It’s time to revise Canada’s low-risk alcohol drinking guidelines

While we are having much-needed discussions around the dangers of opioids, marijuana and tobacco, we must not forget that alcohol is the most common substance used by Canadians and that its use has increased significantly in the past decade.

According to data collected from the 2019 Canadian Alcohol and Drugs Survey (CADS), 76 per cent of Canadians aged 15+ reported drinking alcohol at least once in the last year, with little variation between provinces. At the time of the survey, approximately 15 per cent of Canadians who drank alcohol reported consuming above Canada’s low-risk drinking guidelines (LRDG), established by the Canadian Centre on Substance Use and Addiction (CCSA): a standard three-drink daily maximum (LRDG-acute guideline) and 15-drink weekly maximum for men (LRDG-chronic guideline) and a standard two-drink daily maximum and 10-drink weekly maximum for women.

In the 2008 Canadian Alcohol and Drug Use Monitoring Survey (CADUMS), 10.9 per cent of Canadians exceeded the LRDG-acute guideline and 15 per cent exceeded the LRDG-chronic guideline. But just 11 years later, those numbers jumped to 13 per cent and 18 per cent respectively. For one, Canadian women consume more alcohol now than they did a few decades ago, with increasingly risky drinking patterns. This appears to be part of a larger global trend, reflecting changing gender norms around substance use.

At the same time, in provinces like Ontario, reducing price minimums on beer, expanding the hours alcohol can be sold as well as points of sale have further increased availability. The impact of these policies on alcohol consumption will not be known for some time but is expected to increase consumption further. As well, in the wake of the COVID-19 pandemic, there has been increased alcohol use by many Canadians due to factors such as increased stress from involuntary unemployment, confinement, isolation and boredom.

Since the CCSA established its guidelines in 2011, Canadian alcohol consumption has changed and evidence of alcohol’s harms has accumulated. Findings from the Global Burden of Disease Studies in 2016 and 2020 at the Institute of Health Metrics and Evaluation (University of Washington) have concluded that “alcohol use is a leading risk factor for disease burden worldwide, accounting for nearly 10 per cent of global deaths among populations aged 15-49 years and poses dire ramifications for future population health in the absence of policy action today. Stronger interventions, particularly those tailored toward younger individuals, are needed to reduce the substantial global health loss attributable to alcohol.”

Over the past decade, the once widely held view that moderate drinking had some health benefits have been called into question.

Countries around the globe vary in their alcohol consumption guidelines. For example, Australia currently recommends a maximum of 10 drinks/week for all adults. While not accounting for differences between men and women like the Canadian guidelines, the maximum low-risk alcohol consumption for Australian men is just two-thirds that of Canadian men. Even more staggering, despite comparable alcohol consumption, guidelines differ significantly just south of our border. The National Institute on Alcohol Abuse and Alcoholism in the United States defines heavy drinking in men as consuming more than 14 drinks per week, and in women as more than seven drinks per week. In effect, Canadian low-risk drinking guidelines exceed the definitions of heavy drinking in the United States. This discordance between what should be similar guidelines remains problematic and may confuse and misinform both doctors and the public, inadvertently increasing the “acceptable” baseline level of alcohol consumption.

And over the past decade, the once widely held view that moderate drinking had some health benefits, particularly for cardiovascular health, have been called into question. A World Heart Federation policy brief this year, for example, stated that “alcohol consumption is not good for the heart and increases the risk of many cardiovascular diseases.”

Considering current evidence, a new set of new guidelines is needed, whereby low-risk drinking is defined as a standard one-drink daily maximum, and a three- or four- drink standard weekly maximum. Up-to-date guidelines serve as one of the simplest measures to reduce alcohol consumption at the population-level. As eloquently stated in a 2011 Canadian Medical Association Journal article, “guidelines for the low-risk consumption of alcohol may be perceived by the general population as a ‘safe’ baseline from which to range upward in setting personal limits.”

It is important to acknowledge that alcohol consumption, like other health behaviours, is a personal choice. Nevertheless, strengthening existing guidelines and establishing that the safest level of alcohol consumption is zero is critical to public health. Ultimately, Canadians deserve to be informed of alcohol’s risks to make healthy choices.

Finally, while revising alcohol drinking guidelines can reduce harmful alcohol consumption, this should be combined with policies to discourage alcohol consumption, such as raising taxes on alcohol, reducing its availability, limiting marketing and advertising, and boosting public health information campaigns.

Together, these measures can help reduce alcohol’s significant negative impact on Canadians’ health, economic and social well being.