Drinking Guidelines: Supporting health and life

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Coast to coast to coast, Canada now has one set of recommendations to help people make decisions about alcohol.

Drinking Guidelines | PDF

They were developed by a national group of experts, working with prevention and treatment professionals, the alcohol industry, and advocacy organizations. They are based on the best available evidence from around the world.

Canada’s Low-Risk Alcohol Drinking Guidelines will enable health professionals to provide consistent advice, encourage individuals to monitor and moderate their drinking, create awareness about our cultural attitudes to alcohol, and collect data for monitoring the costs and harms of alcohol at provincial and national levels.

Why do Canadians need drinking guidelines?

Most Canadians drink alcohol. Many drinkers do not experience problems from their drinking. However, as a country, we consume more than 50% above the world average. How we drink causes a lot of alcohol-related problems and results in over $14 billion in costs each year. Much of this is preventable.

The scientific evidence tells us that there are daily and weekly levels of drinking that will help prevent some of the harms and reduce the health, legal and labour costs. The new guidelines help drinkers to balance potential benefits with a consideration of the potential harms. They identify drinking patterns which will help prevent harms or which raise the risk of problems.

The guidelines are not intended to encourage people to drink. They inform drinkers that drinking above the suggested limits will put them at risk for injuries or chronic diseases. They also provide advice on when not to drink (e.g. when pregnant or planning to be pregnant, when driving a vehicle or doing any kind of dangerous physical activity), and they provide tips for reducing risk (e.g. drink slowly, eat before and while you are drinking, do not start drinking for health benefits).

While the guidelines will not change the drinking culture overnight, they may help us reduce the rising costs related to alcohol in our cities and provinces by encouraging Canadians to adopt a culture of moderation when it comes to alcohol.

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A Standard Drink | PDF

A Canadian “standard drink” is a fixed quantity or unit of alcohol. This measure allows drinkers to recognize the amount of actual alcohol present in beverages of different kinds, concentration and size. Knowing how many standard drinks one has had can help a person decide when it’s best to stop. Low-risk guidelines suggest appropriate limits in number of standard drinks per week and on any occasion.

What counts as a standard drink in different beverage categories?

A Canadian standard drink equals the amount of alcohol present in a typical retail container of regular strength beer, our country’s most popular alcohol drink. It also applies to the same volume of alcohol present in other main beverage types—wine and spirits.

Consumers can learn to estimate accurately enough standard drink amounts in various beverage products and servings. Larger volumes or higher concentrations will increase the number of standard drinks present; smaller volumes or lower concentrations will decrease that number.

Learning to count drinks?
  • 18 oz glass of regular beer (5% alcohol) = 1.5 standard drinks

  • bottle of light beer (3.7% alcohol) = 0.7 standard drink

  • can of extra strength beer (8%) = 1.7 standard drinks

  • a 750 ml bottle of wine (12% alcohol) = 5 standard drinks

  • 9 oz glass of wine (14% alcohol) = 2 standard drinks

  • 2 oz shot of spirits (40% alcohol) = 1.3 standard drinks

A Canadian standard drink is 17.05 ml or 13.45 g of pure alcohol

Each of the following are 1 standard drink:

Standard drink

For interactive online practice in pouring a standard drink, take the challenge at www.deflatetheelephant.com.

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Alcohol Screening | PDF

Alcohol screening poses simple questions to people in order to identify those at risk for, or experiencing, harm through their drinking. The questions help recipients reflect on their drinking and become aware of signs of potential problems related to alcohol use.

Screening may be carried out in a variety of settings (formal and casual) by professionals or non-specialists, including peers. It can also be done as a self-help exercise using web-based questionnaires. Whether online or in person, screening paves the way for some form of dialogue or brief intervention (e.g., summary internet advice, a short conversation, one or more short counselling sessions). Brief intervention aims to help the person explore how to deal with potential or existing problems.

Given their purpose, screening questions ideally are few in number, clear, quite concise and simple to respond to, with implications that can readily be taken up in discussion.

How do low-risk drinking guidelines relate to screening?

Low-risk drinking guidelines connect directly with the goal of screening. They point to patterns of risk and offer thresholds that people can use to estimate how susceptible they might be to firsthand alcohol-related problems.

The guidelines specify weekly and daily intake limits. Weekly limits reduce long-term harm such as cancer and heart disease. Daily limits reduce injury or other harms related to impairment.

The low-risk drinking guidelines tell us when it is inappropriate to drink at all, and screening can check for frequency of use in these situations as well.

Alcohol screening and low-risk drinking guidelines can work together to increase awareness and encourage healthier patterns of use.

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Alcohol and Youth | PDF

Why have alcohol guidelines for youth?

