Alcohol-free and low-alcohol drinks are becoming increasingly popular in high-income countries. However, there is limited evidence on their use among general population samples. Drawing on social practice theory, this study aimed to examine how and why people who drink at high-risk levels embed alcohol-free and low-alcohol drinks into their everyday practices when trying to reduce their alcohol consumption. Four online focus groups were conducted with a total of 31 adults from England and Scotland who had made at least one attempt to reduce their high-risk alcohol consumption in the previous 12 months. Data were analysed using reflexive thematic analysis, applying a combination of an a-priori deductive coding framework and inductive coding based on the data. Eight of the 31 participants were ultimately excluded from the final thematic analysis as these participants consistently provided minimal or non-substantive contributions. Consequently, the data come from 23 participants. Three overarching approaches were identified. The first was adopted by participants who mostly consume soft drinks at home but find the material resemblance between alcohol-free and low-alcohol drinks and standard alcoholic drinks allows them to replicate drinking rituals in social events outside the home, evoking meanings of friendship, belonging, celebration and fun. The second approach involves participants who integrate alcohol-free and low-alcohol drinks into routine practices at home (e.g. watching TV, reading), but struggle with diverse pressures to consume alcohol during socially-driven or intoxication-oriented practices. The third approach involves participants who find alcohol-free and low-alcohol drinks conflict with their established drinking practices and perceive them as ‘bad value’ due to their lack of alcohol, poor taste and high cost. Use of alcohol-free and low-alcohol drinks in attempts to reduce alcohol consumption may operate differently among consumers depending on perceptions of their material properties and their fit with key elements of individuals’ pre-existing drinking practices.

INTRODUCTION:In the UK, consumption of alcohol-free (< 0.05% ABV) and low-alcohol (≤ 1.2% ABV; NoLo) drinks is more prevalent among heavier drinkers and socially advantaged groups. If heavier drinkers are substituting alcoholic drinks with NoLo drinks, this could improve public health. However, socioeconomic differences in consumption could exacerbate alcohol-related health inequalities. Socioeconomic groups vary in their reasons for drinking alcohol, with less advantaged individuals more likely to drink alcohol to cope. This study examined whether alcohol drinking motives can help explain differences in NoLo consumption. METHODS:A total of 2549 adults residing in Great Britain provided data on at least monthly NoLo consumption, hazardous drinking (AUDIT-C), alcohol drinking motives, social grade, education, age and gender, via the Alcohol Toolkit Study. Path analysis explored mediating effects of drinking motives between sociodemographic characteristics, hazardous drinking and NoLo consumption. RESULTS:Drinking alcohol to conform, education and hazardous drinking were positively associated with NoLo consumption. Drinking alcohol to cope with depression was a serial mediator between social grade and NoLo. Drinking to cope with depression, more frequently reported among lower social grades, weakened the positive relationship between hazardous drinking and NoLo consumption (β = -0.001, 95% CI -0.002, -0.000). Enhancement and social motives also weakened this relationship, partially mediating pathways between age, gender, education and NoLo consumption. DISCUSSION AND CONCLUSIONS:While hazardous drinking is positively associated with NoLo consumption, for those drinking to cope with depression, for enhancement or for social reasons, this effect diminishes, potentially limiting the public health potential for those who drink for these reasons, including disadvantaged groups.

