EXPERT REACTION: NHMRC Alcohol Guidelines - No more than 10 a week and 4 a day

Embargoed until: Publicly released:
Not peer-reviewed: This work has not been scrutinised by independent experts, or the story does not contain research data to review (for example an opinion piece). If you are reporting on research that has yet to go through peer-review (eg. conference abstracts and preprints) be aware that the findings can change during the peer review process.

National Health and Medical Research Council has released new national guidelines for reducing the health risks from drinking alcohol. The guidelines say healthy men and women should drink no more than 10 standard drinks a week and no more than 4 standard drinks on any one day. The less you drink, the lower your risk of harm from alcohol. They say children and people under 18 years of age should not drink alcohol, and women who are pregnant or planning a pregnancy should not drink alcohol. For women who are breastfeeding, not drinking alcohol is safest for their babies.

Organisation/s: National Health and Medical Research Council (NHMRC)

Funder: Department of Health

Media release

From: National Health and Medical Research Council (NHMRC)

No more than 10 a week and 4 a day…

National Health and Medical Research Council confirms new national guidelines for reducing the health risks from drinking alcohol.

The guidelines are the result of four years of extensive review of the evidence on the harms and benefits of drinking alcohol.

They replace the previous version, published in 2009. They will underpin policy decisions and public health messaging for many years to come.

“We’re not telling Australians how much to drink,” says Professor Anne Kelso, CEO of NHMRC.

“We’re providing advice about the health risks so that we can all make informed decisions in our daily lives.”

Professor Paul Kelly, Australia’s Acting Chief Medical Officer, adds: “Every year there are more than 4,000 alcohol-related deaths in Australia, and more than 70,000 hospital admissions. Alcohol is linked to more than 40 medical conditions, including many cancers.

“Following the guidelines keeps the risk of harm from alcohol low, but it does not remove all risk. Healthy adults drinking within the guideline recommendations have less than a 1 in 100 chance of dying from an alcohol-related condition.”

The three guidelines are:

·          To reduce the risk of harm from alcohol-related disease or injury, healthy men and women should drink no more than 10 standard drinks a week and no more than 4 standard drinks on any one day. The less you drink, the lower your risk of harm from alcohol.

·         To reduce the risk of injury and other harms to health, children and people under 18 years of age should not drink alcohol.

·         To prevent harm from alcohol 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 babies.

A ‘standard drink’ contains 10 grams of pure alcohol. This is about 285 ml of full-strength beer, a can of mid-strength beer, 100 ml of wine, or a single shot of spirits.

The guidelines are backed up by extensive analysis and reviews which are available online at www.nhmrc.gov.au/alcohol. These include systematic reviews on the health effects of drinking alcohol, modelling, data on Australian drinking patterns and best practice guideline development processes.

They were developed by NHMRC, guided by a group of independent health experts including doctors, medical and public health professionals, researchers and consumer representatives on the Alcohol Working Committee. The guidelines were reviewed and endorsed by NHMRC Council which includes the Chief Medical Officers of the Commonwealth and each State and Territory, together with leaders in health, research and ethics.

“Reducing the risks posed by alcohol demands a complex and multi-faceted approach – and the release of the guidelines is a very important part of that,” says Professor Kelly.

“They form part of the Australian Government’s National Alcohol Strategy which seeks to prevent and minimise alcohol-related harms to individuals, families and communities.”

NHMRC provides advice to government and the community on a wide range of matters including nutrition, infant feeding, infection control, blood lead levels and drinking water quality.

Supporting materials included in the guidelines are available at www.nhmrc.gov.au/alcohol:

·         Plain English Summary

·         Practical information: How to apply the Australian Guidelines to Reduce Health Risks from Drinking Alcohol

·         The full guideline publication detailing the evidence for each guideline.

Supporting information in the media pack includes:

·         Profiles on the experts available for interview

·         Reaction comments from the Australian Science Media Centre

·         Infographics:

  • The guidelines
  • What is a standard drink
  • Risk: 1 in 100.

 

Expert Reaction

These comments have been collated by the Science Media Centre to provide a variety of expert perspectives on this issue. Feel free to use these quotes in your stories. Views expressed are the personal opinions of the experts named. They do not represent the views of the SMC or any other organisation unless specifically stated.

Professor Kate Conigrave is Chair of the NHMRC Alcohol Working Committee; Addiction Medicine Physician and Public Health Physician at Royal Prince Alfred Hospital and Conjoint Professor at the University of Sydney

Most Australians who drink alcohol care about how it affects their health. Many want to know more. These guidelines are the result of well-researched and carefully considered information. We believe they will help Australians make informed choices around alcohol.

