Recommendations for what constitutes sensible drinking are not new and have varied across time and place. In 1981, concerned by the increase in admissions to hospital for alcohol-related diseases in the United Kingdom, health educators and clinicians developed the general concept of sensible drinking.1 Drinking sensibly was defined as the opposite of alcohol misuse, which is “drinking to excess or drinking in situations which are not appropriate when the effect in either case is to put the drinker or others at risk of harm.”2 In 1984, the British Health Education Council described sensible drinking as the amount to which people should limit their consumption of alcohol.1 Proposed British limits were 18 standard drinks per week for men (i.e., with 8 g ethanol/drink, 144 g of ethanol weekly) and 9 standard drinks per week for women (72 g of ethanol weekly). In 1987, the British Health Education Council raised the limits to 21 units per week for men (168 g ethanol) and 14 units per week for women (112 g ethanol).1 Those recommendations were based on studies that had focused on the short-term effects of different levels of alcohol consumption, such as social and psychological problems or admissions to hospital. Subsequently, these recommendations were endorsed by three medical colleges (general practitioners, psychiatrists and physicians) and finally adopted by the UK government in 1992. Other countries also adopted this approach. Some countries have adapted the limits to reflect the patterns of drinking in their jurisdictions, i.e., the limits for drinking range from less than one to as many as four drinks or units of alcohol per day, and the measure of a unit of alcohol varies between 8 and 15 g of ethanol (Table 1 and Appendix 1, available at www.cmaj.ca/lookup/suppl/doi:10.1503/cmaj.110363/-/DC1).
In the meantime, the Alcohol Use Disorders Identification Test (AUDIT) international questionnaire was developed by a World Health Organization (WHO) collaborative group as a simple method for screening people who may have problems due to their drinking habits. A brief intervention program was developed and proposed for use among general practitioners from the participating countries. The aim of the program was for primary-care physicians to help people reduce their consumption of alcohol before dependence developed. Experts leading the collaborative group proposed adopting the guidelines already in use in their countries (UK, Australia, Denmark, France, etc.): 21 units per week for men and 14 for women.4 However, the limits proposed by the WHO collaborative group were sometimes wrongly considered to be official WHO guidelines. The WHO has never issued official quantified recommendations for alcohol consumption. Moreover, in plans for reducing the consumption of alcohol in the WHO European region, the message “less is better,” launched at a WHO European Conference in 1995, is the only recommendation consistently promoted.5