The GENACIS project provides an extraordinary dataset, and congratulations are due to the authors of this paper in pulling everything together and reporting the results in such a clear and easy to understand manner [1]. The authors report what they describe as unexpected findings: alcohol is a problem of the middle age. Perhaps these findings are not so unexpected; rather, the middle aged need to own up to them.

The GENACIS project reports that the prevalence of current drinking did not decline with increasing age amongst the majority of studies, with still very high proportions of drinkers amongst the middle aged (Appendix table 2 [1]), that high frequency drinking (≥5 days/week) tended to increase with age (Appendix table 3 [1]), and high volume drinking (>23 g/day) did not regularly decrease with age, and often increased with age (Appendix table 4 [1]) certainly for men and most likely for women. Although episodic heavy drinking (≥60 g in a day in the preceding 12 months) tended to decrease with age, still a very high proportion of the middle aged engaged in this activity (Appendix table 5 [1]). These findings are consistent with other studies. For example, the 2006 Eurobarometer study, although not to the same scientific rigour as the GENACIS project, found similar results across the European Union [2].

Due to the importance of lifetime exposure and risk of ill-health (e.g. brain grey matter volume [3], breast cancer [4] and death [5]), the maintenance of high frequency and high volume drinking into middle age is likely to lead to upward pressure on the global burden of ill-health. It is also likely that epidemiological studies that report alcohol intake over the duration of the study, rather than just at baseline [6], and that have longer follow-up periods [7] will find increased relative risks between alcohol use and harm outcomes.

It is thus also of no surprise, that, for example, in a country with increasing alcohol consumption over recent years, the UK, the steepest increases in alcohol-related deaths, the highest rates, and the greatest number of deaths have occurred amongst the middle age [8].

What do these findings mean for policy? First, middle aged people need to own up to the fact that alcohol is their problem, affecting them to a large degree. Second, since, to a large degree, the middle aged are responsible for producing alcohol and, to a large extent, for failing to implement evidence-based programmes and policies to mitigate alcohol-related harm, they need to recognize that they are harming themselves. Third, the almost obsessive focus that seems to occur on young people and alcohol needs to be reversed. Not only does a focus on young people not work [9], but, even if it did, it would take many years to follow through to a reduction in middle age risky consumption and related harm. Fourth, we need to focus on policies that have immediacy in reducing harm [10, 11]. Tax [12] and controls on availability [13] seem important here. Fifth, we need a much bigger push in getting early identification and brief advice programmes [14] systematized and targeted to the middle age.

In the tobacco field, it took a long time to reorient policy away from a youth focus [15]. The GENACIS study suggests that, with alcohol, we should rather quickly do the same.

Declaration of interest

The author is middle aged.