It’s time to change how we talk about alcohol

Problem 1: These Terms Place Blame On The Individual, Not On THE Industry

Terms such as ‘harmful use of alcohol’, ‘alcohol misuse’, ‘alcohol abuse’, and ‘responsible drinking’ place blame on consumers, falsely implying that health harms from alcohol, such as cancer, are not caused by alcohol, but by the pattern of drinking (e.g. ‘harmful use’). Although health harms from alcohol do increase with greater volume consumed, it is ethanol, not the drinking pattern, which is a causal agent of disease. These terms are also stigmatizing; for example, ‘alcohol abuse’ implies moral wrongdoing. In truth, a person does not abuse alcohol; rather, alcohol itself causes harm to the health and welfare of consumers. Finally, the alcohol industry capitalizes on this language because it absolves them of responsibility for alcohol-related harm. Industry messages to ‘drink responsibly’ are vague, often have underlying support for alcohol consumption, and assume that consumers will drink. ⁸ These messages place blame for alcohol-related harm, including alcohol-related disease, solely on the consumer, not the product.

Problem 2: These Terms Falsely Imply A Dichotomy Between ‘Safe’ And Harmful Drinking

Much of the language used to describe alcohol’s health risks imply a dichotomy of alcohol-related harm. For example, ‘excessive drinking’ and ‘harmful use of alcohol’ imply there is a defined threshold where alcohol transitions from ‘safe’ to harmful or hazardous, misleading consumers to believe they can consume alcohol in a way that does not pose any risks to their health or safety. However, the relationship between alcohol and harm is not dichotomous but continuous.^6,9

Problem 3: These Terms Are Poorly Defined And Are Likely To Be Interpreted Based On Personal Factors

Many alcohol-related terms also lack definitions. The WHO almost exclusively uses the phrase ‘harmful use of alcohol’ to discuss alcohol-related harms, but this phrase does not provide any definition of volume and/or frequency of alcohol consumed. ¹ Most notably, the term ‘responsible drinking’ is ubiquitous in alcohol industry messaging and disclaimers but lacks any defined criteria.

Vague definitions are problematic because perception of risk is strongly influenced by personal factors, including consumption level. Both youth populations and heavier drinkers overestimate the low-risk drinking guidelines, ¹⁰ and the majority of those who frequently consume several drinks in one sitting do not perceive their drinking as harmful. ¹¹ Furthermore, those with the riskiest drinking patterns are also most likely to perceive their consumption as low or very low. ¹² Therefore, terms such as ‘harmful use of alcohol’ are likely to have minimal impact as the drinkers most likely to experience these harms are unlikely to believe they meet criteria for risk.

Problem 4: When Definitions Do Exist, They Are Not In Line With Current Research

Even when terms are defined regarding volume of alcohol consumed, definitions are often discordant with current research. The Centers for Disease Control and Prevention ¹³ defines excessive drinking as binge drinking, heavy drinking, or any use by underage and/or pregnant persons, stating that ‘excessive alcohol use can contribute to cancers’. Under their definition, a female drinking 3–6 drinks per week would not fulfill criteria for excessive drinking, despite having an estimated 15% increased risk of breast cancer due to alcohol consumption. ⁷ Likewise, definitions of ‘moderate drinking’, a term with positive connotations and often implicitly associated with health, exceed consumption levels for overall health and cancer risk. ⁶

Moving Forward

Current alcohol messaging perpetuates outdated ideas about alcohol’s risks and deprives consumers of necessary information to make informed health decisions. To accurately convey important research to consumers, public health messages must clearly state that there is no safe level of alcohol consumption for overall health. Language such as ‘healthy drinking’ or ‘safe drinking’ should be eliminated as these phrases falsely imply there is a safe level of alcohol consumption. In addition, messages ought to recommend that non-drinkers do not start, and current drinkers reduce or eliminate alcohol intake. Finally, it should be made clear that net health hazards, and in particular, the risk of cancer, increase with increased volume and frequency of alcohol consumption. Alcohol messages should not use terms that suggest health harms only apply to select drinking patterns.

Alcohol-related language should frame alcohol consumption in terms of lower-risk, medium-risk, and high-risk. Terms such as ‘excessive drinking’ should be replaced with terms such as ‘high-risk drinking’. Likewise, terms such as ‘responsible drinking’ and ‘moderate alcohol use’ should be replaced with terms such as ‘medium-risk’ or ‘lower-risk drinking’. Messages should emphasize that lower-risk drinking guidelines are not no-risk drinking guidelines. Evidence-based definitions in terms of volume and frequency of alcohol consumption should accompany these designations.

Conclusion

Currently, alcohol is discussed as if its risks only apply to high-risk drinkers, not to all drinkers. Our aim must be to reduce alcohol consumption across all patterns of drinking, with special attention to the highest risk patterns. By using appropriate language to outline the risks associated with alcohol consumption, we can reduce the preventable health risk and high costs associated with alcohol consumption and maximize benefits to public health.