Assessing impact of COVID-19 and the early impact of minimum pricing for alcohol on the wider population of drinkers (summary)

This report presents results from the second wave of a longitudinal study assessing the impact of Minimum Pricing for Alcohol (MPA) on the wider population of drinkers in Wales. The research was conducted by researchers from the University of South Wales in collaboration with researchers from Glyndwr University and Figure 8 Consultancy. 

In the original specification for the research, the plan was to undertake research that would assess the impact of MPA at 18 months and 42 months post-implementation of the legislation.  However, given the confounding effects of the COVID-19 pandemic and lockdown, which ensued only weeks after MPA was implemented in Wales (in March 2020), funding was provided by Welsh Government for an additional wave of interviews with the longitudinal study sample, nine-months post-implementation of the legislation.

The aim of this additional wave of interviews was to undertake a detailed qualitative study of the impact of COVID-19 on the drinking behaviour of the longitudinal sample to provide context for future interpretation of the data.

As part of the interview, feedback on the early impact of MPA on drinking behaviours was also gathered.  However, it was not intended that this would provide any conclusive findings regarding the impact of MPA given the limited amount of time that had passed since its introduction and the confounding effect of the COVID-19 pandemic. Furthermore, this data collection is with a qualitative sample only and cannot therefore be generalised to draw conclusions.

Interviews were conducted by telephone with 32 drinkers, all but one of whom had taken part in a baseline interview shortly before the implementation of MPA.  The sample was mixed in terms of sex, age, area of residence and marital status.  However, the sample was comprised wholly of people who were White British or White Other and some Local Authority areas (e.g. Cardiff and Wrexham) were more heavily represented than others.

Most interviewees scored positively on the quality-of-life measures and where changes had occurred between baseline and follow-up, these were largely in a positive (less harmful) direction. The sample included a mixture of different kinds of drinker including six harmful, 13 hazardous and 13 moderate drinkers. Drinking status (as measured by the AUDIT) remained broadly stable between baseline and follow-up for most interviewees. The only changes recorded were for five drinkers who shifted to less harmful patterns of drinking.

In May 2018, Welsh Government issued a specification for an evaluation that would assess the process and impact of the introduction of a minimum price for alcohol (MPA) in Wales over a five-year period.  The contract was split into four ‘lots’: (1) a contribution analysis, (2) work with retailers, (3) qualitative work with services and service users, and (4) an assessment of impact on the wider population of drinkers.

This report focuses on the assessment of impact on the wider population of drinkers (i.e. Lot 4).  The original plan for this strand of the evaluation was to assess impact at 18 months and 42 months post-implementation. However, an additional wave of interviews was added to gather feedback on the relative impact of MPA and COVID-19 on drinking patterns and related behaviours in the nine-month period following implementation of the legislation.

To help retailers prepare for the implementation of MPA in Wales, WG published a range of resources on its website in November 2019 and a guidance document in January 2020.  An MUP Calculator App was also issued to help retailers calculate the minimum price for specific alcohol products.

Two weeks before implementation, on 17^th February 2020, a broader publicity campaign targeting the general population was launched. The campaign included advertisements on social media, national and local radio and online, but not on television. A short two-minute animation explaining the introduction of the new law was also posted on the WG’s YouTube channel on 2^nd March 2020. 

It is understood from WG representatives that leaving the launch of the media campaign until a fortnight before implementation was based on marketing advice and experience with other campaigns suggesting that a two-week lead-in period would maximise awareness of the messages and minimise desensitisation prior to implementation.

In addition to the public media campaign and guidance for retailers, WG also funded a series of seven awareness-raising workshops that were designed to help services prepare for the introduction of MPA in Wales. The workshops were organised in response to concerns about a general lack of awareness of MPA within treatment and support services and concerns over the possible unintended consequences of the legislation that had been identified by Holloway et al. (2019) in the ‘Switching study’.

By the time the Public Health (Minimum Price for Alcohol) (Wales) Act 2018 came into force, the global COVID-19 pandemic was emerging. Within three weeks of the implementation of MPA within Wales, the UK entered a full pandemic lockdown. During the subsequent 12-month period, Wales entered two more lockdowns. Each lockdown period brought vast restrictions on lifestyles and for a large portion of the period following the implementation of MPA, alcohol was only available to buy from off-licence settings.

