Clear criteria based on absolute risk: reforming the basis of guidelines on low-risk drinking

The paper discusses the approach behind the Australian Guidelines to Reduce Health Risks from Drinking of 2009. The Guidelines involved a new approach to the central conundrum of low-risk drinking guidelines: how to set a guideline threshold on smooth risk curves.

The context of the 2009 Guidelines is discussed in terms of previous Australian guidelines and of risk analyses and threshold setting for other risks to health and well-being, such as environmental and food toxins. The Guidelines were accordingly based on new lifetime risk modelling of absolute risk, with specification of the risk attached to the guideline thresholds of 1 in 100 lifetime mortality risk. The Guidelines thus specify no more than two Australian standard drinks a day, and no more than four drinks on any occasion.

The approach described brings alcohol guidelines within a general analytical frame of guidelines and standards for hazards to health. At the level of 1 in 100 lifetime risk, there is little justification for different guidelines for men and women. On grounds of differential risk, separate guidelines for young adults might be considered, but could not be based on lifetime risk.