We now know much more now about how alcohol affects health than we knew in 2009, when the last Australian Guidelines to Reduce Health Risks from Drinking Alcohol were released. This new knowledge comes from a large number of research studies. In particular, we now know that even relatively low levels of drinking can increase a person’s risk of developing cancer. This includes common cancers such as bowel and breast. That link between alcohol and cancer has led many countries around the world to lower their recommendations on the maximum quantity of alcohol a person should consume. 

Evidence continues to grow about the harms that can arise when children or young people aged under 18 years drink alcohol. We also now know more about how alcohol can harm the developing baby during pregnancy, and about the risks to the baby when a breastfeeding mother drinks alcohol. 

Three Guidelines have been released: the first, for general adults, the second, for children and young people aged under 18, and the third, for women who are pregnant or breastfeeding. We hope that these Guidelines provide Australians with answers to their questions on how to reduce risks to health from drinking alcohol.

Last updated: 08 Dec 2020 11:51am
Declared conflicts of interest:
Kate's conflict of interest statement can be found on the NHMRC website: https://www.nhmrc.gov.au/about-us/leadership-and-governance/committees/alcohol-working-committee

Ms Nicole Hewlett is the National Indigenous Project Manager at Queensland University of Technology / Menzies School of Health

Whether you are a man or woman, a parent or have just turned 18, you have the right to know what the science says about [the effects of] alcohol on you and your children’s health. We have tried to make these guidelines clear, understandable and accessible to all Australians so that no one is left behind when it comes to making informed choices about alcohol.

Last updated: 20 Jan 2021 3:45pm
Declared conflicts of interest:
Nicole would like to declare that she is a Board Member, National organisation Fetal Alcohol Spectrum Disorder.
Scott Wilson is the CEO of Aboriginal Drug and Alcohol Council South Australia, Adjunct Associate Professor and Co-Director of Indigenous Health and Substance Use at The University of Sydney, and Lead Convenor of SA Aboriginal Community Controlled Organisations Network (Coalition of the Peaks)

The 2020  'Australian Guidelines to Reduce Health Risks from Drinking Alcohol' are to be welcomed by the community as a step in the right direction. They have looked at all the new research that has occurred since 2009, and are quite clear in their advice to the Australian population.

If you stick to the new Guidelines your chances of having an alcohol-related injury and or disease such as breast cancer is one in 100. The advice about young people not drinking before 18 is based on the fact that the brain is still developing and guidelines around drinking whilst pregnant or breastfeeding gets rid of any ambiguity by saying 'don't drink'.

The cost to the Australian community from alcohol-related issues run into the tens of billions per year. Alcohol is a teratogen (an agent that can impair fetal development and cause birth defects) that can affect any organ or system of the fetus. So having clear and concise guidelines around pregnancy and breastfeeding is well overdue.

Last updated: 08 Dec 2020 11:46am
Declared conflicts of interest:
None declared.
Professor Elizabeth Elliott is a Paediatrician and Professor at the University of Sydney, Director of the NHMRC Centre of Research Excellence in Fetal Alcohol Spectrum Disorder (FASD), Co-Director of the CICADA Centre, for Care and Intervention for Children and Adolescents Affected by Drugs and Alcohol, and Head of the NSW FASD Assessment Service

The following comments relate to Guideline 3A, that ‘to prevent harm from alcohol to their unborn child, women who are pregnant or planning a pregnancy should not drink alcohol.’

"As a paediatrician, I strongly support Guideline 3. It is consistent with evidence that alcohol may harm the unborn child at any time in the pregnancy with lifelong consequences, and that no safe level of consumption in pregnancy has, or could be, established.

In our Australian studies, about 60 per cent of women report drinking alcohol during pregnancy. Although many stop drinking once they know they are pregnant, about a third are unaware of the harms of alcohol.

Also, some health professionals are unclear about what to advise. I commend Guideline 3, which provides a clear message for clinicians and for women who are pregnant, planning a pregnancy, or who could become pregnant.

Guideline 3 provides a stronger message than the NHMRC’s earlier (2009) guideline that the ‘safest option’ for women who are pregnant or planning a pregnancy is to avoid alcohol.

Guideline 3 aligns well with the mandatory pregnancy warning labels approved for use on all Australian alcohol in July 2020 by the ministers responsible for food regulation. The new, evidence-based label has a pictogram advising against alcohol in pregnancy and says ‘PREGNANCY WARNING. Alcohol can cause lifelong harm to your baby.’

Each week in my clinic in Sydney I see children with Fetal Alcohol Spectrum Disorder (FASD) who have been harmed for life by prenatal alcohol exposure. Alcohol readily crossed the placenta and may cause brain injury, birth defects, learning and developmental problems, and health disorders that characterise FASD. FASD is preventable and I commend the warning in Guideline 3.  

In our research, women tell us they want to be asked about alcohol use in pregnancy and given clear advice by clinicians. Indeed, women say they want to be advised not to drink alcohol. 

