Citation

Holmes J, Angus CR. Addiction 2023; ePub(ePub): ePub.

Copyright

(Copyright © 2023, John Wiley and Sons)

DOI

10.1111/add.16381

PMID

37956973

Abstract

In 2012, Room & Rehm wrote that the process by which health authorities set alcohol drinking guidelines suggested that those involved had 'drawn a deep collective breath and simply voted for specific cut-off levels' ([1], p. 137). More famously, Richard Smith described the 1995 UK guidelines that he helped to set as 'plucked out of the air' [2]. Since then, there have been significant efforts to impose greater rigour on the development of guidelines, particularly by using epidemiological models to identify levels of alcohol consumption that correspond to a level of 'acceptable risk' that is identified a priori. This approach has now been used in countries including Denmark, Australia, the United Kingdom and France [3].

The Canadian process described by Shield et al. builds usefully upon this by describing a continuum of risk, separated into zones, rather than a single guideline level [4]. This shift is a welcome and long overdue development, given plentiful evidence of risks at all levels of alcohol consumption and no clear threshold above which risks increase especially rapidly [5]. However, there are practical challenges to this approach which Shield et al. do not address. It is unclear what numerical guideline(s) should appear in the limited space provided for health messages on bottles and cans. Media focus on the low-risk level of two standard drinks a week also raised eyebrows internationally, and perhaps also in Canada, as a rather prohibitive message; although it partly reflects Canada's generous definition of a standard drink (i.e. 13.5 g of pure alcohol compared to 10.0 g in Australia and 7.9 g in the United Kingdom). Future guideline developers may wish to consider the adjectives they use to describe different levels of risk (e.g. low, increasing, moderate and little), which media messages ensure that the public consider the full range of the continuum, and whether the continuum leads to better understanding of alcohol-related risks than the traditional single guideline...

Language: en

Keywords

epidemiology; Alcohol; drinking guidelines; epidemiological modelling; guideline development; risk acceptability