The role of alcohol price in young adult drinking cultures in Scotland

Abstract

Minimum Unit Pricing (MUP) is one of the Scottish Government's key policy options to reduce alcohol consumption and related harm. Although strongly evidenced for efficacy in reducing headline population level consumption, efficacy in changing the role of alcohol in Scottish culture is unknown. Questions remain as to how MUP will play across population subgroups with different sensitivities to price. In this paper we explore the views of the young adult population and situate the influence of price paid for alcohol alongside broader cultural drivers of consumption. Qualitative data from two studies investigating the role of alcohol in the transition to adulthood from 130 participants (aged 16–30) are analysed to situate the influence of price paid in shaping drinking styles and practices. Findings highlight how considerations of price paid for alcohol compete with non-financial considerations associated with choosing to drink excessively, moderately or not at all. Two broad categories of response to potential price increases were anticipated by drinkers which indicate that young adults are not a homogenous group in relation to price sensitivity. These differences highlight the potential for variation in subgroup responses to a pricing policy conceived to be effective at a population level.

Minimum Unit Pricing as a policy response formulated within a whole population perspective

That Scotland has a high rate of alcohol consumption, and harm has become an epidemiological truism (Leon & McCambridge, 2006; National Alcohol Information Resource, 2004; Smith and Foxcroft 2009). In response, the Scottish Government published Changing Scotland's Relationship with Alcohol: a Framework for Action (Scottish Government, 2009) its national alcohol strategy which is notable for both adopting a population level approach to reducing alcohol consumption and, included within it, a proposal to introduce a Minimum Unit Price (MUP) at which alcohol can be sold. In May 2011, a Scottish Parliamentary Bill set the proposed price at 50 pence per unit, a figure arrived at using evidence provided by the Sheffield Alcohol Minimum Price Modelling team (Meier, Purshouse, & Brennan, 2009; Meng, Purshouse, Brennan, & Meier, 2010; Purshouse, Meier, Brennan, Taylor, & Rafia, 2010). A stated aim of the alcohol strategy is to bring about ‘lasting social and cultural change’ around the place and role of alcohol in Scottish life (Scottish Government, 2009). However, little is known about the nature of the relationship between price manipulations and cultural change, as distinct from easier to measure headline population level rates of consumption. The current evidence on the efficacy of pricing can be criticized on grounds of not addressing alcohol price as a ‘complex stimulus’ for which consumer responses to price increases need to be understood not only as attributes of alcohol beverages themselves but also as reflections of prevailing drink habits and culture (Osterberg, 2004). This raises questions around how policies aimed at reducing population level consumption play out firstly, between different societies in which culturally grounded relationships with alcohol are in play, and within populations where active interpretations and adaptations of national alcohol cultures are in operation, adaptations that are particularly observable in how younger age cohorts drink (Hackett, Seaman, & Edgar, 2012; Martinic & Measham, 2008; Seaman & Ikegwuonu, 2010).

Further, there is a high-level concern that a focus on population level understandings of alcohol as a problem can narrow policy makers perceptions of the range of responses available. As Kneale and French (2008) have previously commented in this journal, the framings and understandings employed in the construction of alcohol as a problem have been subject to historical change. As Berridge and Thom (1994) describe, the 1970s and 1980s saw the emergence of a population level perspective in which the link between per capita consumption and the level of alcohol misuse in the population came to be understood as a policy ‘fact’. The contemporary viewing of alcohol through an epidemiological framework, though useful in providing technologies of measurement, identification of trends and assessing level of policy priority, at the same time runs the risk of ‘ignoring the complexities of medical and public health conceptions of alcohol in favour of much simpler and political expedient stories about the influence of government or the drinks trade’ (Kneale & French, 2008). An example of this simplification within the Scottish alcohol strategy may lie in the aim to bring about ‘lasting social and cultural change’ around the place and role of alcohol in Scottish life (Scottish Government, 2009) through a pricing stimulus. Whilst a whole population approach allied by technologies of epidemiology lend themselves well to measuring the relationship between price manipulations and headline changes in total consumption, whether this demonstrates cultural change; a shift in the meanings and understandings around the role of alcohol and the place of drinking and drunkenness is another matter. This becomes salient in appraising whether a reduction in the amount consumed by a population equates a healthier national relationship with alcohol or merely reduced opportunity to enact that relationship.

