tag:theconversation.com,2011:/id/topics/alcohol-units-8501/articlesAlcohol units – The Conversation2022-08-31T20:19:55Ztag:theconversation.com,2011:article/1896672022-08-31T20:19:55Z2022-08-31T20:19:55ZCanada’s low-risk alcohol use guidelines have been slashed to 6 drinks per week. Here’s why.<figure><img src="https://images.theconversation.com/files/481979/original/file-20220831-1977-ixc18l.JPG?ixlib=rb-1.1.0&rect=7%2C464%2C4985%2C3023&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Canada's previous low-risk drinking guidelines were much more generous, allowing significantly more drinks per week.</span> <span class="attribution"><span class="source">THE CANADIAN PRESS/Darryl Dyck</span></span></figcaption></figure><iframe style="width: 100%; height: 100px; border: none; position: relative; z-index: 1;" allowtransparency="" allow="clipboard-read; clipboard-write" src="https://narrations.ad-auris.com/widget/the-conversation-canada/canada-s-low-risk-alcohol-use-guidelines-have-been-slashed-to-6-drinks-per-week--here-s-why-" width="100%" height="400"></iframe>
<p>New <a href="https://ccsa.ca/update-canadas-low-risk-alcohol-drinking-guidelines-final-report-public-consultation-report">Canadian guidelines</a> for reducing risks to health from alcohol use were released for public comment this week. Key messages include:</p>
<ul>
<li>drinking less alcohol is better for health;</li>
<li>health risks escalate quickly above six standard drinks per week, especially for women;</li>
<li>do not exceed two drinks on any one day to minimize risks;</li>
<li>alcohol is a carcinogen;</li>
<li>alcohol containers should carry prominent health warnings.</li>
</ul>
<p>You may be asking, who took it upon themselves to give this advice to the public and upon what basis? I am a scientist at the <a href="https://www.uvic.ca/research/centres/cisur/">Canadian Institute for Substance Use Research</a> and was a member of the panel that generated this advice. I have also advised or been a panelist on four previous guideline committees over the past 30 years including for Australia, the United Kingdom and Canada. </p>
<p>I try to explain here some of the underlying science and how it has evolved, principally why drinking guidelines internationally have lowered definitions of “low-risk” alcohol use.</p>
<h2>Why have the guidelines changed?</h2>
<p>The new guideline development was led by the Ottawa-based Canadian Centre on Substance Use and Addiction (CCSA) with funding from Health Canada. The previous <a href="https://www.ccsa.ca/sites/default/files/2020-07/2012-Canada-Low-Risk-Alcohol-Drinking-Guidelines-Brochure-en_0.pdf">2011 guidelines</a> were far more generous: low-risk drinking was defined as up to 10 standard drinks per week for women and 15 for men. </p>
<figure class="align-center ">
<img alt="A shopping cart with several bottles of liquor in it" src="https://images.theconversation.com/files/481982/original/file-20220831-24-as8lc9.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/481982/original/file-20220831-24-as8lc9.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=428&fit=crop&dpr=1 600w, https://images.theconversation.com/files/481982/original/file-20220831-24-as8lc9.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=428&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/481982/original/file-20220831-24-as8lc9.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=428&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/481982/original/file-20220831-24-as8lc9.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=538&fit=crop&dpr=1 754w, https://images.theconversation.com/files/481982/original/file-20220831-24-as8lc9.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=538&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/481982/original/file-20220831-24-as8lc9.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=538&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">In Canada, alcohol containers do not state how many standard drinks they contain.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Darryl Dyck</span></span>
</figcaption>
</figure>
<p>A standard drink is a <a href="https://doi.org/10.3109/16066359.2014.955480">mystery to many people</a>, not least because unlike in some other countries (e.g. <a href="https://www.foodstandards.gov.au/consumer/labelling/Pages/Labelling-of-alcoholic-beverages.aspx">Australia and New Zealand</a>) alcohol containers here do not state how many standard drinks they contain. In Canada, a standard drink is defined as 13.45 grams of ethanol, which corresponds to typical serve sizes of average strength beer, wine and spirits: </p>
<ul>
<li>341 millilitres of beer or cider (5 per cent alcohol), </li>
<li>142 millilitres of wine (12 per cent alcohol) or </li>
<li>43 millilitres of spirits (40 per cent alcohol.</li>
</ul>
<p>What has changed in the past 11 years? Why is an expert committee now recommending much lower guidelines? I was also a member of the panel for the 2011 guidelines, which were based upon the simple idea that low-risk drinking was a level that didn’t increase health risks above that of an abstainer. </p>
<h2>Criticism of the old guidelines</h2>
<p>In compiling the 2011 guidelines, we looked at comprehensive reviews of the link between alcohol use and risk of premature death. These almost invariably showed that light and moderate drinkers had less risk than abstainers but, above a break-even point, health risks quickly escalated. Many observational studies have suggested low-volume drinkers are “protected” from heart disease, type II diabetes and some kinds of stroke. This evidence is <a href="https://world-heart-federation.org/wp-content/uploads/WHF-Policy-Brief-Alcohol.pdf">now questioned</a>.</p>
<p>Based on the best quality systematic review available at that time we noted that at two drinks per day for women and three for men, mortality risks were equal to those for abstainers. We recommended at least two days of abstinence a week ending up with the 2011 guideline of 10 drinks per week for women and 15 per week for men.</p>
<p>This approach has <a href="https://doi.org/10.1111/dar.12866">been criticized</a> from many angles. Studies in such reviews are from all over the world, albeit with a North American and European bias, but estimates should be tailored more precisely for any specific country. Another criticism is that estimates of the association between level of alcohol use and death from all causes will be heavily confounded by other lifestyle factors. </p>
<p>A better approach, these critics argue, is to estimate risks from alcohol use for a select number of diseases and types of injury known to be caused by alcohol, such as liver disease, breast cancer, road crash injuries, etc. </p>
<p>When such an approach is used, this break-even point (the point at which potential benefits and risks cancel each other out) is at a much lower level than from the all-cause mortality studies. My colleagues and I <a href="https://www.jsad.com/doi/10.15288/jsad.2020.81.352">recently estimated</a> this would be at about one drink per day, even assuming some protection against heart disease.</p>
<h2>Risk levels</h2>
<p>With the net risk of alcohol-related harm increasing at even low levels of consumption, guideline committees in other countries (such as <a href="https://www.gov.uk/government/publications/alcohol-consumption-advice-on-low-risk-drinking">the U.K.</a> and <a href="https://www.nhmrc.gov.au/about-us/publications/australian-guidelines-reduce-health-risks-drinking-alcohol">Australia</a>) have resorted to defining an “acceptable” level of risk from alcohol. </p>
<p>For external risks such as from air pollution or radiation from a nuclear power reactor, acceptable risk is generally taken as being an increase in mortality risk of less than <a href="https://doi.org/10.1186/s12916-014-0189-z">one in a million</a>. If an equivalent risk for external factors was taken for alcohol, I calculate that would mean, on the basis of the new guideline risk estimates, not drinking more than one drink every 20 years!</p>
<p>For personal behaviours such as sexual risk-taking, smoking and alcohol use, people are prepared to accept higher levels of risk, for example, up to one in 100.</p>
<h2>New Canadian guidelines</h2>
<p>The new Canadian guidelines followed strict procedures for making as impartial and up-to-date an estimate as possible. Committee members were public health, medical and epidemiology experts who had no financial interests in the manufacture or sale of alcohol. </p>
<p>An independent team used strictly defined search criteria to locate the latest high quality published studies on alcohol risks for health conditions specified by the World Health Organization’s <a href="https://doi.org/10.1016/S0140-6736(18)31310-2">Global Burden of Disease</a> study group. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/481981/original/file-20220831-24-vv8pto.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Three cocktails with garnishes: an orange beverage in a wine glass, a red beverage and a yellow beverage in short glasses" src="https://images.theconversation.com/files/481981/original/file-20220831-24-vv8pto.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/481981/original/file-20220831-24-vv8pto.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=420&fit=crop&dpr=1 600w, https://images.theconversation.com/files/481981/original/file-20220831-24-vv8pto.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=420&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/481981/original/file-20220831-24-vv8pto.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=420&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/481981/original/file-20220831-24-vv8pto.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=528&fit=crop&dpr=1 754w, https://images.theconversation.com/files/481981/original/file-20220831-24-vv8pto.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=528&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/481981/original/file-20220831-24-vv8pto.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=528&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Drinking at the new guideline levels will still shave off two or three months of life expectancy — or about five minutes per drink.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Justin Tang</span></span>
</figcaption>
</figure>
<p>When these risk relationships were collected and applied to Canadian data on causes of death and life expectancy, it was estimated that lifetime mortality risk from alcohol was less than one in 100 for men and women consuming no more than six drinks per week. Risks were elevated even at two drinks per week, at a risk level just under one in 1,000.</p>
<p>These new guidelines are provided on the basis of the latest science, guided by the principle that citizens have a right to know potential health effects of products. This <a href="https://doi.org/10.15288/jsad.2020.81.284">is especially true</a> for products distributed and sold directly by Canadian governments in most provinces and territories. </p>
<h2>Alcohol and heart health</h2>
<p>The careful review process identified much weaker evidence than before for the hypothesis that low doses of alcohol can protect against heart disease. This finding is also consistent with a <a href="https://world-heart-federation.org/news/no-amount-of-alcohol-is-good-for-the-heart-says-world-heart-federation/">World Heart Federation</a> statement released earlier this year, advising that the science underlying this hypothesis is now highly contested and, at best, extremely weak.</p>
<p>My colleagues and I are keen to see how these new guidelines are received. There is still much more work to be done, including determining the acceptable level of risk from alcohol for most people. We have calculated that drinking at these new guideline levels will still shave off two or three months of life expectancy — or about five minutes per drink. Is this acceptable to most people? It’s a conversation we need to continue.</p><img src="https://counter.theconversation.com/content/189667/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Tim Stockwell currently receives funding from:
The Canadian Institute for Substance Use Research at the University of Victoria employs me as a part-time scientist;
The Canadian Institutes for Health Research to estimate the impact of alcohol policies on cancer-related illness;
The Public Health Agency of Canada to model the impacts of alcohol policies on alcohol-related illness and death.
