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CHAPTER THREE: ATTITUDES TOWARDS DIFFERENT KINDS OF ALCOHOL MISUSE

Introduction

3.1 This chapter explores attitudes to different kinds of alcohol misuse. Defining 'alcohol misuse' or 'excessive drinking' is not straightforward. Some of the issues involved are discussed below, and the approach taken to defining and measuring alcohol misuse in SSA is described. The main focus of the chapter is on comparing and contrasting attitudes to 'chronic', 'binge' and 'hazardous' drinking, exploring differences in how serious people view these different behaviours to be, what impact they believe they will have on health, whether they believe people should be embarrassed about drinking in these ways, and who, if anyone, people think different kinds of drinkers should turn to for help. Attitudes to 'getting drunk' in general are also explored. Finally, differences in attitudes to these drinking behaviours between different groups of people in Scotland (e.g. by age, sex, class etc.) are explored.

Key questions

• Do people express different attitudes towards different drinking patterns ('chronic', 'binge' and 'hazardous')?
• How acceptable do people think 'getting drunk' is?
• How do attitudes towards different types of drinking vary between different groups in Scotland?

Defining 'alcohol misuse'

3.2 The terminology used in respect of alcohol misuse has evolved rapidly in recent years. Twenty years ago, concerns about someone who appeared to be misusing alcohol would probably have been expressed in terms of wondering whether they were an 'alcoholic'. However, a much wider variety of terms now exists to describe the broad range of drinking behaviours that health professionals and policy makers consider problematic. For example, the phrase 'binge drinking' entered common usage in the mid to late 1990s (Berridge et al, 2007), while more recently researchers and policy makers have referred to 'harmful' and 'hazardous drinking' in discussing the characteristics behaviour of British 'problem drinkers'. But the precise meaning of all these terms appears to vary depending on both context and on who is using them. Berridge et al (2007) show that 'binge drinking' is used in at least 2 different ways in the academic literature:

• to describe heavy drinking that occurs over an extended period of time, usually defined as more than one day of drinking at a time. A 'binge drinker' is thus someone 'who drinks predominantly in this fashion, often with intervening periods of abstinence' ( WHO, 1994), or
• 'to describe a single drinking session leading to intoxication, often measured as having consumed more than X number of drinks on one occasion' (Berridge et al, 2007).

3.3 UK government policies have often defined a 'binge' as drinking more than 6 units for women and more than 8 for men. Berridge et al point out that these types of definitions have been criticised for not taking into account factors such as weight, rate of drinking, and social context. Further, they may bear little relation to the public's understanding of 'binge drinking', which is arguably more likely to be informed by media coverage and direct experience of extreme drunken behaviour in city and town centres.

3.4 The terms 'hazardous' and 'harmful drinking' also appear to be used somewhat differently in different contexts. The 2007 North West Public Health Observatory report on drinking in the English regions defines 'harmful drinking' as 'consumption of over 50 units per week for men and over 35 units per week for women', while 'hazardous drinking' refers to drinking at below this level, but above the recommended weekly limits for each (22-50 units for men and 15-35 for women) ( APHO, 2007). Other definitions, including those included in the glossary of terms produced by the Cabinet Office to accompany its 2004 Alcohol Harm Reduction Strategy for England, do not refer to numbers of units consumed, but rather to patterns of behaviour. 'Harmful drinking' is defined as drinking which is currently causing physical or psychological harm, while 'hazardous drinking' brings the risk of harm either now or in the future (Cabinet Office, 2004). The harm caused by hazardous drinking may not be immediately recognised by drinkers - as described in Goodall and Dawson (2007), 'hazardous drinking' 'appears to cause no current harm, and is probably thought of as both normal and socially acceptable. The drinker is unaware of the health damage being incurred'.

