## Abstract

Aims: To explore the trend in the UK to consume alcohol at home rather than at licensed premises. Methods: A Medline search entering the terms ‘home drinking’, ‘alcohol’ and ‘adult’ covering the period 2000–2011yielded 48 articles, of which 6 met the criteria to be included in the review. Grey literature including survey and market research data were reviewed. Results: In the UK, since 1970 there has been trend for beer to be consumed at home more often than in licensed premises and that the overall trend towards greater home drinking has increased since 2000. The main reasons given are convenience, cost, safety, autonomy and stress relief. There has also been an increase in the practice known as ‘pre-loading’ (drinking before going out). Adults who drink mainly at home report that they are aware that they run a risk of higher overall alcohol consumption but tend to play down the possibility that increased consumption may lead to longer-term harm. Conclusion: Home drinking trends may have long-term public health consequences. Greater understanding of the drivers of this trend will help policy-makers to respond to these societal changes.

## HOME DRINKING IN THE UK: TRENDS AND CAUSES

Survey, sales and excise returns suggest that the levels of consumption in the UK have been falling since 2004 (Alcohol Policy UK, 2009a). However, with respect to the preceding two to three decades, during which consumption had increased, Foster (2008) outlined a number of changes in UK alcohol culture. One of these is the shift towards purchasing alcohol away from licensed premises, in premises such as hotels, pubs, restaurants and bars.

Figure 1 compares trends in on- and off- sales from 2000 to 2009, showing that on-trade sales were stable from 2000 to 2002 and thereafter followed a downward trend, whereas off-sales have increased since 2000 (Institute of Alcohol Studies, 2010). From 2001 to 2008, consumption of alcohol outside the home declined by 40% and off-sales increased by 24%. However, Fig. 2 shows that the trend towards greater beer consumption at home has been evident since 1970 (British Beer and Pub Association, 2007).

Fig. 1.

UK consumption of alcohol: 2000–2009: on versus off-trade. Figures excluded cross-border shopping, smuggling and other illicit consumption. HM Revenue and Customs, National Statistics, Nielsen, CGA and British Beer and Pub Association (Institute of Alcohol Studies, 2010).

Fig. 1.

UK consumption of alcohol: 2000–2009: on versus off-trade. Figures excluded cross-border shopping, smuggling and other illicit consumption. HM Revenue and Customs, National Statistics, Nielsen, CGA and British Beer and Pub Association (Institute of Alcohol Studies, 2010).

Fig. 2.

Beer sales 1971–2005: distribution by place of purchase (on- versus off-license). Figures provided by the British Beer and Pub Association (2007). ‘On Sales’= public houses, hotels, wine bars, restaurants and clubs ‘Off-Sales’ = off licenses, grocers, supermarkets and all other shops. Figures plotted indicate mean values for the 5-year period.

Fig. 2.

Beer sales 1971–2005: distribution by place of purchase (on- versus off-license). Figures provided by the British Beer and Pub Association (2007). ‘On Sales’= public houses, hotels, wine bars, restaurants and clubs ‘Off-Sales’ = off licenses, grocers, supermarkets and all other shops. Figures plotted indicate mean values for the 5-year period.

In 1970, beer consumption accounted for 71% of total UK alcohol consumption; by 2000 this figure had fallen to 49%. Over the same time period, the percentage of spirits consumption was almost stable (17%, 1970; 19%, 2000), but wine consumption increased from 10% (1970) to 26% (2000) (British Beer and Pub Association, 2008). Foster (2008) cited data from the British Beer and Pub Association (2007), quoting 2006 figures showing that 83% of all wine consumed was purchased at off-license outlets; equivalent figures for spirits and beers were 77 and 43%, respectively. Unlike for beer, publicly available data are not available that can track home drinking trends from 1970 for wines and spirits.

In 2009, male survey respondents reported that, in a typical week, 47% of the alcohol they consumed was in the form of normal strength beer, lager and cider compared with a reported 15% among women (Lader and Steel, 2009). Strong beer was defined as a drink containing alcohol by volume of >6%, and the equivalent figures for strong beers were 13% for men and 4% for women. More women than men gave wine and spirits as their preferred beverage; wine (57%, 25% women, men) and spirits (16%, 12% women, men).