I have previously received grants from many research councils, and government agencies. The latter includes government-owned alcohol distribution and retail agencies in Scandinavia (Systembolaget and Alko) and Canada (BC government) for studies of alcohol and public health. I do not receive funding from alcohol industry sources.</span></em></p>Canada’s new alcohol guidelines cut the number of drinks per week in the ‘low-risk’ category by almost half for women, and by more than half for men. Here’s how researchers came to these conclusions.Tim Stockwell, Scientist, Canadian Institute for Substance Use Research and Professor of Psychology, University of VictoriaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1388912020-06-15T14:28:08Z2020-06-15T14:28:08ZToo much alcohol can cause similar effects to dementia – and the two are often confused<figure><img src="https://images.theconversation.com/files/340335/original/file-20200608-176554-11kncyf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">An avoidable condition.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-illustration/alcohol-depression-signs-mental-health-symbol-1027569001">Shutterstock/Lightspring</a></span></figcaption></figure><p>In the UK, 21% of people are drinking more alcohol than they did before the pandemic, according to a <a href="https://alcoholchange.org.uk/blog/2020/covid19-drinking-during-lockdown-headline-findings">recent survey</a>. This follows a <a href="https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/conditionsanddiseases/articles/coronaviruscovid19roundup20to24april2020/2020-04-24">reported 31% increase</a> in alcohol sales at the start of lockdown.</p>
<p>For while pubs and restaurants were forced to close their doors, off licences were considered <a href="https://www.gov.uk/government/publications/further-businesses-and-premises-to-close/further-businesses-and-premises-to-close-guidance#takeaway-food-and-food-delivery-facilities-may-remain-open-and-operational">essential retailers</a>. And as traditional social gatherings were put on hold, virtual pub quizzes and online parties swiftly replaced them. Twitter hashtags such as #Quarantini and #FurloughMerlot revealed how drinking was, for many, a key element of the pandemic experience. </p>
<p>Some may have turned to alcohol to ease <a href="https://newyork.cbslocal.com/2020/03/20/coronavirus-alcohol-dependence-addiction-substance-abuse/">anxiety</a>, stress or even to <a href="https://www.bbc.co.uk/news/uk-wales-52442936">fill time</a> usually spent at the gym or socialising. But whatever the reason, while most drinkers are aware of the effect that alcohol can have on their livers or waistlines, many do not realise how excessive (and continuous) drinking can cause long-term damage to the brain. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-the-coronavirus-is-putting-our-relationship-with-alcohol-to-the-test-135460">How the coronavirus is putting our relationship with alcohol to the test</a>
</strong>
</em>
</p>
<hr>
<p>Alcohol-related brain damage (ARBD) is an <a href="https://pure.southwales.ac.uk/en/publications/alcoholrelated-neurocognitive-disorders-a-naturalistic-investigation-nosology-and-estimation-of-prevalence-in-the-uk(7cad127b-f1d0-4c8d-b200-d2ed5b8f0f76).html">under-recognised</a> set of <a href="https://www.frontiersin.org/articles/10.3389/fpsyg.2018.02618/full">related conditions</a> which involves structural and functional changes to the brain. It can <a href="https://www.alz.org/alzheimers-dementia/what-is-dementia/types-of-dementia/korsakoff-syndrome">impair memory</a>, thinking, planning and reasoning, and cause changes in personality and behaviour. </p>
<p>There is currently a lack of awareness of ARBD amongst the general public as well as clinical specialists, one of whom <a href="https://pure.southwales.ac.uk/en/publications/professional-perspectives-on-supporting-those-with-alcoholrelated-neurocognitive-disorders-challenges--effective-treatment(0849e478-a0af-46d6-a587-a039670b600b)/export.html">told us</a> that recognising and diagnosing cases is a “major issue”. Signs of ARBD may even be confused with appearing intoxicated, while <a href="https://pure.southwales.ac.uk/en/publications/professional-perspectives-on-supporting-those-with-alcoholrelated-neurocognitive-disorders-challenges--effective-treatment(0849e478-a0af-46d6-a587-a039670b600b)/export.html">stigma is also</a> a barrier to recognising and treating people with the condition.</p>
<p>ARBD often starts with mild symptoms but can progress to more severe problems if alcohol is still consumed at <a href="https://www.nice.org.uk/guidance/ph24/chapter/glossary">harmful quantities</a> (defined as 35 units – roughly four bottles of wine – per week for women, and 50 units for men). </p>
<p>Initial signs of ARBD include impulsive behaviour, problems with planning and decision making, and difficulties in forming and retaining new memories. Some may also experience confabulations, which are false or distorted “memories”.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/341518/original/file-20200612-153845-1wh0lx2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/341518/original/file-20200612-153845-1wh0lx2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=323&fit=crop&dpr=1 600w, https://images.theconversation.com/files/341518/original/file-20200612-153845-1wh0lx2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=323&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/341518/original/file-20200612-153845-1wh0lx2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=323&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/341518/original/file-20200612-153845-1wh0lx2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=406&fit=crop&dpr=1 754w, https://images.theconversation.com/files/341518/original/file-20200612-153845-1wh0lx2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=406&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/341518/original/file-20200612-153845-1wh0lx2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=406&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Essential service?</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/off-licence-55052275">Shutterstock/Happy Stock Photo</a></span>
</figcaption>
</figure>
<p>Men are more likely to have ARBD, although <a href="https://pure.southwales.ac.uk/en/publications/alcoholrelated-neurocognitive-disorders-a-naturalistic-investigation-nosology-and-estimation-of-prevalence-in-the-uk(7cad127b-f1d0-4c8d-b200-d2ed5b8f0f76).html">studies suggest</a> that women might be more vulnerable to the effects of alcohol as females develop the condition at a significantly younger age than men. In both sexes, those in their mid to late-50s have the highest rates of ARBD, but some cases have been reported under the age of 35.</p>
<h2>Abstinence and recovery</h2>
<p>These symptoms often overlap with some of the signs of dementia, with research suggesting that <a href="https://pubmed.ncbi.nlm.nih.gov/23347747/">up to 24% of all dementia cases</a> are in fact ARBD. But while dementia patients rarely experience improvements in their condition, those with ARBD have the potential to at least partially recover. This makes it vital to distinguish the condition from dementia by considering drinking history and noticing any signs of improvement or stabilisation.</p>
<p><a href="https://www.alzheimers.org.uk/about-dementia/types-dementia/arbd-treatment-support">Treatment</a> for ARBD typically means abstinence from alcohol, followed by rehabilitation. Usually, at least <a href="https://www.rcpsych.ac.uk/docs/default-source/improving-care/better-mh-policy/college-reports/college-report-cr185.pdf?sfvrsn=66534d91_2">three months without alcohol</a> is needed to see if there are any improvements or signs that the damage might be reversible. There is no agreed “safe limit” once someone has been diagnosed, and any amount of alcohol is likely to cause more damage.</p>
<p>Although ARBD is often <a href="https://pure.southwales.ac.uk/en/publications/alcoholrelated-neurocognitive-disorders-a-naturalistic-investigation-nosology-and-estimation-of-prevalence-in-the-uk(7cad127b-f1d0-4c8d-b200-d2ed5b8f0f76).html">difficult to diagnose</a>, one report in Wales suggests an overall <a href="http://www2.nphs.wales.nhs.uk:8080/SubstanceMisuseDocs.nsf/85c50756737f79ac80256f2700534ea3/8455b3ff0835b96980257dfd0035cde3/%24FILE/Evidence-based%20profile%20of%20alcohol%20related%20brain%20damage%20in%20Wales.pdf">increase of 38.5%</a> of those diagnosed with the condition over a five-year period. </p>
<p>Nor are increases in ARBD restricted to those with poorer socioeconomic backgrounds. They are known to have <a href="https://academic.oup.com/eurpub/article/15/6/587/440068">high rates of the condition</a>, but <a href="https://www.ons.gov.uk/releases/adultdrinkinghabitsingreatbritain2017">recent figures</a> show that those with professional jobs were more likely to regularly drink alcohol compared to those on lower incomes.</p>
