Alcohol guidelines ignore how people drink – that's why they're not heeded

As part of the government’s strategy to cut the human and economic cost of alcohol misuse, it currently recommends that men and women shouldn’t regularly drink more than three to four and two to three units a day respectively. In theory, such guidelines help people make informed decisions about their health, but researchers have questioned their effectiveness.

The consequences of drinking to excess are well known. It increases the risks of chronic health conditions and suffering acute injuries, costing the NHS an estimated £3bn a year. Alcohol is also associated with a range of social and criminal harms, such as domestic violence and antisocial behaviour.

A fair number of people evidently pay no attention to the drinking guidelines whatsoever. To find out why not, we put together focus groups of 66 male and female drinkers in England and Scotland. They were aged between 19 and 65 from a range of socioeconomic backgrounds. We asked them what they thought of the UK guidelines, and asked them to compare them with those of Australia and Canada, both of which distinguish single-occasion and regular drinking.

Guidelines and relevance

The participants told us they didn’t think the UK guidelines were relevant to how they drank. A big concern was that the guidelines are given as daily amounts, but because most of our participants only drank once or twice a week, usually at weekends, they didn’t think that the guidelines applied to them: “because we don’t drink every day, you just don’t take it in”, they told us.

They preferred the idea of a weekly guideline because, “then you can do it to suit yourself during the week”. They saw the Australian and Canadian guidelines' regular and single-occasion drinking distinction as more flexible for different drinking patterns. They also thought the UK guidelines were unrealistic because they failed to recognise the desire to drink to get drunk: “Their too much is not our too much. Their too much is like ‘I’ve only just started’ to be honest”.

Presenting the guidelines in units rather than glasses, pints or bottles created further problems for our participants. While units might be a useful measure for health professionals, they were too abstract for the members of the general public who took part in our study.

Participants regulated their drinking in other ways which made more sense to their everyday lives. They spoke of knowing their own limits, and sometimes regulated themselves by switching to different types of drink according to how they believed they would feel the next day – for instance one respondent talked about avoiding wine in favour of vodka.

Where the drinking guidelines are generally informed by concerns about the nation’s health, participants said they regulated their drinking to meet their commitments to valued everyday responsibilities like employment and childcare. As a simple example, some spoke of not drinking during the week because they didn’t want to be hungover the next morning. These kinds of short-term, immediately negative consequences motivated participants to moderate their intake rather than long-term health risks.

Long-term health is not why we curtail our drinkingPixonomy, CC BY-SA

Room for improvement

The UK’s drinking guidelines are currently being reviewed by the government. Our research seems to have a number of messages for the reviewers. For one thing, introducing separate regular and single-occasion guidelines might suit people’s drinking patterns more than the daily amounts.

Given that the guidelines don’t acknowledge the reasons which influence drinkers’ decisions, such as social concerns and cultural values, future guidance could use narratives which show the impact that drinking can have on family and work life. And if people still count their alcohol consumption in pints, drinks or bottles after all the years of campaigns educating us about units, then perhaps the guidelines should do away with them altogether.

A broader question is the extent to which alcohol strategies should rely on drinking guidelines as a way to reduce harm. Expecting individuals to make “responsible” decisions for their health behaviours obscures the ways in which behaviours are shaped by broader social and economic forces. Rather than placing most of the responsibility on individuals, the people in charge of policy may need to look more to population-level interventions like taxation and pricing to effectively tackle alcohol-related harms.

The research referred to in this piece received funding from the Medical Research Council's National Prevention Research Initiative Grant. Melanie has also received funding from Alcohol Research UK.