Minimum unit pricing (MUP) is a simple policy with a clear goal: to reduce alcohol use and the harm it causes. It sets a minimum price for drinks containing alcohol based on the amount of pure ethanol, the component that causes harm. In practice, this mostly affects cheap, high-strength products linked to the greatest health risks. Because most drinks sold in pubs, bars, and restaurants are already priced above this threshold, MUP primarily affects alcohol bought for home consumption.
Despite its straightforward design, MUP often attracts strong criticism. It is sometimes described as unfair to people on low incomes, or to moderate drinkers, or as ineffective for people who are dependent on alcohol. To build a clearer understanding, we conducted a review of all available real-world evidence from Scotland, Wales, Ireland, Australia, Canada, and other jurisdictions.
The overall message was remarkably consistent: minimum unit pricing reduces alcohol use and improves health outcomes in the real world.
Why the cheapest alcohol matters most
Cheap alcohol makes up only a fraction of the market, yet it drives a disproportionate share of the most serious harm. These products are mostly used by the heaviest drinkers, and put simply, the more someone drinks, the greater their risk. That is why targeted policies like MUP can make a real difference to people’s health and wellbeing.
Studies in our review consistently show the same thing: once MUP is introduced, purchases of very cheap, often high-strength drinks fall sharply, while people who drink relatively little barely notice any change. It is a bit like raising the price of rice: someone picking up a small packet now and then hardly notices, but a restaurant buying huge bags every week certainly does.
Why small shifts achieve big gains
Reducing alcohol use does not only benefit the heaviest drinkers. Alcohol follows the “prevention paradox”, whereby the heaviest drinkers consume the most and experience the most severe harms, but harm reaches far beyond this group.
People who drink relatively little—and even people who do not drink at all—are still affected. For example, someone who abstains may still experience second-hand harms, such as being injured by a drink-driver, dealing with violence or disruption caused by another person’s drinking, or carrying the financial consequences of a family member’s alcohol use.
This pattern is clear in the health data too. Almost half of all alcohol consumed in Canada is drunk by the top 10% of drinkers, yet more than half of alcohol-caused deaths occur among the bottom 90%. Heavy drinking concentrates risk, but harm is widespread.
This is why MUP is so effective. By lowering overall consumption—especially among those drinking the most—it delivers wide-reaching benefits. Even small shifts can lead to meaningful reductions in harm across the whole population.
Correcting misunderstandings about fairness
Some argue that MUP threatens individual freedom, but this misses what the policy intends to correct: a market where the cheapest products are priced far below the harm they create. For instance, research by the Institute of Alcohol Studies estimated that alcohol harm creates a government revenue deficit of around £15 billion each year in England and Wales, highlighting just how distorted the current pricing landscape has become. MUP helps address this imbalance by ensuring that the products responsible for the greatest harm are not sold at unreasonably low prices.
Concerns about fairness for people on low incomes are also understandable, but they do not reflect how alcohol harm is distributed. People in the most deprived communities face the highest rates of alcohol harm, even when their consumption is less than or similar to wealthier groups. Therefore, they stand to gain the most when the price of cheap alcohol is increased.
The evidence for this is clear: across the jurisdictions included in our review, the largest health improvements following MUP were consistently seen in the communities experiencing the greatest burden of harm.
Separating concern from evidence
Public debate about MUP often focuses on what might go wrong. Will people suffering with alcohol dependence go into withdrawal? Will crime increase? Will families struggle to afford essentials? Will people switch to drugs or non-beverage alcohol instead?
Our work found little evidence that these concerns materialise in practice:
- Withdrawal did not rise. Frontline workers and heavy drinkers reported no increase in withdrawal, and hospital data confirmed this.
- Crime did not increase. There was no clear association between MUP and crime.
- Essential spending was mostly unaffected. Only small, inconsistent shifts were reported, with no clear sign of financial hardship caused by MUP.
- Other drug use. Drug use did not increase. Substitution was uncommon and limited to people already using other drugs, with no evidence that MUP triggered people to start using other drugs.
- Non-beverage alcohol use was unchanged. Such use was rare before MUP and remained rare afterwards.
In short, the concerns raised in public debate were not supported by the evidence, whereas reductions in cheap alcohol purchasing and improvements in health were consistent across settings.
Putting policy into practice
MUP works best when implemented alongside other supports. It would be most effective when combined with accessible treatment services, social and community supports, and broader harm-reduction approaches. But by raising the price of the cheapest drinks MUP creates conditions in which these other interventions can have greater impact.
Across the studies included in our review, the pattern was consistent:
- Alcohol use fell. This was especially true among heavier drinkers.
- Public health improved. Hospital admissions and deaths declined, with the greatest benefits observed among communities facing the highest burden of harm.
- Concerns about MUP were largely unfounded. There was little evidence of the concerns raised occurring.
Taken together, MUP is an evidence-based policy with clear public-health benefits and a promising role in reducing socioeconomic inequities. With continued research and careful refinement, MUP remains an important tool for improving health and social equity.
Written by Dr James M. Clay, Postdoctoral Research Fellow, Canadian Institute for Substance Use Research, University of Victoria, and Department of Community Health and Epidemiology, Dalhousie University.
All IAS Blogposts are published with the permission of the author. The views expressed are solely the author’s own and do not necessarily represent the views of the Institute of Alcohol Studies.