There are also gender differences in the outlets from which alcohol is bought. In 2009, 78% of men purchased alcohol at a bar or pub compared with 59% of the women surveyed. Men reported more frequent purchasing of alcohol in restaurants (67%, 57% men, women). There was no difference in the proportions of men and women who purchased alcohol from a supermarket (Lader and Steel, 2009).

The rise in home drinking has been linked to higher socio-economic class (Alcohol Policy UK, 2009b). Previously this has been portrayed as non-problematic, but according to Bosely (2007), harmful drinking is increasingly fueled by home drinking, reflected in changing government responses to the issue with the UK government's National Alcohol Strategy addressing, for the first time in 2007, home drinking among higher socio-economic groups (Home Office, 2007).

Alcohol, particularly wine, has become more readily available from UK supermarkets over the last 20 years (Burnett, 1999) An internet survey (n = 836) of adults (18+) (Mintel, 2010) showed that the purchasing of alcohol has become as part of the normal UK shopping experience. The mean amount spent per week was £12 (£624 annually) and wine was the alcoholic beverage most often purchased in supermarkets (by 75% of those surveyed). It was predominantly the choice of women but was the main ‘compromise item’ between genders. This means it was not the first choice item for men but was an acceptable choice when men and women were either drinking or purchasing alcohol together. Furthermore, wine was said to be seen as socially accessible and less intimidating by consumers (Lader and Steel, 2009).

The most likely explanations for these trends are firstly the increasing popularity of drinking alcohol with meals and secondly the widening gap between the costs of alcohol in the on-trade compared with the off-trade, which is exemplified by supermarkets often selling alcohol as a ‘loss-leader’ (Meier, 2010). However, the Mintel study reported that only 92 (11%) of those surveyed agreed that higher prices in supermarkets would make them use pubs and bars more often.

## UK RESEARCH—CAUSES OF HOME DRINKING

To explore the causes of this trend, a literature review was conducted by entering the search terms ‘home drinking’ and ‘alcohol’ and ‘adult’ into the Medline database from the period 2000–2011. Forty-eight articles were returned of which 6 (12%) were included in the current review. The reasons for excluding the studies were usually that their main emphasis was not on location of drinking, but a tangential topic: adolescent drinking only (n = 22), drink-driving (n = 6), links to other conditions/animal studies (= 3), mercury exposure/dependency (n = 2) and (single studies) on domestic violence, migration, workplace drinking and at-risk sexual behavior.

Thereafter, searches of the websites of the Institute of Alcohol Studies and Alcohol Policy UK were made to access data concerning consumption trends. Finally, stakeholders from the Alcohol Academy were contacted for suggestions about sources of relevant market research data.

A comprehensive attempt to explore UK home drinking was conducted by Holloway et al. (2008). The study, in the UK, employed mixed methods, in one urban area (Stoke on Trent) and one rural area (Cumbria: Eden), and conducted a telephone survey (n = 1139) using a stratified sample based on 2001 census data (Stoke n = 560, Eden, n = 579). The main venue of drinking in both districts was at home or friends/family houses. Thereafter 63 in-depth interviews were performed with drinkers and non-drinkers in both districts (recruited to represent gender, age and social class). The main findings from these interviews are summarized in Table 1.

Table 1.

Main findings of Holloway et al. (2008)

 Home drinking was identified with safety and exercising autonomy Drinking at home was widespread in both settings Home drinking was linked to dinner parties and had a social function Drinking at home was a way of unwinding after work or as an attempt to relieve stress Home drinking had become routine at the end of the day Preloading (drinking before going out) was commonplace, (40% of participants said they did this) Consumption of wine had increased as it became more affordable Wine consumption was seen as less intimidating and socially acceptable Wine was linked with aspiration There was minimal awareness of health concerns Rather than relying on published guidelines individuals preferred to rely on ‘signals from their own body’
 Home drinking was identified with safety and exercising autonomy Drinking at home was widespread in both settings Home drinking was linked to dinner parties and had a social function Drinking at home was a way of unwinding after work or as an attempt to relieve stress Home drinking had become routine at the end of the day Preloading (drinking before going out) was commonplace, (40% of participants said they did this) Consumption of wine had increased as it became more affordable Wine consumption was seen as less intimidating and socially acceptable Wine was linked with aspiration There was minimal awareness of health concerns Rather than relying on published guidelines individuals preferred to rely on ‘signals from their own body’