<p>Although alcohol may provide a short-term release from the stresses of life – particularly during a pandemic – many drinkers may be developing an unhealthy habit with alcohol that is damaging their brains. But one of the distinctive things about ARBD is that it is a preventable, treatable and potentially reversible condition, if recognised and treated early. </p>
<p>To keep control of alcohol consumption, the <a href="http://www.euro.who.int/__data/assets/pdf_file/0010/437608/Alcohol-and-COVID-19-what-you-need-to-know.pdf?ua=1">World Health Organization suggests</a> trying to maintain a routine as much as possible and focusing attention on the things that can be controlled. Instead of passing time drinking alcohol, this could be replaced by physical activity, which is known to boost the <a href="https://journals.physiology.org/doi/full/10.1152/physrev.2000.80.3.1055?url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&rfr_dat=cr_pub%3Dpubmed&">immune system</a> and benefit <a href="https://www.karger.com/Article/PDF/223730">mental health</a>.</p>
<p>So before you reach for your #Quarantini cocktail, it is important to consider the longer term effect these kinds of habits might be having – on the brain as well as the liver.</p><img src="https://counter.theconversation.com/content/138891/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Bev John has received funding from European Social Funds/Welsh Government, Alcohol Concern (now Alcohol Change), Research Councils and the personal research budgets of a number of Welsh Senedd members.</span></em></p><p class="fine-print"><em><span>Gareth Roderique-Davies has received funding from European Social Funds/Welsh Government, Alcohol Concern (now Alcohol Change), Research Councils and the personal research budgets of a number of Welsh Senedd members. </span></em></p><p class="fine-print"><em><span>Rebecca Ward does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Lockdown #quarantinis might seem like a way of getting through, but few realise how much drinking can affect the brain.Rebecca Ward, Senior Research Assistant in Psychology, University of South WalesBev John, Professor of Addictions and Health Psychology, University of South WalesGareth Roderique-Davies, Professor of Psychology, University of South WalesLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1288562019-12-16T01:00:39Z2019-12-16T01:00:39ZCap your alcohol at 10 drinks a week: new draft guidelines<figure><img src="https://images.theconversation.com/files/307002/original/file-20191215-123983-6wr9fd.jpg?ixlib=rb-1.1.0&rect=44%2C630%2C4901%2C2604&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Further evidence about the harms of alcohol has accumulated over the past decade since the last guidelines were released.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/people-leisure-friendship-celebration-concept-happy-611242766">Syda Productions/Shtterstock</a></span></figcaption></figure><p>New <a href="https://online.nhmrc.gov.au/public-consultation/nhmrc-draft-revised-australian-guidelines-reduce-health-risks-drinking-alcohol">draft alcohol guidelines</a>, released today, recommend healthy Australian women and men drink no more than ten standard drinks a week and no more than four on any one day to reduce their risk of health problems.</p>
<p>This is a change from the <a href="https://www.health.gov.au/health-topics/alcohol/about-alcohol/how-much-alcohol-is-safe-to-drink">previous guidelines</a>, released in 2009, that recommended no more than two standard drinks a day (equating to up to 14 a week). </p>
<p>(If you’re unsure what a standard drink looks like, use <a href="https://yourroom.health.nsw.gov.au/games-and-tools/pages/standard-drink-calculator.aspx">this</a> handy reference.)</p>
<p>The guidelines also note that for some people – including teens and women who are pregnant or breastfeeding – not drinking is the safest option. </p>
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Read more:
<a href="https://theconversation.com/drink-drank-drunk-what-happens-when-we-drink-alcohol-in-four-short-videos-100206">Drink, drank, drunk: what happens when we drink alcohol in four short videos</a>
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<h2>What are the new recommendations based on?</h2>
<p>The National Health and Medical Research Council looked at the latest research and did some mathematical modelling to come to these recommendations.</p>
<p>It found the risk of dying from an alcohol-related disease or injury is about one in 100 if you drink no more than ten standard drinks a week and no more than four on any one day. </p>
<p>So, for every 100 people who stay under these limits, one will die from an alcohol-related disease or injury.</p>
<p>This is considered an “acceptable risk”, given drinking alcohol is common and it’s unlikely people will stop drinking altogether. The draft guidelines take into account that, on average, Australian adults have a drink three times a week.</p>
<h2>Why did the guidelines need updating?</h2>
<p>Recent research has shown there is a clear link between drinking alcohol and a number of <a href="http://theconversation.com/four-ways-alcohol-is-bad-for-your-health-92578">health conditions</a>. These include at least seven <a href="https://www.cancercouncil.com.au/2397/about-us/our-annual-reports-and-research-activity-reports/our-position-statements-about-cancer-council-nsw/alcohol-and-cancer2/">cancers</a> (liver, oral cavity, pharyngeal, laryngeal, oesophageal, colorectal, liver and breast cancer in women); diabetes; liver disease; brain impairment; mental health problems; and being overweight or obese.</p>
<p>Some previous research suggested low levels of alcohol might be good for you, but we now know these studies were <a href="https://www.abc.net.au/news/2016-03-22/studies-linking-alcohol-to-health-benefits-flawed-researchers/7264040">flawed</a>. Better quality studies have found alcohol does not offer health benefits.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/health-check-is-moderate-drinking-good-for-me-108921">Health check: is moderate drinking good for me?</a>
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</em>
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<p>The new guidelines are easier to follow than the previous guidelines, which gave recommendations to reduce both short-term harms and longer-term health problems. But some people found these <a href="https://www.ncbi.nlm.nih.gov/pubmed/24494949">confusing</a>.</p>
<p>Although most Australians drink within the previously recommended limits, <a href="https://www.ncbi.nlm.nih.gov/pubmed/24494949">one study</a> found one in five adults drank more than the guidelines suggested and almost half could not correctly identify recommended limits.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/307005/original/file-20191215-124022-1dqfpq1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/307005/original/file-20191215-124022-1dqfpq1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/307005/original/file-20191215-124022-1dqfpq1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/307005/original/file-20191215-124022-1dqfpq1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/307005/original/file-20191215-124022-1dqfpq1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/307005/original/file-20191215-124022-1dqfpq1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/307005/original/file-20191215-124022-1dqfpq1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The draft new guidelines are easier to follow than the old ones.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/red-wine-pouring-into-glass-shallow-578684329">sama_ja/Shutterstock</a></span>
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<p>Although women tend to be more affected by alcohol than men, at the rates of consumption recommended in the guidelines, there is little difference in long term health effects so the guidelines apply to both men and women.</p>
<p>The recommended limits are aimed at <em>healthy</em> men and women, because some people are at higher risks of problems at lower levels of consumption. These include older people, young people, those with a family history of alcohol problems, people who use other drugs at the same time (including illicit drugs and prescribed medication), and those with physical or mental health problems.</p>
<p>The guidelines are currently in draft form, with a <a href="https://online.nhmrc.gov.au/public-consultation/nhmrc-draft-revised-australian-guidelines-reduce-health-risks-drinking-alcohol">public consultation</a> running until February 24. </p>
