Following heated debate over the guidelines, this week a new industry led group - the Alcohol Information Partnership - has also been announced which it says aims to 'bring balance to the debate'. A recent Wall Street Journal article also recently reported that with 'moderate drinking under fire' alcohol companies across the globe are 'on the offensive' in a 'multimillion-dollar global battle'.
Alcohol policy debates are often framed as a two sided battle between health group's objectives and the alcohol industy's interests, which on some level may be true. One the one hand, the recommended guidelines are intended as simply that - guidelines to help inform consumers - and were convened by an expert group who spent years reviewing the latest evidence.
On the other hand, the evidence and experts have of course been subject to various criticisms, of which readers can make their own minds up. Arguably more worthy of debate may be the finer points of how to communicate the guidelines and the subsidiary messages; for instance how or indeed whether to warn of very small risks incurred at moderate levels of drinking.
DoH consultation response & qualitative insights
The consultation response captures many of the themes played out in media coverage of the guidelines as of course many of the responses were from health and industry groups. As such, the responses to most of the questions were evenly split between positive and negative when excluding the 785 responses from individuals through the Campaign for Real Ale (CAMRA), who have been active in opposing the idea of a 'no safe level' message in particular.
In a section outlining 'what has changed', the expert group was reconvened to consider the responses, but the group found 'nothing raised through the process of consultation that they had not already seen and considered', and despite welcoming the challenges still believed the report provided a 'good balance of all the available evidence'. In response an Addendum [pdf] to the original report has been produced addressing the 'common criticisms and misunderstandings from the consultation'.
The expert group unanimously agreed to advise the UK CMOs not to include a specific number of units for the single occasion guideline, thus sticking to a message of 'limiting the total amount of alcohol drunk on any one occasion'. In part the decision was based on limited evidence to support a specific single occasion amount, but also that 'an additional unit guideline would add complexity and potentially confusion with the weekly guideline'. The consultation response includes a number of tables highlighting revised wording and rationale (see figure below on regular drinking).
In addition, a qualitative research report [pdf] was also commissioned by Public Health England to gather a sample of public attitudes and beliefs regarding the new guidelines. Focus groups were conducted covering a range of demographics including low, increasing and higher risk drinkers.
Some key findings of note from the report include:
- Virtually all drinkers were aware of the dangers of drinking to excess, especially the long term health problems, but few felt they were at risk.
- Guidelines were often discussed in terms of how much they allowed or permitted people to drink, rather than being a guide to what consumption levels mitigate the risks of drinking.
- Response to the new draft guidelines was generally favourable, and they were preferred to earlier drafts.
- Most drinkers believed the information about the risks of alcohol and accepted the advice and tips on reducing the risks.
- The exception to this general acceptance was higher risk drinkers, particularly those over about 35, who saw the guidelines as an attempt to stop them enjoying themselves, and felt the advice was irrelevant to them.
- Higher risk drinkers project the risks onto other people who they believe are not in control of their drinking.
- Many drinkers had difficulty grasping how and where the guidelines would be used. In current form – words on paper - they did not attract attention or invite reading.
- In tone the guidelines were perceived as measured, neutral and focused on information. There was little sense of the tone being nannying, except among a heavy drinking minority, who disagreed with the principle of the guidelines.
The qualitative research report suggests that the guidelines were generally considered plausible and well constructed, except among higher risk drinkers who 'see guidelines as unnecessary and object to recommended limits. They regard drinking as a reward for coping with demanding lives, and they want to guard their freedom to drink as they wish. They see advice from government sources or from the medical profession as challenging and possibly threatening this freedom.' This is consistent with evidence suggesting many risky drinkers do not consider their own drinkng as problematic, in part owing to normative misperception.
New 'Alcohol Information Programme' industry funded body
The announcement of a new industry funded group may come as a surprise to those aware of the various organisations that already exist to represent alcohol industry interests or deliver industry backed responsible drinking programmes. However of the existing bodies, none appear to have specific objectives around ensuring 'balanced debate', so the AIP may be an attempt to create a body with a more clear fit and purpose in this regard.
The AIP will be headed up by a Dave Roberts, but not to be confused with the Chief Exec of Alcohol Research UK. Roberts (of the AIP) said it was "here to being balance back to the debate and remind the public that having a drink at home or in the pub can still be a part of a balanced lifestyle as long as it is drunk in moderation". "Too often the facts have been dramatised or exaggerated in order to scare people and skew the debate" he also said.
The AIP will also promote the current partnership approaches between Government, industry, Local Authorities and NGOs that focus on education, enforcement and targeted initiatives. Reports say the AIP claims the recent falls in alcohol misuse shows recent partnership activity has been working - a claim alcohol epidemiologists and others and may regard as somewhat audacious.