One finding was that the focus of media upon the problems created by public binge drinking has led to people rationalizing drinking at home as being unproblematic. The authors wrote: ‘Even harmful/ hazardous domestic drinkers, though bingeing in terms of alcohol consumed, are not breaking social or legal rules by being raucous, ill or violent in a public space. Rather their actions are entirely consistent with wider understandings of home: they are using it as a space to unwind, exercising their autonomy in choosing how to do so, and acting as good hosts by making others feel welcome in their home’.

The study of Holloway et al. just described gave a sociological perspective on home drinking. Foster et al. (2009 and 2010) looked at home drinking in adults from the perspective of public health. Using qualitative methodologies, 38 individuals were interviewed in four focus groups recruited from community groups in the town of Blackpool. There were many themes in common with the study of Holloway et al., but while the latter revealed a belief about home as a place of safety, the participants in the studies of Foster et al. saw drinking at home as taking a ‘calculated risk’—drinking at home was neither inherently safe nor unsafe. Common themes that emerged explaining why participants choose to drink at home can be collapsed around the themes’ convenience, cost and relaxation. The key findings that emerged from Foster's work are presented in Table 2.

Table 2.
 Overarching themes—cost, convenience and relaxation Activities that accompanied home drinking included listening to music, watching television and playing computer games Home drinking linked to food Difficulty of childcare could facilitate home drinking Rituals to promote sensible drinking were employed such as not drinking before a certain time or in front of young children Participants described purchasing more alcohol than they had originally intended because it was cheap Drinking at home was safer than going out Drinking at home was seen as running a ‘calculated risk’ Home drinking was linked to family parties Home drinking was linked to winding down at the end of the day and relief of stress Lesser concerns were preloading, smoking ban and not having to drive
 Overarching themes—cost, convenience and relaxation Activities that accompanied home drinking included listening to music, watching television and playing computer games Home drinking linked to food Difficulty of childcare could facilitate home drinking Rituals to promote sensible drinking were employed such as not drinking before a certain time or in front of young children Participants described purchasing more alcohol than they had originally intended because it was cheap Drinking at home was safer than going out Drinking at home was seen as running a ‘calculated risk’ Home drinking was linked to family parties Home drinking was linked to winding down at the end of the day and relief of stress Lesser concerns were preloading, smoking ban and not having to drive

## DISCUSSION

In the UK there has been an increasing trend for beer to be consumed at home rather than the pub since the 1970s. The general trend towards greater drinking at home seems to have accelerated since 2000. Despite these trends, home drinking has been the subject of minimal research although there are three UK studies already quoted (Holloway et al., 2008; Foster et al., 2009, 2010). These are open to the criticism that they are small localized studies that may not be transferable to other settings. We suggest that there are a number of tasks for researchers. These include conducting a survey exploring the general population patterns of alcohol purchasing and consumption, and expressed reasons for ‘off—versus ‘on’ purchasing, attending also to issues of social class and inequality, factors that interact with the rise in home drinking (Brown, 2007). More data on the risks inherent for young people when drinking in public spaces could be helpful, as offered already by Coleman and Cater (2005) and similarly for the phenomenon of drinking before going out (Hughes et al., 2008; Wells et al., 2009). In addition, the place of home drinking in alcohol-related falls in the elderly (Felson et al., 1988) could usefully be explored, and as Hurcombe et al. (2010) have suggested, there is the issue of home alcohol consumption among ethnic minority groups in the UK.

