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20. Standard Drinks

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Summary:

  • Standard size definitions of a "drink" or "unit" (expressed in grams of pure ethanol) are useful tools for both public health and commercial purposes.
  • Governments and public health bodies in a number of countries have issued definitions of standard "drinks" or "units".
  • The concept of a standard measurement is useful for informing individuals about how much alcohol they are consuming.
  • Definitions of standard alcohol units are often provided in conjunction with drinking guidelines.
  • There is no consensus internationally on a single standard drink size, and a range of measurements is used by official entities and by researchers.
  • For examples of interventions, see the online database Initiatives Reporting: Industry Actions to Reduce Harmful Drinking.

Means of tracking how much alcohol people are drinking can be a useful tool for those serving alcohol, as well as for those consuming it. In a number of countries around the world, drinks are generally served in well-defined amounts at restaurants and bars. From a commercial perspective, this allows servers or retailers to monitor how much alcohol is being dispensed and ensures that drink sizes do not vary significantly across venues. For licensing authorities, standard measures are a useful tool for tracking sales. The sizes of servings are largely shaped by local customs and culture.

Defining a "standard drink"

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Aside from commercial reasons behind standardizing the amount of alcohol sold or served, there is also a strong public health rationale for being able to define with some accuracy the amount of alcohol individuals are consuming. Such information is useful for providing advice on low-risk consumption patterns, for tracking data on drinking practices, and for the development of prevention measures (see MODULE 19: Drinking Guidelines; see also Campbell, Ashley, Carruthers, Lacourciere, & McKay, 1999; Dauer, Sole, & Llacer, 1999; Single & Leino, 1998; Stockwell & Single, 1997).

In response to this public health need, a number of countries around the world have issued definitions of standard "drinks" or "units," equal to a specified amount of pure ethanol expressed in grams (International Center for Alcohol Policies, 2003; Miller, Belkin, & Gold, 1991). The strengths of different types of beverage alcohol vary significantly, and using standard measures allows for uniformity. Thus, in terms of the alcohol it contains, a standard drink or unit will be the same—regardless of whether it contains beer, distilled spirits, wine, or a mix of any of these beverages.

International standards

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Official "drinks" or "units" generally contain between 8 and 14 grams of pure ethanol, although the measure varies among countries (see Table 20.1; see also the Policy Issues: Standard Drinks section of the ICAP website).

Table 20.1 Standard Alcohol Units

Standard drink / unit size
(grams of ethanol)
Country

8

United Kingdom

9.9

Netherlands

10

Australia, Austria, France, Ireland, New Zealand, Poland, Spain

11

Finland

12

Denmark, Italy, South Africa

13.6

Canada

14

Portugal, United States

To date, there is no common convention to define a standard drink measure among countries or in the scientific literature (Turner, 1990). Most countries do not use any standard definition for drinks, and, where serving sizes are defined, these measures depend to a great extent on local culture and customs. Where standard units have been implemented, they may vary according to the type of beverage alcohol—spirits, wine, or beer (Dufour, 1999; International Center for Alcohol Policies, 1998, 2003).

These differences make cross-cultural comparisons difficult. It is important to bear in mind, therefore, that drink sizes and related information need to be viewed within the context of the country that has issued them.

Implications for policy and prevention

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Information and public health uses

Standard definitions of ethanol content are useful components of efforts to create public awareness around drinking and for educating consumers. They are generally used in conjunction with official drinking guidelines and recommendations (see MODULE 19: Drinking Guidelines; International Center for Alcohol Policies, 2003), allowing the consumers to translate into practice the advice they are given regarding drinking levels considered "safe," "low-risk," or "moderate." Ideally, consumers should be able to use this information to monitor their own alcohol intake and to compare their drinking with recommended limits.

In order to make official definitions of standard serving sizes more practical and relevant for consumers (Chan, Chan, P'ng, & Segarajasingam, 1997), alcohol content information is included on the packaging in some countries, either as mandated by governments or voluntarily by producers (Hawks, 1999; Webster-Harrison, Barton, Sanders, Anderson, & Dobbs, 2002). In general, unit labeling and the standardization of drinks are useful measures that can help with educating the public and promoting responsible drinking patterns, particularly when combined with government drinking guidelines and awareness campaigns (Hawks, 1999; Walsh, Bondy, & Rehm, 1998; Winski, 1990).