<p>After that, there will be an expert review of the guidelines and the final guidelines will be released later in 2020. There may be changes to the way the information is presented but the recommended limits are unlikely to change substantially, given they’re based on very careful and detailed analysis of the evidence.</p>
<h2>What’s the risk for people under 18?</h2>
<p>The draft guidelines recommend children and young people under 18 years drink no alcohol, to reduce the risk of injury and other health harms. </p>
<p>The good news is most teenagers <a href="https://www.aihw.gov.au/reports/illicit-use-of-drugs/2016-ndshs-detailed/contents/table-of-contents">don’t drink alcohol</a>. Among 12 to 17 year olds, only 20% have had a drink in the past year and 1.4% drink weekly. The number of teenagers who have never had a drink has increased significantly in the last decade, and young people are having their first drink later.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/three-ways-to-help-your-teenage-kids-develop-a-healthier-relationship-with-alcohol-80892">Three ways to help your teenage kids develop a healthier relationship with alcohol</a>
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</em>
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<p>However, we know teenagers are <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3960066/">more affected</a> by alcohol than adults. This includes effects on their developing brain. We also know the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3960066/">earlier</a> someone starts drinking, the more likely they will experience problems, including dependence.</p>
<p>The idea that if you give teenagers small sips of alcohol it will reduce risk of problems later has now been <a href="https://www.sciencedaily.com/releases/2018/02/180220094247.htm">debunked</a>. Teens that have been given even small amounts of alcohol early are more likely to have problems later.</p>
<h2>What’s the risk for pregnant and breastfeeding women?</h2>
<p>The guidelines recommend women who are pregnant, thinking about becoming pregnant or breastfeeding not drink any alcohol, for the safety of their baby.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/health-check-what-are-the-risks-of-drinking-before-you-know-youre-pregnant-59603">Health Check: what are the risks of drinking before you know you're pregnant?</a>
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</em>
</p>
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<p>We now have a much clearer understanding of the impacts of alcohol on the developing foetus. <a href="https://www.nofasd.org.au/alcohol-and-pregnancy/what-is-fasd/">Foetal alcohol spectrum disorder</a> (FASD) is a direct result of foetal exposure to alcohol in the womb. Around <a href="https://www.health.gov.au/sites/default/files/national-fasd-strategic-action-plan-2018-2028.pdf">one in 67</a> women who drink while pregnant will deliver a baby with foetal alcohol spectrum disorder.</p>
<p>Foetal alcohol spectrum disorder is characterised by a range of physical, mental, behavioural, and learning disabilities ranging from mild to severe – and is incurable.</p>
<h2>Worried about your own or someone else’s drinking?</h2>
<p>If you enjoy a drink, stick within these recommended maximums to limit the health risks of alcohol.</p>
<p>If you have trouble sticking to these limits, or you are worried about your own or someone else’s drinking, call the National Alcohol and other Drug Hotline on 1800 250 015 to talk through options or check out <a href="https://hellosundaymorning.org">these resources online</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/did-you-look-forward-to-last-nights-bottle-of-wine-a-bit-too-much-ladies-youre-not-alone-109078">Did you look forward to last night's bottle of wine a bit too much? Ladies, you're not alone</a>
</strong>
</em>
</p>
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<img src="https://counter.theconversation.com/content/128856/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nicole Lee works as a consultant in the alcohol and other drug sector, including education and training for parents on drugs. She has previously been awarded funding by Australian and state governments, NHMRC and other bodies for evaluation and research into drug prevention and treatment. She is a member of the board of directors of Hello Sunday Morning.</span></em></p>New draft guidelines recommend limiting alcohol consumption to no more than ten standard drinks per week and no more than four standard drinks on any one day.Nicole Lee, Professor at the National Drug Research Institute (Melbourne), Curtin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/559142016-03-30T14:04:29Z2016-03-30T14:04:29ZShould alcohol limits for men and women really be the same?<figure><img src="https://images.theconversation.com/files/116378/original/image-20160324-17859-eubvxb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">It's complicated.</span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/cat.mhtml?lang=en&language=en&ref_site=photo&search_source=search_form&version=llv1&anyorall=all&safesearch=1&use_local_boost=1&autocomplete_id=&searchterm=woman%20drinking%20alcohol&show_color_wheel=1&orient=&commercial_ok=&media_type=images&search_cat=&searchtermx=&photographer_name=&people_gender=&people_age=&people_ethnicity=&people_number=&color=&page=1&inline=370415336">www.shutterstock.com</a></span></figcaption></figure><p>The UK’s new <a href="https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/489795/summary.pdf">alcohol guidelines</a> advise that men and women shouldn’t drink more than <a href="http://www.nhs.uk/Livewell/alcohol/Pages/alcohol-units.aspx">14 units</a> of alcohol a week. Previous advice for the British drinker presented a higher threshold for men, so this represents a considerable change. So what was the evidence that the limits should <em>not</em> take gender into account?</p>
<p>Most countries that provide guidelines on alcohol consumption suggest higher threshold levels for men than women. It is well known that, physiologically, women are more vulnerable to the <a href="http://www.ncbi.nlm.nih.gov/pubmed/23500890">toxic effects of alcohol</a> than men. Pint for pint, women have a greater risk of <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3908713/">alcohol related problems</a> such as dependency, certain cancers (liver, mouth and stomach) and other physical and psychological health issues. </p>
<p>A complex interplay of genetics, environment, personality and motivation contributes towards the likelihood of experiencing these conditions. The different risk factors faced by men and women are particularly apparent at higher levels of consumption – what we now call “drinking with <a href="http://www.alcohollearningcentre.org.uk/Topics/Browse/SocialMarketing/toolkit2010/introduction/IncreasingAndHigherRisk/">increasing risk</a>”. That is, men who regularly drink more than three or four units a day and women who regularly drink more than two or three units a day. But at levels of consumption lower than this, these differences are not as clear cut.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/116389/original/image-20160324-17835-73b2n5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/116389/original/image-20160324-17835-73b2n5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/116389/original/image-20160324-17835-73b2n5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/116389/original/image-20160324-17835-73b2n5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/116389/original/image-20160324-17835-73b2n5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/116389/original/image-20160324-17835-73b2n5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/116389/original/image-20160324-17835-73b2n5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Drinking with increasing risk.</span>
<span class="attribution"><span class="source">www.shutterstock.com</span></span>
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</figure>
<h2>An acceptable risk</h2>
<p>The latest guidelines are based on <a href="https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/489797/CMO_Alcohol_Report.pdf">data</a> provided by the University of Sheffield. It shows that anyone who drinks every day and who consumes no more than 14 units of alcohol a week has a less than one percent chance of dying from an alcohol-related health condition at any time. </p>
<p>One percent was adopted by the guidelines committee as the maximum level of risk that would be acceptable to the public. This has been presented as a similar level of risk to the chance of dying in a car accident. (In fact, the chances of <a href="http://www.medicine.ox.ac.uk/bandolier/booth/Risk/trasnsportpop.html">dying in a road accident</a> are even smaller – at less than 0.5% over a lifetime.) But most people don’t drink every day and so, for the majority, the situation is a little less clear cut. </p>