Studies of cross-cultural variation in the meaning of consumption, as included in Osterberg's (2004) review have been unable to extract a universal price point at which consumption decreases despite showing that increases in alcohol price consistently led to decreases in population level consumption. Local cultural norms around alcohol prevented a mean elasticity value or a value of ‘the sensitivity of quantity demanded to changes in prices, when other determinants remain unchanged’ (Osterberg, 2004, p. 202) being expressed in universal terms. Not only between societies but within them, evidence exists for differentiated interpretations, enactments and understandings of normative practice around alcohol indicating challenge in measuring success at a population level. Such differentiation echoes Plant and Plants’ (2006) description of the United Kingdom possessing a plurality of drinking cultures of which differences both between Scotland and the rest of the UK and within Scotland are evident. For example, the claims that Scotland suffers a burden of high rates of consumption and associated harm in relation to the rest of the UK are supported by mortality and morbidity data (Leon & McCambridge, 2006; National Alcohol Information Resource, 2004; Smith & Foxcroft, 2009). Although such differences will be underpinned in part by shared cultural elements, evidence of differentiated and divergent practices and harms across subgroups suggest differences in how shared cultural norms are played out. For example, consumption patterns indicate that men living in the least deprived areas in Scotland are more likely to drink ‘hazardously’ (30%) than those in the most deprived (24%). However, of those men whose drinking translates into the more serious ‘harmful’ category rates are greater in the most deprived category at 7% compared with 4% in the least deprived (ISD, 2010). Further, alcohol-related hospital discharges in Scotland show a greater polarization by deprivation category; in 2009/10 at 200 per 100,000 for the least deprived category compared with 1600 per 100,000 for the most deprived (ISD, 2010).

Similarly, age segmentation of consumption reveals heterogeneity and within population complexity at a UK level. Smith and Foxcroft (2009) indicate that a ‘possible recent decrease in drinking amongst 16–24 year olds’ is potentially off-set by increases in the consumption of middle and older groups and ‘rising consumption amongst adolescents over the last decade’. The inclusion of abstainers within such headline measures of young adult consumption indicating higher than previously anticipated numbers of moderate or occasional drinkers (Herring, Bayley, & Harcombe, 2012) further obscures the distribution of risk within the population.

Given the tendency of large scale data sets to promote homogenized and generalized views of headline consumption trends, they can neutralize the ‘particular meanings and uses of alcoholic beverages across diverse cultural environments … [which] … interact with a whole web of individual, community and societal influences on daily behaviour’(Wagenaar, Salois, & Komro, 2009). Although attempts to understand the price sensitivities of different subgroups within a population have not been absent from the evidence base for MUP, analyses of variations in responses (often expressed as consumer ‘elasticities’) have tended to operationalize ‘heterogeneity’ in terms of the individual characteristics of drinkers such as their sex and age (Cook et al., 2011; Herttua, Makela, & Martikainen, 2008; Heeb, Gmel, Zurbrugg, Kuo, & Rehm, 2003) or type of drinker, such as whether moderate or heavy consumers (Ayyagari, Deb, Fletcher, Gallo, & Sindelar, 2011; Cook et al., 2011). However, there is less evidence relating to the context in which the drinking takes place as a salient feature of cultural heterogeneity; the different meanings, values and practices around alcohol that operate in the contexts different groups drink. The role of contextual factors in creating variations in price sensitivity may inform policy makers of the unintended consequences of population level interventions whilst also indicating processes that mediate the relationship between pricing interventions and broader cultural change.

Possible insights into contextual differentiation are provided by researchers applying a spatial contextualization of consumption using qualitative methodologies. Focussing on norms and practices, understandings and enactments over measures of absolute consumption, variant alcohol cultures have been identified across rural and urban locales (Heley, 2008; Leyshon, 2008) and city centre destinations within the night time economy (Hayward & Hobbs, 2007; Eldridge & Roberts, 2008). However, as Jayne, Valentine, and Holloway add as a caveat, such spatial contextualization of young adult alcohol consumption can also tend ‘to depict an overly neat picture of evening and late-night drinking ghettos in UK city centres populated by young people who are drunken and violent’ (2008, p. 225).

