This site is intended for health professionals only

How much is too much?

The invitation could easily have been taken either way. 'Tony, come to dinner.' it read,

'We’re having a roundtable discussion and we want the country’s brightest and sharpest minds to attend. We’re sure they’d like to meet you.'

And so it was that I spent an evening discussing the effect of alcohol on health and the Nanny State’s ever shifting goalposts regarding safe and unsafe consumption. An evening sponsored by a multinational drinks company with generous portions of their excellent beers, wines and spirits on offer to keep the conversation flowing.

As the only medic in the squad I slotted myself into central midfield, in the hole between a strike force of proper stand up comedians and a flat back four of proper journalists. It fell to me to answer the opening question, 'What exactly is a unit of alcohol?' Easy, it’s 10ml of actual alcohol.

The follow-up, 'So how do we calculate the number of units in that glass of wine you’re holding?' was a bit trickier, as I normally have to look that up on Wikipedia. After a few permutations involving multiplying the amount in the glass in centilitres and litres by the alcohol percentage by volume of the wine and dividing the result by every order of magnitude between one hundred and one hundred thousand, I took the easy way out, drained the glass and confidently answered, 'Zero'.

'And what about the 21 units a week guideline, is that safer than the four units per day guideline? And if I have two days off can I have an extra unit on the others?'

'I really don’t know, wouldn’t anybody else like to take a question?'

By the time the conch came back around the table to me everybody was getting into their stride. What was the scientific basis of the safe drinking guidelines? I tried to divert attention by asserting that: '17.75% of statistics are made up on the spot' but in the end had to admit that in terms of nailed down evidence to back up the 'safe drinking' limits, there wasn’t any.

Twenty five years ago a report, ‘The medical consequences of alcohol abuse; a great and growing evil’ confessed that there was insufficient evidence to make confident statements about how much alcohol is safe’. You can guess by the publication’s entirely unbiased title which side of the fence they were sitting on.

Twenty one units a week for men and fourteen units for women became the upper limits of acceptability, based on nothing much. In 1995 the deck chairs were rearranged, offering daily limits, but in doing so appeared to sanction 'everyday drinking'. Weasel words like 'hazardous' and 'harmful' appeared despite, once again, the boffins’ owning up that the new recommendations were a ‘best judgement’ having taken into account 'areas of uncertainty and inaccuracy'.

So in the end I stood up, addressed the room and admitted: 'My name is Dr Tony Copperfield and I have a drink problem. The couple of pints a night I used to enjoy in the doctors’ mess of an evening off duty would now mark me out as a functional alcoholic rather than one of the boys.'

But my real alcohol problem is figuring out what to tell patients when they ask, 'How much is too much?'

Dr Tony Copperfield is a GP in Essex