Our Favourite Drug
Reprinted from "Alcohol" issue of Visions Journal, 2006, 2 (9), p. 4-5
I’m delighted to have the opportunity to introduce this special issue of Visions.
We are all familiar with alcoholic beverages and most of us enjoy drinking them. Everyone is now familiar with the dangers of drunk driving—even though the problem still plagues us, there has been a huge advance in awareness from a generation ago. Through literature, movies and popular culture in general—and all too often through personal experience—we are also aware that some people develop alcoholism or engage in alcohol abuse. The personal stories in this issue testify to the social and health damage that alcohol-related problems bring.
An array of risky drinking patterns poses different degrees of risk to health and safety, ranging from low to extremely high. The great extent of these patterns demands not only the best possible range of accessible treatment programs, but also an effective regulatory system for what is clearly “no ordinary commodity.”
Hazardous drinking patterns
It is useful to distinguish three major kinds of potentially hazardous drinking patterns.
Drinking to intoxication
Even occasional heavy alcohol use can place the drinker at risk of injuries and acute medical conditions, especially in high-risk settings. Two out of every five British Columbians drink at the recognized risk levels of 4+ drinks in one day for women or 5+ for men.3 One out of every five do so at least once a month.4 The majority of alcohol-related deaths among Canadians are from these acute effects of alcohol.
Regular use of alcohol above risk levels
Among British Columbians, 5% of women and 9% of men drink above the Centre for Addiction and Mental Health guidelines’ upper limits of nine drinks a week for women and 14 for men.4 This significantly increases the risk of various cancers, strokes, birth defects, liver cirrhosis and other problems. As a group, such high-risk drinkers still contribute less to the overall burden of alcohol-related harm in the community than the more numerous low-risk drinkers as a group—a phenomenon known as the “prevention paradox.
A small proportion of drinkers meet criteria for a diagnosis of alcohol dependence. Alcohol dependence varies in severity and includes elements of both psychological and physical dependence, with impaired ability to control consumption. People suffering from alcohol dependence are most likely to experience acute and chronic harms from their drinking. They are also at most risk of mental health problems; in particular, anxiety states and depression.
The case for economic and regulatory harm reduction strategies
An analysis of the 2004 Canadian Addiction Survey found that although reported consumption was 30% of what would be expected from known alcohol sales, most drinking reported placed the drinker at risk of acute or chronic harm.4 Rehm et al estimate that approximately 4,500 Canadians, up to age 70, die each year from alcohol-related causes.8 The health benefits of low-risk drinking have recently been questioned,9 but even if the benefits are real, very few people drink in a pattern that would protect against heart disease (less than one drink a day for women and one to two drinks a day for men). These facts make a compelling case for taking the regulation of alcohol’s price and availability extremely seriously.
These days, everyone in mental health advocates for an “evidence based” approach to treatment and prevention of problems from substance use. Regarding alcohol, evidence suggests universal strategies that impact all drinkers are needed. The strongest evidence for successfully reducing harm at the population level points at a variety of economic and regulatory strategies: keeping alcohol prices in line with the real cost of living; taxing the alcohol content of drinks rather than taxing the cost of making them; and limiting the trading hours of licensed premises and also limiting the density of late-night liquor outlets in entertainment areas.2 We also need the best and most accessible treatment services for people with severe alcohol-related problems, and a range of humane harm reduction strategies, including “wet shelters,” for people with chronic dependence who are unable to respond to standard treatment programs.
The Centre for Addictions Research of BC recently identified major shortcomings, from a public health perspective, within the alcohol taxation system in Canada. I argue that remedying these shortcomings offers the greatest opportunity to reduce, across the whole community of BC, such problems as alcohol-related road trauma, alcohol-related violence, fetal alcohol syndrome, and liver disease and alcohol dependence. These remedies would at least involve:
Updating alcohol excise taxes with the cost of inflation (not done since 1991)
Taxing the alcohol in drinks so that there are price incentives for manufacturers, retailers and consumers to select lower alcohol content beverages
Ensuring minimum prices are regularly updated and high-strength drinks are banned from the market
An invitation and a challenge
At CARBC we believe it is essential to have accurate data on risky alcohol use and related harms at local, regional and provincial levels. It is also essential that the evidence for “what works” in prevention, treatment and policy be well understood and integrated into local practice. Together, these elements can form a powerful evidence base for improved responses—including making the case for more and better services. Conversely, high-level policy changes, such as alcohol tax reforms, are more likely to occur when they carry the moral authority of support from those engaged in service delivery. I therefore invite you to study the articles and stories in the coming pages, to visit our CARBC websites (www.silink.ca and www.carbc.uvic.ca) and then consider how you might express your support for improved alcohol policies in BC.
About the Author
Tim is Director of the Centre for Addictions Research of BC (CARBC) at the University of Victoria (UVic), Co-leader of the BC Mental Health and Addictions Research Network and a professor in the psychology department at UVic
Babor, T., Caetano, R., Edwards, G. et al. (2003). Alcohol: No ordinary commodity—research and policy. Oxford, UK: Oxford University Press.
Loxley, W., Tounbourou, J., Stockwell, T. et al. (2004). The prevention of substance use, risk and harm in Australia: A review of the evidence. Canberra, Australia: Australian Government Department of Health and Ageing.
World Health Organization. (2000). International guide for monitoring alcohol consumption and related harm. Geneva: WHO.
Stockwell, T., Sturge, J. & Macdonald, S. (2005). Patterns of risky alcohol consumption in British Columbia: Analysis of the 2004 Canadian Addiction Survey. (Statistical Bulletin No. 1). Victoria, BC: University of Victoria, Centre for Addictions Research of BC. Retrieved from www.carbc.uvic. ca/alcoholbulletin2005.pdf.
Single, E., Robson, J., Rehm, J. & et al. (1999). Morbidity and mortality attributable to alcohol, tobacco, and illicit drug use in Canada. American Journal of Public Health, 89(3), 385-390.
Rossow, I. & Romelsjö, A. (2006). The extent of the ‘prevention paradox’ in alcohol problems as a function of population drinking patterns. Addiction, 101(2), 84-90.
Rehm, J., Room, R., Monteiro, M. et al. (2004). Alcohol use. In M. Ezzati, A.D. Lopez, A. Rogers et al. (Eds.), Comparative quantification of health risks. Global and regional burden of disease attributable to selected major risk factors. (pp. 959-1108). Geneva: World Health Organization.
Rehm, J., Patra, J. & Popova, S. (2006). Alcohol-attributable mortality and potential years of life lost in Canada 2001: Implications for prevention and policy. Addiction, 101(3), 373-384.
Fillmore, K.M., Kerr, W.C., Stockwell, T. et al. (2006). Moderate alcohol use and reduced mortality risk: Systemic error in prospective studies. Addiction Research and Theory, 14(2), 101-132.
Stockwell, T., Leng, J. & Sturge, J. (2006). Alcohol pricing and public health in Canada: Issues and opportunities (Technical Report). Victoria, BC: University of Victoria, Centre for Addictions Research of BC.