Background Strategies to reduce alcohol-related health and social harms may include restrictions on alcohol availability. ‘Reducing the Strength’ (RtS) is a local-level intervention whereby off-licence stores voluntarily stop selling inexpensive ‘super-strength’ (≥6.5% alcohol by volume) beers and ciders. The intervention aims to reduce alcohol consumption, crime and disorder, notably amongst homeless and street drinkers. As part of a broader evaluation, we explored the mechanisms by which RtS may affect these populations in one urban English local authority.
Methods We conducted one large focus group with alcohol treatment professionals (N = 11) and semi-structured interviews with professionals working in homeless hostels (N = 6), alcohol services (N = 2) and street outreach teams (N = 2). Service providers were recruited following introductions from a local authority hostel commissioning manager and a public health strategist. After undertaking interviews with hostel staff, interviews were conducted with residents (N = 9) at two hostels. Data were analysed thematically utilising NVivo 10 for data management.
Results Professionals and drinkers generally concurred that street drinkers and homeless drinkers were distinct, but intersecting subgroups and many, but not all, consume super-strength products. Some questioned whether availability could be substantially reduced by a voluntary scheme in a small, densely-populated area. Many highlighted the often reciprocal relationships between drinkers and shopkeepers, which may impact shops’ willingness to comply with the initiative. In the intervention area there was some evidence that super-strength drinkers might consume less alcohol by using their limited income to purchase (still available) weaker beer. However, other drinkers talked about finding shops that still sold the product within or, given the small scale of the intervention, outside the intervention area. They also described increasing begging, switching to drinks with even higher alcohol contents or using illegal substances. Many professionals and drinkers participants argued street drinking was already being tackled directly through enforcement-related initiatives. The majority of professionals believed that intervention effectiveness depends on clear linkages to services that address the complex underlying reasons for excessive alcohol consumption.
Conclusion This study underscores the challenges faced when intervening in a complex social system. The feasibility of local initiatives to reduce alcohol-related harms is affected by the ability to identify the target population and the products they consume, intervention scale, compliance and linking of services. There may also be unintended, and potentially harmful, responses to the removal of specific products amongst a target population characterised by multiple risk behaviours.