<p>So it’s not just how much, but also how often, we drink that counts, with decreasing frequency associated with increased risk. The Sheffield data shows that men drinking 14 units a week on a single occasion have a 4.5% lifetime risk of dying from an alcohol-related health condition. For women drinking at the same level on a single occasion each week, the risk is 2%.</p>
<p>Interestingly, at the new guideline threshold, men have an almost five times (0.99%) greater risk of death than women (0.18%), but still less than 1% overall. If we consider the previous threshold of 21 units a week for men drinking seven days a week, the risk of alcohol-related death increases to 3%. Complicated, isn’t it? </p>
<p>The new guidelines present the message that there is no “safe” level of alcohol consumption but stop short of recommending abstention as the best policy. In fact, the Sheffield data shows that for both men and women drinking up to seven units a week, spread across three or more days, actually has a protective effect on death from an alcohol-related health condition. For men the benefit is very small (a 0.1% improvement), compared with over 2% for women.</p>
<h2>A better way to present the data</h2>
<p>Given that there are well established and significant differences between male and female responses to alcohol across a range of quantities and frequencies of consumption, it is difficult if not impossible to encompass this diversity into a single recommendation of what represents the optimal limits of consumption with regard to the likelihood of dying from an alcohol related condition. </p>
<p>It might be better to present information on the <em>relative</em> risks associated with increasing use. This allows a comparison with non-drinkers, for example: “Men who regularly drink five units a day have a threefold increased risk of death from cirrhosis of the liver compared with non-drinkers.” In fact, the expert committee that helped to put the guidelines together noted that this might have been a better way to illustrate the relationship between drinking and death.</p>
<p>The situation is complex. Although it’s clear that there are benefits to both health and society by reducing alcohol consumption, the reasoning behind the cut-off of 1%, as an acceptable level of risk, or the underlying assumption that those who drink do so on a daily basis, is unclear. </p>
<p>While the guidelines set out to provide helpful advice about drinking, ignoring the differences between male and female responses to alcohol, is a risky strategy. If the guidelines don’t resonate with those of us who choose to drink, they will simply be ignored, and that won’t do anyone any good at all.</p><img src="https://counter.theconversation.com/content/55914/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Bob Patton does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The new alcohol guidelines limit of 14 units a week for men and women hides a more complicated story.Bob Patton, Lecturer in Clinical Psychology, University of SurreyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/530562016-01-15T11:00:00Z2016-01-15T11:00:00ZDrinking is bad for you – that’s why it’s fun<figure><img src="https://images.theconversation.com/files/107904/original/image-20160112-6964-1lw4zae.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Villainised</span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-141131041/stock-photo-mid-age-man-drinking-red-wine-at-home.html?src=pd-photo-92551108-cn3Xo-TkhrSvBNTyvgQEWg-8">www.shutterstock.com</a></span></figcaption></figure><p>Why do we drink alcohol? And what would make us do less of it? The government has its own answers – on January 8, the chief medical officer for England, Dame Sally Davies, announced the new <a href="https://www.gov.uk/government/news/new-alcohol-guidelines-show-increased-risk-of-cancer">government alcohol guidelines</a>. There is now no “safe” drinking level, and the recommended lower-risk maximum per week has been reduced to 14 units, for both men and women. That’s roughly six pints of beer or six glasses of wine. We are advised not to consume all these units in one epic binge, or lunchtime tipple, depending on your habit. A “heavy drinking” session is now three pints of beer, or three glasses of wine.</p>
<h2>Annual media drama</h2>
<p>Many people, like me, will be surprised to be suddenly labelled a heavy drinker. Could it be that the UK alcohol policy pantomime is running out of villains? First, it was those <a href="http://www.tandfonline.com/doi/abs/10.1080/09687630802511456">reckless young people</a>. Then the “hidden problem” of <a href="http://www.theguardian.com/society/2015/may/29/middle-aged-are-riskier-drinkers-than-young-adults-study-finds">middle-aged drinkers</a> emerged. Finally, the gently sozzled suburban middle classes were cast as the <a href="http://www.dailymail.co.uk/news/article-3172734/Middle-class-drink-epidemic-Affluent-50s-sleep-walking-health-crisis-likely-consume-harmful-levels-alcohol-week.html">irresponsible “other”</a> in this annual media drama.</p>
<p>Unsurprisingly, there is no evidence that we change our drinking behaviour as a result of the now ritualised piety of <a href="http://alcoholresearchuk.org/news/the-new-alcohol-guidelines-explained/">alcohol guidelines</a>. <a href="http://www.dailymail.co.uk/news/article-3185486/Binge-drinkers-ignore-unrealistic-alcohol-guidelines-30-year-old-official-limits-deemed-irrelevant-Britons-drink-excess-weekends.html">We don’t calculate how many units we drink</a>. Why would we? We already know that drinking is not good for us – that’s <a href="https://theconversation.com/sticking-two-fingers-up-to-sensible-guidance-fuels-drinking-appeal-and-alcohol-brands-know-it-46687">one of the reasons it’s fun</a>. Alcohol guidelines make little sense as a behavioural intervention. They make more sense understood as a cycle of social drama enacted through the media. </p>
<h2>Generating an emotional response</h2>
<p>Victor Turner’s <a href="https://books.google.co.uk/books?id=zNoOAQAAMAAJ&source=gbs_navlinks_s&redir_esc=y">The Anthropology of Experience</a> suggests that social dramas follow a process of “breach”, “crisis”, “redress”, and “reintegration”. They are accompanied by “metacommentaries” in which we <a href="http://business.nmsu.edu/%7Edboje/theatrics/7/victor_turner.htm">tell stories about ourselves, to ourselves</a>.
Turner referred to major news events of political significance, but the media’s appetite for crisis and conflict seems now to extend to any story that can generate emotional responses. </p>
<p>Crises are worked up through dramatic representations of alcohol-related ill health and social harm, suggesting a breach between the health system, sensible citizens, and the irresponsible risk-takers. The metacommentaries of resistance, dissent, agreement and reconciliation, along with dollops of self-righteousness, guilt, and scorn, are acted out in social media. Like Hamlet’s play within a play, the drama draws us into moral self-reflection. </p>
<h2>Assessing the risk</h2>
<p>It isn’t just alcohol policy that displays this theatrical character. The World Health Organisation recently informed us, with a similar flurry of media hand-wringing, that <a href="http://www.bbc.co.uk/news/health-34615621">bacon, sausages and ham are potentially carcinogenic</a>. The Department of Health insists that alcohol guidelines are about content, not process. They want to alert people to the risks, so that we can make informed judgements about our drinking. The magnitude of the risk, though, is far from clear. </p>
<p>Some 8,400 people in the UK died of alcohol related causes in 2014 according to the Office for National Statistics, roughly <a href="http://www.ons.gov.uk/ons/rel/subnational-health4/alcohol-related-deaths-in-the-united-kingdom/2013/sty-lives-lost-to-alcohol.html">1.6%</a> of all the 501,424 deaths recorded that year. Alcohol was not recorded as one of the UK’s <a href="http://www.ons.gov.uk/ons/rel/vsob1/mortality-statistics--deaths-registered-in-england-and-wales--series-dr-/2014/sty-what-do-we-die-from.html">top ten</a> killers.</p>
<p>The game changer for the chief medical officer (CMO) seems to be epidemiological research that links alcohol to cancers. It is probably not true that a drink is “<a href="http://www.theguardian.com/commentisfree/2016/jan/10/alcohol-guidelines-drinking-orwell-perfect-pub">potentially as carcinogenic as a cigarette</a>” but alcohol is likely to be implicated in some 4-6% of deaths from cancers of the <a href="https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/490584/COC_2015_S2__Alcohol_and_Cancer_statement_Final_version.pdf">head, neck, mouth and digestive system</a>.