INTRODUCTION:The increasing popularity of alcohol-free and low-alcohol (NoLo) drinks could reduce alcohol-related harm if those at greatest risk replace their standard alcoholic drinks with these products. This paper aimed to identify: (i) characteristics associated with occasional purchase of NoLo drinks in Great Britain in 2021; and (ii) whether these characteristics changed between 2018 and 2021. METHODS:Logistic regression using data from Worldpanel by Numerator dataset detailing alcoholic and NoLo drink purchases in the off-trade (i.e., shops) by households in Great Britain in 2018 (n = 14,702) and 2021 (n = 15,257). The primary outcome was occasional NoLo purchasing (≥ 4 times in the past year), and secondary outcomes were occasional NoLo beer, cider or wine purchasing. RESULTS:In 2021, 5.7% of households purchased NoLo ≥ 4 in the past year, compared to 3.0% in 2018. In 2021, these households were more likely to be alcohol purchasers than non-purchasers [low-risk purchasers (≤ 112 g per week): OR = 7.11, p < 0.001; increasing risk (113-280 g per week): OR = 10.72, p < 0.001; higher risk (> 280 g per week): OR = 12.10, p < 0.001] and less likely to be from lower social grades than grade AB (Grade C2: OR = 0.72, p = 0.008; Grade D: OR = 0.58, p < 0.001; Grade E: OR = 0.46, p < 0.001). Results were similar for occasional purchasers of NoLo beer, but there was no significant association with social grade for purchasing NoLo cider or wine. The characteristics associated with occasional NoLo purchasing did not change significantly between 2018 and 2021. DISCUSSION AND CONCLUSIONS:Households from higher social grades who purchase more alcohol are more likely to regularly purchase NoLo products.

INTRODUCTION:Governance of alcohol-free and low-alcohol (No/Lo) drinks has the potential to influence their public health impact. However, regulation remains poorly understood. This study aimed to identify, summarise and compare formal legal frameworks, non-binding government guidance and recognised self-regulatory frameworks for the labelling, taxation, licensing and condition of sale and marketing of No/Lo drinks across a diverse set of countries. METHODS:We conducted a desk-based analysis, supplemented by expert input. Eight case study countries (Australia, Finland, Germany, the Netherlands, Norway, Thailand, the United Kingdom [UK] and the United States of America) were selected for their diversity in geography, alcohol consumption and policy environments. Targeted searches identified documents for determining how No/Lo products were regulated in relation to their labelling, taxation, licensing and conditions of sale and marketing. Data were extracted, tabulated and reviewed for accuracy. RESULTS:Regulatory thresholds (%ABV) that determine when drinks fall under alcohol legislation vary widely both across and within countries and definitions of No/Lo products are uncommon. For example, drinks can be labelled as alcohol-free at ≤ 0.05% alcohol by volume (ABV) in the UK, but ≤ 1.15% ABV in parts of Australia. Sales of drinks below defined thresholds generally do not require a premises licence. Marketing restrictions were generally shaped by those for standard alcoholic drinks, although new self-regulatory guidance has been developed in Australia, the Netherlands and the UK. DISCUSSION AND CONCLUSIONS:Governance of No/Lo drinks is fragmented and inconsistent, with definitions and regulatory thresholds varying both across countries and between policy areas within countries.

BACKGROUND AND AIMS:Alcohol-free and low alcohol [no/lo; ≤1.2% alcohol by volume (ABV)] drinks are increasingly popular in some high-income countries and offer potential public health benefits if used as substitutes for regular-strength drinks; however, perceived high prices may deter people from buying these products. This paper explored whether no/lo drinks are more expensive than regular-strength drinks. We compared for no/lo and regular-strength drinks: (i) average prices and price distributions; (ii) prices of products matched on brand and pack size; and (iii) average prices across different multipack sizes, container sizes and container types (e.g. bottle vs. can). DESIGN:Cross-sectional analysis of population-level, off-trade (i.e. shops) sales data. SETTING:Great Britain, 2024. CASES:N = 21 147 no/lo and regular-strength stock-keeping units (SKUs, e.g. 6x300ml Heineken 0.0). MEASUREMENTS:We analysed data from the market research company Circana. Analyses were stratified by beverage categories: beer, cider, wine, spirits and ready-to-drinks (RTDs). Our primary measures were median prices of all products available and median purchase prices (i.e. weighted by sales volume). Prices were per standard serving size for each beverage type. We used quantile regression to test differences in median prices. FINDINGS:In 2024, the median price of no/lo drinks available was lower than for regular-strength drinks (ranging from beer -19% to wine -44%; P < 0.001), except for RTDs (11% higher; P = 0.390). In contrast, the purchase price of no/lo drinks was 7% higher for beer (P < 0.001), similar for cider (0.4% difference; P < 0.001) and lower for wine (-47%; P < 0.001), spirits (-10%; P < 0.001) and RTDs (-31%; P < 0.001). Top-selling no/lo products were cheaper than matched regular-strength products of the same brand and pack size. For example, 15 of the 17 top-selling no/lo beers were between 6% and 42% cheaper than their regular-strength equivalents; however, the top-selling no/lo products were primarily premium brands, and no/lo beers and ciders were typically sold in smaller, less cost-efficient pack and container sizes. CONCLUSIONS:In Great Britain, the alcohol-free and low alcohol (no/lo) products available to buy in the off-trade (i.e. in shops) are cheaper on average than regular-strength drinks, but people still tend to pay more for no/lo beer than regular-strength beer and pay a similar price for no/lo cider as regular-strength cider. This discrepancy is partially because no/lo beers and ciders are often sold in smaller, less cost-efficient pack and container sizes. The premium branding of top-selling no/lo products may also contribute to higher prices.

