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André Picard

Sip on this: Like all drugs, alcohol isn’t consequence-free Add to ...

You can say this about Canadians: We like our beer. And wine, spirits and coolers.

The average Canadian buys almost 76 litres of beer, 16 litres of wine, five litres of spirits and four litres of other alcohol-based drinks annually.

Alcohol is an accepted part of everyday life, a social lubricant at weddings, birthdays, parties, and a staple of sporting and cultural events, as well as meals.

But there’s a dark side to the $20.5-billion we spend annually on drink.

Alcohol kills and maims in a perversely diverse number of ways: liver disease, fetal alcohol spectrum disorder, impaired driving; it fuels violence, sexual assault, suicide, traumatic injuries and hikes the risks of cancer and heart disease. All told, alcohol negatively affects more than 200 health conditions.

The impact of alcohol on health is one of the most neglected public policy issues.

That’s why a new report from Canada’s Chief Public Health Officer, Dr. Gregory Taylor, is a welcome, if long-overdue, offering. The 76-page report, entitled Alcohol Consumption In Canada, presents some sobering statistics.

Alcohol is not a big killer, relatively speaking, accounting for about 4,000 deaths a year in Canada, compared to 37,000 smoking-related deaths. (And, at this point, marijuana activists will chime in and remind us pot doesn’t kill. Fair enough.)

Alcohol misuse costs the Canadian economy about $14.6-billion a year. About half that amount is lost productivity, with direct health-care costs are estimated at $3.3-billion and alcohol-related policing costs are not far behind at $3.1-billion, while motor vehicle crashes and fires related to alcohol cost another $1-billion a year.

Meanwhile, alcohol sales and taxes bring in about $10.5-billion to state coffers.

A psychoactive substance, alcohol lowers inhibitions and impairs judgment. One of the most common and harmful side effects of over-imbibing is violence – from bar fights through to sexual assaults. More than one in three police calls are related to alcohol.

Alcohol also has a direct impact on health.

The ethanol in alcoholic drinks is particularly damaging to the liver, causing cirrhosis, but it is also carcinogenic, increasing the risk of everything from liver cancer to breast cancer.

A depressant, alcohol can be particularly harmful to people with mental health conditions such as depression. Almost one-third of people who die by suicide had been drinking excessively.

Still, alcohol is not all bad, nor should it be vilified. Most people drink responsibly and moderate drinking – like a glass of wine with dinner – can lower the risk of cardiovascular disease.

In recent years, the number of abstainers has increased to about 20 per cent of Canadian. (Worldwide, 60 per cent of people do not drink, though it still kills about 3.1 million people a year; generally speaking, alcohol is consumed routinely in wealthy countries. There are also a number of religious prohibitions on alcohol.)

At the same time, the number of risky drinkers (defined a more than 15 drinks weekly for a man or 10 for a woman) and binge drinkers – those who drink to the point of blacking out or suffering alcohol poisoning – is on the rise, particularly among youth.

Clearly, context matters a lot: How, where and when you drink has a significant influence on whether alcohol use is healthy or not.

One of the most troubling consequences of alcohol use and misuse is its impact on the fetus. In Canada, about 3,000 babies a year are born with fetal alcohol spectrum disorder (FASD) and there is growing evidence that even small quantities of alcohol can be damaging.

Last week the U.S. Centers for Disease Control and Prevention found itself in hot water by recommending that women of childbearing age not drink unless they are using hormonal birth control because of the risk of FASD.

While message was well-intentioned – after all, half of pregnancies are not planned and the damage done by alcohol is most pronounced in the first weeks when many women don’t yet know they’re pregnant – but it was seen as condescending and paternalistic.

In short, as Dr. Taylor notes in his report, “the story of alcohol is complicated,” and so is the necessary public health response. History tells us that prohibition doesn’t work.

As with most public health issues, the best tool is awareness – the recognition that, as with all drugs, recreational and medicinal, alcohol use and misuse is not consequence-free.

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Follow on Twitter: @picardonhealth

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