In recent decades, there have been major changes in the pattern of alcohol use in the UK. Through most of the 20th century, UK licensing laws tightly restricted the availability of alcohol. Alcohol duty (a specific sales tax) made alcoholic drinks expensive to consume, especially at home. From around 1980, the UK government lifted restrictions on the availability of alcohol and the relative cost was allowed to drop. It is well established from the international evidence that overall population consumption of alcohol within a nation is closely related to availability and affordability. As prices have dropped, there has been a considerable rise in per capita alcohol consumption. Rates of alcohol-related harm, including death, have steadily risen.

At present, the alcohol industry accepts the need to control alcoholrelated harm. Their preferred method is educational. They use advertising campaigns to encourage the population to drink responsibly. They draw a sharp distinction between irresponsible drinkers, who drink in bad and harmful ways, and responsible drinkers, who, it is said, drink in moderate, harmless or even health-enhancing ways. The distinction between responsible and irresponsible drinking patterns has a commonsensical appeal. It echoes the popular idea of the ‘alcoholic’, who suffers from a disease of alcoholism, and drinks in a pathological fashion that is different to how other people drink. However, the distinction between ‘responsible drinkers’ and ‘irresponsible drinkers’ is hard to sustain on the basis of the scientific evidence (Bailey et al, 2011).

Levels and patterns of alcohol consumption are continuously distributed in the population. Harmful drinking differs from less harmful drinking as a matter of degree, not type. There is a syndrome of physical and psychological dependency (characterised by tolerance, withdrawal symptoms and a range of behaviours reflecting the salience of drinking over other activities), but a large proportion of those harmed by alcohol do not show this. Increases in alcohol consumption have affected everyone who drinks (about 95% of the UK adult population). It is not confined to ‘problem’ drinkers or the alcohol dependent. Rates of heavy drinking have increased especially quickly among women, who in general tend to consume less than men.