The COVID-19 pandemic has made many Australians more health aware, and many are now looking for ways to improve their wellbeing. One of those ways is paying attention to the amount of alcohol we drink, said Professor Anne Kelso, chief executive of the National Health and Medical Research Council in December when she launched new national alcohol guidelines.
Previous guidelines, from 2009, recommended no more than 14 standard drinks per week and a limit of four per session. They also recommended delaying drinking in people under 18 for as long as possible and said it was best to avoid drinking while pregnant or breastfeeding.
A decade later, the thinking has changed.
This time, experts say evidence about the harms of even low levels of alcohol consumption has become clearer while evidence around potential benefits has weakened. The guidelines have become more specific in response.
They are not hard and fast rules, Kelso says, and it’s up to people to make their own choices, but it’s interesting to see what’s behind them.
So what is the latest evidence? And why are experts urging people to take a “less is more” approach to drinking?
What’s the takeout from the latest guidelines?
The guidelinesrecommend people consume no more than 100 grams of alcohol in a week. In Australia, that equates to 10 standard drinks. Within that limit, it’s recommended people have no more than four drinks on any one day.
“It’s perfectly consistent with sharing a bottle of wine a couple of times a week,” says Professor Emily Banks, an epidemiologist and public health physician at the Australian National University.
If you want to follow the guidelines, it’s up to you to decide how to spread out your drinking during the week, adds Banks, who was deputy chair of the health and medical research council’s alcohol working committee.
“A bottle of wine contains six to eight standard drinks, and if you share that reasonably evenly, that’ll be within your four-drink-a-day limit.” Or you might opt for a couple of drinks a day and a couple of booze-free days, which is what’s promoted in France. The Australian guidelines are consistent with countries around the world, says Banks.
Besides France, the UK has recommended since 2016 no more than 112 grams of alcohol (equivalent to 14 standard British drinks) and the Dutch advise either consuming no alcohol or seven standard drinks at most (70 grams of alcohol) per week.
In the US, there is a proposal to limit consumption to one standard drink a day. Currently, the guideline is one a day for women and up to two for men.
Australian guidelines are the same for men and women. Women feel the immediate effects of alcohol more quickly than men, and the same amount of alcohol leads to a higher blood-alcohol concentration in women than in men, but evidence shows the long-term physiological differences between men and women have only a small impact on risks of harm.
The Australian guidelines also recommend that women who are pregnant or trying to get pregnant should not drink any alcohol, and that it’s safest to abstain while breastfeeding. Children should not drink any alcohol until after they turn 18.
But why have governments around the world been pushing to limit people’s alcohol intake?
What’s the harm in a drink?
Firstly, following the recommendations does not completely eradicate your risk of alcohol-related harm. “If you want to eliminate the risks of alcohol to you personally, not drinking at all is pretty much the best option there,” Banks says.
The 10 drink per week limit is about giving people a less than one-in-100 risk of dying from alcohol-related illness.
For example, there’s increasing evidence around the long-term effects of alcohol on cancer, Banks says. “What that’s also been showing is that there’s no threshold there with cancer; it’s just the more you drink, the higher your risk,” she says. In other words, there’s no safe level before risk kicks in.
“For every extra drink a woman has every day, her risk of breast cancer increases by 10 per cent. So if a woman is having four standard drinks a day, chronically, her risk of breast cancer is 40 per cent higher than a woman who doesn’t drink at all.“
Alcohol is linked to more than 40 health conditions, including mouth and throat cancers as well as liver, pancreatic, bowel and prostate cancers.
On the more immediate side of drinking harms and health concerns, people are at risk in other ways, including from injuries, drownings and poisonings. Alcohol is linked to 22 per cent of injuries related to motor vehicle occupants and 14 per cent of suicides and self-harm injuries, according to the Australian Institute of Health and Welfare.
“Alcohol is associated with the risk of death by suicide, and that’s particularly from people getting acutely drunk and then being disinhibited, so they’re doing things that they wouldn’t otherwise do,” Banks says.
