Alcohol Guidelines - Science and Technology Committee Contents

Written evidence submitted by 2020health (AG 07)

1.  Introduction

1.1  At 2020health we have recently conducted research into "risky drinking" to be published in our forthcoming report "From One too many: The risks of frequent excessive drinking". In this report we have drawn on both our internal and external expertise. Our Consultant Director, Gail Beer, was a renal nurse in her early work within the NHS, before becoming an NHS Trust COO, and we conducted interviews and conversations with experts in the field. The area of patient education and information is a central theme at 2020health and we have identified alcohol consumption as an area where there is not enough knowledge in the general population for people to be able to make informed choices about their lives.

1.2  In our report we identified the confusion regarding recommended safe limits. DH guidelines state that men should drink no more than 3-4 units per day and women 2-3. However historically weekly guidelines have been given that men should drink no more than 21 units per week and women 14 units, and these weekly guidelines are often still used. These two figures are clearly at odds with each other and cause some confusion. In addition there is misunderstanding of the term unit. A unit is taken as 8g of alcohol but many drinks contain more than 8g and drinkers are often unaware they are drinking more than 1 unit.

1.3  The current use of daily guidelines suggest that it's acceptable to drink every day and that this causes no harm; this may be the case if only 1 unit is consumed. Where the guidelines fail is when consumers believe that the maximum recommended limit is the amount they can safely consume every day. We believe that education about the risks of drinking at different levels would be more beneficial than the setting of limits.

2.  What evidence are Government's guidelines on alcohol intake based on, and how regularly is the evidence base reviewed?

2.1  The evidence base for the government's current guidelines is unclear. Research has shown that for many alcohol-related conditions there is a continuing increase in risk with the amount of alcohol drunk and no clear cut-off between "safe" consumption and "risky" consumption. Whilst much is known about the risks of different levels of alcohol consumption over a period of time, and the risks of binge drinking, there is no clear reason for the current daily limit on alcohol consumption.

3.  Could the evidence base and sources of scientific advice to Government on alcohol be improved?

3.1  There is extensive medical evidence around the relationship between alcohol consumption and the risk of many different diseases, including liver disease, many types of cancer, hypertension, stroke, pancreatitis and mental illness. Graphs showing the relationship between level of alcohol consumption and increasing risk of each condition show that there is no cut-off limit beneath which alcohol consumption is "safe". Any level of consumption will increase the risk of developing these conditions. For this reason the government should not attempt to define a "sensible limit" for drinking, but instead should educate the population of the risks associated with different levels of drinking. Drinking alcohol should be treated In a similar manner to smoking, where the focus is on public education of the risks associated with the behaviour.

Figure 1


3.2  As we have described in our forthcoming report "From one to many: The risks of frequent excessive drinking" there are three main types of drinkers. These are:

—  binge drinkers;

—  dependent drinkers; and

—  risky drinkers.

The risks for these different groups are different. Whereas binge drinkers are more likely to subject themselves to acute damage, risky drinkers, who drink but do not get drunk, increase their risk of chronic conditions such as cancer and liver disease.

3.3  Separate guidelines should be issued by the government to target risky drinkers and binge drinkers. These types of drinking carry different risk. Education about the risk of chronic conditions are needed for risky drinkers, whereas warning about the risks of binge drinking is also needed. Targeting these two populations should in turn help to avoid the development of alcohol dependence.

4.  How well does the Government communicate its guidelines and the risks of alcohol intake to the public?

4.1  The current guidelines on the risks of alcohol intake are confusing and this has resulted in poor understanding of the recommendations around alcohol consumption in the population. Both daily limits of 3-4 units per day for men and 2-3 units per day for women and weekly limits of 21 units per week for men and 14 units per week for women are used. These guidelines are not compatible and result in confusion.

4.2  A YouGov poll conducted in January 2010 showed that 55% of English adults believe that alcohol only damages your health if you binge drink or get drunk. The poll showed that 83% of those who regularly drink more than the recommended limits don't think their drinking is putting their long-term health at risk. In another survey from 2008, 46% of the population did not know the sensible drinking guidelines.[2] There is a widespread ignorance of the harms associated with heavy drinking. While 86% of drinkers surveyed knew that drinking alcohol is related to liver disease, many were unaware of the links with cancer, stroke or heart disease. One of the difficulties in making sound behavioural choices is the time gap between the drinking behaviour and the health consequences. Chronic diseases such as liver disease and cancers may not manifest until the damaging drinking behaviour has continued for many years. This makes education about the risks and future consequences of this behaviour essential.

4.3  As explained above any guidelines issued by the government need to target risky drinkers and binge drinkers separately. Targeting these two populations should in turn help to avoid the development of alcohol dependence.

4.4  Risky drinkers are those who drink regularly, but do not binge drink or get drunk. They may be drinking several drinks every day, and are increasing the risk of developing long-term health conditions. Given the time lag between alcohol consumption and the development of conditions such as liver disease or cancer, the harm caused by drinking is often not seen for up to 10 or 20 years. This makes the need for education about the risks more pressing.

4.5  Rather than an arbitrary choice of limits for alcohol consumption, education of the public is needed about the different conditions related to alcohol consumption and the relationship between level of consumption and risk. Guidance should state that it is inadvisable to drink every day, and a public education campaign is needed to convey the risks of drinking at different levels. Information such as that shown in Table 1 should be more widely known and understood.