Background and Aims Participation in Dry January is associated with reductions in alcohol consumption six-months later. Increased drink refusal self-efficacy (DRSE) appears to mediate these reductions. However, little is known about other potential determinants and mechanisms of change. We aimed to overcome limitations of previous studies and examine outcomes of Dry January participation for people who drink at hazardous levels (AUDIT-C &gt;4) and investigate factors that may underpin these reductions, including seasonal variation in alcohol consumption, access to online supports, and other psychological and social constructs. Design Prospective observational study in which we administered a series of online surveys across four timepoints: pre-Dry January, post-January, and three and six months later. Setting Data was collected from participants based in the UK using online surveys. Participants Three groups of participants (AUDIT-C&gt;4) were recruited, those who: (1) registered for Dry January with the organisers Alcohol Change UK (‘official’, n=291, mean age = 49.10); (2) attempted an independent alcohol-free January without registering for the official campaign (‘unofficial’, n=115, mean age = 45.09); and (3) did not participate in Dry January at all (‘No Dry January’, n=225, mean age =47.91). Measurements The primary outcome measure was AUDIT-C at six months. Predictors were DRSE, drinker identity, motivation to change, social contagion, level of abstinence during January, and frequency of use of online supports (Try Dry app, emails, Facebook groups). Findings ‘Official’ Dry January participants had a significant reduction in AUDIT-C at six-months (baseline mean (SD) = 9.44 (1.92), six-months mean (SD) = 7.65 (3.03); z= -10.42, p&lt;.001, r=.61). Six-month AUDIT-C was lower for ‘official’ participants compared to both ‘No Dry January’ and ‘unofficial’ Dry January groups. Significant pathways of change were identified for ‘official’ Dry January participants: relative to ‘No Dry January’ participants, improvements in DRSE predicted reductions in AUDIT-C at six months (β =-0.04, z= -2.39, p=.017). Greater abstinence during January predicted increased DRSE during January which in turn predicted lower AUDIT-C at six months (β=-0.02, z=-2.29, p=.022). Conclusion People who drink at hazardous levels who participate in Dry January report reduced alcohol consumption six months later. Enduring reductions in consumption cannot be fully attributed to seasonal variation in alcohol consumption and are enhanced by registering for the ‘official’ campaign and having access to structured online supports. Pathways between level of abstinence, DRSE, and subsequent alcohol consumption were identified. However, effect sizes were small indicating that other mechanisms of change remain to be identified.

ISSUE:There is a growing alcohol-free and low-alcohol (no/lo) drinks market in Great Britain. Insight about when this emerged and how it has developed is needed to inform and interpret the growing body of research into the use of no/lo drinks. We therefore document the development of the no/lo market in Great Britain between 2011 and 2022 and examine which stakeholders have been involved in development and what actions they have taken. APPROACH:Narrative timelines created through a documentary review of trade magazines (2011-2022) and market intelligence reports (2015-2022), focusing on product launches, marketing activity, industry changes, retailer actions, governmental actions and third sector activity. FINDINGS:A mainstream no/lo market emerged and established from 2015, with activity thereafter characterised by intensive market entry, expansion, and consolidation among both independent producers and mainstream alcohol brands. While initial development concentrated on beers, innovation has since proliferated across the cider, spirits, wine and ready-to-drink categories. Development appears predominately driven by market forces (e.g., product launches and marketing), with January a focal point of activity. Government has not introduced any legislation around no/lo drinks, although it has consulted on appropriate no/lo descriptors (in 2018) and committed (in 2019) to work with industry to grow the no/lo market. IMPLICATIONS AND CONCLUSIONS:While initial development in the no/lo market concentrated on beers, recent developments across categories, coupled with continued consolidation and expansion among beers, suggest the market may still develop further. Any assessment of the public health impact of no/lo drinks should be subject to longer-term follow-up once the market matures.