The impact of these changes, and of the pandemic more broadly, on alcohol consumption has attracted significant media attention. Some stories have referred to alarming increases in drinking while others have referred to decreases.  For researchers tasked with assessing the impact of MPA on drinkers in the general population, the situation poses a particular challenge.  How can we disentangle the relative impact of COVID-19 on drinking and related-behaviours from the impact of MPA? 

To begin the process of addressing this complex situation, systematic searches of the literature were conducted to identify peer-reviewed papers published in the period since the implementation of MPA in Wales (i.e. March 2020) that had assessed (a) the impact of COVID-19, and/or (b) the impact of minimum pricing for alcohol policies, on drinking and related behaviours. Brief summaries of these two reviews are presented below.

Impact of COVID-19 on alcohol use and related behaviours

Searches of the literature identified 59 studies based on research conducted in a wide range of countries. This included one systematic review of the literature, which summarised findings from studies conducted in 34 different countries (Bakaloudi et al., 2021) and a review focusing on data relating to England (Public Health England, 2021). Of the remaining 57 publications, most were based on cross-sectional research designs and survey methods with very few studies based on longitudinal designs or qualitative methods.

The findings corresponded broadly with the results of the two reviews of the literature in noting that most people maintained existing patterns of alcohol use following the pandemic. Where changes were reported, these varied across studies with some reporting larger increases than decreases while other studies reported the opposite. However, there seemed to be a general agreement that heavier drinkers were the most likely to increase consumption and experience more alcohol-related harms in the period following the emergence of COVID-19.

While there seems to be some agreement across the evidence base in terms of the broad direction of findings, it is important to note that the studies on which the empirical findings are based vary enormously in terms of their design, methods and samples. Any conclusions must therefore be drawn with a degree of caution.

Impact of MPA on alcohol use and related behaviours

As part of WG-funded research on MPA, two reviews of the literature relating to the impact of minimum pricing for alcohol have been published to date (Holloway et al, 2019, Buhociu et al, 2021). In this report, the review is updated for a third time and includes new material emerging from countries such as Scotland and Australia where the impact of MPA policies continues to be monitored and evaluated.

Twenty eligible studies were identified and their results add further positive findings to those identified previously.  Research emerging from Scotland, for example, has been unanimously positive in noting that Minimum Unit Pricing is having a successful early impact in terms of increasing prices and reducing sales, consumption and alcohol-related harms including deaths (Robinson, et. al. 2020; Ferguson et al., 2021; Alcohol Focus Scotland, 2021).

Furthermore, evidence of negative consequences that were anticipated particularly among dependent drinkers, has not materialised, although some shifting of household budgets from essential supplies to alcohol has been noted (Buykx et al., 2021). 

Early findings in relation to the impact of MPA in Wales are also positive and mirror those from Scotland (Anderson et al., 2021). Indeed, both countries recorded reductions in alcohol purchases, which were greatest for cider and spirits than for other alcoholic beverages.  In England, however, alcohol remains available at ‘pocket money’ prices with cider being the cheapest and available for as little as 19p per unit (Alcohol Change, 2021; Alcohol Health Alliance, 2020).

While the conclusions of the updated review are largely positive in finding that alcohol pricing policies can help to reduce alcohol-related harm in certain jurisdictions, there is some evidence to suggest that other policies will be needed to sustain its positive impact.  It is also clear that there is still a need for further research on the topic, particularly in a wider range of social and cultural locations including those with large illegal markets.

Preparing for the introduction of MPA

During the baseline interviews, participants were asked to anticipate whether, in knowledge of the upcoming MPA legislation, they would do anything to prepare for its introduction. Most of the participants indicated that they had no plans to prepare and the small number who did, indicated that this would involve stockpiling cheap supplies of alcohol prior to implementation (Buhociu et al., 2021).

In the follow-up interviews, participants were asked to report whether they did, in fact, do anything to prepare for the implementation of MPA. With one exception, all interviewees (across all types of drinkers) were clear that they had done nothing to prepare for the implementation of the MPA legislation. One interviewee, however, gave a vague answer and speculated that he ‘might have’ purchased a ‘nice’ bottle of whisky before its price went up. The predictions of any stockpiling that were made at baseline did not materialise.

At follow-up, publicity about MPA prior to its implementation was noted by the majority of interviewees. However, some interviewees had not noticed any publicity, which might suggest that the information had not been publicised widely enough.