However, to date, most information included on packaging does not directly address consumers or offer guidance in monitoring or regulating their drinking. While packaging may include the percentage of alcohol by volume contained in the beverage (% ABV), "proof" or "degrees" of alcohol, there is little guidance on how to translate such information into, for example, the number of drinks. A further confounding factor is the practice in some countries to include information on alcohol content on certain types of beverage alcohol, but not others.

Other considerations

It is worth noting that the usefulness of standard drinks labeling is limited to those beverages whose strengths are known or that are served in "standard" containers (Graves & Kaskutas, 2002; Stockwell & Honig, 1990). As a result, it is most useful for commercially produced beverage alcohol or home-produced beverages whose strength is well defined.

Another complication is that much beverage alcohol is consumed in the home or other venues where the sizes of glasses may vary and drinks poured are not quantified (Banwell, 1999; Gill & Donaghy, 2004; Lemmens, 1994). However, understanding the relationship between drinks sizes, strengths, and drinking patterns can still help individuals gauge their intake even under these circumstances (Gill & Donaghy, 2004; Hawks, 1999).

A significant proportion of all beverage alcohol consumed around the world is "noncommercial," meaning it is home-produced, illicit, or otherwise unrecorded (see MODULE 21: Noncommercial Alcohol; see also World Health Organization, 2004). The alcohol content of such beverages may be hard to determine (Paine & Davan, 2001). In many developing countries, home brews are traditionally consumed from communal vessels, also making intake difficult to monitor.

Conclusions

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There is evidence that standard drink or unit labeling can be an effective part of educating the public and therefore contribute to reducing potential risk for harm. It is also a measure that enjoys support from both the public health community and the beverage alcohol industry. At the same time, the definition of a standard drink should be in keeping with prevailing cultural norms and practices of a given country (Carruthers & Binns, 1992; Dauer et al., 1999; Gual, Martos, Lligona, & Llopis, 1999).

It is important to note that standard drink definitions by themselves are of limited use as a policy measure. The general public may be largely unaware of their existence, unsure of what the exact definitions are, or, importantly, how they translate into practice (Carruthers & Binns, 1992; Chan et al., 1997; Kaskutas & Graves, 2000; Kemm & Rowe, 1991; Lemmens, 1994).

In order to be useful, standard drinks and units are best coupled with other measures—such as campaigns to create awareness and the inclusion of relevant information on packaging. Drinks sizes are most helpful when applied in tandem with messages on levels of consumption, patterns, and outcomes. If implemented properly, standard drinks information and labeling can assist individuals in making responsible decisions and choices (Stockwell, Blaze-Temple, & Walker, 1991a, 1991b).

POLICY OPTIONS: Standard Drinks

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In developing policies and approaches, consideration of a number of key elements is required. While some may be necessary at a minimum and under most conditions, others may not be appropriate in all cases, or may be difficult to implement. The list below offers a menu of areas that need to be addressed, based on effective approaches that have been implemented elsewhere. Specific examples are provided in the online database Initiatives Reporting: Industry Actions to Reduce Harmful Drinking.

Information

Definition of a standard "unit" of alcohol or "drink," consistent with culture and prevailing norms.

  • International definitions typically range between 8 and 14 grams of ethanol, with 10 grams being commonly used.
  • Consistency in applying the standard, especially across serving establishments.

Use of standard units in conjunction with official drinking guidelines issued by governmental and quasi-governmental bodies.

  • Realistic and relevant information regarding limits (in terms of standard units) recommended per day and per week.
  • Information relating standard units to commercially available containers and packaging.

Consumer education

Education of consumers about standard drinks sizes and relevance. May be done through:

  • Media campaigns and announcements.
  • Physicians’ offices and health centers.
  • Inclusion of standard unit information on packaging.

Research

Efforts to standardize (or at least define clearly) measurement being used to ensure cross-cultural consistency.

  • Drinks information within the context of definition used in a particular country.

References

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Banwell, C. (1999). How many standard drinks are there in a glass of wine? Drug and Alcohol Review, 18, 99–101.

Campbell, N. R., Ashley, M. J., Carruthers, S. G., Lacourciere, Y., & McKay, D. W. (1999). Recommendation on alcohol consumption. Canadian Medical Association Journal, 160, 13–20.

Carruthers, S. J., & Binns, C. W. (1992). The standard drink and alcohol consumption. Drug and Alcohol Review, 11, 363–370.