IntroductionThe UK has promoted increasing the availability of alcohol-free and low-alcohol drinks (no/lo, ≤1.2% ABV) as a public health strategy. To be effective, no/lo beverages must replace, and not supplement, standard alcoholic drinks. Emerging qualitative evidence suggests the reasons people drink alcohol may be important when investigating the potential public health impact of these drinks. This has not yet been explored quantitatively. This study aimed to determine whether alcohol drinking motives were associated with no/lo consumption after accounting for sociodemographic characteristics and alcohol consumption.MethodsA cross-sectional sample of adults residing in Great Britain (aged 16-93) who had drunk alcohol in the past year were recruited via the Alcohol Toolkit Study (N = 2555; 49.0% female). The dependent variable was frequency of no/lo consumption (less than/ at least monthly). Five questions captured respondents’ alcohol drinking motives (enhancement, social, conformity, coping-anxiety, coping-depression). Sociodemographic characteristics (age, gender, social grade, education, index of deprivation) and hazardous alcohol use (AUDIT-C) were included in the analyses. The proportion of respondents who reported drinking no/lo at high and low levels of endorsement of each drinking motive is presented. Quasibinomial regression modelling explored relationships between alcohol drinking motives and no/lo consumption, accounting for sociodemographic characteristics and hazardous drinking. ResultsDrinking alcohol to conform was the only drinking motive associated with no/lo consumption after accounting for sociodemographic characteristics and hazardous drinking (OR = 1.10, 95% CI 1.00-1.21, p=0.041). A higher frequency of drinking alcohol to conform was associated with an increased probability of drinking no/lo at least monthly. Conclusions No/lo drinks may be a useful substitute for those wishing to reduce their alcohol consumption whilst avoiding pressure to conform to social norms. Those drinking alcohol to conform were not typically higher-risk drinkers, which may limit the public health benefit of no/lo drinks.

Introduction:The UK has promoted increased availability of alcohol-free and low-alcohol drinks (no/lo, ≤1.2% alcohol by volume) as a public health strategy. To be effective, no/lo beverages must replace, and not supplement, standard alcoholic drinks. Emerging evidence suggests that the reasons people drink alcohol may be an important determinant of the potential public health impact of these drinks. This study aimed to determine whether alcohol drinking motives were associated with no/lo consumption after accounting for sociodemographic characteristics and alcohol consumption. Methods:A cross-sectional sample of adults residing in Great Britain (aged 16-93) who had drunk alcohol in the past year were recruited via the Alcohol Toolkit Study (N=2555; 49.0% female). The dependent variable was frequency of no/lo consumption (less than vs at least monthly). Five questions captured respondents' alcohol drinking motives (enhancement, social, conformity, coping-anxiety, and coping-depression), derived from the Drinking Motives Questionnaire-Revised. Sociodemographic characteristics, including age, gender, social grade, education, Index of Multiple Deprivation (a UK-wide measure of relative deprivation for small geographic areas), and hazardous alcohol use (Alcohol Use Disorder Identification Test), were also assessed. Descriptive analysis presents the proportion of respondents drinking no/lo at least monthly among low endorsement (ie, drinking for a motive less than half the time) versus high endorsement (ie, drinking for a motive at least half the time) of each drinking motive. Quasibinomial regression modelling explored relationships between alcohol drinking motives and no/lo consumption, accounting for sociodemographic characteristics and hazardous drinking. Results:Drinking alcohol to conform was associated with an increased likelihood of at least monthly no/lo consumption after accounting for sociodemographic characteristics and hazardous drinking (OR 1.10, 95% CI 1.00 to 1.21, p=0.041). Conclusions:No/lo drinks may facilitate reduced alcohol consumption by offering an alternative for individuals wishing to participate in alcogenic environments. However, those who drink alcohol to conform are not typically higher-risk drinkers, which may limit the public health benefit of no/lo drinks. Further research is needed to explicitly explore substitution effects.

