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 person’s life as the amount consumed rises. 

However, a 2017 report by a group of experts commissioned by Santé publique France and INCa defined what are considered acceptable risks and proposed a single guideline for both genders, expressed as the number of standard drinks: no more than 10 standard drinks per week and no more than 2 standard drinks per day. These same experts recommend having days during the week when no alcohol is consumed and, on each occasion when alcohol is consumed, to:

• reduce the total amount of alcohol consumed on each occasion
• drink slowly, while eating and alternating with water
• avoid risky places and activities
• make sure you are surrounded by people you trust and that you can get home safely

These guidelines can be summarized as follows:

“FOR YOUR HEALTH, LIMIT ALCOHOL TO A MAXIMUM OF 2 DRINKS PER DAY—AND NOT EVERY DAY”

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

• throughout pregnancy and while 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” as served in a bar or restaurant contains 10 grams of pure alcohol, regardless of the type of alcoholic beverage (wine, beer, or spirits).

Risk Prevention

The long-term risks associated with alcohol consumption are still poorly understood and are often downplayed or put into perspective, and consumers tend to dismiss them. It is therefore important to be able to identify, inform, and assist individuals with risky drinking patterns—that is, those who exceed recommended consumption limits. The proactive role of healthcare professionals is essential.

The alcohol meter tool allows individuals to assess their consumption and understand the risks involved. It can be used independently or recommended by healthcare professionals to their patients. 

General practitioners or primary care providers (midwives, obstetrician-gynecologists, pharmacists, etc.) are the key actors in identifying risky alcohol consumption. By identifying these patients and, if necessary, conducting a “brief” intervention, they have the opportunity to inform them of the risks associated with their alcohol consumption, encourage them, and support them in reducing their intake. This screening stage 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. It is recommended to do this at least once a year, and at any time deemed appropriate (life events, health issues, prescription of a medication that interacts with alcohol, etc.). Certain high-risk situations also provide an opportunity to discuss the issue: pregnancy, driving, and psychosocial stressors (academic failure, exams, job changes, etc.). 

Healthcare professionals can take action on 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 risky drinking (exceeding recommended limits) or even harmful drinking, “brief” intervention can prevent the progression to complications, reduce the harm resulting from this behavior, and improve patients’ quality of life.
• For patients with a severe alcohol-use disorder or who are dependent, a referral to a specialized treatment facility may be made.

Early Detection and Brief Intervention (EDBI)

EIDBI is a preventive procedure aimed at identifying the use of psychoactive substances—in this case, alcohol—and reducing that use.

It primarily targets individuals who are not alcohol-dependent. Those who are dependent may, following the screening phase, be referred to specialized addiction treatment facilities.
EIT 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.

Numerous studies show that RPIB is an effective strategy for reducing alcohol consumption. Longer interventions are not necessarily associated with a significantly greater reduction in consumption.

In practice: early screening

The goal of early identification is to determine risky drinking patterns To do this, the patient should be asked about their level of drinking, 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?”), which can sometimes be difficult to answer.
To facilitate data collection, there are a wide variety of questionnaires available, depending on the types of 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)

Brief Intervention

Support for healthy behaviors should be offered to any consumer who exceeds the guidelines for lower-risk consumption. A brief intervention can be conducted: it aims to motivate a change in behavior among drinkers. It takes the form of a motivational interview. It should be offered, in particular, to individuals with the following misuse scores:

• 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, the brief intervention can be a one-time session or repeated.
The recommended steps are:

The intervention is based on empathy-driven motivational interviewing to strengthen the individual’s motivation and provide them with information while respecting their choices and ambivalence. Success depends largely on the quality of the relationship—particularly the trust between the patient and the professional. Do not hesitate to refer individuals to specialized services. 

Preventing Alcohol Use During Pregnancy

Alcohol is toxic throughout pregnancy, particularly to the brain. Any amount of alcohol consumption is considered risky because no safe dose for the fetus has been established. As a precautionary measure, it is therefore recommended to avoid alcohol during pregnancy—and even when planning to conceive. If alcohol is consumed, it is beneficial to stop drinking at any stage of pregnancy. It is also recommended to avoid drinking alcohol while breastfeeding.

Without making the pregnant woman feel guilty, those around her can provide support (for example, by not drinking alcohol in her presence, suggesting other activities, etc.).

As a healthcare professional, the issue of alcohol consumption during pregnancy should be discussed with every patient as a matter of routine. There are several appropriate times to bring this up, 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 visits provide an opportunity—just as smoking is discussed—to screen for alcohol use and provide information on the associated health and obstetric risks.