A key driver of research on subgroup variations in price sensitivity has been to understand the proportional effects of pricing policies on different types of drinker (Meier et al., 2009). In the Scottish debate around MUP, a key test for the political acceptability of the proposed policy was whether it would reduce the consumption of harmful drinkers whilst not disadvantaging less affluent consumers. Evidence has highlighted that an MUP policy would not only reduce population level consumption and harm but also target drinkers experiencing the highest levels of harmful consumption. For example, a study of Scottish addicted drinkers found this subgroup as the group most likely to purchase the cheapest alcohol available and therefore most likely to reduce consumption after implementation of a MUP policy (Black, Gill, & Chick 2011). However, Meier et al. (2009) have also raised the question of unintended consequences of making alcohol more expensive through the potential for substitution to other substances or increases in criminality driven by decreased affordability of alcohol. Black et al. were unable to speculate whether price legislation would encourage stealing of alcohol or the consumption of substitutes. However, a review of existing literature (Moore, 2010) indicated that the drinking subgroup ‘consuming stronger alcoholic beverages more frequently’ had a greater likelihood of complementing their consumption with a range of intoxicants other than alcohol. Understanding the unintended consequences of a population level policy requires situating alcohol decision making within a wider nexus of influences, normative practices and the available range of intoxication choices within the drinker's milieu. For example, Sumnall, Tyler, Wagstaff, and Cole's (2004) study of polysubstance users in their early twenties, for whom alcohol consumption sat within a range of substance choices, found that increases in the price of alcohol led to decreases in alcohol consumption but promoted amphetamine use.

Young adulthood as a context of alcohol decision making

The period of young adulthood as a life-stage can be understood as a particular social and cultural context in which norms and practices around consumption are shaped by the behavioural expectations of others. For this subgroup of drinkers, the price and availability of alcohol are interwoven with drivers within the cultural enactment of young adulthood. Although young adults have been demonstrated as a group particularly sensitive to price (Dhalwani, 2011; Lockhart, Beck, & Summons 1993) how price sensitivity might emerge within the enactment of young adulthood (in which peer belonging becomes central) and the potential for variation therein is less understood within alcohol pricing research. A study in England (Cook et al., 2011) of consumers of all ages found the 18–24 year old subgroup more likely to decrease consumption in light of hypothesized price increases (30% compared to 22% of the entire all age sample), yet other evidence points to a contextual influence on the relationship between price and consumption. For example, Purshouse et al. (2010) identified policies targeting cheap – on trade alcohol having greater efficacy for 18-to-24-year-old ‘hazardous’ drinkers than policies targeting cheap off-trade alcohol, highlighting a potential role for the context in which purchasing and consumption takes place. This limited perspective on contextual influence does not however assist in developing the understanding of how differentiation in elasticity arises.

Existing explorations of the contemporary cultural context of young adult consumption have highlighted the prominence of ‘determined’ or purposeful drunkenness as a normative feature of alcohol use within the enactment of the life-phase (Hayward & Hobbs, 2007; Martinic & Measham, 2008; Plant & Plant, 2006). Such work has focussed on young adulthood as a ‘liminal’ or in-between life-stage in which identity, whilst in flux, allows the exploration of excessive relationships with alcohol without damaging longer term self-identities (Banister & Piacentini, 2008; Piacentini & Banister, 2006, 2009). Yet, we should not view young adulthood itself and relationships with alcohol therein as universally experienced within a culture. In response to an observed headline reduction in alcohol consumption in the 16–24 age group between 2000 and 2006 (Robinson & Harris, 2011), a potential ‘polarization’ of consumption, characterized by more abstainers and heavier consumption in those continuing to drink (a ‘more alcohol down fewer throats’ scenario) has been described (Measham, 2008). Further, research by these authors indicated that transitional or ‘liminal’ relationships and practices around alcohol are made possible by the availability of resources found within in the contexts and timings of young adulthood, experienced differently across socio-economic trajectories (Seaman & Ikegwuonu, 2011). Given that alcohol consumption is normative, culturally located behaviour as much as a rational response to stimuli such as price, there is a need to understand how price paid for alcohol relates to the overlain cultural drivers of consumption, particularly in an age group for whom alcohol has a distinctive role in the enactment of social and cultural identities.