Background In the UK, consumption of alcohol-free and low-alcohol (NoLo) drinks is more prevalent among heavier drinkers and socially advantaged groups. If heavier drinkers are substituting alcoholic drinks with NoLo drinks, this could improve public health. However, socioeconomic differences in consumption could exacerbate alcohol-related health inequalities. Socioeconomic groups vary in their reasons for drinking alcohol, with less advantaged individuals more likely to drink alcohol to cope. This study examined whether alcohol drinking motives can help explain differences in NoLo consumption, with a particular aim of understanding socioeconomic differences. Methods 2,555 adults residing in Great Britain provided data on at-least monthly NoLo consumption, hazardous drinking (AUDIT-C), alcohol drinking motives, social grade, education, age, and gender, via the Alcohol Toolkit Study. Path analysis explored the mediating effects of drinking motives between sociodemographic characteristics, hazardous drinking, and NoLo consumption. Results Drinking alcohol to conform, education, and hazardous drinking were positively associated with NoLo consumption. Drinking alcohol to cope with depression was a serial mediator between social grade and NoLo. Drinking to cope with depression, more frequently reported among lower social grades, weakened the positive relationship between hazardous drinking and NoLo consumption (β = -0.001, 95% CI -0.002, -0.000). Enhancement and social motives also weakened this relationship, partially mediating pathways between age, gender, education, and NoLo consumption. Discussion Whilst hazardous drinking is positively associated with NoLo consumption, for those drinking to cope with depression, for enhancement, or social reasons, this effect is diminished, potentially limiting the public health potential for these groups.

BackgroundParticipation in temporary abstinence challenges such as Dry January is associated with benefits including enduring reductions in alcohol consumption. However, undertaking temporary abstinence requires people to negotiate certain challenges. Building on previous research, we examined how and why particular strategies were used to address challenges and how use developed following January. Given differences in reported outcomes, we also explored differences and similarities in strategy use between 'official' UK Dry January registrants and those attempting an 'unofficial' alcohol-free January.MethodWe conducted 16 online semi-structured interviews with individuals who participated 'officially' or 'unofficially' in Dry January 2022 and who, prior to this, were regular drinkers. Data were analysed using reflexive thematic analysis and themes constructed around the common challenges people faced and the strategies used to address them.ResultsFour themes were generated: breaking the routine, dealing with socialising whilst not drinking, avoiding loss of motivation, and dealing with the potential for 'failure.' People took personalised approaches to addressing these challenges, retaining the meaning of important rituals and practices whilst still changing their alcohol consumption. This personalisation was reflected in the variation in strategy use and adaptation of strategies over time. Despite overall variation in strategy use, many strategies were employed by both 'official' and 'unofficial' participants.ConclusionsDry January provides an opportunity for people to learn what strategies do and do not work for them. Capitalising on the flexibility of Dry January to offer additional opportunities for personalisation may help people get the most from their Dry January experience.

Non-alcoholic and low-alcohol (NoLo) beverages are increasingly popular among adolescents, raising concerns about their potential gateway effect on alcohol use. This study combines a mapping review of the literature and an analysis of the Dutch Health Behavior in School-Aged Children (HBSC) study (N = 4746, mean age 13.74). The review identified three studies on NoLo prevalence (18.35-31.8%, all in Eastern populations) and two on parental attitudes. National data revealed that 46% of Dutch adolescents aged 12-16 had tried NoLo beverages, with 8% reporting weekly use. NoLo drinkers are overall more similar to non-drinkers, but exhibit characteristics like fewer peer problems and more hyperactivity similar to alcohol drinkers. NoLo use is most common among younger adolescents and those in pre-university tracks. Our findings highlight the need for nationally representative research on NoLo consumption in Western societies. Adolescents may use NoLo beverages to experiment with risk behaviors as an alternative to alcohol, driven by social conformity or a desire for new experiences.

