2 Background
History of alcohol guidelines
5. Concerns about the rising number of alcohol-related
deaths and illnesses in the 1970s prompted the Government to produce
a consultative document Prevention and Health: Everybody's
Business.[5] The focus
of that document, however, was on overall levels of alcohol consumption
and on corresponding legal, fiscal and social controls. At the
individual level, alcohol consumption remained a matter of personal
choice.[6] In 1981, the
UK Health Departments published the booklet Drinking Sensibly,
which provided a definition of alcohol misuse and introduced the
concept of sensible drinking. The booklet called for a programme
of public education about sensible drinking.[7]
It was not until 1984 that guidance on individual drinking was
produced, in a pamphlet That's the Limit, published by
the then Health Education Council. The pamphlet gave "safe
limits" for drinking, defined as 18 "standard drinks"
a week for men and 9 for women. One standard drink was equivalent
to one alcohol unit—a concept that would be introduced in
the next edition. The pamphlet also defined "too much"
alcohol as 56 standard drinks a week for men and 35 for women.[8]
The 1987 edition of the leaflet described units for the first
time and revised the 1984 guidelines down to "sensible limits"—described
as the amount to which people should limit their drinking if they
wanted to avoid damaging their health—as 21 units a week
for men and 14 for women, with "too much" defined as
36 units for men and 22 for women. A 1989 edition of the pamphlet
contained the same guidelines.[9]
In 1986 and 1987, the three medical Royal Colleges—the Royal
College of General Practitioners, the Royal College of Physicians
and the Royal College of Psychiatrists—produced reports
on alcohol that endorsed the Health Education Council's 1987 guidelines
on sensible drinking.[10]
6. The advice of the Royal Colleges and Health Education
Council was officially adopted by government in 1987, in a report
that stated "the Government does not wish to discourage the
sensible consumption of alcohol, but is committed to reducing
alcohol related harm".[11]
In 1992 the sensible drinking message was used to set targets
for the reduction of alcohol misuse in The Health of the Nation
and other national health strategies.[12]
7. By the early 1990s, however, scientific evidence
had emerged suggesting that alcohol might reduce the risks of
coronary heart disease (CHD), prompting the Government to set
up an inter-departmental working group to review the guidelines
in 1994. The working group produced the 1995 report Sensible
Drinking, that has formed the basis of individual drinking
guidelines since. The most significant change to the Government
guidelines was the move from weekly limits to daily limits. The
Royal Colleges also revisited the issue in 1995, including a review
of the evidence linking alcohol and CHD, and concluded that the
guidelines adopted in 1987 were still sufficient.[13]
This marked a divergence in opinion between the Government and
Royal Colleges that is explored further in the next chapter.
8. The Government's sensible drinking message, based
on the analysis in the 1995 report and agreed by the devolved
health departments, is that:
a. men should not regularly drink more than three
to four units a day;
b. women should not regularly drink more than
two to three units a day; and
c. after an episode of heavy drinking, it is
advisable to refrain from drinking for 48 hours to allow tissues
to recover.[14]
9. The 1995 Sensible Drinking report contained guidance
for pregnant women, which was that "to minimise risk to the
developing fetus, women who are trying to become pregnant or are
at any stage of pregnancy, should not drink more than 1 or 2 units
of alcohol once or twice a week, and should avoid episodes of
intoxication".[15]
Following revised guidelines published by the Chief Medical Officers
in 2006 and advice from the National Institute of Health and Clinical
Excellence (NICE), current guidance for pregnant women in England
is that:
pregnant women or women trying to conceive should
avoid drinking alcohol; if they do choose to drink, to minimise
the risk to the baby, they should not drink more than one to two
units of alcohol once or twice a week and should not get drunk.
NICE additionally advised that the risks of miscarriage
in the first three months of pregnancy mean that it is particularly
important for a woman not to drink alcohol at all during that
period.[16]
10. Until 2009, alcohol consumption guidelines had
been produced only for adults. The 1995 report considered alcohol
consumption by children and young people "very briefly".[17]
The Chief Medical Officer for England published specific guidance
on the consumption of alcohol by children and young people in
2009. The advice was that:
- An alcohol-free childhood is
the healthiest and best option;
- If children do drink alcohol, they should not
do so until at least 15 years old;
- If 15 to 17 year olds drink alcohol, it should
be rarely, and never more than once a week. They should always
be supervised by a parent or carer; and
- If 15 to 17 year olds drink alcohol, they should
never exceed the recommended adult daily limits (3-4 units of
alcohol for men and 2-3 units for women).[18]
Alcohol units
11. Units are a fundamental concept used in alcohol
guidelines. In the UK, one unit is 8 grams (g) of alcohol.[19]
One unit, or 8 g, is equivalent to 10 millilitres (ml) of pure
ethanol (alcohol), which is the amount of alcohol the average
adult can process within an hour.[20]
This means that if the average adult consumes a drink containing
one unit of alcohol, within an hour there should in theory be
no alcohol left in their bloodstream, although it will of course
differ according to the individual.[21]
Approximately, one unit equates to a 25 ml measure of spirit or
half a pint of beer, whereas a 175 ml glass of wine contains two
units,[22] although the
situation is complicated by the differing strengths of alcoholic
beverages. The strength of an alcoholic beverage is commonly expressed
as alcohol by volume (ABV) or sometimes just "vol.".[23]
For example, if a 750 ml bottle of wine contains 12 per cent ABV,
this means that 12 per cent of the total volume of wine (750 ml)
is pure alcohol, which works out to 90 ml alcohol, or 9 units.