Data collection

Two qualitative studies exploring the cultural role of alcohol in the transition to adulthood were undertaken between 2008 and 2011. The first study was funded by the Joseph Rowntree Foundation with the second follow on study funded by the Glasgow Centre for Population Heath. The first study explored the socio-economic trajectories of young adults influenced alcohol use in the formation of identities, the enactment of young adulthood as a lifephase and the formation and maintenance of social networks (Seaman & Ikegwuonu, 2010). The follow on study explored similar interests but with concentration on the role of gender (Seaman & Edgar, 2012). Both studies adopted mixed qualitative methods including interviews, focus groups and visual methods in the forms of graphical elicitation (Prosser & Loxley, 2008). The data generation sought to situate drinking practices within the lived experience of young adults paying particular attention to intentions around drinking occasions relating to transition milestones (e.g. participation in education, entering the labour market, partnering, parenthood and leaving home) and the network and environmental influences of drinking decisions. Consequently, it was possible to situate participant discussions of price paid as a stimulus for consumption styles and amount consumed within this broader set of influences.

The first study included 80 participants aged between 18 and 25 of which 76 currently drank alcohol. All 80 took part in focus groups which were purposively selected on the basis of gender and educational status as an indicator of lifecourse trajectory; whether participants were in higher education, full-time employment or not in education, training or employment. Of the 80, 35 took part in individual interviews which utilized relational mapping (Bagnoli, 2009, Josselson, 1996) to help locate drinking practices within social networks. Interviews were conducted twice at least three months apart to encourage reflection over the time period and to explore change over time. In the second study, 50 participants aged between 16 and 30 years old were included across eight focus groups composed of young adults of the same gender, age (16–18 or 25–30) and trajectory to adulthood (whether on a higher education trajectory or not). A higher upper age limit was included to further explore changes in alcohol use as young adults incrementally achieved successive markers of full adult status, a factor raised in the first study. The follow on study was not designed to replicate the design of the first study, but to provide additional insight into gender influence. Therefore we chose gendered focus group using graphical elicitation as the primary form of data collection.

Data analysis

With the aid of the Atlas ti software package, transcribed data from both studies were interpreted through a Grounded Theory (Glaser & Strauss, 1967; Strauss, 1987) approach to generatively identify themes that could be compared and contrasted between subgroups in relation to gender, socio-economic trajectory and age range. We began the process with ‘open coding’ by categorizing the data into coded sections and organizing the codes into broader thematic categories. ‘Axial coding’ was employed to explore the relationships between the thematic categories. A third stage of selective elective coding involved understanding links between the categories and selecting a core, emergent theme (Strauss, 1987).

Findings

Although reference was made to the price paid for alcohol in descriptions of consumption habits, accounts also situated decision making within the broader drinking milleux of young adulthood. Excessive alcohol consumption in young adulthood, although supported by the cheaper availability of alcohol, also had origins within a confluence two cultural drivers of excessive consumption, the enactment of both a transition to adulthood understood in broad cultural terms, and in the case of this West of Scotland sample, combined with an enactment of national cultural identity. Both these cultural drivers saw alcohol consumption and intoxication recast by participants as predominantly social, shared and collective activity. Consequently, in anticipating increases in price paid for alcohol, two categories of response emerged from the analysis suggesting responses to pricing are shaped as much by understandings of appropriate consumption within a culturally located transition to adulthood as much as they are rational responses to price stimuli.

The value of alcohol consumption in enacting a ‘Scottish’ transition to adulthood

In the data generated across the studies, a perceived norm for excessive consumption in young adulthood was contextualized as having a local or national element. This led to reports of a clear dissonance when considering the potential harms and benefits from excessive consumption. Alcohol's role was positively framed as central in defining occasions of celebration, relaxation and socializing and consequently its role in facilitating explorations of identity and in forming and maintaining friendships was highly valued. However, although simultaneously identified as potentially damaging, it was the cultural place of alcohol which permeated descriptions of learning to drink.

