Low-risk alcohol guidance sparks debate as drinkers start examining habits, evidence

Canada’s latest guidance on alcohol is sparking loads of debate, and while some experts say it could lead on to frank conversations with health providers to assist drinkers make informed selections, others are questioning the recommendation to imbibe fewer than two drinks per week.

Heidi Tworek, associate professor of public policy on the University of British Columbia, said the guidance aimed toward changing people’s behaviour to cut back their risk of alcohol-related cancer or heart disease needs to be accompanied by other strategies that help them assess their very own situation based on family history or alcohol-use disorder, for instance.

The Canadian Centre on Substance Use and Addiction said in a report released last week that no amount of alcohol is protected and those that devour as much as two standard drinks per week face a low health risk. This increases to moderate risk for 3 to 6 weekly drinks, and is high beyond that.

The guidance is more like a dial fairly than a lightweight switch that some people will find helpful as they monitor their consumption, said Tworek, a Canada Research Chair in health communication.

“The guidance will reach some people, but there are numerous people for whom this isn’t going to resonate or they’re never going to listen to about it in the primary place,” she said.

The CCSA updated its advice from 2011, when it said 15 drinks per week for men and 10 drinks per week for girls was considered low risk. The brand new recommendations were based on the newest research into risk of cancers including of the breast and colon, in addition to risk of injuries, accidents and violence.

It also called for governments to mandate warning labels on alcohol bottles and cans so people know the way many standard drinks they contain, the health risks involved and guidance on consumption.

Nonetheless, conveying details about people’s individual risk shall be a challenge without broader conversations in regards to the evidence that justified the updated guidance, Tworek said.

“This has been difficult in science communication on the whole, like in the course of the pandemic: how do you communicate around uncertainty and why your guidelines are changing? It can take numerous time and multiple modes of communication to succeed in people,” she said.

Tworek said the guidance also needs to be translated into different languages to serve various communities as federal and provincial governments do their part through education campaigns and public health policies.

The office of federal Addictions Minister Carolyn Bennett said Health Canada “will proceed to interact Canadians on the CCSA’s recommendations” to cut back alcohol-related harms.

Canada’s guidance is stricter than in other countries including France, the UK and Australia.

Compared with Canada, guidelines in Australia, as an example, suggest 10 drinks per week pose a low risk.

Nonetheless, standard drinks in Canada are about one-third stronger because they’re based on 13.45 grams of ethanol versus 10 grams of ethanol in Australia, said Dr. Peter Butt, who co-chaired the CCSA’s guidance project.

“Their 10 drinks is de facto about seven of our standard drinks,” said Butt, who can also be an associate professor of family medicine on the University of Saskatchewan. “What we now have when it comes to the moderate risk range is three to 6 drinks. So the difference is one standard drink per week based on the Australian evaluation of the info and what we took from Australia and updated.”

“We’re not promoting abstinence,” he said. “We are literally encouraging Canadians to be higher educated almost about beverage alcohol, reflect on their use and situate themselves almost about the risks and harms and make an informed decision,” he said, adding Canada’s guidance is in line with a recent statement by the World Health Organization on alcohol-related harms about no protected level of consumption.

The CCSA’s recommendations mean one to 2 standard drinks per week represent a one in 1,000 level risk of death, consistent with other voluntary activity corresponding to unprotected sex as per international standards. The danger of dying rises to at least one in 100 if six standard drinks per week are consumed, it said.

“We’re not presenting the relative risk, we’re presenting absolutely the risk,” Butt said, adding the recommendation is predicated on population health studies.

The rules have spurred some people to rethink their alcohol consumption.

Lisa Scotland, who was having fun with a glass of wine along with her sister during lunch at a restaurant in Vancouver, said seeing warning labels on containers of alcohol could make some people consider their selections.

“I don’t think the (guidance) will necessarily change my behaviour but I’ll give it some thought each time I even have a drink,” she said.

“I don’t think numerous people take into consideration cancer risks so a label could be idea. If it could help, wouldn’t it’s price it? If it may possibly destroy your liver, shouldn’t there be a warning?”

Scotland noted the risks of smoking were well-known long before warning labels were placed on cigarette packages but said text and graphic images about health risks helped many individuals kick the habit.

Her sister, Dianna Reimer, said warning labels on alcohol could also be more practical for younger people compared with those that are set of their ways in the case of the quantity they drink.

“I understand the risks but sometimes you may have the worst day ever and you may have just a few glasses of wine,” she said.

Dan Malleck, a medical historian on alcohol policy at Brock University in St. Catharines, Ont., called the guidance “fearmongering” that ignores the social advantages some people gain from gathering to enjoy just a few drinks.

“There’s a certain ideological perspective on this, which is the angle that alcohol is not any good, has no advantages, only harms. And we just must chart how much harm you ought to be aware of.”

“I see the language of temperance, of ethical judgment. And I feel that’s an issue,” he said.

Individuals who have an illness that will put them at greater risk of harm from alcohol are higher off monitoring how much they drink, but “on a regular basis people” shouldn’t be stigmatized for having greater than two drinks at a sitting, Malleck said.

The CCSA could discredit itself by “going too far in a single direction,” with its guidance, he said.

Malleck also challenged the methodology used for the guidance, but Butt said it’s based on international standards and the “best evidence,” which makes the risks “more transparent” so people could make their very own selections.

Dr. Eric Cadesky, a family physician in Vancouver, said he shall be asking patients about their alcohol intake during periodic health examinations and when discussing concerns corresponding to sleep problems.

“It’s a chance to examine in on their alcohol use and to tell them on what we all know now,” he said, adding nurses, social staff and mental-health professionals is also trusted sources on the recommendations.

“Trust is such a crucial commodity today and there are lots of individuals who can deliver that message. Unfortunately, we learn about 20 per cent of the population throughout Canada doesn’t have a family doctor. And people who have a family doctor shouldn’t have ready access.”

This report by The Canadian Press was first published Jan. 23, 2022.

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