3.5 In terms of the impacts of different kinds of alcohol misuse, a review of the evidence on alcohol-related harm by the Cabinet Office (2003) emphasises that alcohol misuse does not lead automatically to harm, but it does increase the risk of harm in terms of, for example, liver cirrhosis, haemorrhagic stroke and raised blood pressure. Moreover, they highlight that the risks generally increases with the amount of alcohol consumed, particularly where this is above a 'moderate' level (i.e. above recommended daily and weekly limits). Drinking to intoxication in itself can also lead to a variety of problems, such as accidents, injuries, violence, alcohol poisoning and some types of acute tissue damage.

Use and measurement of 'chronic', 'binge' and 'hazardous' drinking in this report

3.6 While recognising that the meanings of terms like 'binge drinking' are not fixed, in order to classify attitudes towards different kinds of drinking that may be viewed as problematic the following terms are used in this chapter:

• 'chronic drinking' is used to describe drinking at levels that are already having a negative impact on physical and psychological health. This could also be described as 'harmful drinking'. Historically, a 'chronic drinker' would probably have been described as an 'alcoholic'.
• 'binge drinking' is used in what is perhaps the more colloquial sense of the term, to describe heavy bouts of drinking to intoxication (in a public place), punctuated by periods of abstinence.
• 'hazardous drinking' is used to describe drinking at levels that fall above recommended daily and weekly limits, which may cause psychological or physical harm in the future but which do not appear to be causing significant problems for the individual at present.

3.7 Respondents to SSA 2007 were presented with three different scenarios intended to represent each of these types of drinking behaviour. For each, approximately half the sample were asked about a male drinker and half about a female drinker, so that we could explore whether attitudes to men and women drinkers are different. The three scenarios were as follows:

Colin/Mary (chronic drinker)

( Colin/Mary) is 40 and lives alone. ( He/She) has a history of alcohol problems. For the past five years ( Colin/Mary) has been drinking heavily on most days, and is often unable to remember bits of what ( he/she) did the night before. ( Colin/Mary) lost ( his/her) job because of this heavy drinking. ( He/She) worries that ( his/her) memory isn't as good as it used to be.

Karen/Mark (binge drinker)

( Karen/Mark) is 20 and is a student with a weekend job. ( She/He) doesn't drink much during the week, but ( she/he) and ( her/his) flatmates spend most Friday and Saturday nights out drinking. ( She/He) is often unable to remember bits of what ( she/he) did the night before, and is sometimes so ill the following day that ( she/he) can't go to work. From time to time ( Karen/Mark) does something when ( she's/he's) drunk which ( she/he) later regrets.

John/Elaine (hazardous drinker)

( John/Elaine) is 45 and married. ( He/She) has a stressful job and often works long hours. ( He/She) drinks ( two thirds of a bottle of wine/half a bottle of wine) most evenings, sometimes more if ( he/she) has had a particularly stressful day. ( John/Elaine) now and then feels slightly hungover in the morning, but doesn't believe it affects ( his/her) ability to do ( his/her) job or ( his/her) family life.

3.8 Note that in the 'hazardous drinking' scenario, the amount of alcohol drunk varied depending on whether the male or female version of the scenario was being read out, since the amounts of alcohol classed as just above daily and recommended weekly limits (but not constituting 'chronic' or 'harmful' drinking) differ for men and women.

3.9 After each scenario was read out and given to the respondent on a card, they were asked the same series of 4 questions about that person:

• How serious a problem would you consider (NAME)'s drinking to be, or do you not think it's a problem?
• How likely is it that (NAME)'s drinking behaviour will seriously damage (his/her) health if continued long-term?
• How much do you agree or disagree that (NAME) should feel embarrassed about (his/her) drinking? And
• Suppose you knew someone like ( NAME) who wanted help. Who would you advise them to turn to first for help?

Are different patterns of drinking viewed differently?

3.10 The simple answer to this is 'yes'. There is a clear gradation in how serious different patterns of drinking behaviour are viewed to be, with almost everyone (99%) viewing the 'chronic drinker' as having a 'very' or 'fairly' serious problem, falling to 80% for the 'binge drinker' and 71% for the 'hazardous drinker' (Figure 3.1). While these figures suggest that a majority of people view all three patterns of drinking as problematic, far fewer people view 'binge' and 'hazardous' drinking as 'very' rather than just 'fairly' serious. Thus there may be some scepticism about exactly how problematic these types of drinking really are.