The implementation of MPA

While some interviewees had noticed signs in shops about MPA, most interviewees were unaware that MPA had been implemented in March 2020. Several explanations for this lack of awareness were given including: their choice of drink being unaffected by MPA, limited trips to shops during lockdown and a lack of interest in prices. Those who were aware varied in terms of the point at which they noticed the change in price.  For some this was on the day of implementation but for others it took longer to reach their radar. 

When price changes were noticed, these were in respect of a range of alcoholic products including strong ciders and beers, wine, spirits and even some lower alcohol products. Changes were also noted in the price of bulk products (i.e. crates of lagers). Availability was largely unchanged although a few interviewees noticed that some products including strong ciders were no longer available.

Changes in drinking patterns

Given the potential confounding effect of COVID-19 and lockdown on drinking patterns, interviewees were asked to reflect on the impact of MPA as well as the impact of COVID-19 and the associated lockdown on their drinking patterns.

Most interviewees reported changes in their drinking in the period since the baseline interview and this included both drinkers who increased their consumption and those who decreased the amount of alcohol consumed. 

In all but one case, the change in drinking pattern was attributed to COVID-19 rather than to MPA. The only MPA-related change was in relation to a harmful drinker who switched away from cider to vodka as the prices of the two became closer following the implementation of MPA. 

The main COVID-related reason for a decrease in alcohol consumption was linked to the lack of socialising during lockdown while the main explanations for increases were due to loneliness, boredom and anxiety. Some interviewees described participating in a greater number of drinking sessions, which resulted in an overall increase in the amount of alcohol consumed. Another commented that the restrictions on shop opening times had resulted in him consuming larger quantities of alcohol more rapidly than previously.

Overall, the mixed findings reported support those of other researchers exploring the impact of COVID-19 on drinking patterns in the UK.

Changes in purchasing patterns

Interviewees were asked to describe any changes in their alcohol purchasing patterns in the period since MPA was implemented. This included any changes in the amount of money spent on alcohol and changes in how they purchased alcohol in the period since the baseline interview. Those interviewees who indicated that their expenditure on alcohol had increased were also asked to explain how they funded this additional spending.

Some interviewees continued to spend similar amounts of money post-implementation of MPA. Others, however, reported increases while others described decreases. The reasons corresponded broadly with those given for the changes in quantities consumed reported in the previous section. However, some additional explanations were also given including changes in diet (leading to a switch to more expensive wines rather than beers), and an increase in expenditure on alcohol to help them cope with a recent bereavement.

Those who increased their spending on alcohol had little difficulty funding the additional costs. Most were able to absorb the increase into their existing household budgets while others were able to use the money saved by not going out during the lockdown period. 

Some drinkers, however, had to make changes to their spending habits in order to fund their continued use of alcohol.  As predicted in previous studies, there was some evidence that some harmful drinkers funded their continued use of alcohol by changing their purchasing patterns of household goods and by participating in more begging (Holloway et al. 2019, Buhociu et al. 2021).

Most interviewees continued to purchase alcohol in the same way that they had done prior to MPA.  However, the few who made changes described shifts to online shopping, home deliveries and greater use of local convenience stores, attributing these changes to the pandemic.

Use of other substances

During the scrutiny stages of the MPA Bill, concerns were raised about the possibility that some drinkers might switch from alcohol to cheaper illegal drugs as a result of an increase in the price of alcohol.  In the previous ‘Switching study’ and in the baseline interviews people were asked to predict what might happen in this regard. The general consensus of opinion was that switching was unlikely, but if it did occur it would be among those with histories of previous use and to substances that have a similar effect to alcohol (Holloway et al. 2019; Buhociu et al. 2021).

As predicted, most interviewees did not switch from alcohol to other substances during the follow-up period.  For these drinkers, alcohol remained their substance of choice and switching to illegal drugs was not an option. Also, as predicted, switching to illegal drugs was only noted among dependent drinkers with histories of using these substances.  Indeed, one interviewee reported an increase in the use of crack as a cheaper alternative to alcohol (a decision influenced by both MPA and the pandemic) and another turned to tranquillisers to help them cope with unplanned alcohol withdrawal symptoms. 

General impact of MPA legislation

Interviewees were also asked to reflect more broadly on the impact of MPA on their lives as well as the impact on their friends, family and those in their communities. 