It is important that, in addition to pregnant women, this message targets women who are planning a pregnancy or who could get pregnant. Harm can be done from alcohol in the first few weeks of pregnancy, even before a woman knows she is having a baby. Also, many pregnancies are still unplanned."
 
The following comment relates to Guideline 3B, that ‘for women who are breastfeeding not drinking alcohol is the safest for their baby.’

"Research shows that alcohol and its bi-products cross into the breast milk and may harm the breastfeeding child. Guideline 3 provides sound advice that not drinking alcohol is safest for the baby."

The following comment relates to Guideline 2, that states ‘to reduce the risk of injury and other harms to health, children and people under 18 years of age should not drink alcohol.'
 
"As a paediatrician, I strongly endorse the recommendation in Guideline 2 that children and youth under the age of 18 years should not drink alcohol. This now aligns with the legal age for purchase and use of alcohol in Australia.
 
Children and youth are particularly vulnerable to short-term harms from alcohol use - including intoxication and poisoning, car accidents, interpersonal violence, unwanted sex, and even death. 
 
Adolescence is a risky time enough, without the additional risks posed by alcohol use. 
 
Also, the evidence is now clear that alcohol can cause long term harm to users under the age of 18 years by interfering with the development and function of the immature brain. 
 
Early alcohol use increases the risk of harmful patterns of drinking in later life and may be associated with mental and physical health outcomes.   
 
Doctors, parents and family members have an important role to play as role models and life guides and will welcome clear, evidence-based advice to support them in promoting the health of their children - now and into the future.

Last updated: 08 Dec 2020 11:42am
Declared conflicts of interest:
None declared.
Jake M Najman PhD FASSA is Director, Queensland Alcohol and Drug Research and Education Centre, School of Public Health at UQ and Chair of the Queensland Coalition for Action on Alcohol

These guidelines reflect recent findings that confirm the carcinogenic properties of alcohol. The alcohol industry has vigorously challenged any efforts to restrain the marketing and sale of alcohol and can be expected to defend their promotional efforts. However, it is now time for alcohol products in Australia to carry warnings about the risk of cancer in much the same way that Australian alcohol sold in the USA carries such warning.

Last updated: 08 Dec 2020 11:38am
Declared conflicts of interest:
None declared.
Professor James Smith is a Father Frank Flynn Fellow (Harm Minimisation) and Head of the Alcohol, Other Drugs and Gambling team at Menzies School of Health Research

The new NHMRC national guidelines for reducing the health risks of drinking alcohol are strongly welcomed by Australian public health experts, and are closely aligned with the intent of multiple national health policies and strategies.

These revised guidelines are based on a comprehensive assessment of the best available international evidence. It now brings Australia into line with many other developed countries; and the guidelines reflect a deeper understanding of the multi-faceted health and social risks associated with drinking alcohol. 

A key strategy for minimising the harms of alcohol is to ensure the general public understand what a standard drink constitutes, and that they should not exceed more than 4 standard drinks on a given day, or more than 10 standards drinks across a week. 

We know that Christmas and the New Year are around the corner and that these are periods when binge drinking increases. It is important that people consider the new guidelines to make informed choices about their drinking practices, both now and in the future, to protect the health and wellbeing of individuals, families and the communities in which they live, work and play.

Importantly, the guidelines need to be accompanied by targeted health promotion investment. A multi-strategy approach, targeting high risk and vulnerable populations, is critical. For example, there is growing evidence about the lifelong impacts and harms of Fetal Alcohol Spectrum Disorder (FASD). This shows why separate guidelines targeting women who are pregnant or are planning a pregnancy to stop drinking are required. Concurrent education, supportive environments, and evidence-based public health legislation can also help to further reduce the risks and harms of alcohol in the Australian community.

Last updated: 08 Dec 2020 11:35am
Declared conflicts of interest:
None declared.
Clare Hughes is Chair of the Nutrition and Physical Activity Committee at Cancer Council Australia

Cancer Council Australia supports and commends the National Health and Medical Research Council’s updated guidelines to reduce health risks from drinking alcohol, in light of growing evidence of the link between alcohol use and cancer.  
 
Research has shown that even small amounts of alcohol increase your risk of cancer. If Australians reduced their alcohol intake in line with the new guidelines, this would make a big impact in reducing the 3,500 cancers currently caused by alcohol across the nation each year. 
 
As we head into the festive season, we encourage everyone to keep the guidelines in mind and have no more than 10 standard drinks per week, whilst also having a few alcohol-free days each week.

Last updated: 08 Dec 2020 11:29am
Declared conflicts of interest:
None declared.

News for:

Australia
NSW
QLD
SA
NT

Media contact details for this story are only visible to registered journalists.