Figure 3.1 How serious a problem would you consider their drinking to be? (%)

Base: All respondents
Sample size: 1508

3.11 A very similar pattern is apparent with respect to beliefs about how likely these behaviours are to seriously damage people's health in the long-term. While 94% believe this is 'very' likely to happen for the 'chronic drinker', this falls to 47% for 'binge drinkers' and just 35% for 'hazardous' drinkers, although again the proportion who believe they are either 'very' or 'fairly' likely to damage their health is high for all three groups (Figure 3.2).

3.12 It is worth noting that the proportions who believe binge and hazardous drinking are likely to damage health are higher than the proportions who believe they constitute serious problems. In fact, 16% of those who say that binge drinking is 'very' or 'fairly' likely to damage long-term health if continued and 18% of those who say the same of hazardous drinking nonetheless think that these types of drinking do not present a 'very' or 'fairly' serious problem. This apparent tension may reflect a belief that these types of drinking patterns are unlikely to be sustained over the long-term, and are therefore unlikely to damage health in the longer-term.

Figure 3.2 How likely is drinking behaviour to seriously damage health if continued long-term? (%)

Base: All respondents
Sample size: 1508

3.13 Although 'chronic' drinking is clearly viewed as the most serious behaviour, with most potential to damage health, slightly fewer people believe the 'chronic drinker' should be embarrassed about their drinking than think this about the 'binge drinker' (56% compared with 60% - see Figure 3.3). As discussed in Bromley and Ormston (2005), this may reflect a tendency among some respondents to view 'chronic drinking' within a 'medical model' of alcohol misuse, whereby it is seen as an illness over which the drinker has limited control. 'Binge drinking', on the other hand, may be viewed as more of a 'social problem', which the drinker should be embarrassed about their failure to assert control over.

3.14 'Hazardous' drinking appears to attract far less stigma than either 'binge' or 'chronic' drinking in this respect, with just 38% agreeing that the 'hazardous' drinker should feel embarrassed. This may reflect the fact that 'chronic' and 'binge' drinking are more obviously associated with behaviour that may be perceived as embarrassing (and indeed this was reflected in the scenarios used), while 'hazardous' drinking may lead to future health and social problems, but is less likely to be associated with either of these in the very short term. Thus as noted above 'hazardous' drinking may simply be more widely viewed as 'socially acceptable'. These more permissive attitudes may reflect the fact that a significant minority of respondents are themselves likely to be drinking at 'hazardous' levels. ¹⁹

Figure 3.3 Agree/disagree drinker should be embarrassed about their drinking? (%)

Base: All respondents
Sample size: 1508

3.15 The notion that 'chronic' drinking is more likely than 'binge' or 'hazardous' drinking patterns to be viewed within a 'medical model' of alcohol misuse is reinforced by the fact that nearly half (49%) think someone who wants help with this kind of drinking should turn to their doctor in the first instance. This is substantially higher than the 36% who think the 'hazardous drinker' should consult their doctor if they want help, and higher still than the 29% who think the 'binge drinker' should seek medical help in the first instance (Table 3.1). A further 27% think the 'chronic drinker' should seek out a support group, such as Alcoholics Anonymous. In contrast, only around 1 in 10 think that either the 'binge' or 'hazardous' drinker should approach a support group in the first instance, which may suggest that this kind of help is seen as better suited to those with chronic drinking patterns rather than other kinds of alcohol misuse.

3.16 The notion that 'binge' drinking tends to be seen as a social issue is reinforced by the fact that the most commonly suggested source of help for the 'binge drinker' is family or friends (32%). Friends and family are also commonly identified as the most appropriate source of support for a 'hazardous drinker' wanting help (29%), although ' NHS doctor/ GP' is the most common answer for this group (36%).

