 2022/23 to 61.6 in 2023/24.

Implications for alcohol treatment

While the profile of heavy drinkers in England has changed, the profile of people in alcohol treatment has changed relatively little. The proportion of people in alcohol treatment aged 65+ increased from 2% to 4% between 2012 and 2022. The chart below illustrates the extent to which older drinkers are under-represented in alcohol treatment, despite making up a larger share of harmful drinkers.

There are several barriers to older people accessing alcohol treatment:

1. The perception that drinking is a younger person’s issue may prevent professionals from spotting problem drinking in older people, and the signs of problem drinking may be confused with other age or medication associated presentations.
2. Older people themselves may perceive themselves as too old to benefit from treatment.
3. Reflecting this view, professionals may recognise problem drinking in an older person but fail to refer them due to their age.
4. Many alcohol treatment facilities moved some services online during the pandemic, which risks disproportionately excluding older drinkers.

The reality is that alcohol treatment services have never reached all heavy drinkers, nor do they aim to contain all of the risks of heavy alcohol drinking. Alcohol treatment is provided to people with a psychological or physical dependence on alcohol, which may or may not be present in a harmful drinker. It is estimated that less than half of heavy drinkers have a dependency, and less than one-fifth of dependent drinkers will access treatment.

Even if a heavy drinker is not psychologically or physically dependent on alcohol, and does not qualify for treatment, their alcohol intake itself carries significant risks of disability and death. Outside of alcohol services, GPs play a crucial role in harm reduction for dependent and heavy drinkers alike. GPs are often the first point of contact for those who are worried about their alcohol consumption, and GPs are often well-placed to identify the physical signs of harm from drinking in patients.

Discussion

The changing profile of drinkers in England highlights critical challenges for alcohol treatment services and the wider health system. Despite the popularity of sobriety among younger people, alcohol-specific deaths have surged in recent years.

The last unified national alcohol strategy was published in March 2012. This strategy, which focuses much of its attention on binge drinking and “drunks turning up in A&E”, no longer reflects the reality of problematic drinking in England. Since then, the profile of heavy drinkers has changed substantially. Heavy drinkers are older, more of them are male, and they face wider risks to their health from drinking and more complex barriers to treatment.

Wes Streeting, the Health and Social Care Secretary, recently outlined “three shifts” to ensure the sustainability of the NHS – the third of which was a shift towards “prevention over treatment”. As the government moves towards a greater emphasis on prevention, it is essential that attempts to reduce alcohol harm acknowledge the changing landscape of drinking in England. This may include, but is not limited to, ensuring health professionals can recognise harmful drinking in older people, improving public knowledge of the risks of drinking, and carefully evaluating the potential for policies like minimum unit pricing now that drinking behaviour has changed.