Dr Adam Winstock is an addictions specialist and the founder of the Global Drugs Survey, an annual review of how people around the world consume drugs and alcohol. To take part in this year's survey, click here.
The government's new guidelines on alcohol – no more than seven pints a week for both men and women – make sense. Based on a huge body of international epidemiological evidence, whether you like it or not the new advice reflects the fact that there is no safe level of drinking, and that only the smallest percentage of the population may benefit very minimally from very low levels of drinking.
The UK's Chief Medical Officer, Professor Dame Sally Porter, identifies part of her job as making the public aware of the health risks associated with different consumptive behaviours, be that the consumption of alcohol, sugar or cigarettes. She states that the guidelines can be used to help doctors and other clinical staff engage their patients in conversations about drinking in order to support healthy behavioural change. As a medical doctor and addictions specialist I cannot disagree with that.
The question is whether or not the new guidelines are just a case of the government attempting to be seen to be doing the right thing, despite their refusal to do the three things we know would reduce drinking levels: a rise in tax; a reduction in drinking hours and outlet density, i.e. all the places you can buy booze; and a drop in the drink-drive limit.
Of course, the problem is that these three highly-evidenced, regulation-based approaches to reducing the harm caused by excessive alcohol consumption – endorsed by the government's own expert review over the last 20 years – would upset the government's cosy relationship with the powerful drinks lobby, as well as infringing on our right to put what we want into our own bodies.
So the question I have is what should the key outcomes for drinking guidelines be? Should they simply be an accurate reflection of drinking-related risks, with advice on how best to minimise these? Or should they be created with the primary aim of reducing the UK population's alcohol consumption levels?
That second option presents one big problem: developing even more restrictive guidelines may well further alienate the huge proportion of people who drink above existing guidelines, by making the guidelines increasingly less meaningful. The Global Drug Survey (GDS) examined this topic a few years ago when we asked drinkers from around the world what strategies they adopted to reduce their risk of harm from alcohol and other drugs.
While over 80 percent of the more than 6,000 UK drinkers who took part in GDS2014 said they were aware of drinking guidelines, less than 20 percent said they pay them any attention while drinking. However, the government can take some solace in the fact that many (almost 80 percent) reported usually having two or more alcohol-free days per week, while a similar proportion said they make sure to eat something before drinking. Almost half said they took breaks of at least two weeks from drinking each year.
That said, compliance with these safer drinking guidelines is entirely undone by one big factor: that people occasionally drink to get drunk, so they're not going to stop until they start to feel a buzz, regardless of what health experts suggest. Our findings show that women in the UK need, on average, about three medium glasses of wine to feel the effects, while men need, on average, two-and-a-half pints of medium strength beer – clearly more than the recommendations laid out in today's guidelines.
So the problem, as I see it, is that these new guidelines – although rightly making people aware of the risks of drinking – are unlikely to have any significant impact on the UK population's health.
In the meantime, a better approach might be to enable people to reflect on the impacts of their own drinking and offer some guidance as to the risks of drinking above recommended limits. Perhaps, for instance, it would be useful to help people understand the different risks associated with getting a bit drunk and very drunk, or of getting a bit drunk two or three times a year, versus every week, and – most importantly – how moderating those existing behaviours might end up improving their health.
Personalising feedback using online and smart phone apps such Global Drug Survey's free Drinks Meter – which also considers impacts based on personal health conditions, vulnerability, calories and cash –is an effective way of informing people about their own drinking habits and helping to nudge them towards reducing their alcohol consumption, while still remaining realistic. Another tactic could be to remind drinkers of all the embarrassing stuff they do when they get too drunk; GDS' One Too Many test does exactly that.
Although based in fact, and coming from the right place, the UK's new drinking guidelines do not reflect reality: that many people (in fact, those most at risk of alcohol-related harm) drink to feel the effects of alcohol. I'm not condoning ever drinking to excess, because the reality is that binge drinking even once a month undermines any potential benefits derived from moderate drinking for the rest of the month. However, any guidelines do need to acknowledge both the pleasures and harms caused by alcohol, because if the government ignore the basic truths of drinking, they're likely to be ignored by the majority of people they're trying to reach.
If you want to help GDS understand a little more about drugs and alcohol, take part in this year's Global Drugs Survey.
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