Scotland’s grim reputation for abnormally high drug fatalities has become embedded in the public consciousness over the past year. The fact that fake benzodiazepines (‘street valium’) can be procured for 50p a pill on the streets of Dundee and Glasgow is now common knowledge, as is Scotland’s unenviable place at the top of Europe’s drug deaths league table. However, belated attention to this crisis should not allow signs of another to slip below the radar. New figures from National Records of Scotland (NRS) show a 17 per cent surge in alcohol-specific deaths between 2019 and 2020, a rise from 1,020 to 1,190 in the space of 12 months, what NRS terms ‘a marked increase’.
At first glance, these statistics appear to confirm fears about the impact of lockdowns on mental well-being, though NRS notes a slight decrease in suicides over the same period. It is certainly feasible that confining the population largely to their homes for extended periods of time contributed to the highest annual alcohol-related death rate since 2008. If these numbers do indeed represent the human cost of lockdowns, they are unlikely to be the last of their kind.
For the Scottish Government, the growth in alcohol-related deaths is especially unwelcome, coming as it does three years into the SNP’s flagship policy of minimum unit pricing (MUP) for alcohol. Introduced in May 2018 after a protracted legal battle, MUP currently stands at 50p per unit and the Nationalists have not been shy about heralding any favourable trend as proof of the policy’s success.
SNP MSPs have previously seized on data indicating fewer alcohol-related hospital admissions or alcohol-specific deaths to claim ‘minimum unit pricing is already saving lives’. Then Scottish health secretary Jeane Freeman said a fall in alcohol sales in 2018 showed ‘a promising start following our world-leading action to introduce minimum unit pricing’ and indicated ‘we are moving in the right direction’.
In June, public health minister Maree Todd touted figures showing alcohol sales down in 2020 and said they ‘demonstrate that the restrictions in place did not simply translate into an increase in the total amount of alcohol being consumed’, and that ‘[i]n fact, the opposite is the case’. Todd said she was ‘more convinced than ever that MUP is one of the main drivers in reducing alcohol harms’.
The figures make difficult reading for other restrictionists. A Newcastle university study published in the Lancet in May concluded that minimum unit pricing was ‘an effective alcohol policy option to reduce off-trade purchases of alcohol and should be widely considered’. However, the same research established that, among households that bought the most alcohol, ‘the lowest income households did not seem to reduce the amount of alcohol they purchased, and their expenditure on alcohol increased’.
We know from other research that the most socioeconomically disadvantaged are most likely to suffer alcohol-related harms. The bluntest tool still lands with a thwack, so it would hardly be surprising if minimum pricing did discourage alcohol consumption to some degree, but its difficulty in doing so among those most at risk is not an insignificant drawback.
A 17 per cent increase in fatalities in a year marked by lockdowns hints at other problems. We might surmise that, even if lockdown-exacerbated mental health or other problems played some part in the elevated death rate, either burdensome physical restrictions in supermarkets had no impact on off-licence purchases or increased use of home delivery made it easier to access alcohol. There would seem to be questions about how lockdowns interact with minimum unit pricing and whether the convenience of grocery deliveries offsets the higher per-unit cost of alcohol.
The restrictionist response to the latest figures has been as expected. Alison Douglas, chief executive of Alcohol Focus Scotland and a cheerleader for minimum pricing, calls the spike in deaths ‘devastating’ and intones that we cannot afford to take our eye off the ball. Her remedy, predictably, is further crackdowns:
‘If we are to prevent more people losing their lives to alcohol and to reduce health inequalities we need to redouble our efforts by reducing the availability of alcohol, restricting its marketing and by uprating minimum unit price.’
Douglas does at least call for more support services. Scotland’s unwanted distinction as the drugs death capital of Europe has brought attention to the SNP government’s decision during its time in power at Holyrood to cut funding for drugs programmes. What is less well known is that the cuts were to alcohol programmes as well, for a combined reduction of 53 per cent. Battling for minimum pricing in the courts — casting your government as a plucky David up against the megabucks Goliath of the drinks industry — all the while slashing alcohol support budgets, requires a remarkable amount of cynicism.
The similarities with the drugs-death epidemic may seem striking, but we are at risk of repeating with alcohol mistakes made with drugs policy. Even as Scotland is coming to terms with the failure of the war on drugs, we seem to be edging closer to a war on drink, a revival of the old temperance movement and likely with much the same results.
The authoritarian approach, thirsty for more bans, restrictions, government-ordered market distortion, and general finger-wagging, risks fetishising alcohol as much as alcoholics do. It is the same mindset that once inveighed against the ‘demon drink’. And if today it speaks in the quasi-clinical language of public health progressivism, it nonetheless treats alcohol as a malefactor rather than a product from which many derive pleasure and some misuse.
It is the misuse that is the problem, but it is a problem that is difficult and costly to address. By contrast, blanket pricing policies and other universal limits on alcohol purchase, retail or marketing can be legislated in much less time and at much less cost to the public purse.
At risk of sounding like a sociology lecturer on a fringe panel at Labour conference, we need to tackle the root causes of misuse, be they societal (poverty, inequality, homelessness, joblessness) or emotional (depression, trauma, loneliness, low self-esteem) or both.
Like problem drug-taking, gambling or eating, problem boozing numbs a pain, fills a hole, supplies a momentary lift or a brief escape. Reducing the availability of a particular form of self-medication can be a legitimate public health measure in certain circumstances, but it is a half-measure, suppressing the dependency rather than remedying the cause. It pretends a secondary problem is the primary problem and pretends the primary problem doesn’t exist.
The state could shutter every pub, clear every supermarket booze aisle and chain up every distillery in the land and it would do nothing to alleviate the desperation that leads to alcohol misuse. Scotland cannot come to terms with its booze or drugs problems until it comes to terms with what makes so many Scots seek solace in oblivion.