Have two alcohol-free days a week, say MPs

MPs have called for “two alcohol-free days each week and clearer guidelines on drinking”, The Guardian and other news sources reported. The news is based on a new report by the House of Commons Science and Technology Committee, which examined the UK’s alcohol guidelines.

Current Department of Health guidance recommends that men should not regularly drink more than 3–4 units of alcohol a day, while women should not regularly drink more than 2–3 units. “Regularly” is defined as drinking every day or on most days of the week. Guidelines also recommend that people do not drink alcohol for 48 hours after a heavy drinking session to let their bodies recover.

The Committee report looked at how well current government guidelines match the evidence on the effects of alcohol consumption, and how well they are communicated to and understood by the public.

After listening to submissions from medical bodies, charities and the alcohol industry, the Committee reached a range of conclusions, primarily that there should be a thorough review of the evidence regarding alcohol and health risks. In the meantime, they suggest that the public should be advised to have at least two alcohol-free days a week and that the sensible drinking limits should not be increased.

Who produced the report?

The report came from the House of Commons Science and Technology Committee. The committee of MPs produced the report as they wanted to look at:

how evidence-based the current government guidelines on alcohol consumption are
how well the guidelines are communicated to the public
how well the public understands the current guidelines

To do this, they issued a call for interested parties to submit written evidence on this subject in July 2011. In response, a number of individuals and organisations contributed written and verbal evidence, including MPs, the Department of Health, the British Medical Association, the Royal College of Physicians and representatives of the alcohol industry.

What is current government advice?

Official UK government guidance recommends that men should not regularly drink more than 3–4 units of alcohol a day and women should not regularly drink more than 2–3 units a day. “Regularly” means drinking every day or on most days of the week. People are also recommended to take a break from alcohol for 48 hours after a heavy drinking session to let their bodies recover.

Pregnant women and women trying to conceive should not drink alcohol. If they choose to drink alcohol, they are advised not to drink more than 1–2 units of alcohol once or twice a week and not to get drunk, in order to minimise the risk to their baby. The National Institute for Health and Clinical Excellence (NICE) advises women to avoid alcohol in the first three months of pregnancy in particular, because of the increased risk of miscarriage.

What evidence did the report look at?

The Committee asked for people to submit evidence regarding the following questions:

What evidence are government guidelines on alcohol intake based on, and how regularly is the evidence base reviewed?
Could improvements be made to the evidence base and sources of scientific advice that are provided to the government on alcohol?
How well does the government communicate to the public its guidelines and the risks of alcohol intake?
How do the UK government's guidelines compare to those provided in other countries?

What did the report find?

The Committee found that:

The UK’s alcohol guidelines were broadly in line with those in other developed nations. However, the Committee noted that international comparisons should not be relied on as an indicator of how appropriate UK guidelines are, as national guidelines can be influenced by social and cultural factors, in addition to scientific evidence.
There is a lack of agreement among experts about the possible health benefits of alcohol, and a lack of conclusive evidence about the benefits of low alcohol consumption compared to being teetotal. The Committee judged that it seems likely that any potential benefits from alcohol consumption could be obtained through a healthy lifestyle, and that the potential for benefits should not be used as the basis for daily alcohol guidelines for all adults.
Public awareness of alcohol units seems to be high, but there is less understanding of how many units alcoholic drinks contain.
Some of the current government advice on alcohol consumption is unclear, in particular how advice on “regular” drinking relates to the advice to take a 48-hour break after heavy drinking episodes.

The Committee also noted that the government is working with the drinks industry, which has pledged to ensure that over 80% of alcohol products are labelled with alcohol unit content and the drinking guidelines by 2013. The Committee felt that if the government exercises proper scrutiny and oversight, the potential conflict of interest between sensible drinking messages and the drinks industry’s business objectives should not endanger the progress of the alcohol pledges.

What recommendations did it make?

The Committee recommended that:

There is a need to review the evidence on alcohol and health risks. It recommends that the Department of Health and the devolved health departments establish a nationwide expert working group to review the evidence base and whether the guidelines should be changed.
The working group should advise the government on whether the current alcohol guidelines are evidence-based and, if not, what they should be changed to.
In the meantime, there does not appear to be enough evidence to justify increasing the current drinking guidelines.
The government should provide specific alcohol guidelines for older people.
Lower drinking limits for women should be maintained.
Advice about drinking in pregnancy across the UK should be consistent. The Committee was satisfied that the UK's Chief Medical Officers had recently reviewed the evidence around this issue and come up with balanced guidance, but noted that their guidance differs from that of the Scottish Chief Medical Officer.

It is recommended that the government, industry and charities should emphasise:

the specific risks associated with drinking patterns, including the acute risks associated with individual episodes of heavy drinking and the chronic risks associated with regular drinking
that there are situations where it is not appropriate to drink at all, for example while operating machinery
that people should have some drink-free days every week

Recommendations on public information and understanding:

The concept of alcohol units should be retained, and efforts focused on helping people to translate alcohol units and sensible drinking guidelines into practice.
Alcohol guidelines should be viewed by the government as a source of information for the public, rather than a way to influence drinking behaviour.
If daily alcohol guidelines are kept, the government should consider simplifying them to advise that people take at least two alcohol-free days a week, as is the case in Scotland.
The Department of Health should consider introducing guidance for individual drinking episodes in their review of the evidence. This should only be introduced if the revised guidance states recommended limits in terms of weekly consumption rather than daily consumption, as two daily limits would be confusing.
There should be a website where people could obtain more individualised advice that takes into account factors such as weight, age, ethnicity and family history of alcohol problems. The resource should include links to sources of further information and support, and recommendations on whether to seek further expert medical advice. Charities and other organisations should develop ways to increase access to this type of advice for people who have limited or no access to the internet.

With regards to the drinks industry, the Committee recommended that:

The government should immediately set an interim alcohol labelling target for December 2012 to assess progress towards some of the alcohol-related pledges in the existing Public Health Responsibility Deal. These include a voluntary pledge by the drinks industry that by 2013 over 80% of products on the shelf should have "labels with clear unit content, NHS guidelines and a warning about drinking when pregnant". If targets are not met by the time of this interim review, the government should review the programme, including the possible need to make compliance with the labelling pledge mandatory.
The cooperation of the drinks industry is needed to achieve the Public Health Responsibility Deal's alcohol pledges. The government should exercise scrutiny and oversight to ensure that any conflicts of interest on the part of the drinks industry are reduced and managed.