NEWS BRIEFING: Reducing the health risks from drinking alcohol - New Australian draft guidelines released

Studies have shown alcohol increases your risk of a number of cancers including those of the mouth, pharynx, larynx, oesophagus, breast, bowel and liver.

Previous estimates, based on the current recommendation of two standard drinks per day, showed we could prevent 30,000 cancer cases over the next 25 years if Australians consumed no more than two standard drinks per day, so the proposed guidelines have the potential to prevent even more cancer cases.

Cancer Council supports recommendations that encourage a reduction in the total number of alcoholic beverages Australians should consume each week. While the draft NHMRC alcohol guidelines aim to achieve this we would need to see rigorous consumer testing to ensure Australians understand that the recommendation of no more than 10 standard drinks per week does not encourage higher consumption of alcohol in a single occasion.

An overall weekly amount does not mean you can save your drinks for one or two nights of the week, so we would need to understand if Australians think about their alcohol consumption in terms of a total weekly figure or whether daily recommendations are simpler to understand and measure.

It is important to understand that any level of alcohol consumption increases your risk of cancer so the less you drink, the lower your risk of alcohol-related harm.

The revised draft Guideline Three, “To reduce the risk of harm to their unborn child, women who are pregnant or planning a pregnancy should not drink alcohol” is clear, correct and to the point. This is an important improvement on the 2009 Guideline for pregnancy, which had been confusing to many.
 
The draft Guidelines state that their success in improving health outcomes is entirely dependent on disseminating, communicating and raising awareness about the Guidelines, including to health professionals.

Critically, they also state that the Australian Government is responsible for successful dissemination, communication and awareness-raising. This is another important improvement on the 2009 Guidelines, where there was limited evidence of effective dissemination.

These are conservative guidelines but for the first time acknowledge that there is a direct relationship between the amount of alcohol consumed and the risk of harm. Australians are being informed that alcohol consumption at all levels, including moderate levels of consumption, lead to harm. Surely it is time for warning labels on bottles of alcohol that reflect the wide range of harms associated with the moderate consumption of alcohol.

Australia has been a world leader in low-risk guidelines on drinking, and this report builds on that tradition. It provides clear advice and explains its basis in what has been learned in recent research.

The main advice is on avoiding harm to the drinker’s health; the report mentions but does not take into account other harms, including harms to others (except through pregnancy). The emphasis is on chronic health harms, where scientific developments point to a lowering of the guidelines for weekly consumption to ten drinks.

Immediate harms from intoxication are also taken into account, with a daily limit of four drinks: a chart in the report shows that the cumulative risk from the ten drinks is more than doubled if they are all drunk in one day rather than spread across three days, but considerably reduced if they are spread across all seven days. This intoxication dimension, which is particularly important for harm to others from drinking, might be emphasised more. But within its frame of advice in terms of health harm to the drinker, the NHMRC should be congratulated for a balanced and evidence-based report, in the face of opposing pressures from the politically powerful alcohol industry.

The release of the revised National Health and Medical Research Council guidelines for drinking alcohol is an important milestone. It brings together an authoritative analysis of the current literature which has been interpreted by experts to assist the public make informed decisions regarding their alcohol consumption. These guidelines will greatly enhance people’s ability to weigh up the potential risks and harms that can occur.

Every Australian family and community has seen the harms of alcohol first hand – from immediate effects such as injury, car accidents and violence, to long-term increased risks of conditions such as cancer, stroke and mental health problems. Each year in Australia alcohol causes around 4000 deaths, 70,000 hospitalisations and 10-15% of emergency department presentations.

The new guidelines bring together evidence from millions of people participating in thousands of studies worldwide to provide the best possible advice to Australians. Limiting intake to 10 standard drinks a week will save thousands of lives and reduce suffering and disability.

Australians – especially young Australians – are making great progress in reducing drinking and most are already drinking within the levels advised in the new guidelines. For those drinking above these levels, cutting down will benefit their health, as well as the health and wellbeing of the community.

As a doctor I see firsthand the harms from alcohol. Young people in the Emergency Department with alcohol poisoning – having drunk so much they can’t keep themselves safe. Some at risk of their breathing stopping. I also see the smashed up faces – young and old.

On the other hand, I also see people who used to drink too much but who have now cut back or stopped. Their sleep has improved, their mood has improved, their blood pressure has returned to normal. So working out what amount of drinking is OK for health is so important."

Australians want this information:

"I have seen how keen Australians are to understand the complex relationship between alcohol and health. Around this time of year, every year, media are on the look-out for experts to comment on the health effects of alcohol. The community wants to know. Young people ask me about those heavy nights out – do they cause any long-term harms? They all know about the short term harms than can occur. Young people who are planning to get pregnant are confused. They have heard that alcohol might be risky for the developing baby, but they hear mixed messages about when they need to stop. The Australian public is thirsty for knowledge and clear guidance."

Parenting teens:

As a mother of five, I can identify with all the parents who want guidance on how to handle the issue of alcohol with their teenage children. They hear different stories from different places. And they see in the media the tragic stories of drinking gone wrong -- at Schoolies or parties. As a committee we worked hard to give clear and evidence-based guidance to those parents, and to the young people themselves.

Decoding the data

"There is a mass of webpages and scientific articles out there on how alcohol affects your health. A Google Scholar search turns up over three million results. The public can’t be expected to digest all that information themselves. Our committee set out to present a clear and balanced summary of this evidence. Our committee members brought to the task a pooled total of well over 200 years of academic and clinical experience in understanding the research around alcohol and health.

With the added help of outside experts, we’ve brought together all that scientific knowledge to produce a clear and fair interpretation of the evidence. We’ve presented the results as transparently as possible. That way, individual Australians can see our guidelines. They can also choose to drink less or more: selecting the risk level that they themselves are prepared to accept.

"Today we are releasing for public comment the newly revised Australian guidelines to reduce health risks from drinking alcohol.

We’re not telling Australians how much to drink. We’re providing advice about the health risks from drinking alcohol so that we can all make informed decisions in our daily lives – for ourselves, and for our children.

It’s ten years since our last review of the guidelines and we now know more about the effects of alcohol. We know that alcohol continues to have significant direct health consequences for many Australians.

In 2017 there were more than 4,000 alcohol-related deaths in Australia, and, for the 2016 to 2017 financial year period, more than 70,000 hospital admissions. Alcohol is linked to more than 60 medical conditions, particularly numerous cancers. We’re learning that alcohol is linked to health harms even at low levels of consumption. The health risks, therefore, are something we all need to consider.

The draft guidelines say:

1. Healthy men and women:
   To reduce the risk of harm from alcohol-related disease or injury for healthy men and women, drink no more than 10 standard drinks per week and no more than 4 standard drinks on any one day. 
   The less you choose to drink, the lower your risk of alcohol-related harm. ​For some people not drinking at all is the safest option.
2. Children and young people:
   To reduce the risk of injury and other harms to health, children and young people under 18 years of age should not drink alcohol.
3. Pregnancy and breastfeeding:
   To reduce the risk of harm to their unborn child, women who are pregnant or planning a pregnancy should not drink alcohol.
   For women who are breastfeeding, not drinking alcohol is safest for their baby."