N:  It's the way you’re brought up.

M:  Aye your parents did it. My mum used to tell me stories about when she went to parties and folk were being sick downstairs and stuff. I suppose it's just part of the tradition … . I would say that everybody who is sixteen to eighteen in Scotland has experienced a house party of some description.

Males 16–18, higher education trajectory, second study

For such a small country but with a massive alcohol problem, we are just constantly confronted with it and sometimes when you are younger, you’re just like, well let's deliver on that promise.

Female 25–30, higher education trajectory, second study

A central value of alcohol therefore came not from the intrinsic qualities of its taste or even its intoxicating potential but a value created by the cultural positioning of the commodity. Alcohol facilitated participation within the dual cultural narratives of ‘becoming adult’ and ‘becoming adult in Scotland’. This link with alcohol use as part of the enactment of a time limited life-phase has been identified in previous research as allowing experimental and excessive relationships with alcohol whilst protecting individuals from perceiving themselves as having a longer term problematic relationship with alcohol, believing they will grow out of it (Banister & Piacentini, 2008: Martinec & Measham, 2008). In the context of this research, however, the addition of a local cultural understanding of the role of alcohol increased the sense of hazard and risk rather than minimizing it.

The situating of excessive alcohol use as a normative part of young adulthood led to a role for the price paid for alcohol in facilitating choices around where and how alcohol was consumed. On one level, young adults viewed themselves as price-sensitive consumers who, on limited incomes as recent arrivals to the labour market, searched for financially efficient means of enacting young adult drinking practices; ‘The price of drinks often determines which pub we go to. Like ‘V Club’ does cheap drinks on weekdays so we tend to go then’ (Male, higher education trajectory, second study). Further, the relative affordability of alcohol could support and encourage excessive consumption; ‘Sometimes I get really drunk, especially when it is pound a drink night because you are not spending much money’ (Female, 18–25, in higher education, first study).

However, further exploration of the experience of drinking in cheaper venues revealed the relative affordability of drink was not the main motivating factor in decisions around excessive drinking. The price of alcohol was an integral feature of an overall ‘offer’ being made to young people by venues that situated excessive alcohol consumption as central to participation and in doing so, underlined the sense that the venue was age appropriate. In such spaces, respondents described the rapid consumption of multiple drinks to achieve intoxication as normal practice. Indeed, price played an important role in setting the pace of the consumption, not just through allowing access to greater amounts of alcohol but also by establishing a norm for excessive consumption within venues.

A: Maybe you wouldn’t want to drink but you just do because everybody's drinking and you know you’re just going to be in a mood if everyone else is just shouting at you because they’re drunk or trying to pull you up to dance. They’re all like getting their groove on and you’re like trying, but you’re not drunk.

J: You just look really silly if you’re sober

Female group, 16–18, non-higher education trajectory, second study

Affordability would also influence drinking expectations within a venue in less direct ways. One group of young women told of how the sale of cheap drink often lengthened queues at the bar which in turn made multiple purchases at a time appear rational to avoid re-queuing. Further, drinks were often consumed rapidly not to achieve drunkenness per se but to allow dancing, as leaving drinks unattended meant female drinkers risked spiking. Woven throughout accounts of the relationship between price and consumption was the pursuit of friendship activity meaning price paid for alcohol often became a background consideration. This was evident in account of ‘pre-drinks’ – domestic drinking of off-sales alcohol prior to a night out. In existing research and policy literature, this phenomena is often termed ‘pre-loading’ (a term never used by our participants), which foregrounds the volume of alcohol consumed. ‘Pre-drinks’ on the other hand, though describing the same practice, tends to prioritize the social and integrative aspects of the activity. Rather than being a strategy for increasing the volume consumed to price paid, ‘pre-drinks’ was described as a social activity foregrounding the intentionality of group identity formation through alcohol use. Sharing news, catching-up on gossip and getting ready were features of ‘pre-drinks’ which also described elsewhere (Forsyth, 2010), in our data the pursuit of intoxication itself was described through reference to the creation of a shared, collective experience that could help forge group solidarity.