Since people younger than 19 years old are not permitted to buy or have alcohol in British Columbia, some might suggest the only guideline for youth should be, “Don’t drink.” But a high percentage of older youth in British Columbia are using alcohol on a regular basis—some in very risky ways. Low risk drinking guidelines acknowledge the evidence that alcohol can harm both physical and mental development, particularly in early adolescence but continuing well into early adulthood (at least to age 24). At the same time, the guidelines recognize that many young people do use alcohol and that there is good evidence to suggest that certain patterns of use are more risky than others.

What are the key factors that impact risk for youth?

The risk factors for developing problematic patterns of alcohol use are complex and simplistic accounts are not helpful. Nonetheless, the following are important considerations.

Regularly drinking alcohol (and in particular frequent intoxication) in early adolescence is associated with increased problems later in life.

Childhood trauma is associated with both early alcohol use and quicker progression from first drink to heavy drinking.

When young people believe alcohol is easy to get, they tend to use it more and to experience more problems.

What can parents or other adults do to support youth?

Promoting messages about lower risk drinking that teach young men and young women (and their role models) to drink alcohol in less risky ways when they choose to drink is important.

Clear rules are helpful, but good communication in which the younger person feels comfortable and well understood is more important than monitoring and surveillance.

A commitment to early childhood development that minimizes the likelihood of experiencing trauma and provides early supports is critical.

According to the Adolescent Health Survey
  • Past month use of alcohol by school-aged youth in British Columbia declined from 43% in 1998 to 37% in 2008

  • Heavy drinking episodes are still common—24% of school-aged youth in British Columbia report having consumed five or more drinks within a two-hour period at least once in the past month

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Alcohol and Women | PDF

Why are the weekly drinking limits lower for women?

In general, women are more vulnerable to the effects of alcohol than men for several reasons. On average, women weigh less than men, and smaller people reach higher blood alcohol levels than larger people. In addition, pound for pound, women have less water in their bodies than men do—even if a woman and a man of the same weight drink an equal amount of alcohol, the woman’s blood alcohol concentration will be higher. Thirdly, women have less alcohol-metabolizing enzymes and digest alcohol in the stomach differently than men.

The guidelines are a starting place for women to assess their individual drinking practices. Exceeding these amounts can potentially lead to a wide range of short- and long-term health and social problems, including alcohol dependence.

Low risk drinking guidelines are based on research on the average person, but the effects of alcohol vary greatly from one woman to another. Some of the factors that can influence the way individuals respond to alcohol include weight and size, genetics and family history, mixing alcohol with other substances or medications, and overall stress, hunger and lack of sleep.

Women face particular health risks and realities

Heavy alcohol use in women can lead to serious and in some cases unique health problems. Osteoporosis, breast cancer, heart disease and reproductive problems are all associated with drinking by women. Women are more susceptible to alcohol-related heart disease than men. Women who drink alcohol are more likely to develop alcoholic hepatitis than men. Mood altering drugs interact with alcohol to increase risk, and women are twice as likely to be prescribed these medications. As well, women are at greater risk of experiencing gender-based violence such as sexual assault when drinking heavily.

Everyone needs to understand the specific health risks of drinking for girls and women.

According to the Canadian Addiction Survey
  • 76% of Canadian women reported drinking alcohol in the past 12 months

  • Most women drink in moderation. However, 15% of women exceeded low-risk drinking guidelines in the past 12 months

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Alcohol and Pregnancy | PDF

Alcohol use can cause adverse effects on the physical and mental development of the child. It can also increase the risk of congenital defects. The spectrum of disorders related to alcohol use in pregnancy is referred to as Fetal Alcohol Spectrum Disorder (FASD). FASD includes a range of physical, mental and behavioural effects and learning disabilities. FASD has been found to occur in about one in 100 live births. FASD includes difficulties with language, poor impulse control, and problems in attention or judgment which can in turn affect success in school and all other areas of life. Unlike the effects of many other illicit drugs, the effects of in utero alcohol exposure are lifelong.

The risks to fetal development are greatest with heavy drinking while pregnant. However, researchers have not been able to establish a known safe level of alcohol use in pregnancy. This is not surprising given the many individual factors, such as nutrition, stress and exposure to violence and/or lack of prenatal support, that affect women’s drinking and health.

Studies on the effects of low to moderate levels of alcohol exposure during pregnancy have been inconsistent. But, taken together, these studies suggest that even low to moderate alcohol use at any time during pregnancy may be associated with an increased risk of spontaneous abortion, and long term adverse outcomes, including slower growth during the first year of life and poorer cognitive and behavioural development. Therefore, it is safest not to drink any alcohol during pregnancy.

