COMMENTARY COMMENTARY: IF YOU DRINK ALCOHOL,DRINK SENSIBLY: IS THIS GUIDELINE STILL APPROPRIATE? Liezille Jacobs, PhD; Nelia Steyn, PhD Objective: Alcohol abuse remains one of the most serious substance abuse disorders in South African society, resulting in inordinately large social, economic and health problems at all levels of society. Alcohol consumers in South Africa are estimated to drink 16.6L per annum with a per capita consumption of 7.1L. South Africa has one of the highest rates of death attributable to crime, violence, traffic accidents, and HIV/AIDS in the world. These rates have been directly related to the high prevalence of alcohol abuse and risky drinking patterns. A food-based dietary guideline that encourages alcohol consumption would ap- pear to be not in the nation’s best interest. Methods: We conducted a search of websites supported by the World Health Organization to find published literature on substance abuse in South Africa and also reviewed the website of the Medical Research Council of South Africa for studies on the social impact of alcohol abuse in humans. We used the search terms alcohol guidelines, alcohol abuse, non-communicable diseases, health benefits of alcohol, moderate drinking, alcohol, and intake patterns and reviewed studies that hade been published between 2002 and the current time. Results: Based on evidence over the past two decades, messages that convey the positive health benefits of moderate alcohol consumption (eg, the increased levels of HDL cholesterol) should be raised and even encouraged for those who are very moderate drinkers (ie, one alcoholic drink/ day for women and a maximum of 2 drinks/day for men). For those who do not consume alcohol at all, even moderate drinking is not encouraged. Nutrition educators should emphasize the nega- tive consequences of alcohol abuse. Conclusion: The current food-based dietary guideline, ‘‘If you drink alcohol, drink sensi- bly,’’ from the South African Department of Health should not remain as is. (Ethn Dis. 2013;23[1]:110–115) Key Words: Alcohol, South Africa, Alcohol Abuse INTRODUCTION In 2002, the Department of Health in South Africa (SA) adopted food-based dietary guidelines (FBDGs) that included an alcohol-consumption guideline to be adopted by the general public: ‘‘If you drink alcohol, drink sensibly.’’ 1 This guideline was based on findings from the South African Expert Consultation Group that examined published evidence on alcohol use. In this article, we examine evidence from 2002 to date to re-evaluate the appropriateness of this guideline. When this guideline was developed, the responsible expert working group had much discussion on whether there should, in fact, be a guideline on alcohol. Much of the discussion cen- tered on the negative aspects of alcohol consumption, the high prevalence of alcohol addiction, related crime and violence, and the concern that a guide- line would have the unintended conse- quence of encouraging alcohol con- sumption. However, a strong body of evidence supports the cardiovascular health benefits of moderate alcohol consumption, 2 which made it difficult to ignore since the FBDGs are meant to foster nutritional health and well being. The final decision was to include a guideline on alcohol that would clearly identify the recommended amounts of alcohol consumption in a supporting document to be called the FBDG Guidelines. Socio-political Influences and Historical Trends on Alcohol Consumption in South Africa The history of alcohol dependence in South Africa runs through the history of the country’s segregation. In traditional African society, the use of alcoholic drinks was well-regulated socially. 3 After coloni- zation, the British unsuccessfully prohib- ited the use of alcohol by Africans in an attempt to prevent what they saw as social decay and disorder encouraged by its use. 4 In 1962, it became legal for Black people to purchase alcohol from White-owned liquor stores. 5 Alcohol was also seen as a means for establishing and maintaining economic and social control, particularly on the farms, mines and in urban industry. 4 Employers at vineyards and other farms in the Cape, and in the emerging diamond and gold mines to the north, used alcohol to attract and retain workers from rural areas. 5 Although not legally allowed, the ‘dop’ system is still practiced today on various vineyards in the Western and Northern Cape Provinces 4 where workers receive alcohol as partial compensation in lieu of money. In the townships, municipal beer halls were established by local authorities to help finance township development and control. The responses to these controls were abuse and social decay, as well as defiance and resistance. Many people turned to illegal activities related to Address correspondence to L. Jacobs, PhD; Centre for Science, Technology and Innovation Indicators, Population Health; Health Systems, and Innovation. Human Sciences Research Council; P Bag X9182; Cape Town, 8000, South Africa; liezillejacobs. phd@gmail.com From the Centre for Science, Technol- ogy and Innovation Indicators, Population Health, Health Systems, and Innovation. Human Sciences Research Council, Cape Town, 8000, South Africa (LJ) and the Centre for the Study of Social and Environ- mental Determinants of Nutrition; Popula- tion Health, Health Systems, and Innova- tion. Human Sciences Research Council, Cape Town, South Africa (NS). 110 Ethnicity & Disease, Volume 23, Winter 2013