What we’ll do is this, we’ll get a big bowl and fill it with vodka and put diluting juice in and everyone get a straw and drinks it. … Just so we’re all at the same level of drunk, if that makes sense.

Female group, 16–18, higher education trajectory, second study

How would drinking intentions and behaviours change in response to price increases?

Given the intertwined nature of cultural and contextual imperatives with pricing stimuli in shaping young adult drinking practices, how did participants believe drinking would change in response to alcohol becoming less affordable? Two broad categories emerged from respondents’ accounts. The first category of response viewed favourably the removal of cheap alcohol as encouragement for moderated consumption in support of aspirations to drink in a ‘more sensible’ manner. This ‘moderating’ predicted response would sit with intentions to ‘move on’ from a drinking style participants were beginning to view as youthful and immature. A second viewpoint prioritized the cultural benefits associated with drinking excessively and the removal of an opportunity for social participation that would accompany lowered consumption. This latter viewpoint predicted a ‘reconfiguring’ of excessive drinking in the face of decreased affordability and such accounts included predictions of substitution or ‘saving up’ opportunities to drink excessively.

‘Moderating’ response

The ‘moderating’ viewpoint was aligned to the view that cheap alcohol made for intoxogenic drinking spaces orientated towards younger drinkers, and thus undermined intentions to drink moderately. Older participants repeatedly described a process whereby their intentions around alcohol had begun to focus more on the quality of experience associated with drinking. This process often combined with the attainment of markers of full adult identity such as entering the job market or partnering as discussed elsewhere (Seaman & Ikegwuonu, 2011). The evidence from the qualitative data suggest that the early twenties were considered the appropriate time to ‘move on’ from youth-orientated drinking environments, consistent with Maggs and Schulenberg's (2004) identification of 22 years through cross-cultural comparison. One respondent felt this to be normative reporting ‘once you hit twenty three you can’t be seen in a club ever again [laughs]. It's just, you don’t want to be that creepy older guy in a club, […] you’ve only got like 5 years to do it’ (Male, 16–18, higher education trajectory, second study). Cheap alcohol and the places where cheap alcohol was sold were considered to encourage low-quality, high-quantity drinking associated with younger adulthood. The above quote also illustrates the intertwined nature of culturally appropriate relationships with alcohol and the age-appropriateness of associated places. Similarly, the availability of cheap vodka shots in bars was seen to override preferences for ‘better tasting’ drinks associated with more moderate consumption styles.

Interviewer: So how do you decide what you want to drink?

L: Generally price. Like if we’re going to a place and it's like £1 a pint or a vodka mix, I go for that. But if it's normal prices for everything, I’d go for what tastes best.

I: You’d probably drink higher quality alcohol … like some of this stuff you get at clubs, the cheap vodka like (brand)- this can’t be good for me. Doesn’t feel natural, it doesn’t feel good.

Males, 18–25, higher education trajectory, first study

If one drink is more expensive you make it last rather than buying three, you become more sensible

Male, 18–25, in employment, first study

Paying more for alcohol was associated with qualities beyond its ability to bring intoxication such as the overall quality of the drinking experience. With this understanding, being restricted to purchasing smaller amounts of alcohol for the same expenditure could be tolerated. There was also evidence of increases in predicted income encouraging moderation despite increasing affordability. This suggests increased income as a component of affordability was associated with an emerging period of maturity when decision-making around what and how to drink were based on criteria associated with full adult status rather than those of young adulthood.

I think if I had more money I would drink less, but drink good stuff. Some nice cider rather than (Cheap white cider brand). Nicer stuff, but less of it.

Female, 18–25, higher education trajectory, first study

However, for individual drinkers in the youth-orientated night time economy, we found evidence of pricing failing to work as a moderating influence with some individuals spending as much as was required to continue their drinking:

K: Spend as much money as you can [laughs].

Int: Right so how much would you spend?

K: Well two weekends ago I spent four hundred and twenty five pounds in one weekend

Int: Right ok.

K: So I’m absolutely skint now.

Female group, 16–18, non-higher education trajectory, second study

‘Reconfiguring’ response

A contrary position to moderation was – the ‘reconfiguring’ perspective on price increases, explored the view that the cultural benefits associated with excessive alcohol consumption, particularly in the transition to adulthood, held a value which would continue to be sought even at a higher price. Affordable alcohol was seen to democratize social participation with substitution to illegal alcohol or intoxication by other means not ruled out in response to price increases.

