Effects of ‘No Safe Level’ and ‘Cutting Down’ Alcohol Messages on Problem Recognition, Defensive Processing, and Self-Efficacy in Heavy Drinkers: A Randomized Experimental Study

Background: Public health groups have increasingly been adopting a no safe level of alcohol consumption message. We aimed to test how this message affects psychological outcomes relevant for alcohol use and how it compares with a gain-framed message emphasising the benefits of cutting down.Methods: Adults who drank alcohol at risky or harmful levels (AUDIT-C ≥ 5; N = 485) were randomised to view one of three messages: Control (n = 165), No safe level (n = 163), or Cutting down (n = 157). Outcomes were problem recognition, defensive processing (message derogation, risk recognition, fear), and self-efficacy. Linear regression models adjusted for age, sex, employment status, AUDIT-C score, and drinker identity. Moderation by drinking level was tested using interactions between message condition and AUDIT-C score.Results: Compared with the control message, no safe level increased problem recognition (estimate = 0.22, 95% CI [0.03, 0.41]), elicited much stronger fear (0.92, [0.73, 1.11]), and was derogated more (0.89, [0.69, 1.09]). It also reduced self-efficacy (−0.23, [−0.43, −0.02]). Cutting down increased fear also modestly (0.30, [0.10, 0.49]) and lowered self-efficacy (−0.28, [−0.48, −0.08]) but had little effect on problem recognition (0.06, [−0.13, 0.26]) or derogation (0.13, [−0.07, 0.33]). Neither message had a clear effect on risk recognition. When compared directly, no safe level generated more fear than cutting down (estimate = 0.62, 95% CI [0.43, 0.82]) and was derogated more strongly (0.76, [0.56, 0.96]), but any effect on problem recognition was uncertain and likely smaller (estimate = 0.15, 95% CI [-0.04, 0.35]). There was no clear evidence that effects differed by AUDIT-C score (all interaction p>.13).Conclusions: The no safe level message increased problem recognition relative to control, though not when compared with cutting down. Compared to cutting down, the no safe level message elicited much greater fear and message derogation. These mixed responses caution against assuming public health benefits of communicating ‘no safe level of alcohol consumption’ type messages.