New evidence on alcohol-related harm to people other than the drinkerAlistair Aguelo
New evidence on alcohol-related harm to people other than the drinker.
The nature of the problem
We all know about the harmful effects of alcohol to the drinker. However, evidence is emerging for the harm caused by the drinker to their families, co-workers, the community and society. The actions of drinkers’ impact on the health and wellbeing of others and are sometimes criminal. In response, the health system, the criminal justice system and the welfare system all provide services for those affected, so these harms have a financial cost too.
The scale and nature of the problem in England
PHE has published the results of a national survey of alcohol-related harm to others . This was the first ever national survey on this topic in England and the largest ever survey conducted in the UK. We found that one in five adults had been harmed by the drinking of another person in the previous 12 months.
The most common harms were being kept awake at night and feeling uncomfortable or anxious at a social situation. While these may seem relatively minor, this is not necessarily the case. Sleep disruption, for example, can have a considerable impact on health and quality of life if frequent and long term.
Of more concern, the survey highlighted the burden of violence associated with another’s drinking: 3.4% of respondents said they had felt physically threatened, 1.9% said they had been physically assaulted and 0.7% said they had been forced or pressurised into something sexual. In total almost one in twenty people said they had experienced at least one of these three aggressive harms in the previous year.
It is already known that alcohol is a prevalent feature in violent and sexual crimes. Data from the Crime Survey for England and Wales show that in about half of all violent crimes the victim perceived the offender to be under the influence of alcohol. Data from the Office for National Statistics show that in 38% of cases of rape/assault by penetration (including attempts) the victims reported the offender had been drinking. Alcohol consumption can also increase in victims after experiencing physical or sexual assault.
Several personal, social and behavioural characteristics were found to put a person at higher risk of experiencing harm from another’s drinking. For example, people who were younger, drank themselves at harmful/hazardous levels, were white British, had a disability, were educated and lived in private rented accommodation (compared to owned outright) were at highest risk.
Having children in the household (compared to being young and single) and being retired (compared to being employed) were less likely to experience harm.
Who causes harm and how frequent is it?
While friends and strangers were the people who caused almost half of all harms, the person causing harm varied depending on the type of harm. Strangers were most likely to be the perpetrators of physical threats and physical assaults.
One in five (19%) people who were forced or pressured into something sexual said this was at the hands of a stranger, but 23% said this was caused by the partner they lived with, increasing to almost 40% when including partners who lived elsewhere.
While the number of people who reported being forced or pressurised into something sexual was small in our survey, these findings are supported by other sources. Data from the Crime Survey for England and Wales, for example, show that partners/ex-partners of women commit a higher number of rapes or assaults by penetration (including attempts), than other types of perpetrator.
Most harms (75%) occurred less than monthly but 5% occurred daily or almost daily showing some people shoulder a considerable burden. Harms which occurred daily or almost daily were those which occurred over a long time and/or involved contact with the person causing the harm, such as caring for a person who had an illness caused by drinking. Other research has shown that exposure to heavy drinkers is linked to poorer health, well being and quality of life.
What can be done?
Research on alcohol-related harm to others is well established in some other countries but is relatively new in the UK. As such, more work is needed to fully understand this issue. Individual stakeholders can make a difference. For example, mechanisms are in place for local authorities to reduce persistent alcohol-related noise and services are available which offer support for people caring for a drinker.
However, the biggest reduction in alcohol-related harm to others would likely come from a reduction in alcohol consumption in the population as a whole; reducing an individual’s drinking would reduce the risk they pose to others.
Previous research by PHE has identified that the most effective interventions to reduce alcohol use are personalised interventions targeted to at-risk drinkers, enforced legislative measures, and policies that address alcohol affordability, availability and marketing.
Finding ways to reduce the levels of unmet need for treatment amongst alcohol dependent adults, and in particular parents, is likely to impact on violent crime, including intimate partner violence; while programmes that reduce sales to intoxicated adults in the night time economy may also have an important role to play in that setting.
Since physical and sexual assault can occur in private settings such as households, supportive approaches working directly with offender groups may be useful to reduce these harms.
Evidence of harm from passive smoking provided the impetus for effective public health action. Evidence presented here, and from other sources, shows alcohol-related harm to others deserves the same attention.
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