Guidelines for Alcohol Consumption

There is no such thing as risk-free alcohol consumption. The health risks associated with alcohol consumption increase over the course of a lifetime in proportion to the amount consumed.
However, a report issued by a group of experts commissioned by Santé publique France and INCa attempted to define acceptable risks and proposes a single guideline for both genders, expressed as the number of standard drinks: 10 standard drinks per week and no more than 2 standard drinks per day. These same experts recommend having days during the week without alcohol consumption and, for each occasion of drinking, to:

• reduce the total amount of alcohol consumed on each occasion

• drink slowly, while eating and alternating with water

• avoid risky places and activities

• ensure you are surrounded by people you trust and can get home safely

These guidelines can be summarized as follows: for your health, alcohol means:

“MAXIMUM 2 DRINKS PER DAY AND NOT EVERY DAY”

Generally speaking, the safest option is to avoid alcohol in the following situations:

• throughout pregnancy and breastfeeding

• during childhood, adolescence, and throughout the growth period

• when driving

• when participating in high-risk sports

• when taking certain medications

• if you have certain medical conditions

For reference, a “standard drink” contains 10 grams of pure alcohol, regardless of the type of alcoholic beverage (wine, beer, or spirits).

Risk Prevention

Even with alcohol consumption considered low, health risks exist. It is therefore important to be able to identify, inform, and assist individuals with risky drinking habits—that is, those exceeding recommended consumption limits. The Alcoomètre tool allows for self-assessment and can be offered to patients and the general public: alcoometre.fr.
This tool is a redesign of the tool launched in 2010 and positively evaluated in a randomized controlled trial (Guillemont J, Cogordan C, Nalpas B, et al. Effectiveness of a web-based intervention to reduce alcohol consumption among French hazardous drinkers: a randomized controlled trial. Health Educ Res. 2017 Aug 1;32(4):332-342).

General practitioners, as well as primary care providers (midwives, obstetrician-gynecologists, pharmacists, etc.), are the key actors in identifying alcohol-related problems. By identifying these patients and, if necessary, conducting a so-called “brief” intervention, they have the opportunity to inform them of the risks associated with their alcohol consumption. This screening program is crucial because non-dependent drinkers find it easier to reduce or stop their alcohol consumption, with appropriate support and effort, than those who are already dependent. Healthcare
professionals can take action at several levels:

• For patients with low-risk drinking, the goal will be to reinforce health-promoting behaviors (primary prevention).

• For patients in whom the physician has identified probable problematic drinking, brief intervention (detailed in this fact sheet) will help prevent the progression to complications, reduce the harm resulting from this behavior, and improve patients’ quality of life.

• For dependent patients, a referral to a specialized treatment facility will be made

Early Identification and Brief Intervention (EIBI)

EBIR is a prevention procedure aimed at identifying substance use behavior—specifically alcohol use in this context—and promoting a shift toward reduced consumption.
It primarily targets individuals who are not alcohol-dependent. Dependent individuals, on the other hand, may be referred to specialized addiction treatment facilities.
EBIR consists of two stages:

• Screening: this involves collecting self-reported consumption data and assessing risks using a questionnaire

• Brief intervention: This takes the form of a motivational interview.

The RPIB has proven effective in numerous studies.

In practice: Early screening

The goal of early screening is to identify risky drinking patterns. To do this, the patient should be asked about their level of consumption, particularly in terms of quantity and frequency. It is better to ask specific questions (e.g., “How many drinks do you have per week?”) rather than vague questions (e.g., “Do you drink alcohol?”) that are sometimes difficult to answer.
To facilitate data collection, there are a wide variety of questionnaires available, tailored to the specific substances they assess. Regarding alcohol, two of the most commonly used questionnaires are:

• AUDIT (Alcohol Use Disorders Identification Test)

• and FACE (Fast Alcohol Consumption Evaluation)

AUDIT
, developed by the World Health Organization (WHO), consists of 10 questions that assess self-reported alcohol consumption over the past 12 months. The questions measure the frequency of alcohol consumption, dependence, and problems caused by alcohol use. Misuse [dependence
] is suspected:

• in men with a score of 7 or higher [>12]

• in women with a score of 6 or higher [>12].

Brief intervention

Brief intervention aims to motivate behavioral change among at-risk drinkers. It should be offered to:

• Men with a score of 7 to 12 on the AUDIT questionnaire or 5 to 9 on the FACE questionnaire.

• Women with a score of 6 to 12 on the AUDIT questionnaire or 4 to 9 on the FACE questionnaire.

Lasting anywhere from 5 to 20 minutes, brief intervention can be a one-time session or repeated.
The recommended steps are:

Prevention of Alcohol Use During Pregnancy

The issue of alcohol consumption during pregnancy must be addressed with every patient, systematically. There are several appropriate times to do so, but the sooner the better.

• Preconception 

• Upon confirmation of pregnancy 

• During the early prenatal visit 

• During a follow-up visit

• During childbirth preparation classes 

Many questionnaires are available, but they cannot replace dialogue. They can, however, facilitate dialogue by encouraging and informing the conversation. The T-ACE is the test that is generally used.

In addition to pregnancy, for women of childbearing age, gynecological and medical consultations provide an opportunity—just as we address tobacco use—to screen for alcohol use and inform patients about the associated health and obstetric risks.