Table 3.1 Who would advise drinker to go to first if wanted help (%)

Attitudes to 'getting drunk'

3.17 In addition to scenarios designed to tap attitudes to different drinking patterns, SSA 2007 also included two questions specifically about attitudes to getting drunk. In general, there appears to be a fairly low level of approval of getting drunk, with just 15% agreeing that getting drunk at the weekends is perfectly acceptable (Figure 3.4) and just 10% agreeing that there is nothing wrong with people their age getting drunk regularly (Figure 3.5).

3.18 However, although relatively few people appear to be willing to assert that getting drunk regularly or at weekends is acceptable, a significant minority 'neither agree nor disagree' with each of these statements (26% with respect to getting drunk at weekends and 16% for people their age getting drunk regularly). In fact, across this report it is apparent that a substantial minority of people 'neither agree nor disagree' with many statements about alcohol. This may suggest that for some people attitudes to the acceptability and role of alcohol are not fixed and may vary depending on context. Alternatively, it may be that some people are hesitant about admitting that they do not perceive a big problem with alcohol or with getting drunk. Although many of the statements about alcohol in SSA were included in the self-completion section of the survey in order to minimise the likelihood of respondents giving what they perceive to be 'socially acceptable' answers, it is still possible that some people feel hesitant about expressing a more 'permissive' view on these issues.

Figure 3.4 Agree/disagree 'Getting drunk is a perfectly acceptable thing to do at weekends' 2004 & 2007 (%)

Base: all who completed a self-completion questionnaire
Sample size: 2004 = 1,514, 2007 = 1,312

Figure 3.5 Agree/disagree 'There's nothing wrong with people my age getting drunk regularly' 2004 & 2007 (%)

Base: all who completed a self-completion questionnaire
Sample size: 2004 = 1,514, 2007 = 1,312

Changes in attitudes to different types of drinking since 2004

3.19 Questions about attitudes to getting drunk and about the 'chronic' and 'binge' drinking scenario were also included in the 2004 SSA. In general, differences between the 2004 and 2007 survey are not large. However, it is worth noting some differences that are statistically significant. ²⁰

• Slightly fewer people in 2007 compared with 2004 appear to believe that either 'chronic' or 'binge' drinker has a 'very serious' problem (88% in 2007 compared with 92% in 2004 for the 'chronic drinker' and 30% compared with 36% for the 'binge drinker').
• Slightly more people in 2007 believed the 'binge drinker' was 'very likely' to seriously damage their health (47% compared with 43%). This may, however, reflect a small change in wording between 2004 and 2007. ²¹
• Fewer people in 2007 agreed that the 'binge drinker' should be embarrassed about their drinking (60% compared with 68% in 2004).
• Slightly more people disagree that getting drunk at the weekends and people their age getting drunk regularly are acceptable (57% in 2007 compared with 52% in 2004 disagree that getting drunk at the weekends is perfectly acceptable, while 73% in 2007 compared with 65% in 2004 disagree that there's nothing wrong with people their age getting drunk regularly).

3.20 Although these differences are statistically significant they are relatively small. Moreover, they do not all run in the same direction. For example, while the proportion of people disagreeing that getting drunk is OK appears to indicate a higher level of concern about binge or heavy drinking, the fact that fewer people think a binge drinker has a very serious problem or should be embarrassed about their behaviour can be seen as more permissive. Caution should therefore be applied before inferring that any changes indicate a clear 'shift' in attitudes across this relatively short period. However, these questions will be revisited in future years to establish whether they do in fact indicate the start of a change in attitudes.

How do attitudes to different drinking patterns vary between different groups in Scotland?

3.21 As discussed in Chapter One, alcohol-related ill health varies considerably between different groups of the Scottish population, while patterns of consumption vary between age groups and by gender. Are there related variations in attitudes towards different drinking behaviours? For example:

• Given that we know that younger people are more likely than older people to drink double the daily recommended number of units on a regular basis, are they less concerned about the seriousness and possible health impacts of binge drinking and drunkenness?
• We know that men drink more and more often than women, but is this reflected in their attitudes towards particular types of drinking?
• Given that alcohol-related health problems are more prevalent in deprived areas, do the attitudes of those on lower incomes differ from those of more affluent respondents?
• Is the growing concern about 'middle-class wine drinkers' matched by lower concern about 'hazardous drinking' among those in managerial and professional households?
• Are those who display higher levels of awareness of recommended limits and the alcohol content of drinks more likely to show concern about different types of alcohol misuse?