It is also concerning that the long-term trend for alcohol consumption and alcohol-related deaths in the UK is upward, unlike those of some other <a href="https://www.drinkaware.co.uk/about-us/research-and-impact/databank/data-and-facts-on-alcohol-consumption-and-the-consequences/comparisons">European countries</a>. So, some risk there, but it is small. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/107910/original/image-20160112-6996-16d07yf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/107910/original/image-20160112-6996-16d07yf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/107910/original/image-20160112-6996-16d07yf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/107910/original/image-20160112-6996-16d07yf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/107910/original/image-20160112-6996-16d07yf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/107910/original/image-20160112-6996-16d07yf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/107910/original/image-20160112-6996-16d07yf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Probably not as dangerous as smoking.</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/cat.mhtml?lang=en&language=en&ref_site=photo&search_source=search_form&version=llv1&anyorall=all&safesearch=1&use_local_boost=1&autocomplete_id=&search_tracking_id=ocpJTJbECerxmWEYVkEpdw&searchterm=smoking%20a%20cigarette&show_color_wheel=1&orient=&commercial_ok=&media_type=images&search_cat=&searchtermx=&photographer_name=&people_gender=&people_age=&people_ethnicity=&people_number=&color=&page=1&inline=232964731">www.shutterstock.com</a></span>
</figcaption>
</figure>
<p>Confusing the issue further, though, is the matter of comorbidity. Dependence on alcohol and cigarettes are highly correlated, and both are <a href="http://pubs.niaaa.nih.gov/publications/AA71/AA71.htm">correlated with cancers, heart disease and mental illness</a>. Even income could be a factor in susceptibility to alcohol related illness. Managerial and professional workers suffer far less <a href="http://www.ons.gov.uk/ons/rel/subnational-health4/alcohol-related-deaths-in-the-united-kingdom/2013/sty-lives-lost-to-alcohol.html">alcohol related ill health than unskilled workers</a>. So, there is certainly risk attached to drinking, with consequences for public health. But the risk in interaction with other factors in our lives, such as obesity, stress, smoking, loneliness, genetic factors or lack of exercise, is impossible to generalise across diverse populations. Alcohol will kill a few of us, but which of us cannot be predicted just from the amount we drink. </p>
<h2>Drawbacks</h2>
<p>There are two drawbacks to socially dramatised alcohol policy. One is that the use of real instruments of policy, such as taxation, licensing restrictions and marketing regulation becomes displaced by the <a href="http://www.palgrave-journals.com/bp/journal/v7/n3/full/bp20127a.html">media performance</a> of alcohol policy. The other is that government public relations officers have to think of new ways to excite journalists and readers with a sense of crisis. </p>
<p>This time next year, could we see a call to arms about “passive drinking” (the damage done to non-drinkers as a result of consuming alcohol)? Probably not, although the idea was seriously mooted as a policy theme by a <a href="http://www.tandfonline.com/doi/abs/10.1080/13698570903329482">previous CMO in 2009</a>. But never say never.</p><img src="https://counter.theconversation.com/content/53056/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Chris Hackley has in the past received ESRC funding as part of a team studying alcohol and young people RES-148-25-0021 </span></em></p>The new alcohol guidelines are just a bit of social drama acted out by the media.Chris Hackley, Professor of Marketing, Royal Holloway University of LondonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/357692015-03-25T06:31:31Z2015-03-25T06:31:31ZCall time on soft approach to Big Alcohol<figure><img src="https://images.theconversation.com/files/75669/original/image-20150323-17672-1j84zxk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Gauging the pressure to make changes to the law.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/ell-r-brown/4178017589/in/photolist-7ncr52-cFdGJs-vQHTS-8AGoVZ-9AEMYz-bqcxCB-a6x7e7-7ncq6F-nCzUe9-fEjzjc-9AW9tM-pTCrPZ-6vZmkH-9wVUMY-r4Zx9t-D1rWM-kqZqB-kqZut-66vK3f-EnBFd-4WFVY8-q5h5Dc-4MucdR-gTBSu-4E4LbL-gTBZf-6vZm5B-6vZkVk-8hmiVP-9tNMYN-9RAFrM-p4Lmu5-5MTQFf-oc8NK-pkNU5-aeXTYp-ayjuwp-bx2Vxb-kfV7G8-9XMwPs-9RDA7A-5rBhcE-ekT6f8-64jAPc-c16vD9-braE6a-fEBcxL-bgM1rD-9iHtmr-aqSzuE">Elliott Brown</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><p>Ten years ago the World Health Organisation’s <a href="http://www.who.int/fctc/en/">Framework Convention on Tobacco Control</a> (FCTC) came into force. It was <a href="http://apps.who.int/iris/handle/10665/89478">not the first</a> international health treaty negotiated by the WHO, but in many ways it was the most remarkable. Achieving global consensus around any kind of public health treaty is quite a feat. So achieving a consensus when the main target of the treaty was, in effect, that most slippery and dangerous of customers – Big Tobacco – was close to miraculous. </p>
<p>Within a year, <a href="http://www.who.int/fctc/signatories_parties/en/">168 states</a> had signed the treaty and <a href="http://www.fctc.org/about-fca/tobacco-control-treaty/latest-ratifications">many more</a> are now parties to the convention. As the WHO <a href="http://www.who.int/fctc/about/en/">loudly (and rightly) trumpets</a>, this makes it “one of the most rapidly and widely embraced treaties in the history of the United Nations”. </p>
<p>In the decade that has passed since the FCTC earthquake shook the international health law landscape, the global public health community has increasingly turned its attention to another industry: <a href="https://theconversation.com/big-alcohol-and-big-tobacco-boozem-buddies-9668">Big Alcohol</a>. So far the WHO has stopped short of using its authority to create a Framework Convention on Alcohol Control (FCAC). </p>
<p>Instead it has opted for a more softly-softly approach. This has primarily taken the form of a <a href="http://www.who.int/substance_abuse/activities/gsrhua/en/">global strategy</a> to reduce the harmful use of alcohol which was endorsed by the 63rd World Health Assembly in 2010. This strategy is designed to tackle the growing impact of alcohol on individuals and society. However, <a href="http://www.who.int/substance_abuse/alcstratenglishfinal.pdf?ua=1">as a</a> “portfolio of policy options and measures that could be considered for implementation and adjusted as appropriate at the national level” it growls more than it bites. </p>
<h2>The calls for FCAC</h2>
<p>The unwillingness of the WHO to grasp the framework nettle has annoyed many a medical expert. The <a href="http://www.wma.net/en/30publications/10policies/a22/">World Medical Association</a>, the <a href="http://www.apha.org/policies-and-advocacy/public-health-policy-statements/policy-database/2014/07/07/11/50/a-call-for-a-framework-convention-on-alcohol-control">American Public Health Association</a> and the <a href="http://www.asam.org/docs/publicy-policy-statements/1est-of-framework-convention-4-07.pdf?sfvrsn=0">American Society of Addiction Medicine</a> have issued policy statements calling for an international convention to control alcohol and many leading medical journals <a href="http://bit.ly/1CKc3WV">such as The Lancet</a> have published supportive editorials. </p>
<figure class="align-left zoomable">
<a href="https://images.theconversation.com/files/75694/original/image-20150323-17702-1ordm7a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/75694/original/image-20150323-17702-1ordm7a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/75694/original/image-20150323-17702-1ordm7a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=800&fit=crop&dpr=1 600w, https://images.theconversation.com/files/75694/original/image-20150323-17702-1ordm7a.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=800&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/75694/original/image-20150323-17702-1ordm7a.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=800&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/75694/original/image-20150323-17702-1ordm7a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1005&fit=crop&dpr=1 754w, https://images.theconversation.com/files/75694/original/image-20150323-17702-1ordm7a.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1005&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/75694/original/image-20150323-17702-1ordm7a.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1005&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Smoking and drinking both cost.</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-67545415/stock-photo-thoughtful-gangster.html?src=iThofN1zi4CUBtQ_WGGu-g-1-30">Drinking by Shutterstock</a></span>
</figcaption>
</figure>
<p>The underlying reason for these calls relates to the fact alcohol is beginning to rival tobacco in the deadly harvest that it reaps. Tobacco still rules the roost in terms of the global impact on health; around <a href="http://www.who.int/mediacentre/factsheets/fs339/en/">half of the billion-strong smokers</a> living today will probably die of tobacco-related diseases. However, the <a href="http://www.who.int/substance_abuse/facts/global_burden/en/">global burden of disease</a> attributable to alcohol is very similar to the burden attributable to tobacco and in certain groups, <a href="http://www.who.int/mediacentre/factsheets/fs349/en/">especially the young</a>, alcohol may already cause more havoc.</p>
<h2>Harm caused by alcohol</h2>
<p>In 2012, 5.9% of all global deaths and 5.1% of the global burden of disease and injury were <a href="http://www.who.int/substance_abuse/facts/alcohol/en/">attributable to drinking alcohol</a>. This translates into 3.3m souls succumbing to the allure of beer, wine and spirits. The problem is especially acute <a href="http://www.theguardian.com/world/2014/jan/31/russian-men-losing-years-to-vodka">in countries like Russia</a>. But the UK is <a href="http://www.theguardian.com/society/2013/nov/13/britain-liver-disease-epidemic-alcohol-cirrhosis-young-people">badly affected</a> too. </p>
<p>Alcohol, like tobacco, can also affect third parties. Adults and <a href="http://www.theguardian.com/commentisfree/2014/may/14/tobacco-farm-child-labor-laws">children</a> who <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1497768/">cultivate tobacco</a> are exposed to a number of hazards and may develop conditions like acute nicotine sickness. <a href="http://www.nhs.uk/chq/pages/2289.aspx?categoryid=53&">Passive smokers</a> are also at risk. However, alcohol has much more wide-ranging impacts on third parties. <a href="http://www.who.int/roadsafety/projects/manuals/alcohol/drinking_driving.pdf">Road traffic incidents</a> and <a href="http://www.who.int/violence_injury_prevention/violence/world_report/factsheets/ft_intimate.pdf">domestic violence</a> are prime examples. </p>
<p>Alcohol also downs a lot of resources. The NHS forks out <a href="http://www.hscic.gov.uk/catalogue/PUB10932/alc-eng-2013-rep.pdf">£3.5 billion annually</a> to treat the consequences of alcohol misuse. This is a bit more than the cost to the NHS of <a href="http://www.ash.org.uk/files/documents/ASH_121.pdf">treating diseases caused by smoking</a>.