People around those who drink can be harmed by the effects of alcohol, too. The 2019 National Drug Strategy Household Survey found that, in the 12 months before the survey, 21 per cent of people had been verbally or psychically abused or been made fearful by someone under the influence of alcohol. Of all instances of alcohol-related abuse, 10.6 per cent of cases were serious enough to require a person being admitted to hospital.
In young people, there is now more evidence of the effect of alcohol on developing brains. The brain continues to develop until around 25 years of age, and this means that the brains of people under 18, in particular, are more sensitive to damage from alcohol, Kelso says. “There’s no known safe or no-risk level of drinking alcohol in children or people aged under 18 years.”
In terms of any benefits from alcohol, she says the evidence is not firm. “Any protective effects of alcohol are debated by experts. If they do exist, they’re less than previously thought and possibly only apply to some people.”
The experts who compiled the new guidelines examined thousands of research papers from around the world on the harms and benefits of alcohol, and their recommendations were reviewed by another expert committee. All their research is available on the National Health and Medical Research Council website.
What’s the latest on why drinking when pregnant is a no-no?
A study of almost 10,000 children, led by the University of Sydney’s Matilda Centre for Research in Mental Health, found exposure to low levels of alcohol in utero led to more problems including depression and anxiety than in children who were not exposed to alcohol.
“We’ve found really clear evidence that even this low-level alcohol use at any stage during pregnancy is linked to these poorer outcomes,” Briana Lees, the study’s lead author, said at the time.
That’s why the alcohol guidelines recommend women who are planning to get pregnant should stop drinking.
With breastfeeding, Banks says the “pump and dump” method of having a few drinks, expressing breast milk and then throwing it out before feeding the baby the next lot of milk, has been a particularly persistent myth.
“That is really untrue,” she says.
Alcohol persists in breast milk in a similar way to blood so, depending on how much you drank, the alcohol could stay in breast milk for hours. One way to get around that issue, Banks said, is to express plenty of milk before you begin drinking, and then use that milk to feed the baby that until you have no alcohol left in your system.
What’s the future of drinking in Australia?
Between 2016 and 2019, the proportion of ex-drinkers in Australia grew from 7.6 per cent to 8.9 per cent, or from roughly 1.5 million people to 1.9 million, according to the 2019 National Drug Strategy Household survey.
At the start of the pandemic, online alcohol sales soared, and in May, a longitudinal study from the Australian National University found 22.8 per cent of women and 17.9 per cent of men reported an increase in their drinking since the beginning of the pandemic.
But young people seem less interested in drinking these days. The number of young adults aged between 18 and 29 who abstained from drinking has more than doubled long term. One in 10 people aged between 18 and 24 were reported abstaining from alcohol in 2001; by 2019, it was one in five. In 2001, of people aged between 25 and 29, about one in 10 were abstaining but the proportion was one in four by 2019.
But the older people are, the more likely they are to drink daily. The survey found that 12.6 per cent of people older than 70 drink daily, compared to just 1.2 per cent of those in their 20s.
“Because the younger generations are drinking less, that actually translates to, over time, reductions in overall drinking,” Banks says.
Announcing the guidelines, Chief Medical Officer Professor Paul Kelly highlighted the fact that alcohol still costs the country a lot.
“Alcohol is expensive, in its effects on individuals, families and communities, and its impacts on hospitals and calls on emergency services,” he said. “One in four Australians are drinking alcohol at risky levels. One and two women who are pregnant still, despite all the warnings and the guidelines over many years, consumed alcohol during their pregnancy.”
Banks won’t speculate about the future. Instead, she hopes the new health consciousness prompted by the pandemic helps us make the best choices.
“With the pandemic, I think people can really see that their actions make a difference to the health of the public.”
If you or anyone you know needs support, call Lifeline 131 114 or Beyond Blue 1300 224 636.
Rachel Clun is a federal political reporter at The Sydney Morning Herald and The Age, covering health.