Explaining trends in alcohol-related harms in Scotland, 1991–2011 (I): the role of incomes, effects of socio-economic and political adversity and demographic change

•Alcohol-related mortality in Scotland has increased then decreased since the 1980s.•To evaluate the impact of alcohol policy we need to understand the causes of these trends.•Income trends and alcohol affordability explain part of the rise and fall.•Adults aged 40–70 years during the 1990s and 2000s experienced the greatest change.•Lagged effects from historical change remain plausible from the available data.