BACKGROUND AND AIMS:The UK Government has committed to reducing alcohol consumption by 2025 through increasing the availability of alcohol-free and low-alcohol (no/lo) drinks. This study estimated current and future trends in key indicators of the availability, sale, purchasing and consumption of no/lo products in Great Britain. DESIGN:Seasonal autoregressive integrated moving average models of market research data and repeat-cross-sectional survey data on alcohol consumption. SETTING:Great Britain (England, Scotland and Wales), January 2014-December 2025. PARTICIPANTS/MEASUREMENTS:The study used population-level data on no/lo product availability and sales in the on-trade (e.g. bars, pubs, clubs, restaurants), as well as the off-trade (e.g. supermarkets and convenience stores) (2014-2023), continuous household panel data on purchasing (n ≈ 30 000; 2018-2023) and repeat-cross-sectional survey data on consumption (n ≈ 80 000, 2020-2024) to construct monthly time series for seven indicators. It described current trends and forecast them to December 2025. FINDINGS:All indicators showed increasing trends to 2025. The forecast level of each indicator in December 2025 was: Indicators 1 and 2: Percentage of alcoholic drinks sales volume that is no/lo products: 2.3% (50% Prediction Interval 2.1%-2.9%, off-trade) and 1.0% (50% Prediction Interval 0.8%-1.1%, on-trade); Indicator 3: Percentage of pubs selling draught no/lo products: 6.8% (50% Prediction Interval 6.1%-7.5%); Indicator 4: Percentage of households purchasing off-trade no/lo products but not alcoholic products: 12.3% (50% Prediction Interval 10.9%-13.6%); Indicator 5: Percentage of higher alcohol purchasing households that are increasing off-trade purchasing of no/lo products: 24.3% (50% Prediction Interval 21.3%-30.6%); Indicator 6: Percentage of households increasing off-trade purchasing of no/lo products and decreasing purchasing of alcoholic products: 1.8% (50% Prediction Interval 0.8%-2.8%); Indicator 7: Percentage of risky drinkers using no/lo products in most recent cut-down attempt: 42.4% (50% Prediction Interval 37.2%-53.3%). CONCLUSIONS:Consumption of alcohol-free and low-alcohol drinks is increasing in Great Britain but predicted to remain low in 2025 (estimated at 1.0% of on-trade and 2.3% of off-trade alcohol sales volume in servings by the end of 2025). There is some evidence that people are using no/lo drinks in attempts to reduce their alcohol consumption.

INTRODUCTION:Sales of alcohol-free and low-alcohol (no/lo) drinks are increasing rapidly but the drivers of this trend remain unclear. Reductions in alcohol consumption during January, including through temporary abstinence campaigns like Dry January, are one potential driver. This study estimates the immediate and long-term impact of changes made in January on sales of standard alcoholic and no/lo drinks in Great Britain. METHODS:Population-level sales data for standard alcoholic and no/lo drinks were analysed using ARIMAX time series models for the on-trade (e.g. bars; June 2014 to January 2024), off-trade (i.e. shops; January 2020 to December 2023), and overall market (January 2020 to December 2023). Outcome measures were sales volumes of standard alcoholic and no/lo drinks in servings and the percentage of total servings that were no/lo drinks. RESULTS:In the overall market, alcoholic drink sales were lower in January than other months and highest in December (β=+263,074,000 servings; 95 %CI 230,629,000--295,520,000), while no/lo drink sales were higher in January compared to February, March, and the autumn months (lowest in November; β=-1081,000 servings; 95 %CI -1965,000 ---196,000). The percentage of servings that were no/lo drinks peaked in January. There was uncertain evidence of large reductions in alcoholic drink sales each January driving long-term reductions in the off-trade (β=-48,383,000 servings; 95 %CI -106,104--9338,000) but there did not appear to be substantial impacts on other long-term trends. CONCLUSIONS:There are short-term decreases in standard alcoholic drink sales and increases in no/lo drink sales in January but there appeared to be no substantial sustained changes.

