Alcohol Guidance from the Chief Medical Officer [2016]

In January 2016 the first new alcohol guidelines were issued in over 20 years by Dame Sally Davies and fellow UK Chief Medical Officers (CMO’s). The new guidance has been met with mixed response as it departs significantly from previous guidance, and, differs from international guidance. Here the guidance is outlined, the evidence reviewed and the various responses from across the scientific, media, and third sector communities presented.

The guidance was developed over the last two and a half years from three independent groups of experts who have reviewed 44 systematic reviews and meta-analyses for the health effects of alcohol. The key changes are:

• The recommended weekly allowance is now the same for men and women.
• There is no safe limit of alcohol to drink, however to keep health risks to a low level a limit of 14 units per week is now recommended.
• There is no recommended daily limit.
• Heavy episodic drinking (binge-drinking) should be limited as it increases the risk of illness, accidents and injuries.
• If a women is pregnant they should not drink at all.
• The group determined that the evidence for the protective effects of drinking (notably on Ischaemic Heart Disease) is now weaker than previously thought, and that there is no justification for drinking on health grounds.

The changes have been made as there is considerable new evidence available on the harms of drinking since the previous guidance was issued. The new guidance was informed by a report from Sheffield University on mortality and morbidity risks from alcohol consumption in the UK. The cut-off point at which an individual became at ‘risk’ from developing a health condition attributable to alcohol was set at 1%. That is, out of 100 people at risk of developing a health condition from drinking, 1 person would develop it at this level.

The report found that even low levels of drinking increase an individual’s risk of cancers of the mouth, throat, breast and digestive system. Furthermore, there is evidence of other long-term health risks of drinking regularly over-time, which increase the risk of stroke, heart disease, liver disease and damage to the nervous system and brain. There is also clear evidence of the risk of a small number of heavy drinking episodes on health.

The guidance has been met with a mixed response: Health organisations, bodies and charities such as the Alcohol Health Alliance, the Royal College of Physicians, Alcohol Concern and the British Liver Trust have welcomed the new guidance as a positive step towards raising awareness of the risks of alcohol and enabling individuals to make informed choices about their drinking. On the other hand, reports in the media have criticised the new guidance as ‘hyperbolic’ and reflective of Britain being a ‘nanny state’. It has also been suggested that the 1% level of risk needs to be put into context: Professor David Spiegelhalter from the University of Cambridge reported to the BBC that watching TV for an hour or eating a bacon sandwich a couple of times a week had a higher level of risk than the 1% set by the new guidance.

There is also some controversy around different limits set by different countries; as there is no World Health Organisation recommendation, countries are free to choose their own guidance. The UK is now stricter than France and Spain (although roughly in-line with the US and Ireland). Limits set by other countries range from 10.5 units per week in Germany to 21.3 in Spain, but no other country has the same guidance for both men and women. The latter has been viewed as somewhat controversial, particularly because of some scientific evidence to suggest that men and women metabolise alcohol differently. The justification by the CMOs was that new evidence suggests that the overall health risks are broadly similar for men and women at the 14 unit a week limit. However this is complicated by the fact that whilst short-term risks are greater for men, long-term risks are greater for women.

The aim of the new guidance is to keep the public up-to-date with the most recent evidence for drinking so they can make informed decisions. Important changes to the guidance reflect the stronger evidence we now have for risks attributable to alcohol. However, some of these changes are quite significant, and they have been met with a sceptical response, especially by the media. Whilst some of the guidance is clearer, there still remain several ambiguities around limits for heavy episodic drinking and potential gender differences. This is compounded by the varying limits set by different countries. The hard task is getting the British population to actually cut down their drinking, and such guidance is a necessary first step, albeit in a long uphill struggle to change drinking behaviours.

Further resources:

The full report from the Department of Health
A helpful infographic from  NHS OneYou
The Sheffield Report
Alcohol and cancer statement

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