When other costs, such as policing and lost productivity are added, the total bill for England alone is about <a href="https://www.alcoholconcern.org.uk/help-and-advice/statistics-on-alcohol/">£21 billion</a> per annum. This dwarfs the UK-wide tax receipts generated from alcohol duties which amounted to <a href="http://www.ias.org.uk/Alcohol-knowledge-centre/Price/Factsheets/Taxation.aspx#sdendnote5sym">£10 billion</a> in 2013-2014. </p>
<h2>Tobacco but not alcohol?</h2>
<p>Given the similarities between alcohol and tobacco it may seem odd that there is a legal framework for tobacco but not for alcohol. </p>
<p>Two simple explanations for the difference in approach can be dismissed quite quickly. The first is that tobacco, unlike alcohol, is always dangerous. The second is that alcohol, unlike tobacco, has health benefits. The first claim is strained. If your total tobacco consumption amounts to smoking one – and only one – cigar on your birthday the extra risk to your health is either non-existent or infinitesimally small. </p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/75696/original/image-20150323-17688-4ktndi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/75696/original/image-20150323-17688-4ktndi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/75696/original/image-20150323-17688-4ktndi.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/75696/original/image-20150323-17688-4ktndi.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/75696/original/image-20150323-17688-4ktndi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=504&fit=crop&dpr=1 754w, https://images.theconversation.com/files/75696/original/image-20150323-17688-4ktndi.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=504&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/75696/original/image-20150323-17688-4ktndi.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=504&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Red wine debate still bubbling away.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/derekgavey/5677844045/in/photolist-9DJrdR-qt3acr-m8mtF2-pJTLyf-pJTLtW-pJTLD5-9yjfkM-pNtsHQ-qpkzdq-49tx65-bAtSF6-5BesSM-5MHsQR-f8o9BN-ddYyaX-osBGNB-gZi161-qHu6GL-614Ty7-4NMsRm-dskyuL-dskzjb-9dqh3D-dskz3U-dskpoM-dskzmG-qpkzoA-qprVaB-8KYRv5-9jVDyY-mVDSZX-GKfFU-9aNZ2Q-5hBvae-4ruiuE-qDBfSN-e9J1QW-dNK14C-7EYX31-qgH4JR-7Hjzmo-dFAKR3-5XNqLh-8LpdFz-nK9Utz-6aGgY1-73UjZA-dQrfUs-7gwT6b-9aFAz3">Derek Gavey</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>The second claim has more force, especially (<a href="http://heart.bmj.com/content/94/7/821.extract">perhaps</a>) when the alcohol consumed takes the form of <a href="http://www.ncbi.nlm.nih.gov/pubmed/86728">red wine</a>. However, the health benefits of alcohol are increasingly contested and according to some experts may <a href="http://www.bmj.com/content/350/bmj.h407">evaporate entirely</a> when the evidence is properly scrutinised. </p>
<p>What other reason could there be for the different approach to alcohol? One procedural explanation is that international legal treaties take a lot of time and effort to negotiate – the FCTC took ten years and cost <a href="http://www.amphoraproject.net/files/Addiction%20fcac%20Taylor.pdf">in excess of US$34m</a>. Having expended so much effort on the FCTC is it possible that framework-fatigue has already kicked in? </p>
<p>A more cynical explanation is that Big Alcohol has lobbied the WHO more effectively than Big Tobacco ever managed to do. The recent debacle in England regarding a minimum price for a unit of alcohol certainly suggests that policymakers can be <a href="http://www.bmj.com/content/348/bmj.f7646">under the influence</a>. </p>
<h2>Calling time</h2>
<p>Even the most ardent supporter of tobacco and alcohol – and I speak as a <a href="https://www.salimetrics.com/article/smoking-definitions">never smoker</a> but a regular drinker – must admit that these products are causing an immense amount of ill-health to users around the world, and significant harm to children and third-parties. As such, a firm legislative and global response is needed. </p>
<p>This is not some kind of paean to prohibition. Aside from the fact that criminalising consumption or sale of alcohol or tobacco <a href="http://www.theguardian.com/film/2012/aug/26/lawless-prohibition-gangsters-speakeasies">does not work</a>, competent adults have the right to take risks with their own health. </p>
<p>Instead, this is a call for legally binding international conventions to help <a href="http://jech.bmj.com/content/64/6/473.extract">defend tobacco and alcohol control policies in trade courts</a> and help countries deal with issues, such as web advertising, that can leak across national borders. It is also a call for global conventions that would enable ministries of health to implement strong domestic regulation and would empower non-governmental organisations to bring <a href="http://www.nature.com/nature/journal/v482/n7385/full/482302a.html">legal and social pressure</a> to bear on corporations and corrupt legislators. </p>
<p>Thanks to the WHO we already live in a world governed by such a convention relating to tobacco. We should now call time on the soft approach to Big Alcohol by implementing some hard law.</p><img src="https://counter.theconversation.com/content/35769/count.gif" alt="The Conversation" width="1" height="1" />
The most ardent supporters of alcohol must admit it causes an immense amount of harm.Carwyn Hooper, Senior Lecturer in Medical Ethics and Law, St George's, University of LondonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/278492014-06-11T09:23:58Z2014-06-11T09:23:58ZHard Evidence: has Scotland had enough to drink?<figure><img src="https://images.theconversation.com/files/50740/original/hxx2y64t-1402432244.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Attitudes towards alcohol in Scotland are changing</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/marcs-album/4763112773/in/photolist-dxVyNr-bAeomf-8EUDNh-9VT31K-9UbetT-9Ubetr-2bgDi-8S3cUH-C4NPh-dxVwyi-bJuZN-8BKEp6-7kP1wM-4EZ6aA-4EZ4Gs-8fUcu2-hJFbrP-6G9EdD-7oUVxR-ibg7st-4TffbF-9UbjCD-kBBf2-a97BFV-52AG3w-52wrCg-j17VG9-em7yud-5R4vkY-cyXLQj-gWCddK-2AGuYc-iXknb8-9a34cf-aXw7sn-gG1w52-53BmJu-bAj16-em7yx1-4vcJhh-9VTbFx-9UbfUc-8PDiAW-4EUPgB-4EUMW4-4EUMZ8-4EUMre-4EUN5R-4EZ59G-4EUNDk">Marc Roberts</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p>Scotland is often portrayed as a place where heavy drinking comes as part of the furniture, yet it seems the Scottish public are less and less inclined to agree. New results from the <a href="http://whatscotlandthinks.org/ssa">Scottish Social Attitudes (SSA) 2013 survey</a> suggest they are growing tired of the stereotyping of the Scots as a hard-drinking nation and are well aware of some the problems it’s causing society. </p>
<p>Only 19% of Scots think that, “getting drunk is a perfectly acceptable thing to do on the weekends”. Admittedly this is not much different to 10 years ago, when we started measuring attitudes to alcohol, but the proportion of young people of that opinion has dropped sharply over that period (from 53% in 2004 to 40% in 2013). </p>
<p>Just 16% of all people agreed with the statement: “getting drunk occasionally is all part of being Scottish”, while most (62%) disagreed and around one in five (21%) had no strong view either way. This is the first time that we asked this question. </p>
<p>So most don’t approve of getting drunk and most reject the claim that getting drunk is an innate part of being a Scot. Yet it is known that many Scots continue to drink excessively. The <a href="http://www.scotland.gov.uk/Topics/Statistics/Browse/Health/scottish-health-survey">Scottish Health Survey</a> reports that 41% drink more than the government guidelines. </p>
<p>We also know that how we perceive our own drinking can be pretty wide of the mark sometimes. Only 10% of those exceeding the government guidelines described themselves as “heavy drinkers”. While getting drunk might be perceived as a particularly harmful or serious behaviour, people may still not be aware of what it means to drink at excessive levels and the harms associated with this. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/50825/original/bzhy9rjz-1402477471.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/50825/original/bzhy9rjz-1402477471.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/50825/original/bzhy9rjz-1402477471.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=447&fit=crop&dpr=1 600w, https://images.theconversation.com/files/50825/original/bzhy9rjz-1402477471.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=447&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/50825/original/bzhy9rjz-1402477471.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=447&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/50825/original/bzhy9rjz-1402477471.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=562&fit=crop&dpr=1 754w, https://images.theconversation.com/files/50825/original/bzhy9rjz-1402477471.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=562&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/50825/original/bzhy9rjz-1402477471.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=562&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Figure 1: Agree/ agree strongly that “Getting drunk is a perfectly acceptable thing to do on the weekends”, by age (2004, 2007, 2013)</span>
<span class="attribution"><span class="source">ScotCen</span></span>
</figcaption>
</figure>
<h2>Rising awareness</h2>
<p>The latest findings also suggest a growing view that alcohol is problematic to Scottish society, even more so than hard drugs like heroin, cocaine and crack. Six in ten (60%) Scots chose alcohol as the drug that caused the most problems for Scotland in 2013, according to the latest results. This represents a significant increase over time – increasing from 46% in 2004 and from 51% in 2007. </p>
