New Thresholds for Safe Alcohol Consumption in Canada

Proposed new recommendations on alcohol use by the Canadian Centre on Substance Use & Addiction (CCSA) are refreshing but won’t go down easy. 

Last weekend, I enjoyed a vacation with my two eldest children at a cottage resort. There were many activities, all geared toward family fun. However, as I did some people watching (who doesn’t love people watching?) I was struck by the amount of casual drinking and sedentary behaviour of my adult peers. To me, this is an illustration of our costly societal preoccupation with drinking for the enhancement of leisure. 

Every summer and sporting event we are bombarded with alcohol marketing, as though the ideal experience of being human is to be sitting on a dock, having a cold one. And whose more popular than the guy who shows up to the BBQ with a cooler full of beer? As a parent and physician, I grow steadily wearier of these depictions, feeling deeply we need a culture shift. 

Evidently, I am not alone. In August, the CCSA issued its update of Canada’s Low-Risk Alcohol Drinking Guidelines, now open for public consultation. The extensive and well researched report presents sobering data, strongly linking alcohol consumption with several ways to die too soon. Best of all, they have finally abandoned the long-outdated thresholds for increased risk. 

Let’s first interject some alarming facts. The best available data suggest the at least 75% of Canadians drink alcohol, and 40% consume more than six drinks per week (remember that number). It is estimated that alcohol is responsible for about 7000 cancer deaths per year in Canada, mainly breast and colorectal. There are also strong data linking alcohol with increased risk of heart disease, and of course bodily injury or death due to intoxication.

With those data in mind, it is worrisome that, as far as I know, the standard thresholds of 14 drinks/week for men and 9 drinks/week for women have continued to be taught in medical schools and persist in public health guidelines. These were the levels beyond which we could say a person’s risk of alcohol-related adverse health outcomes increased. Of course, it was never meant to be interpreted as anyone drinking less was safe from bad outcomes, but poor messaging and a general societal acceptance made it seem so.

I always tell my patients that the safest amount of alcohol to consume is none. Understanding human behaviour, though, abstention is generally not a successful strategy. So, I revise my recommendation to an occasional one or two drinks, perhaps monthly, is reasonable. The CCSA guidelines have helped move the needle is this direction. 

First, the CCSA’s decision to remove sex-specific thresholds is excellent. I applaud this move. Next, the creation of low, moderate, and high-risk levels of consumption will help to educate the public. Here’s how it breaks down by risk level (odds of premature death):

Low risk (1 in 1000): 1-2 drinks per week

Moderate risk (1 in 100): 3-6 drinks per week

High and increasing risk (>1 in 100): 7+ drinks per week

Strikingly, the new thresholds immediately place 40% of Canadians in the high-risk drinking category. We clearly have a lot of work to do to lower risk across the board. The tricky part for those of us in health care or public health is how to translate the notion of risk, let alone thresholds of it. 

Consider the moderate-risk category. If you consistently consume between 3-6 drinks per week, then your risk of premature death, due to alcohol, is around 1 in 100. Put differently, if there was a room full of 100 people, all of whom drank about that amount, one of them would die earlier than they should because of alcohol. Most cagey people will quickly retort that 99 people with the same habits did not suffer the same fate. So, what’s the big deal? 

With enough time, we can go on to have a conversation about how that one premature death was directlyattributed to alcohol. However, the other 99 have also increased indirect risk of cancer and heart disease, while likely partaking in other unhealthy lifestyle behaviours, and not to mention spending a bunch of money of alcohol. But we often don’t have enough time to unpack this conversation with our patients, let alone the public at large. 

We also haven’t addressed the fact that people are notoriously bad at assessing long-term risks of any kind, as highlighted by the field of behavioural economics. This is where I like to turn the question around. Instead of focusing so much on risks, tell me how your consumption of alcohol benefits you. Please, take a moment to really consider this. 

Do you truly need to drink to have fun? Are your friends so boring sober that alcohol is the only way to liven up the party? Are you simply drinking because that’s what everyone did while you were coming of age? Are you a food snob and need the correct wine or beer pairing to enhance the culinary experience? Or is there a harder truth that you don’t like the way you feel, and alcohol helps you temporarily escape? 

Now that we’ve introspected, how do we move forward? The CCSA does put forth a recommendation, that in my opinion is tepid, though pragmatic. Essentially it distills down to labeling. They suggest that we ought to include educational information about the risk thresholds and quantity of standard drinks a bottle contains, right there on the label. Problem solved. Only it won’t be. All we need to do is look to the tobacco industry for evidence. 

Ultimately, reducing cigarette smoking took decades of lobbying, legal battles, and policy changes, including banning advertising and smoking sections in restaurants, that made it undesirable to smoke. Although people still smoke, it is far less an issue than 20 years ago. We must also acknowledge that relying on governments to create alcohol-reduction policies, while generating revenue from alcohol sales and taxation ($13.5 billion annually across Canada), is fraught with conflicts of interest. Ontario’s most recent policy change was to increase purchasing accessibility in more locations. 

To bring things to a close, I was happy to see the CCSA’s guidelines come out with strong data and healthier thresholds for public awareness. I hope that its guidance will be taken seriously and lead to something of a wakeup call to a society that has been averse to disease prevention and healthy living for far too long. Until then, drink not only responsibly, but minimally.