Alcohol-free and low-alcohol drinks (no/lo drinks) are now widely available and popular with consumers in high-income countries; however, it is unclear whether clinicians and others working to prevent or treat severe alcohol-related health problems should take a zero-tolerance approach to these alcohol-like products or encourage patients to try them. We argue that no/lo drinks may have an important role to play for people who drink at high-risk levels and those with alcohol use disorders (AUD) or alcohol-related liver disease (ARLD), particularly where debate and guidance related to treatment of these problems considers goals other than abstinence. The limited available evidence available suggests no/lo drinks may be useful in supporting attempts to reduce alcohol consumption or maintain abstinence among high-risk drinkers who do not have severe AUD or ARLD; however, they may also entail significant risks of relapse in those recovering from AUD. We therefore need further experimental and longitudinal studies testing whether use of no/lo drinks can lead to, or support, reductions in alcohol consumption. We particularly need high-quality experimental studies to test whether exposure to and sustained use of no/lo drinks affects treatment and recovery outcomes. Evidence is also needed on which subgroups of AUD and ARLD patients would benefit or be at risk from use of either alcohol-free or low-alcohol drinks. Finally, guidance should recognise that many patients already use these products and that a zero-tolerance approach may alienate patients or erode trust in clinicians.

The sale and consumption of alcohol-free and low alcohol drinks (no/lo drinks) has increased substantially in many high-income countries, including Great Britain (GB). Some people report that using no/lo drinks helped them to restrict (i.e., reduce or stop) their drinking. This study investigated the sociodemographic characteristics of people who use no/lo drinks to restrict drinking and whether consuming no/lo drinks in an attempt to restrict drinking was associated with whether an attempt was successful. We analysed four waves of data (2023-2024) from a nationally-representative cross-sectional survey (Alcohol Toolkit Study) with 1022 GB adults (16+) who attempted to restrict drinking in the last year. Among those, 33 % used no/lo drinks to support the attempt and 77 % reported reduced alcohol consumption since the restriction attempt. Using no/lo drinks to restrict drinking was more common among those consuming no/lo drinks at least monthly (ORadj = 6.34, 95 % CI = 4.63-8.75), and those who attempted to restrict drinking out of concerns about future health problems (ORadj = 1.77, 95 % CI = 1.27-2.49). There was inconclusive evidence on whether using no/lo drinks to restrict drinking was associated with self-reported success of the restriction attempt (OR = 1.47, 97.5 % CI = 1.00-2.19, BF = 5.43; ORadj = 1.26, 97.5 % CI = 0.81-2.00, BF = 1.48). Given the inconclusive association between the use of no/lo and success of the restriction attempts, further research is needed to determine whether no/lo use supports reductions in alcohol consumption and to understand underlying causal mechanisms.

Introduction Sales and availability of alcohol-free and low alcohol drinks have increased in the UK since 2020. This study aimed to assess trends in the use of alcohol-free and low alcohol drinks to reduce alcohol consumption among people who drink at increasing and higher risk in Great Britain. The study compared trajectories across different subgroups from 2020 to 2024.Methods Data were drawn from the Smoking and Alcohol Toolkit Study, which surveys adults monthly across Great Britain about their drinking behaviour. The study included 9397 adults with an AUDIT-C score of 5 or above who attempted to reduce their alcohol consumption in the past year. The analysis used regression analyses to assess time trends in using alcohol-free and low alcohol drinks to cut down overall and among subgroups (eg, gender and age), and in using evidence-based support compared with alcohol-free and low alcohol drinks in attempts to cut down alcohol consumption.Results The proportion reporting the use of alcohol-free and low alcohol drinks to reduce alcohol consumption increased from 35.0% (95% confidence interval (CI): 31.8, 38.4) in October 2020 to 43.9% (95% CI: 40.9, 46.9) in August 2024 in serious attempts and from 25.5% (95% CI: 23.2, 28.0) to 38.8% (95% CI: 37.2, 40.4) in any attempt to cut down. Among subgroups, trajectories were mostly comparable. Noticeably, older adults first had lower prevalence of using alcohol-free and low alcohol drinks than young and middle-aged adults but had larger increases over time. While the proportion of participants using alcohol-free and low alcohol drinks in attempts to cut down consumption increased, the proportion using neither alcohol-free/low alcohol drinks nor evidence-based support decreased, and the proportion using evidence-based support, either alone or in combination with alcohol-free/low alcohol drinks, remained low.Conclusion The growing use of alcohol-free/low alcohol drinks to reduce alcohol consumption among people at risk of increasing and higher risk drinking in Great Britain highlights the urgent need for more research to establish their effectiveness for alcohol reduction and to inform public health policy. While the use of alcohol-free/low alcohol drinks to cut down rose, the use of evidence-based support remained limited.

