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Research Summary

Subtle Change in Drinking Guidelines Could Have Increased Alcohol-related Harm

In 2010, the US Departments of Agriculture and Health and Human Services considered changing recommended drinking levels in the Dietary Guidelines for Americans. “Moderate” drinking guidelines had been 1 drink or less for women (2 for men) on any 1 day.The proposed change was 1 drink or less for women (2 for men) per day on average and 3 (4 for men) or fewer on any 1 day.* Researchers assessed the impact the proposed guidelines would have on alcohol-related harm by assessing risks in a nationally representative longitudinal sample of adult drinkers (2 survey assessments 3 years apart, n=26,438). People drinking amounts within the proposed guidelines, but exceeding the established guidelines, were deemed to be in the “gray zone” of consumption.

  • Compared with those drinking lower risk amounts, those in the gray zone had a significantly increased incidence of alcohol dependence (adjusted odds ratio [OR], 1.5; population attributable fraction** [PAF], 9%) in 3 years.
  •  The OR and PAF were 1.8 and 9%, respectively, for alcohol-related interpersonal problems.
  • The OR and PAF were 2.3 and 3%, respectively, for past-year dependence and 1.2 and 5%, respectively, for job loss.

*The same as current National Institute on Alcohol Abuse and Alcoholism (NIAAA) limits.
**The proportion of drinkers who would experience alcohol-related harm due to gray-zone consumption.


The proposed guidelines did not go into effect, and this analysis suggests that decision avoided substantial population harm. To some, a change to an average daily limit may seem subtle. But, as suggested by Naimi, it would have been interpreted as condoning up to 3 drinks daily for women (4 for men) as long as average limits were not exceeded. He provides the following analogy: the change would be like a guideline for low-risk drinking and driving that condones drinking up to a blood alcohol concentration of 0.079%, a level at which there is substantial impairment (despite the 0.080% legal limit for driving in the US). Simply put, dietary guidelines that recommend what to eat and drink for health should not be the same as limits that indicate health risks. Richard Saitz MD, MPH


Dawson DA, Grant BF. The "gray area" of consumption between moderate and risk drinking. J Stud Alcohol Drugs. 2011;72(3):453–458.

Naimi TS. "Gray area" alcohol consumption and the U.S. Dietary Guidelines: A comment on Dawson and Grant (2011). J Stud Alcohol Drugs. 2011;72(4):687.