Within a 175 ml glass of 12 per cent ABV wine, there will be 2.1
units. A 750 ml bottle of wine with 13 per cent ABV, on the other
hand will contain 9.8 units of alcohol and a 175 ml glass of that
wine will contain 2.3 units.
International comparisons
12. Table 1 summarises recommended drinking guidelines
from a range of developed countries.Table
1: International comparisons of recommended alcohol consumption
guidelines (countries ranked according to male daily guidelines)[24]
| Country (ranked low to high)
| Unit/ standard drink
| Men | Women
|
| Japan | 19.75 g
| 1-2 units/day (19.75-39.5 g/day)
| |
| United States | 14 g
| 1-2 units/day (14-28 g/day), not to exceed 14 units/week (196 g/week)
| 1 unit/day (14 g/day), not to exceed 7units/week (98 g/week)
|
| Australia | 10 g
| no more than 2 standard drinks (20 g) on any day reduces lifetime risk
| no more than 2 standard drinks on any day
|
| Poland | 10 g
| 2 units/day (20 g/day) up to 5 times/week (not to exceed 100 g/week)
| 1 unit/day (10 g/day) up to 5 times/week (not to exceed 50 g/week)
|
| Slovenia | N/A
| not to exceed 20 g/day and 50 g on a drinking occasion
| not to exceed 10 g/day and not to exceed 30 g/drinking occasion
|
| Sweden | N/A
| not to exceed 20 g/day
| not to exceed 20 g/day
|
| Czech Republic | N/A
| less than 24 g per day
| less than 16 g per day
|
| Austria | 10 g
| 24 g pure ethanol per day
| 16 g pure ethanol per day
|
| Finland | 11 g
| not to exceed 15 units/week (165 g/week) [equivalent to 24 g/day]
| not to exceed 10 units/week (110 g/week)
|
| Germany |
| not to exceed 24 g/day
| not to exceed 12 g/day
|
| United Kingdom |
8 g | should not regularly drink more than 3-4 units/day (24-32 g/day)
| should not regularly drink more than 2-3 units/day (16-24 g/day)
|
| Canada | 13.6 g
| not to exceed 2 units per day (27.2 g/day); 14 units per week (190 g/week)
| not to exceed 2 units/day (27.2 g/day); 9 units per week (121.5 g/week)
|
| Portugal | 14 g (unofficial)
| 2-3 units/day (28-42 g/day)
| 1-2 units/day (14-28 g/day)
|
| Spain | 10 g
| not to exceed 3 units/day (30 g/day)
| not to exceed 3 units/day (30 g/day)
|
| New Zealand | 10 g
| not to exceed 3 units/day (30 g/day), 21units/ week (210 g/week)
| not to exceed 2 units/day (20 g/day), 14 units/week (140 g/week)
|
| France | 10 g
| not to exceed 30 g/day
| not to exceed 30 g/day
|
| Ireland | 10 g
| 21 units/week (210 g/week) [equivalent to 30 g/day]
| 14 units/week (140 g/week)
|
| Romania | N/A
| not to exceed 32.5 g beer/day or 20.7 g wine/day
| not to exceed 32.5 g beer/day or 20.7 g wine/day
|
| Denmark | 12 g
| not to exceed 21 alcohol units (252 g) a week [equivalent to 36 g a day]
| not to exceed 14 (168 g) units a week
|
| South Africa | N/A
| not to exceed 21 units/week (252 g/week) [equivalent to 36 g/day]
| not to exceed 14 units/week (168 g/week)
|
| Nether-lands | 9.9 g
| not to exceed 4 units/day (39.6 g/day)
| not to exceed 2 units/day (19.8 g/day)
|
| Italy | 12 g
| less than 40 g per day
| less than 40 g per day
|
It is worth noting that units vary by country, for
example one unit of alcohol in the United States is 14 g and in
Japan a unit is significantly larger at almost 20 g.[25]
International comparisons, therefore, should be adjusted to represent
a like-for-like basis. The Sheffield Addiction Research Group
considered that "the UK drinking guidelines can be considered
as in line with other developed nations and there appears no case
to be made for altering them on the basis of international consensus"
and stated:
As different nations define a unit of alcohol
differently or base guidelines upon the notion of a 'standard
drink', it is easier to compare guidelines after converting recommended
levels into pure alcohol consumption in grams. [...]