INTRODUCTION:The impact of alcohol-free and low-alcohol (no/lo) drinks on public health and health inequalities depends on who consumes them and how they are consumed. This study aimed to estimate: (i) the proportions of adults in Great Britain who consume no/lo drinks at different frequencies and in different settings; and (ii) the associations between no/lo drink consumption and individual characteristics. METHOD:Pooled data (N = 7691) from four waves of a repeat cross-sectional survey on alcohol use completed in 2022-2023 by adults (16+) resident in Great Britain were analysed using descriptive statistics and logistic regression models. RESULTS:In all, 31.3% of adults reported ever consuming no/lo drinks and 9.8% reported drinking them weekly. Ever consumption of no/lo drinks was associated with: being an increasing risk drinker of alcohol relative to not drinking (ORadj: 3.96, 95% CI 3.27-4.80), being aged 16-24 compared with 65+ (ORadj:1.29, 95% CI 1.07-1.57), having previously smoked compared with having never smoked (ORadj:1.19, 95% CI 1.05-1.34) and living in a rural rather than urban area (ORadj:1.14, 95% CI 1.00-1.29). It was less likely among those in lower social grades or with lower educational qualifications; those living in Yorkshire and the Humber, and Scotland, compared with the South-East of England; and those using nicotine products. DISCUSSION AND CONCLUSIONS:A third of adults in Great Britain have consumed no/lo drinks and approximately one in 10 do so weekly. Consumption is more common among riskier drinkers of alcohol and among more advantaged social groups, which may contribute to the sustaining or widening of health inequalities.

BACKGROUND AND AIMS:Alcohol consumption has decreased in England in recent decades, while alcohol-specific death rates have remained relatively stable. Age-period-cohort (APC) models offer the potential for understanding these paradoxical trends. This study aimed to use an APC model approach to measure long-term trends in alcohol abstention and consumption in England from 2001 to 2019. DESIGN, SETTING AND PARTICIPANTS:The study used grouped and proxy-variable APC models of repeat cross-sectional survey data, set in England (2001-19). Participants were residents in England aged 13 years or over who took part in the Health Survey for England. MEASUREMENTS:Outcome variables were alcohol abstention and consumption in units. We created nine age groups (13-15, 16-17, 18-24, 25-34, until 65-74 and 75+, reference 45-54 years), four periods (2001-04, 2005-09, 2010-14 to 2015-19, reference 2005-09) and 18 5-year birth cohorts (1915-19 to 2000-04, reference 1960-64). We proxied age effects (systolic and diastolic blood pressure), period effects (alcohol affordability, internet usage and household alcohol expenditure) and birth cohort effects (prevalence of smoking and prevalence of overweight). FINDINGS:The odds of abstaining were considerably larger at young ages, 13-15 years [odds ratio (OR) = 5.38; 95% confidence interval (CI) = 4.50-6.43], were lowest during the first period, 2001-04 (OR = 0.83; 95% CI = 0.79-0.86) and had a U-shaped pattern by birth cohort. For units of alcohol, the incidence rate ratio (IRR) increased until age 18-24 years (IRR = 1.41, 95% CI = 1.34-1.48) and decreased afterwards, were highest during the first period, 2001-04 (IRR = 1.07; 95% CI = 1.05-1.08) and showed an inverted J-shape by birth cohort. Our proxy variable approach revealed that using blood pressure measures, alcohol affordability and prevalence of overweight as proxies resulted in APC effects that differed from our base-case model. However, internet usage, household expenditure on alcohol and smoking prevalence resulted in APC effects similar to our base-case model. CONCLUSIONS:The discrepancy between decreasing alcohol consumption and increasing alcohol-related deaths observed in England from 2001 to 2019 may, in part, be explained by the halt in abstention trends since 2010 and a slight consumption decline since 2001.