The general consensus of opinion was that MPA had made little difference to our interviewees’ lives. For the most part this was because they did not drink enough for it to affect them or because they could afford the price increase.

While most interviewees had not noticed an impact on those around them, a small number noticed or felt that it had and these changes were broadly in line with the predictions made in previous research (see Holloway et al. 2019 and Buhociu et al. 2021).

Some interviewees noticed a switch to illegal drugs (e.g. synthetic cannabinoids – ‘Spice’, crack cocaine and cannabis) while others noted a switch from one type of alcohol to another (i.e. from cider to spirits). Some interviewees noted that family members had started shopping for alcohol over the border in England where MPA is not operating, while others suspected an increase in shoplifting and noted shifts in household budgeting (i.e. adjusting spending on food) to fund continued use of alcohol.

This study is the first to gather feedback on the impact of minimum pricing for alcohol on drinking patterns and related behaviours in Wales. It is also the first in the UK (and one of very few studies across the world) that has examined the impact of COVID-19 on drinking patterns using a longitudinal design and qualitative research methods.

The research differs to previous research on MPA in Wales in that it is based on real-life scenarios rather than predictions of events (Buhociu et al., 2021; Holloway et al., 2019). It has therefore enabled us to monitor whether the anticipated changes, including possible unintended consequences, have in fact materialised and been borne out by events.

The feedback gathered from this qualitative sample suggests that to date, the implementation of MPA has had little impact on the drinking patterns or lives of the drinkers in our sample. While some drinkers reported increases and others decreases in consumption in the period following implementation, these changes were attributed, in all but one case, to COVID-19 rather than to MPA.

In line with COVID-related research from around the world, increases in alcohol consumption were linked to loneliness, boredom and stress while decreases were linked mainly to a lack of socialising during periods of lockdown.

Importantly, the widely anticipated negative consequences of increasing the price of alcohol (e.g. increases in crime, homebrewing, substance switching, use of illegal alcohol, unplanned withdrawal), were not widely reported within our sample. The few cases where potentially harmful behaviours (e.g. a shift to crack and tranquilliser use) were reported, these were, as predicted, among dependent drinkers and those with histories of illegal drug use. 

Whether or not the positive impact of minimum pricing on consumption and alcohol-related harms noted in Scotland prior to the pandemic, will materialise in Wales post-COVID, remains to be seen. The next wave of data collection, which will include a follow-up data collection for the online survey will be some time after any significant national lockdown in Wales. As such, it presents a useful opportunity to assess the impact of MPA without the confounding impact of national lockdowns and a global pandemic.

This report is the second of four reports planned for the assessment of the impact of MPA on the wider population of drinkers in Wales. The next report will focus on data collected two years post-implementation of the legislation and the fourth will present findings based on data collected 42 months post-implementation. Both of these reports will be important in helping to assess the impact of MPA on drinkers in Wales. They will present findings from research conducted at a time, hopefully, when people are able to socialise more freely and when on-licenced premises are open for business. 

In the next wave of the research, the plan is to conduct a third round of interviews with our interview sample. Attrition is a key issue in any longitudinal study and this project is no exception. Indeed, of the original sample of 41 interviewees, it was not possible to include 10 in the second wave of interviews. Moving forward, it is intended to replace all lost sample members with similar types of drinker (e.g. through the National Survey for Wales, and through our hostel contacts).  This will help to maximise the input of the different kinds of drinker in the research. 

It is also planned to repeat the cross-sectional survey that was run in the baseline study in the next wave of the research.  As noted in the baseline report, the characteristics of survey respondents will be monitored throughout the data collection period and a flexible but targeted campaign to generate interest and encourage participation among any under-represented sub-groups will be employed. The goal will be to obtain responses from as representative a sample as possible.

The portfolio of research emerging from the assessment of MPA on the wider population of drinkers is important. It will help to inform and guide the shape and scope of MPA in Wales and, potentially, other countries around the world.

Authors: Holloway, K., Buhociu, M., Murray, S., Livingston, W. and Perkins, A.

Views expressed in this report are those of the researchers and not necessarily those of the Welsh Government

For further information please contact:
Janine Hale
Email: research.healthandsocialservices@gov.wales

Media: 0300 025 8099

Social research number: 23/2022
Digital ISBN: 978-1-80391-783-2

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