1. Presentation January 2016 Jan Gill

2. Prof. Jonathan Chick Fiona O’May Robert Rush Prof Barbara McPake Heather Black Cheryl Rees Jane Doogan Christine Galloway Lucie Michalova The Research Team Acknowledgements NHS Lothian Endowments Fund. SMHRN

3. 6 months12 months18 months24 months Data collection Time-point 1 Time-point 2Time-point 3Time-point 4 MUPMUP Supplemented with Qualitative interviews Cohort study; n=639 (females = 181, males = 458) heavy drinkers, ‘harmed by alcohol’, recruited in Edinburgh, and Glasgow. Data to be presented were collected at Time-point 1. MUPMUP Original study design

4. Participant inclusion criteria: Attending an alcohol problems service out-patient appointment or being admitted to hospital, and having a diagnosis of an alcohol-related condition (whether or not another diagnosis has also been made) Measures: Detailed record of drinks consumed in ‘last’ or ‘typical’ week, type, volume, price paid, location of purchase. (Self-reported health conditions. ARPQ – 11 item questionnaire, physical and mental health(6), domestic (3), police (1), work-related problems (1). )

5. Edinburgh N= 294 Recruited during 2012 67% male Edinburgh N= 294 Recruited during 2012 67% male Glasgow N=345 Recruited during 2012 75.7% male Glasgow N=345 Recruited during 2012 75.7% male

6. Challenges and observations 1.The cities 2.Follow-up of Participants 3.Cheap alcohol 4.Addiction

8. 2. Attrition etc Recruited 639, completed second interview = 227. Deaths = 105 ‘not known at this address’, ‘no fixed abode’, pawning of mobile phone, incarceration etc. Challenges re-contacting attempts vs ethical concerns vs ‘right to withdraw’ Phone vs ‘face-to face’

9. http://www.healthscotland.com/uploads/documents/21782-MESAS%20August%20Update%202013.pdf 3. Cheap alcohol

10. http://www.healthscotland.com/uploads/documents/21782-MESAS%20August%20Update%202013.pdf % of total volume of alcohol sold through off-trade (excluding discount retailers) Litres pure alcohol Price band per UK unit

11. All Off- trade units

12. 95% of these units = white cider

13. I get up early in the morning, and I go to bed quite early at night, usually 10, half 10, maybe 11, but I’m up at 6, half 6, and first thing I’ll do, is I’ll have a drink, and it’s eh, it’s not to get drunk, it’s just to stop shaking. It’s like medicine. And then I’m like that all the way through the day, right up until when I go to bed. So I don’t, even though 4-5 litres of strong white cider sounds a lot, for me, because of the tolerance, my body asks for it….. I don’t actually get drunk on that. (Glasgow Participant 5) 4. Addiction

14. …..if you’ve been drinking as long as I have, you can be sitting at 8 o’clock in the morning, just looking at the watch, going hurry up, hurry up, 10 o’clock, 10 o’clock, 10 o’clock, 10 o’clock. And then at 10 o’clock in the morning, you always know all the drinkers because there’s a queue, and eh … you feel bad, I dae feel bad myself, knowing they must be thinking well here are the drinkers in, their in for 15 minutes, then it’s back to the normal customers. And it’s like, uh huh. (Glasgow Participant 15)

15. The first thing I would touch, first thing in the morning, to stop the shakes and the DTs is go for a large whisky, that would sort of calm me down, but the more I actually drunk, the less I wanted to eat, and just even the thought of food, it literally made me throw up. (Glasgow Participant 13)

16. That’s when it gets a haud of you, you need it to function, it’s no through greed, it’s 2 different things. (Edinburgh Participant 10)

17. references Black, H.,Michlaova, L, Gill,J. et al (2014) White cider consumption and heavy drinkers: a low-cost option but an unknown price. Alcohol & Alcoholism 49(6) 675-680. Gill J, Chick J, Black H, Rees C, O’May F, Rush R and McPake B. (2015) Alcohol purchasing by ill heavy drinkers; cheap alcohol is no single commodity. Public Health http://dx.doi.org/10.1016/j.puhe.2015.08.013 Gill J, Chick J, Black H, Rees C, O’May F, Rush R and McPake B. (2015) The enigma of ‘harmful’ alcohol consumption; evidence from a mixed methods study involving female drinkers in Scotland. Perspectives in Public Health (in press). Lachenmeier, D.W., Gill, J.S., Chick,J. and Rehm, J. (2015) The total margin of exposure of ethanol and acetaldehyde for heavy drinkers consuming cider or vodka. Food and Chemical Toxicology 83,210-214. doi: 10.1016/j.fct.2015.05.006. Robinson and Beeston (2013) Monitoring and Evaluating Scotland’s Alcohol Strategy. Annual Update of alcohol sales and price band analysis. August 2013. Edinburgh: NHS Health Scotland;2013.

18. THANK YOU