Women are also advised to either avoid drinking alcohol during the months they are breastfeeding or to breastfeed or pump breast milk before drinking alcohol. Alcohol consumed by the mother passes readily into her breast milk and can affect the infant. For example, there is some evidence to suggest that children feed less well if breast milk contains alcohol and that alcohol in breast milk can impair child development.

According to the Canadian Maternity Experience Survey
  • 11% of women reported ever drinking alcohol during their pregnancy (this figure excludes women who drank alcohol before they knew they were pregnant)

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Alcohol and Older Adults | PDF

Many adults enjoy a drink when socializing, relaxing, or celebrating. Seniors can continue to enjoy alcohol if they carefully monitor their use. It is important for seniors to understand how alcohol can affect their health as they age, and consider what low-risk drinking means for them.

Alcohol, health and medications

As we get older, our bodies process alcohol more slowly, and we become more sensitive to the effects of alcohol. With advancing age there is a tendency to lose lean body mass, resulting in less water in the body to dilute the alcohol. An age-related decline in the production of an enzyme which helps break down alcohol also places an extra burden on the liver - the major organ involved in processing alcohol.

Many health problems can be aggravated by consuming more than a safe amount of alcohol. These include: high blood pressure, memory loss, mood disorders (e.g. depression, anxiety), diabetes, digestive problems, loss of appetite, osteoporosis and stroke.

Drinking alcohol also distorts vision and hearing and reduces psychomotor skills. It affects alertness, judgment, memory and reaction times. Alcohol consumption also interferes with coordination, mobility and balance, and may result in an unexpected fall.

Almost half of all the prescription drugs taken by older people interact with alcohol. Drinking even small amounts of alcohol can either reduce or neutralize the effect of many over-the-counter drugs or prescribed medications. Some drugs can also intensify the sedative effects of alcohol, increasing drowsiness and reducing motor coordination.

Considering our patterns of drinking as we age

Some older adults start or increase drinking later in life due to life altering events such as the loss of a friend, a pet, a job, their health, mobility, or the family home. Social isolation, boredom, and long stretches of leisure time can also trigger increased alcohol use.

It is important for seniors to understand that the health impacts of alcohol use change as they age. Seniors need to review the Canadian low-risk drinking guidelines for men and women, and carefully monitor their drinking in order to protect their health.

According to the Canadian Addiction Survey
  • In 2004, 73% of BC residents 65+ years were current drinkers

  • Almost 10% of BC residents 65+ years used alcohol above recommended levels for avoiding short-term or longerterm harm

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Alcohol and Chronic Disease | PDF

Alcohol and Your Heart

You may have heard that alcohol is good for your heart. In fact, alcohol can lower the risk of stroke and heart disease. However this applies only to people who are 45 years of age and older. There is no health protection from drinking alcohol for younger men and for women who have not reached menopause.

In fact, the risk of heart disease and stroke rises when alcohol consumption exceeds recommended weekly limits.

Cancer and Other Serious Illnesses

Many people do not realize that drinking alcohol is associated with a number of serious health problems. These include several types of cancer, such as mouth, throat, esophagus, colon, and liver cancer. The risk of breast cancer in women is also increased with drinking. As a person’s average weekly consumption of alcohol increases, so does the chance of facing these illnesses. Alcohol can also contribute significant calories which makes it difficult to maintain a healthy weight.

Alcohol and Dependence

Regular drinking can lead to tolerance (a need for more alcohol to achieve the same effect) and to habit formation. These can lead to alcohol dependence (a condition where alcohol takes a dominant role in one’s life). People can protect themselves by not drinking on some days each week.

The Bottom Line

People should not start drinking in order to improve their health. There is no level of drinking that is “no risk”—drinking, even at moderate levels, brings some risk of chronic disease.

The best advice is to stay within the weekly limits. This will help maintain a balance between benefits and risks. Drinking above these limits results in rapidly increasing risk and no additional benefit. Other ways to improve and maintain heart health include regular exercise, following Canada’s Food Guide and not smoking.

According to the BC Alcohol & Other Drug Monitoring project
  • In 2009, BC hospitalization rates for alcohol-related conditions were estimated to be 433 per 100,000 residents—up significantly from 2002 (361 per 100,000 residents)

  • Per capita consumption increased from 7.8 to 8.9 litres of absolute alcohol between 2002 and 2009

  • 42% of alcohol is consumed in ways not recommended by the guidelines

 

To get help anywhere in British Columbia, call Alcohol and Drug Information Referral Service 1-800-663-1441 (throughout BC) or 604-660-9382 (in Greater Vancouver)

 

Developed for BC Partners for Mental Health and Addictions Information (www.heretohelp.bc.ca) by the Centre for Addictions Research of BC and the BC Centre for Excellence for Women's Health

 
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