Alcohol Still Sold to Obviously Drunk Patrons

Professor Karen Hughes Professor in Behavioural Epidemiology Centre for Public Health Liverpool John Moores University Liverpool L3 Interview with:
Professor Karen Hughes
Professor in Behavioural Epidemiology
Centre for Public Health
Liverpool John Moores University
Liverpool L3 2ET What are the main findings of the study?

Answer: We used trained actors to test whether servers in pubs, bars and nightclubs would sell alcohol to people showing signs of extreme intoxication, despite this being illegal in the UK. In over four fifths (83.6%) of purchase attempts, bar servers sold alcohol to the pseudo-drunk actors – even though many clearly identified the actors as being drunk. We also collected data on bar environments, looking specifically at ten factors that have been associated with alcohol-related harm in previous studies: low levels of seating, loud noise, crowding, poor lighting, dirtiness, cheap drink promotions, young bar staff, young customers, rowdiness, and customer drunkenness. We found that the more of these characteristics bars had, the more likely they were to sell alcohol to drunks, with 100% of bars with 8 or more of these characteristics serving the pseudo-drunk actors. However, even in bars with none of these characteristics, two thirds of purchase attempts resulted in an alcohol sale. Having security staff managing entrance to the premises was also associated with alcohol service; possibly suggesting that bar servers in premises with door staff believe responsibility for vetting customers lies with such staff. Were any of the findings unexpected?

Answer: Along with the very high level of alcohol service to pseudo-drunk actors, in almost one in five alcohol sales actors’ notes identified that bar servers had tried to sell them a larger drink (i.e. a double rather than a single vodka). This was an unexpected finding, and as actors were not specifically asked to record this information the actual extent of such ‘up-selling’ might have been even higher. Thus, not only were most alcohol servers ignoring the law preventing sales of alcohol to drunks, they often saw no problem in providing vulnerable individuals with more alcohol than they had actually asked for. What should clinicians and patients take away from your report?

Answer: Excessive alcohol use has a huge impact on health and the provision of health services, with emergency departments in England struggling to cope on weekend nights and alcohol-related hospital admissions continuing to rise. The enforcement of legislation to prevent the sale of alcohol to people who are drunk has the potential to reduce excessive drinking and change harmful nightlife cultures, yet this legislation is hardly used anywhere in England (with just 3 convictions nationally in 2010). With strategies such as minimum alcohol pricing having been stalled in England, health professionals have a major role to play in advocating for other mechanisms to reduce drunkenness and the harms it causes, and preventing sales to drunks should be a key priority. What recommendations do you have for future research as a result of this study?

Answer: Measures that can effectively reduce sales of alcohol to drunks need to be identified, implemented and evaluated in UK. Such measures may include those to raise public awareness of legislation on sales of alcohol to drunks, provide training to bar servers in service refusal techniques, and specifically to increase enforcement activity to identify and punish those breaking the law. Studies such as this can serve as a baseline to measure the effectiveness of such measures.


Does legislation to prevent alcohol sales to drunk individuals work? Measuring the propensity for night-time sales to drunks in a UK city

Karen Hughes, Mark A Bellis, Nicola Leckenby, Zara Quigg, Katherine Hardcastle, Olivia Sharples, David J Llewellyn
Centre for Public Health, WHO Collaborating Centre for Violence Prevention, Liverpool
John Moores University,
J Epidemiol Community Health
Published Online First: Jan 15 2014 doi:10.1136/


Last Updated on January 16, 2014 by Marie Benz MD FAAD