<p>As in previous years of SSA, the proportion that chose alcohol as causing the most problems far outweighs other types of drugs, with only 19% choosing heroin, 6%, tobacco and 3% cocaine. Interestingly this trend was apparent across all age brackets –- not just in the older age groups. The percentage of 18–29 year olds who thought alcohol was the drug that causes the most problems for Scotland increased from 44% in 2004 to 55% in 2013.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/50826/original/2ts4c222-1402477540.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/50826/original/2ts4c222-1402477540.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/50826/original/2ts4c222-1402477540.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=423&fit=crop&dpr=1 600w, https://images.theconversation.com/files/50826/original/2ts4c222-1402477540.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=423&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/50826/original/2ts4c222-1402477540.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=423&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/50826/original/2ts4c222-1402477540.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=531&fit=crop&dpr=1 754w, https://images.theconversation.com/files/50826/original/2ts4c222-1402477540.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=531&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/50826/original/2ts4c222-1402477540.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=531&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Figure 2: Which drug causes the most problems for Scotland as a whole? (2004, 2007, 2013)</span>
<span class="attribution"><span class="source">ScotCen</span></span>
</figcaption>
</figure>
<p>Further evidence of public awareness came from a new question posed to participants for the first time in 2013. When asked how much harm, if any, they thought alcohol causes in Scotland, around half (49%) were of the view that alcohol causes “a great deal” of harm. A further 35% viewed it as causing “quite a lot” of harm. </p>
<h2>More to do</h2>
<p>It’s estimated that alcohol is responsible for around 20 deaths a week in Scotland. Scottish health minister Alex Neil has described this as “Scotland’s Shame” –- and it also comes expensive: alcohol abuse is said to cost every adult in Scotland the equivalent of £900 per year. It would be difficult to refute that alcohol is damaging the nation. </p>
<p>The long-term strategy for dealing with alcohol problems is partly premised on the idea that fostering more positive attitudes to alcohol will help reduce consumption. But while the increasing awareness of the problematic and harmful nature of alcohol is encouraging, it hasn’t been coupled with a shift in some attitudes to alcohol. For example drinkers increasingly believe that others would think it odd if they didn’t drink at all (31% in 2007 to 41% in 2013). </p>
<p>Some in society hold particularly permissive views towards drinking. For example a sizeable proportion (33%) did not see a problem with a student binge drinking. And as well as the fact that most people remain unaware of what constitutes sensible drinking, many people are unclear about how many units are contained in alcoholic drinks. </p>
<p>One in three were unaware of the current guidance on daily alcohol consumption and around half were unaware of the unit content of a pint of beer. The challenge to increase awareness and foster more positive attitudes towards alcohol continues. </p><img src="https://counter.theconversation.com/content/27849/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Clare Sharp does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Scotland is often portrayed as a place where heavy drinking comes as part of the furniture, yet it seems the Scottish public are less and less inclined to agree. New results from the Scottish Social Attitudes…Clare Sharp, Senior Researcher, ScotCen Social ResearchLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/218652014-01-08T15:05:57Z2014-01-08T15:05:57ZBan on below cost alcohol sales would be 40 times less effective than minimum pricing<figure><img src="https://images.theconversation.com/files/38679/original/z5vxdhhq-1389186279.jpg?ixlib=rb-1.1.0&rect=9%2C0%2C3290%2C2198&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Roll up, roll up! Alcohol still going cheap.</span> <span class="attribution"><span class="source">Sang Tan/AP</span></span></figcaption></figure><p>The British Medical Journal’s <a href="http://www.bmj.com/content/348/bmj.f7646">investigation</a> into the role played by the alcohol industry in public health policy focuses on the government’s decision to drop its commitment to introduce a minimum unit price for alcohol and instead bring in a ban on selling alcohol “below cost”. </p>
<p>Our research at the University of Sheffield shows that while <a href="http://www.shef.ac.uk/polopoly_fs/1.291621!/file/julyreport.pdf">minimum unit pricing would be effective</a> in reducing the harm caused by alcohol without penalising responsible drinkers, the government’s chosen policy of banning <a href="http://www.shef.ac.uk/polopoly_fs/1.291630!/file/Addendum.pdf">below cost selling</a> would have very little impact on the problem.</p>
<h2>Minimum pricing vs below cost ban</h2>
<p>To inform the government’s decision-making, we first looked at minimum unit pricing: setting a threshold below which a unit of alcohol cannot be sold to consumers. The government focused on a threshold of 45p per unit – which would mean a bottle of wine that contained nine units of alcohol would cost at least £4.05, and a pint of beer containing two units would cost no less than 90p. </p>
<p>We then looked at banning below cost selling, which also sets a minimum price threshold but bases the threshold on the cost of the tax (duty and VAT) payable on the product. As duty is very low on cider, higher on beer and wine, and higher still on spirits, this means a unit of cider could cost as little as 6p, while a unit of vodka would need to cost at least 34p. However, for all types of drink the price thresholds under a below cost selling ban are much lower than the 45p per unit threshold under minimum unit pricing.</p>
<p>This difference matters when we look at the effects these two policies would have on alcohol consumption and the harm it causes. </p>
<p>By analysing data on the relationship between alcohol prices, consumption and spending, and the health risks posed by drinking, we found big differences in the effectiveness of the two policies. </p>
<p>Introducing a 45p minimum unit price was estimated to reduce alcohol consumption by 1.6%, leading to approximately 625 fewer deaths per year due to alcohol, 23,700 fewer hospital admissions and 34,200 fewer crimes. </p>
<p>In contrast, the lower price thresholds of a below cost selling ban mean that policy would only reduce consumption by just 0.04%, leading to around 15 fewer deaths, 500 fewer hospital admissions and 900 fewer crimes related to alcohol per year.</p>
<p>This 40 to 50-fold difference in the effectiveness of the two policies led us to conclude that the government’s chosen policy of banning below cost selling would not be an effective way of reducing the harm caused by alcohol – <a href="http://www.huffingtonpost.co.uk/2013/07/17/david-cameron-minimum-alcohol-price_n_3610226.html">the very point</a> of the government’s foray into this area. It would simply affect too few products by too small an amount to make a substantive dent in the rate of alcohol-related harm.</p>
<h2>Clear evidence</h2>
<p>When announcing <a href="http://www.bbc.co.uk/news/uk-politics-23346532">the decision</a> to downgrade minimum unit pricing from a commitment to “under consideration”, Home Office minister Jeremy Browne voiced concerns the policy may “penalise responsible drinkers”. Our research has consistently shown this would not be the case.</p>
<p>Minimum unit pricing only directly affects alcohol sold below the price threshold; this tends to be high-strength, low-quality or sold in multi-packs. Therefore, people are only affected to the extent that they buy these types of drinks. </p>
<p>Moderate drinkers tend to buy higher priced alcohol in smaller packs and as such, less of the alcohol they buy would be affected by minimum pricing. </p>
<p>We estimate that moderate drinkers would reduce their consumption by around two units per year under a 45p minimum unit price – the equivalent of a pint of beer per year. In contrast, those drinking at harmful level are estimated to reduce their consumption by around 135 units per year. This targeted effect of the policy on those at greatest risk of harm occurs because these groups buy more of the alcohol which would increase in price.</p>
<p>These findings are supported by a wider body of scientific research including evaluations of the <a href="http://onlinelibrary.wiley.com/doi/10.1111/add.12139/abstract">effects of minimum pricing in Canada</a>. While the government must take this evidence into account alongside a range of other considerations and perspectives when choosing its alcohol policies, today’s BMJ report has raised questions about the <a href="http://www.theguardian.com/society/2014/jan/08/government-dancing-tune-drinks-industry-doctors">alcohol industry’s role</a> in that process. </p>
<p>The evidence on minimum unit pricing is clear: it would be effective, targeted on those at greatest risk of harm and substantially more effective than banning below cost selling. </p><img src="https://counter.theconversation.com/content/21865/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>John Holmes receives funding from the Medical Research Council, Economic and Social Research Council, Alcohol Research UK, European Union and National Institute for Health Research.
The Sheffield Alcohol Research Group has also received funding for research relating to minimum unit pricing from the Scottish Government, UK Government, Northern Ireland Assembly and Republic of Ireland Government.</span></em></p>The British Medical Journal’s investigation into the role played by the alcohol industry in public health policy focuses on the government’s decision to drop its commitment to introduce a minimum unit…John Holmes, Research Fellow, Sheffield Alcohol Research Group, University of SheffieldLicensed as Creative Commons – attribution, no derivatives.