Minimum alcohol pricing: Is Scotland's flagship policy a failure?
Scotland’s minimum unit pricing for alcohol has been branded a failure by some commentators after a report found evidence of some dependent drinkers cutting back on food and bills rather than alcohol because of the measure.
The Public Health Scotland (PHS) report also failed to find clear evidence that the policy led to less alcohol consumption among harmful or dependent drinkers.
But health experts have continued to support the policy, and said the findings are not a damning criticism.
The report’s lead investigator, John Holmes, a professor of alcohol policy at Sheffield University, said it should be taken in context of a series of PHS investigations into different aspects of minimum unit pricing (MUP).
Despite being labelled a “final report”, there is still further research to come, and PHS’ true final conclusions will not be made for another year.
MSPs will then vote on the future of MUP, which has a “sunset clause” to expire in April 2024.
Prof Holmes described his findings as a “mixed picture”.
The lack of evidence that drinking reduced in harmful drinkers, which make up around five per cent of the population, contradicts previous studies, he said.
"So it's not the case that we've conclusively proved that minimum pricing isn't having an effect, it's more that we've introduced some uncertainty into the previous findings,” he said.
“There have been quite a lot of studies looking at the impact on alcohol sales and on people's purchasing of alcohol, and we're just one study adding a little bit more evidence to that.
"Our evidence reaches slightly more negative conclusions, but we wouldn't necessarily say that our study is better than those other ones… people need to look at the evidence in the round, rather than drawing the conclusions they may wish to draw just from one study.”
The study found some dependent drinkers (about one per cent of the population) were facing increased financial strain because of MUP, but some experts say they were unsurprised by this, as this behaviour had been evident before the policy was introduced.
“If you're addicted to alcohol, and money is tight, then even before minimum unit pricing you will have been potentially making a proactive choice not to spend money on other products in order to pay for your alcohol,” said Elinor Jayne, director of Scottish Health Action on Alcohol Problems (SHAAP), a partnership of royal colleges and the faculty of public health.
And while this is seen as a negative consequence of MUP, they point out that there were fears of many others before the policy was introduced in 2018.
It is a “good news story” that no other problems were seen, said Prof Holmes.
These include concerns about dependent drinkers resorting to crime in order to obtain alcohol or the money to buy it.
There were also fears of people switching to drugs, or using other forms of alcohol such as mouthwash.
For many, the major takeaway from the report is that MUP is not a complete solution, and more must be done alongside it to support dependent drinkers.
“There is clearly more to be done, especially in areas of Scotland with poorer health outcomes linked to deprivation,” said Chair of BMA Scotland Dr Lewis Morrison.
"Minimum unit pricing cannot be a stand-alone policy – it has to be part of a range of measures and interventions aimed at preventing and managing harmful alcohol use, including addressing socioeconomic conditions which can lead to addiction, and specifically highlighting the need for better resourced mental health services to deal with the problems that lead to, or accompany, alcohol misuse.”
“Minimum unit pricing is one part of much bigger strategy to try and reduce alcohol harm,” said Laura Mahon, deputy chief executive of Alcohol Focus Scotland.
“It’s a prevention policy, and it must go hand in hand with a robust treatment and support strategy.
“We already know that in Scotland roughly only a quarter of people who need help with an alcohol problem are currently accessing services, which means that three quarters of people who need help with an alcohol problem are not getting the support that they need.”
She added: “We need to think about these things alongside one another. You're introducing a prevention policy with an aim of reducing the whole population’s consumption, but particularly those who are drinking really strong, really cheap alcohol - and we knew that the people that were drinking that alcohol often tended to be people who were drinking at levels where you would presume they would require support to cut down.
"So you have to think of treatment and support at the same time, and this study would certainly suggest that that hasn't really been happening.”
Scrapping MUP is “simply not the solution”, added Elinor Jayne.
“What we should be doing is putting in place services, and why this report is really significant.
“This group of dependent drinker is always going to need more support. Their lives are complex, and they will need different kinds of support in different ways.”
She added: “The whole purpose of minimum unit pricing is to change behaviour. And what we've found in lots of the other reports that have been carried out on different groups in the Scottish population is that that is exactly what is happening.”
A spokesperson for the Scottish Government said the study was “large and complex”, and pointed to the lack of evidence of other negative consequences of MUP.
“We will review the final evaluation report from Public Health Scotland before drawing overall conclusions,” they said.