They are not going to stop it by putting the prices. Putting prices up means you just go and buy something else. Just going to resort to taking drugs. Instead of me going to the shop, one of my mates sells vodka for £6.50 a bottle. Or I can buy wine. She sells cases of that; six bottles for £15.

Male, 18–25, not in education or in employment, first study

I do think if they put the price of alcohol up more people would turn to ecstasy. You need to have fun on a night out!

Female, 18–25, in full time employment, first study

The above reconfiguring responses highlight how understandings of heterogeneity should take account of the context in which drinking takes place, as well as the individual characteristics of the drinker. In the cases of those predicting substitution to other substances, a prerequisite was existing connection with other markets for intoxication (whether illegally sold alcohol or other drugs). For those not comfortable with purchasing illegal products, there was no suggestion of substitution. For those predicting substitution to either illegal alcohol or other drugs, the risks associated with both chronic harmful consumption and other forms of substance misuse remain extant possibilities. Given that substitution to illegal alcohol or other drugs requires existing contact with such markets highlights how MUP may have the potential to exacerbate existing environmental risks located within the places and associated norms of intoxication. Specifically, access to street-sold alcohol and drugs were mentioned as mediating factors (see male 18–25 and above). For drinkers demonstrating this response, risks over the long term are possible.

Reconfiguring in other cases took the form of continuing to drink excessively when the occasion merited it, but drinking excessively less frequently to absorb price increases. This view saw achieving drunkenness as an ‘event’ or ‘treat’ worth greater expenditure episodically. The key contextual factor here was the cultural value placed on alcohol in the enactment of young adulthood as a life phase and, as we see below, whether pricing stimuli will produce different styles of consumption and relationships with alcohol is a moot point.

I have to say most times I go out with the intention of getting really drunk, because when I do go out it is kind of an event and I don’t really pay attention to like how much things cost.

Female, 18–25, higher education trajectory, first study

In such instances of reducing the episodes of consumption, but still maintaining them occasionally highlights how the risks and harms associated with hazardous drinking, such as injuries, will still prevail for such drinkers even after an MUP policy. Therefore the question after MUP may be for which types of drinker and in which contexts will the potential for headline reductions in consumption and harm be reflected?

Conclusion

The data described here highlight a limitation of seeking to solve alcohol as a problem at the national level through the application of universal polices. Through understanding alcohol's cultural value within young adulthood, potential heterogeneity in responses to a population level policy in the form of minimum pricing are revealed. Young adults themselves represent a group of consumers for whom, once cultural imperatives associated with drinking are understood, can predict a continued excessive relationship with alcohol or other substances in certain contexts. This illustrates scope for differentiation in responses within this age group. The two varieties of ‘reconfigured’ responses to decreased affordability shown here suggest that responses to MUP policy for certain drinkers may not track headline population-level predictions of reduced consumption and harm.

The predicted responses to decreased affordability are neither exhaustive of how all groups respond, nor may their predictions translate into actual behaviours post MUP. This is a limitation of using qualitative methods to predict future behaviour in circumstances not yet arisen. Additionally, the self-selecting nature of those opting into the study means generalization of responses is unwise, however, other harmful adaptations may exist in other age groups. A classic criticism of focus groups as a method of data collection is that they tend toward consensus or culturally expected views (Bryman, 2008; Morgan, 2002) and some individual narratives and processes outside the consensus could not be pursued in depth. The implementation of MUP in Scotland would however provide the opportunity for further empirical explorations of differential responses to the use of pricing stimuli as a population level intervention, given the indication of differentiated and potentially harmful response indicted here. This highlights a need to monitor and identify the variety of differential responses to MUP within the population and not only the headline measures of national consumption which may disguise hidden risks and harms. Ideally, a longitudinal study of how particular types of drinker (segmented by age, gender, socio-economic trajectory and/or area level of deprivation) respond to pricing stimulus complemented with qualitative explorations of decision making would assist in the design of policy and practice responses for groups for whom hazard and harm may remain extant possibilities.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article.