Chan, M. D., Chan, M. Y., P'ng, S. S., & Segarajasingam, D. S. (1997). Visibility and effectiveness of standard drink labelling. Medical Journal of Australia, 167, 344.

Dauer, A. R., Sole, A. G., & Llacer, J. J. (1999). The "standard drink unit" as a simplified recording system of alcohol consumption and its measurements in Spain. Medicina Clinica, 112, 446–450.

Dufour, M. C. (1999). What is moderate drinking? Defining "drinks" and drinking levels. Alcohol Research and Health, 23, 5–14.

Gill, J. S., & Donaghy, M. (2004). Variation on the alcohol content of a "drink" of wine and spirit poured by a sample of the Scottish population. Health Education and Behavior, 19, 485–491.

Graves, K., & Kaskutas, L. A. (2002). Beverage choice among native American and African American urban women. Alcoholism: Clinical and Experimental Research, 26, 218–222.

Gual, A., Martos, A. R., Lligona, A., & Llopis, J. J. (1999). Does the concept of a standard drink apply to viticultural societies? Alcohol and Alcoholism, 34, 153–160.

Hawks, D. (1999). Not much to ask for, really! The introduction of standard drink labelling in Australia. Addiction, 94, 801–811.

Haworth, A., & Simpson, R. (Eds.). (2004). Moonshine markets: Issues in unrecorded alcohol beverage production and consumption. New York: Brunner-Routledge.

International Center for Alcohol Policies. (1998). What is a "standard drink"? ICAP Report 5. Washington, DC: Author.

International Center for Alcohol Policies. (2003). International drinking guidelines. ICAP Report 14. Washington, DC: Author.

Kaskutas, L. A., & Graves, K. (2000). An alternative to standard drinks as a measure of alcohol consumption. Journal of Substance Abuse, 12, 67–78.

Kemm, J. R., & Rowe, C. (1991). Do people understand "units of alcohol"? Health Education Journal, 51, 59–63.

Lemmens, P. H. (1994). The alcohol content of self-report and "standard" drink. Addiction, 89, 593–601.

Miller, N. S., Belkin, B. M., & Gold, M. S. (1991). Alcohol and drug dependence among the elderly: Epidemiology, diagnosis, and treatment Comprehensive Psychiatry, 32, 153–165.

Paine, A., & Davan, A. D. (2001). Defining a tolerable concentration of methanol in alcoholic drinks. Human and Experimental Toxicology, 20, 563–568.

Single, E., & Leino, E. V. (1998). The levels, patterns and consequences of drinking. In M. Grant & J. Litvak (Eds.), Drinking patterns and their consequences (pp. 7–24). Washington, DC: Taylor & Francis.

Stockwell, T., Blaze-Temple, D., & Walker, C. (1991a). The effect of "standard drink" labelling on the ability of drinkers to pour a "standard drink." Australian Journal of Public Health, 15, 56–63.

Stockwell, T., Blaze-Temple, D., & Walker, C. (1991b). A test of the proposal to label containers of alcoholic drink with alcohol content in standard drinks. Health Promotion International, 6, 207–215.

Stockwell, T., & Honig, F. (1990). Labelling alcoholic drinks: Percentage proof, original gravity, percentage alcohol or standard drinks? Drug and Alcohol Review, 9, 81–89.

Stockwell, T., & Single, E. (1997). Standard unit labeling of alcohol containers. In M. A. Plant, E. Single, & T. Stockwell (Eds.), Alcohol: Minimising the harm. What works? (pp. 85–104). London: Free Association Books.

Turner, C. (1990). How much alcohol is in a "standard drink"? An analysis of 125 studies. British Journal of Addiction, 85, 1171–1175.

Walsh, G. W., Bondy, S. J., & Rehm, J. (1998). Review of Canadian low-risk drinking guidelines and their effectiveness. Canadian Journal of Public Health, 89, 241–247.

Webster-Harrison, P. J., Barton, A. G., Sanders, H. P., Anderson, S. D., & Dobbs, F. (2002). Alcohol awareness and unit labelling. Journal of Public Health and Medicine, 24, 332–333.

Winski, A. (1990). Preference for "standard drink" labels in Australia. The Australian Financial Review, 4.

World Health Organization (WHO). (2004). Global status report on alcohol. Geneva, Switzerland: Author.