This is an update of the evidence review produced for the 2016 United Kingdom Chief Medical Officers alcohol guidelines group, to determine how people understand and respond to official public health guidance.

The information in this report will be useful to guideline developers trying to determine the acceptability and feasibility of recommendations and those creating knowledge translation products to communicate recommendations. The report can also help developers to pose the right questions to the public when developing and evaluating different products and strategies, and highlights content that may need to be addressed in those products and strategies.

Key messages:

• There appears to be little understanding among the public about what a standard drink is, and most times people overestimated the standard drink size. The public also overestimated the number of daily and weekly drinks recommended in guidelines. Typically, people indicated that those recommendations were unrealistic and did not want to count drinks.
• Views about the amount of alcohol consumption that was not sensible or that was harmful were often associated with excessive intake or “problem drinking,” but people often noted that their own drinking was not a problem.
• Less than half the people who responded to surveys were aware of the harms of alcohol intake, and there was less awareness in people who drink at high or very high-risk levels. While some people were aware of the harms, they still had a positive attitude toward alcohol use, especially in social situations.
• The applicability to their own lives of guidelines generally and guidelines specifically for low-risk drinking was questioned by the public with many reasons given for why guidelines might not be applicable. For example, individual tolerance levels and physical reactions to alcohol can differ, and the effects of different types of alcohol on an individual can also differ.
• People suggested that guidelines should include strategies to help apply the low-risk drinking recommendations, such as refusing drinks when not really wanted or eating while drinking.
• While participants in the studies indicated that a health agency should provide recommendations, they preferred advice rather than strict rules or patronizing messages