3.22 The findings presented in the remainder of this chapter are informed by regression analysis, which identified those factors significantly and independently related to holding attitudes which indicate less concern about the three drinking scenarios and about 'getting drunk'. Full details of this analysis are presented in Annex B.

Age

3.23 As might be expected given they are more likely to exceed recommended daily limits, younger people do hold more permissive attitudes than older respondents towards binge drinking and getting drunk. For example, they are less likely than those aged 30 or above to think that the binge drinker has a very or fairly serious problem (58% of 18-29 year-olds compared with 72% of 30-39 year-olds) and less likely to think they should be embarrassed about their behaviour (36% compared with 51% of 30-39 year-olds). They are also much more likely to agree that 'getting drunk is a perfectly acceptable thing to do at weekends' and much more likely to agree that 'there's nothing wrong with people my age getting drunk regularly' (Figure 3.6).

Figure 3.6 Agree/agree strongly with statements about getting drunk by age, 2007 (%)

Base: all who completed a self-completion questionnaire
Sample size: 18-29 = 155, 30-39 = 214, 40-64 = 634, 65+ = 306

3.24 However, it is worth noting that with respect to 'hazardous' drinking, the 30-39 year-old group also express relatively lower levels of concern. For example, 30-39 year-olds are not significantly more likely than 18-29 year-olds to consider the 'hazardous drinker' to have a 'very' or 'fairly' serious problem (64%/59%, compared with 74% of those aged 40-64) and they are similarly likely to disagree that they should feel embarrassed about their drinking (45% of both age groups, compared with 30% of the 40-64 year-old age group). Thus while those under 30 express the least concern about binge drinking, concern about hazardous drinking also appears relatively low among those in their 30s.

Sex of respondent

3.25 Gender appears to make much less of a difference to attitudes towards different types of alcohol misuse than age. For example, after controlling for age and other factors sex is not significantly associated with attitudes towards the 'seriousness' of 'binge' or 'hazardous' drinking, or with attitudes towards getting drunk. However, there is some evidence that women take the health risks of both 'hazardous' and 'binge drinking' more seriously than men - for example, 89% of women compared with 80% of men think 'hazardous' drinking is 'very' or 'fairly likely' to damage health if continued long-term. ²²

3.26 Women are also slightly less likely to agree that a 'chronic' drinker should feel embarrassed about their drinking (52% compared with 60% of men). As discussed above, this may be associated with seeing 'chronic drinking' as a medical problem, and therefore deserving sympathy rather than judgement. ²³

Sex of drinker

3.27 Attitudes appear to vary not only by respondent's own gender, but also by whether the drinker being described to them is a man or a woman. In particular, attitudes towards the young female 'binge drinker' (Karen) suggest that her behaviour attracts slightly more concern than that of her male counterpart (Mark). For example, of those asked about Karen, 34% say her drinking is a very serious problem and just 16% that it is 'not very' or 'not at all' serious. In contrast, just 26% think Mark has a 'very serious' problem and 23% consider it 'not very' or 'not at all' serious (Figure 3.7). Similarly, a higher proportion say Karen is 'very likely' to damage her health (51%, compared with 43% for Mark).

Figure 3.7 How serious a problem 'binge drinker' has, by sex of drinker, 2007 (%)

Base: All respondents
Sample size: Female scenario = 748, Male scenario = 760

3.28 However, with respect to the two 'hazardous' drinkers (Elaine and John), regression analysis suggests that people are in fact slightly more likely to be sceptical about the health impacts for Elaine than for John. Moreover, they are slightly more likely to disagree that Elaine should feel embarrassed about her behaviour. ²⁴ As discussed above, the amount of alcohol consumed varied for two versions of the scenario, with Elaine drinking half a bottle of wine a night, compared with two-thirds for John. This was intentional, since the scenario was designed to show people drinking just above recommended daily limits and these vary for men and women. ²⁵ However, given that, as discussed in Chapter Four, a significant minority of people are not aware of these recommended daily limits it is possible that some people are simply less likely to be concerned about someone drinking half a bottle of wine a night compared with two-thirds, regardless of gender.