Increased risk associated with drinking:
3 units of alcohol per day
(1.5 pints of beer, 250ml of wine)
6 units of alcohol per day
(3 pints of beer, 500ml of wine)
Liver disease3 times 7 times
Mouth cancer2.5 times 5 times
Throat cancer1.8 times 3 times
Breast cancer1.3 times 2 times
Hypertension (high blood pressure)1.7 times 3 times
Ischaemic strokeNo change 2 times
Haemorrhagic stroke1.8 times 3 times
Pancreatitis1.3 times 2 times

Table 1: The increased risk associated with drinking 3 or 6 units of alcohol per day. Data taken from the Australian Guidelines to Reduce Health Risks from Drinking Alcohol[3] and Corrao et al. (2004).[4]

4.6  Binge drinkers are those who drink eight or more units in a single session for men and six or more for women. In addition to the messages about risky drinking, it needs to be understood that binge drinking is not recommended. The harms of binge drinking are better understood than risky drinking as the effects of alcohol are usually seen immediately. Binge drinking can result in acute health problems, violence, crime, as well as a cost to employers due to time off or decreased productivity at work.

4.7  In order for the public to regulate their alcohol intake efficiently, they need to be aware of not only the risks associated with the consumption of a given number of units of alcohol, but they also need to be aware of how many units are contained in their drink. For this reason it is very important that beverages are labelled with information giving the units of alcohol contained both on the bottle/can itself and on drinks menus in restaurants/pubs.

5.  How do the UK Government's guidelines compare to those provided in other countries?

5.1  In most respects the UK Government guidelines are comparable to those given in other European countries. However the UK guidelines around drinking in pregnancy are less clear than in the rest of Western Europe, North America and Australasia. Whilst the UK CMOs advise that "pregnant women or women trying to conceive should avoid drinking alcohol" this conflicts with NICE guidance which only advises women to avoid alcohol in the first trimester of pregnancy. CMO and DH guidance to drink no alcohol throughout pregnancy should be made more explicit.

5.2  One area where there is a disparity between the UK and other European countries is the marketing and advertising of alcohol. Alcohol advertising encourages positive attitudes to alcohol and increases levels of drinking. The UK operates a voluntary, self-regulatory code with no legal limitations in force and compared to many European countries is seen to be lax on alcohol advertising. Whilst the UK has voluntary codes of practice detailing how, where and when alcoholic drinks can be advertised, France has a legal ban on advertising of all alcoholic drinks over 1.2% abv on TV and in cinemas and also prohibits sponsorship of sport or cultural events by alcohol companies. In Italy there is a ban on TV and radio advertising of alcohol between 4pm and 9pm and alcohol advertisements are prohibited within 15 minutes of the start or end of children's programmes. Meanwhile, in Sweden there is a complete ban on advertising of all drinks above 2.25%abv, except at the point of sale and in trade journals.[5]

5.3  The ELSA (Enforcement of National Laws and Self-regulation in Advertising and Marketing of Alcohol) project which was funded by the European Commission and concluded in 2007, made specific recommendations for the protection of young people and vulnerable groups which should be taken into account during further development of UK alcohol policy. Statutory regulation on advertising in the UK should be brought in line with other European countries and WHO recommendations.

6.  2020health Key Recommendations

6.1  The clear display of units on bottles or cans of all alcoholic drinks should be made compulsory. Units should be displayed on the front of the bottle and a minimum font size should be specified.

6.2  Statutory regulation on advertising should be brought in line with other Northern European countries, following WHO recommendations.

6.3  A national public health education campaign is needed to ensure that the population is made aware of the harms related to risky drinking. The campaign needs to advise people of the risks of different conditions associated with drinking and the harms of drinking every day. In particular the campaign should highlight risks such as the risk of specific cancers, of which many are not aware.

7.  Further Information

7.1  For further information on the harm and cost of risky drinking please see our forthcoming report, due to be published mid-October "From one to many: The risks of frequent excessive drinking."

8.  Declaration of Interests

8.1  2020health is an independent health and technology think tank with no connection to the alcohol industry. Our forthcoming report on alcohol "From one to many" has been sponsored by an unrestricted educational grant from Lundbeck, a pharmaceutical company with a specialist focus on psychiatry and neurology. This submission draws on the research undertaken for this report, but is an independent submission by 2020health.

September 2011

1   Rehm J, Zatonksi W, Taylor B, Anderson P (2011): Epidemiology and alcohol policy in Europe. Addiction, 106 (Suppl. 1), 11-19 Back

2   Wilkins D, Payne S, Granville G, Branney P (2008): The Gender and Access to Health Services Study. Department of Health. London. Back

3   National Health and Medical Research Council (2009): Australian Guidelines to reduce health risks from Drinking Alcohol. NHMRC. Canberra. Back

4   Corrao G, Bagnardi V, Zambon A, La Vecchia C. (2004): A meta-analysis of alcohol consumption and the risk of 15 diseases. Prev Med. 38(5):613-9. Back

5   Institute of Alcohol Studies (2010): Alcohol & Advertising IAS Factsheet. Back

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Prepared 9 January 2012