Low-risk drinking guidelines to reduce alcohol-related harm: Delphi survey to explore aspects ‘beyond epidemiology’

Background: Low-risk drinking guidelines across Europe portray a wide variation. We turned to European experts to identify areas of agreement and disagreement on questions relevant to forming and communicating low-risk guidelines: need and purpose of guidelines, criterion for low risk, desired components and stratification, views over evidence base and communication aspects.

Methods: A policy Delphi survey carried out in two rounds in 2015 with public health and addiction experts (n?=?51), using the web-based eDelfoi survey tool. Both closed and open-ended questions were used and free-format comments were invited. Frequency counts are presented, and textual answers and comments were subjected to qualitative content analysis. In the second round, key questions were repeated, and new questions, formulated based first-round comments, were presented.

Results: The experts considered as the main rationale for drinking guidelines the public’s right to be informed about risks of drinking. Separate guidelines were called for regarding longer term average consumption and drinking on single occasions, and at-risk groups and high-risk situations were identified that require special attention. Scepticism arose from the complexity of alcohol-related risks and, in particular, from the need to differentiate the advice for various subgroups.

Conclusions: The Delphi survey provided insight into aspects of forming low-risk drinking guidelines that go beyond the epidemiology and will potentially help towards more aligned messages in future guidelines.