## POLICY IMPLICATIONS

The main policy development that is likely to have an impact on home drinking is the move to introduce a minimum price for a unit of alcohol. The British Beer and Pub Association who represent pub owners, licensees and hoteliers are supportive in principle, while two of the large UK supermarkets (ASDA and Morrisons) have protested that such a measure would penalize their shoppers. The University of Sheffield (Meier et al., 2009) produced a report to examine the impact of minimum pricing and recommended a minimum price of 50 p per unit of alcohol (0.6 Euros, 0.77$). The rationale for the 50 p cut-off is that this would have a significant impact upon heavy drinkers and young people while increasing the cost of alcohol for moderate drinkers (MD) by only £10–12 (11.9–14.3 Euros; 15.5–18.6$) per year. This is the equivalent of a round of 3–4 drinks purchased in a pub or two bottles of medium priced wine in a supermarket (authors' italics). MD were defined as drinkers with an intake of alcohol less likely to damage health and/or not associated with negative consequences. The consumption level for MD was up to 21 units per week for men and 14 units for women. A unit of alcohol in the UK is 8 g ethanol. Recently, the Scottish Government has re-introduced proposals for Scotland to introduce a minimum price for alcohol. This was after the original proposals under the previous minority government had been voted down by the opposition parties (BBC News Scotland, 2011). The first attempts at minimum pricing for England and Wales have now been proposed (but not yet implemented) by the Westminster coalition government whereby, in England and Wales, alcohol should no longer be sold below the cost of duty and Value Added Tax. This would be a minimum price of 38p (0.45 Euros; 0.59$) for a can of 440 mls lager (approximately two units of alcohol), which equates to a price per unit of about 16p (0.19 Euros: 0.25$) and £10.71 (12.71 Euros; 16.60$) for a liter of Vodka (40 units) (Boggan, 2011), which equates to about 27p (0.32 Euros: 0.42$) per unit.

Further evidence from Scotland (Black et al., 2010) indicates that the impact of lower unit price on dependent drinkers (mean consumption 200 units per week) is likely to be particularly acute as these drinkers tend to drink the cheapest alcohol available. Furthermore, there is a link between harm and ‘home drinking’—93% of the interviewees, who had all suffered health harms from drinking, purchased the majority of their alcohol from off-licenses and supermarkets (75% never used on-sales). The impact may be greater for women than men, women being less likely to purchase alcohol as ‘on sales’ than men.

It has been illegal to smoke in a restaurant or bar in the UK for a number of years (Scotland preceding the rast of the UK by about 1 year), and there was a commonly held belief that this would lead to more drinking at home. McKee et al. (2009), in a study of 1059 adult smokers and non-smokers from Scotland and the rest of the UK conducted 12 months after the smoking ban was introduced in Scotland on 26th March 2006, found that there was not an increase in home drinking between March 2006 and March 2007. Furthermore, there were no significant differences in trends in drinking behavior when the Scottish and English samples were compared.

## CONCLUSION

The evidence from the UK shows a long-term trend towards consuming more alcohol at home compared with licensed premises and this is accelerating. Thus, it becomes important for professionals to understand why adults are increasingly choosing to drink at home and, because the volumes consumed tend to be greater than on-licensed consumption, to draw attention to the possibility that this may have on future health costs rather than focusing, as much UK research has done, upon the problems of visible drinking around licensed premises. Furthermore, researchers should be ready to investigate the effects for health of the proposal to introduce a minimum price for England and Wales. The view has been expressed that this proposal to fix a price for alcohol such that a 440 ml can of 4.5% lager can be purchased for 38p (0.45 Euros; 0.59\$) will have ‘no impact whatsoever on the vast majority of cheap drinks sold in supermarkets’ (Ian Gilmore, Royal College of Physicians of London, BBC News Politics, 2011). Price is a factor in home drinking and, for the UK at least, the trend towards home drinking may have health costs for the future and should be one of the priorities of alcohol researchers.

## Funding

The study has no external funding, and the authors confirm they have no connections with the tobacco, alcohol, pharmaceutical or gaming industries or any body substantially funded by one of these organizations. There are no contractual restraints on publication of this work.

Conflict of interest statement. None declared.

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