What Clinicians Should Know About Alcohol in the New Dietary Guidelines
Key Highlights
- While a “less is more” strategy toward alcohol consumption is directionally correct, a lack of quantitative limits may make the current dietary guidelines less actionable.
- The National Institute for Alcohol Abuse and Alcoholism offers tools and resources for patients and clinicians navigating the impacts of alcohol on overall health.
- Societal shifts toward providing non-alcoholic drink options and participating in abstinence periods offer hope that people are already reducing drinking.
In this video, Johannes Thrul, PhD, MS, associate professor at Johns Hopkins Bloomberg School of Public Health, discusses the new dietary guidelines that recommend reducing alcohol consumption for overall health, but do not specify quantitative limits.
Additional Resources
- Rethinking Drinking. https://rethinkingdrinking.niaaa.nih.gov/. Accessed March 10, 2025.
Transcript:
Consultant360: Can you briefly summarize what’s new or most notable about the alcohol recommendations in the latest U.S. Dietary Guidelines?
Johannes Thrul, PhD, MS: The new guidelines recommend less alcohol for better overall health, but they don't give any specific limits anymore. They also give a number of groups of people that are recommended to avoid alcohol altogether, including pregnant women, people who are recovering from alcohol use disorder, and a few other groups. But those are really the main alcohol guidelines in the new dietary guidelines.
C360: Are there specific patient populations – by age, sex, comorbidity, or life stage – for whom alcohol poses particularly high risk according to the guidelines?
Dr Thrul: The guidelines mention specifically pregnant women, people who are recovering from alcohol use disorder or are unable to control the amount they drink, and then folks who are taking medications and have medical conditions that might interact with alcohol. For example, they mention folks with a family history of alcohol use disorder.
C360: How should clinicians interpret “moderate” drinking in light of newer evidence suggesting there may be no completely safe level of alcohol consumption?
Dr Thrul: The guidance in the new guidelines to consume less alcohol for better health is directionally correct and consistent with the latest evidence. Where these guidelines become less useful is they remove a clear quantitative benchmark that give people and clinicians guidance, and it makes the less a little bit more difficult to operationalize in real life. What does that mean? So a large body of research now shows that alcohol harms rise with increased intake. So the more you drink, the worse your outcomes. And for some outcomes, specifically for cancer risk, we know that there is no safe limit or safe threshold. So as a public health message, “less is better,” is broadly defensible, but guidelines are most effective when they are also actionable and numeric limits help people translate these guidelines into behavior.
C360: How do the U.S. guidelines compare with alcohol recommendations from other countries or global health organizations?
Dr Thrul: The guidelines I always like to point out are by the Canadian Center on Substance Use and Addiction. And a few years ago, they have quantified alcohol guidelines in a rigorous way and in a relatively conservative way. And so they recommend no more than two drinks a week for optimal health and ideally no drinking at all. And so those are things that are missing from the current dietary guidelines in the US, which I think would've been helpful to give folks clearer benchmarks to target.
C360: Are there screening or counseling tools that align with the spirit of the new recommendations?
Dr Thrul: The widely available tools that I'm familiar with are by the National Institute for Alcohol Abuse and Alcoholism (NIAAA). They give some tools for patients, for individuals to use. Rethinking Drinking is a program that gives folks some ideas of what to do if they want to reexamine their relationship with alcohol or the way they drink and reduce harm from drinking.
But in general, I think the research evidence points in a direction that less is better and that we now know that the best evidence exists for the health benefits of no drinking whatsoever. And previously there were some, I would say, conflicting findings of potential health benefits of low-risk drinking, but in my mind, the evidence is moving in a direction where the benefits of low-risk drinking are not as robust as we previously thought. And the more rigorous science that is coming out, because science is always a process and is in flux, is demonstrating that the safest level of drinking is no drinking at all.
C360: Do you anticipate resistance or misinterpretation of the alcohol guidance from clinicians, patients, or industry?
Dr Thrul: As I said, I think it is a little bit in flux our understanding of the science and of the evidence, and it takes a little bit of time until new evidence arrives in the office of the clinicians and then in broad understanding of the general public. The way that the current guidelines are worded with “less alcohol for better overall health” is directionally correct. Now, how people interpret that is a different kind of question, and so the “less” is more difficult to operationalize what that means, and it doesn't give people a clear target. So that's where I see the guidelines could be strengthened by giving folks maybe a clearer target to aim for. And with all that being said, the best health outcomes you will get from no drinking.
C360: If you could give clinicians one message to take away from the new alcohol guidance, what would it be?
Dr Thrul: I think being in conversation with your patients about alcohol use, getting interested in the role that alcohol plays in their life, and sending a clear message that there are health benefits to be had from reducing or quitting drinking.
C360: Is there anything else you would like to add?
Dr Thrul: I always like to end on a message of hope, and that is that there are health benefits to be had from reducing or quitting drinking. And I think now we see that society is evolving in that way in how many non-alcoholic drink options are available that previously were not as widely available. So we are seeing a shift in the kind of products that are available for people to try. We're seeing increasing interest in abstinence breaks like Dry January, Sober October, things like that, where people can give it a try and see how it feels when you don't drink for a period of time and the health benefits that maybe materialize more quickly. And those tend to be anxiety, a reduction in anxiety, an improvement in sleep, and those tend to be the things that people notice relatively quickly and experience that there are benefits to be had that are at a very different timescale from the cancer risk that is usually further down the line.