The UK guidelines recommend not regularly drinking
more than 24-32 g of pure alcohol a day if you are a man and not
more than 16-24 g if you are a woman. These levels are similar
to those used in many other nations such as Italy (24-36 g and
12-24 g), the USA (24 g and 14 g), France (30 g and 20 g), Germany
(36 g and 24 g) and New Zealand (30 g and 20 g). Some nations
do have slightly higher recommendations, particularly for men,
such as The Netherlands and Spain (both 40 g and 24 g). Few nations
have significantly lower guidelines and those that do include
Denmark (21 g and 14 g), Poland (20 g and 10 g) and Slovenia (20
g and 10 g).[26]
Dr Richard Harding, member of the 1995 Sensible
Drinking working group, told us:
World-wide recommendations on alcohol consumption
show wide disparity among countries. This is in some ways surprising,
given that the science is the same everywhere. But the objective
of those who frame such guidance is to influence their target
populations. It follows therefore that several factors then become
relevant, e.g. the behaviour that is thought to be in need of
change, the culture and mindset of the target population, and
the kind of message that is likely to be effective.
Therefore the best approach is to formulate advice
firmly based on and argued from the science, but that which is
also appropriate to the problems that the UK face and is likely
to be effective, and not to take much notice of what other governments
or health bodies recommend.[27]
13. The UK's alcohol guidelines are about average,
compared with those of other developed nations. However, national
guidelines can reflect social objectives and cultural differences
as well as scientific evidence, and therefore we do not consider
that international comparisons should be relied on as an indicator
of how appropriate the UK's alcohol guidelines are.
14. Aside from additions to the advice for pregnant
women and children, the guidelines have not been the subject of
a formal review since 1995.[28]
The next chapter explores the evidence base for the current guidelines.
5 Department of Health, Sensible Drinking: Report
of an inter-departmental working group, 1 December 1995, Annex
E Back
6
Department of Health, Sensible Drinking: Report of an inter-departmental
working group, 1 December 1995, Annex E Back
7
Department of Health, Sensible Drinking: Report of an inter-departmental
working group, 1 December 1995, Annex E Back
8
Department of Health, Sensible Drinking: Report of an inter-departmental
working group, 1 December 1995, Annex E Back
9
Department of Health, Sensible Drinking: Report of an inter-departmental
working group, 1 December 1995, Annex E Back
10
Ev 27 [Department of Health] para 1; The Royal College
of General Practitioners, Alcohol: a balanced view , 1987;
The Royal College of Psychiatrists, Alcohol: our favourite
drug, 1986; and The Royal College of Physicians,
A Great and Growing Evil: the medical consequences of alcohol
abuse, 1987 Back
11
Department of Health, Sensible Drinking: Report of an inter-departmental
working group, 1 December 1995, Annex E Back
12
Department of Health, Sensible Drinking: Report of an inter-departmental
working group, 1 December 1995, Annex E Back
13
Department of Health, Sensible Drinking: Report of an inter-departmental
working group, 1 December 1995, Annex E Back
14
Ev 27 [Department of Health] para 3 Back
15
Department of Health, Sensible Drinking: Report of an inter-departmental
working group, 1 December 1995, p 27 Back
16
Ev 27 [Department of Health] para 6 Back
17
Ev 27 [Department of Health] para 8 Back
18
Ev 28 [Department of Health] para 9 Back
19
Ev 30 [Department of Health] para 28 Back
20
Alcohol Units: your guide to alcohol units and measures",
Drinkaware, 25 Oct 2011, Drinkaware.co.uk Back
21
Alcohol Units: your guide to alcohol units and measures",
Drinkaware, 25 Oct 2011, Drinkaware.co.uk Back
22
Ev 55 [Drinkaware] para 2.6 Back
23
Alcohol Units: your guide to alcohol units and measures",
Drinkaware, 25 Oct 2011, Drinkaware.co.uk Back
24
Ev 45 [The British Beer & Pub Association, The National Association
of Cider Makers, The Scotch Whisky Association and The Wine and
Spirit Trade Association] Back
25
Ev 45 [The British Beer & Pub Association, The National Association
of Cider Makers, The Scotch Whisky Association and The Wine and
Spirit Trade Association] para 27 Back
26
Ev w25, paras 4.1-4.3 Back
27
Ev 50, paras 34-35 Back
28
Ev 28 [Department of Health] para 10 Back
|
