Good practice principles low rik drinking EU RARHA

Review of adult drinking guidelines in the UK
Lisa Jones a
Adult drinking guidelines were first developed by the UK Health Departments in the 1980s. “Safe
limits”, defined as standard drinks per week, were published in 1984. In 1987 the guidelines were
revised down to “sensible limits” and the concept of a unit was introduced, equivalent to 8g pure
alcohol and corresponding to the amount of alcohol an average adult can process within an hour.
The “sensible drinking” guidelines were reviewed and updated in 1995. The most significant
change was that guidelines were given regarding daily, rather than weekly, consumption, to take
into account emerging evidence of potential health benefits from regular drinking of small
amounts of alcohol, particularly in relation to coronary heart disease. Guidelines on drinking during
pregnancy were revised in 2006, advising women who are pregnant or trying to conceive to avoid
drinking alcohol. In 2009, specific guidance on the consumption of alcohol by children and young
people was published by the Chief Medical Officer for England. In 2012, a process to review the
adult guidelines was started in response to a call from the UK House of Commons Science and
Technology Committee [ 1 ]. Expert groups were tasked to consider the scientific evidence and
advise accordingly. In January 2016, the UK Chief Medical Officers proposed new guidelines for
people who wish to keep health risks from alcohol to a low level. The proposed guidelines were
presented for public consultation between January and April 2016.
Considering new health evidence
The UK Chief Medical Officers asked a Health Evidence Expert Group to consider the evidence on the
effects of alcohol on health. The Group examined evidence from 44 systematic reviews and metaanalyses
published since 1995 [ 2 , 3 ], and consulted experts recently involved in the updating of
Australian and Canadian alcohol guidelines. The Group concluded that there was significant new, good
quality evidence available on the effects of alcohol consumption on health and that an update to the
guidelines was needed. The Group also concluded that the evidence supporting a protective effect of
alcohol consumption was now weaker than it was in 1995. A Behavioural Expert Group was asked to
assess the evidence of the effectiveness of the current UK guidelines for alcohol consumption, and
evidence about the use, understandings and impact of national guidelines on other health-related
behaviours. In practice limited evidence was found [ 4 ] and so the Group identified some general
principles that could be used to maximise understanding and acceptance of guidelines.
Developing new adult drinking guidelines
In early 2014, the two previous expert groups combined to form a Guideline Development Group
(GDG). The GDG was tasked with advising the UK Chief Medical Officers on the most appropriate
methodological approach to developing guidelines and to advise on the content of the new guidelines.
The GDG based its advice on the following principles: (i) people have a right to accurate information
and clear advice about alcohol and its health risks; and (ii) there is a responsibility on Government to
ensure this information is provided for citizens in an open way, so that they can make informed choices
[5]. The GDG considered the suitability of methodologies used in the development of lower risk
drinking guidelines in Canada and Australia as a basis for UK guidelines. To explore the impact of
alcohol on mortality and morbidity in the UK population, scientific modelling was carried out applying
the Sheffield Alcohol Policy Model (v.2.7), a mathematical simulation model previously used to appraise
various alcohol policy options [6]. Using the Canadian and Australian approaches [6], similar guideline
thresholds were implied by the model (see Table 1 for a summary of the main findings). The Canadian
approach set the threshold at the level at which the risks of drinking were equivalent to abstaining from
alcohol. Based on the Australian approach, the thresholds were alternatively set at a level where 1% of
annual deaths would be attributable to drinking.
a
Centre for Public Health, Liverpool John Moores University
73
Good practice principles for low risk drinking guidelines