Class, deprivation and income

3.29 Evidence that the middle-classes are increasingly drinking at 'hazardous' levels does not appear to be reflected in more permissive attitudes to this type of drinking among this group. In fact, regression analysis suggests that those in managerial and professional households are slightly less likely than those in routine and semi-routine households to dismiss the risks of 'hazardous drinking' - they are less likely to think 'hazardous drinking' is 'not very' or 'not at all' serious, and less likely to think this type of drinking is 'not very' or 'not at all' likely to damage health. ²⁶

3.30 In spite of the close association between deprivation and alcohol-related ill-health, there is no clear relationship between deprivation and income and attitudes towards the three drinking scenarios. ²⁷ With respect to getting drunk at the weekends, those in both the top and bottom income quartiles express less disapproval than those in middle-income groups - 21% of both those on under £10,000 a year and those on £38,000 or more agree that getting drunk at the weekends is perfectly acceptable, compared with just 10% of those earning £10-£22,999 and 8% of those earning £23-37,999.

Frequency of drinking

3.31 The relationship between frequency of drinking and attitudes varies depending on the type of drinking in question. There do not appear to be significant differences in attitudes towards binge drinking by how frequently respondents themselves drink. As discussed in Chapter Two, frequency of drinking is not always a good indicator of volume consumed. Perhaps even those who drink every day consider themselves to drink less than the hypothetical 'binge drinker', and therefore express concern about this type of behaviour.

3.32 However, attitudes towards the 'hazardous' drinker do appear to be somewhat more permissive among those who drink more often. Frequent drinkers are more likely than occasional drinkers to regard 'hazardous drinking' as 'not very' or 'not at all' serious (42% of those who drink 5 or 6 days a week or more, compared with 15% of those who drink once or twice a year or less). They are also more likely to disagree that 'hazardous' drinkers should be embarrassed about their behaviour (39% of those who drink 5 or 6 times a week or more often, compared with 19% of those who drink once or twice a year or less). ²⁸

3.33 Attitudes towards 'getting drunk' also vary by frequency of drinking. Regression analysis suggests that the biggest differences are between those who drink at least weekly and those who drink less often than this, with little significant difference between the attitudes of those who drink once or twice a week and those who drink almost every day. In fact, overall it is those who drink once or twice a week, rather than those who drink nearly every day, who are most likely to think that getting drunk is a perfectly acceptable thing to do at weekends (Figure 3.8). Again, these findings may reflect the fact that that frequency of drinking is not always a good indicator of volume consumed. It may be that those who drink once or twice a week are as likely (or more so) to get drunk at weekends as those who drink every day.

Figure 3.8 Agree/agree strongly with statements about getting drunk by frequency of drinking (%)

Base: All who completed a self-completion questionnaire and not don't know/refused at how frequently drink
Sample size: Every day/5/6 days = 120, 3/4 days a week = 163, 1 or 2 days a week = 395, 1 or 2 days/month/every couple of months = 343, once or twice a year or less = 136, does not drink = 143

Knowledge of recommended limits and alcohol content of wine

3.34 Knowledge of recommended daily limits for men and women is discussed in Chapter Four in detail. However, it is worth noting that knowledge of recommended limits is not very strongly associated with more or less concern about any of the three types of alcohol misuse explored in this chapter. ²⁹

3.35 Attitudes towards the 'hazardous' drinking scenario, which involved Elaine and John drinking wine most evenings, were also analysed by whether or not respondents could correctly identify how many units there are in a normal bottle of wine. ³⁰ Those who over-estimate the number of units are significantly more likely to view hazardous drinking as serious and as likely to impact on health. For example, while 84% of those who correctly identify the units in a bottle of wine say that hazardous drinking is 'very' or 'fairly likely' to impact on health, this rises to 92% among those who over-estimate the units per bottle. However, there are no significant differences in attitudes between those who under-estimate and those who correctly identify the number of units in a bottle. Thus it appears that accurate knowledge of recommended units and actual alcohol content alone does not necessarily have a strong positive impact on attitudes towards excessive drinking.

Other factors

3.36 Other factors associated with one or two of the questions discussed in this chapter include education, marital status and self-rated health.

3.37 Graduates are less likely than those with no educational qualifications to agree that the chronic drinker should feel embarrassed about their behaviour (possibly because they are more likely to feel their drinking should be viewed within a 'medical model' of alcohol misuse). Regression analysis also suggests that graduates are somewhat less likely than those with no qualifications to agree that getting drunk at weekends is acceptable. However, in fact it is those with no qualifications who are most likely to disagree with this statement (71% compared with 53% of graduates), with graduates simply more likely to express ambivalence, saying they 'neither agree nor disagree'.

3.38 Those who are single (never married) are more likely than those who are married or cohabiting and those who are divorced or separated to agree that 'there is nothing wrong with people my age getting drunk regularly'. Perhaps more surprisingly, regression analysis also suggests that those who are widowed are more likely than people who are married or cohabiting to think there is nothing wrong with getting drunk regularly. ³¹

3.39 Finally, those who consider their health to be 'fair' or 'fairly good', rather than those who consider it to be either 'bad/very bad' or 'very good' are most likely to regard 'hazardous drinking' as 'not very' or 'not at all' likely to damage long-term health. One speculative reason for this could be that those at the two extremes of the scale are more likely to take an active interest in their health, whereas those who feel in moderately good health may be less concerned with health-related issues.

Key points

• There is clear variation in how serious different patterns of drinking behaviour are seen to be - 99% view 'chronic' drinkers as having a very or fairly serious problem, falling to 80% for 'binge' drinkers and 71% for 'hazardous' drinkers. This is reflected in beliefs about how likely these behaviours are to seriously damage health in the long term (94%, 47% and 35% respectively think these types of behaviour are 'very likely' to damage long-term health).
• Slightly fewer people agree that 'chronic' drinkers should be embarrassed about their behaviour compared to 'binge' drinkers (56% compared with 60%). 'Hazardous' drinking attracts less stigma (just 38% agree they should be embarrassed).
• 49% of people think that a 'chronic' drinker who wants help should seek advice from a doctor in the first instance, compared to 36% and 29% for the 'hazardous' drinker and 'binge' drinker. Family and friends are viewed as the most appropriate source of support for 'binge' drinkers.
• Only 15% agree that getting drunk at weekends was perfectly acceptable, and just 10% agreed that there is nothing wrong with people their age getting drunk regularly. However, a substantial group of people 'neither agree nor disagree' on these questions.
• Young people hold more 'permissive' attitudes towards binge drinking and getting drunk - only 36% of 18-29 year olds agree that the 'binge' drinker should be embarrassed about their behaviour, compared to 51% in the 30-39 age category. They are also more likely to agree that there is nothing wrong with getting drunk regularly. However 30-39 year olds also hold relatively 'permissive' views in relation to 'hazardous' drinking.
• The behaviour of young female 'binge' drinkers appears to attract slightly more concern than that of young men - 34% say the hypothetical female 'binge' drinker has a 'very' serious problem compared to 26% in relation to the young man.
• Those in managerial and professional households are slightly less likely than those in routine and semi-routine employment to dismiss the risks of hazardous drinking.
• Attitudes towards 'hazardous' drinkers were more permissive among those who drink more often - 42% of frequent drinkers (who drink at least 5 or 6 days a week) think that 'hazardous' drinking is 'not very' or 'not at all' serious, compared with 15% of those who drink once or twice a year or less.
• However, those who only drink on one or two days a week are more likely than those who drink nearly every day to think that getting drunk is a perfectly acceptable thing to do at weekends.
• Knowledge of recommended daily limits for men and women is not strongly associated with more or less permissive attitudes towards any of the three types of 'problem drinking.'

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