Canada’s new guidelines for health and drinking were released this week by the Canadian Centre on Substance Use and Addiction (CCSA). Based on recent research, the new guidelines say that two drinks or less per week present a low health risk; three to six drinks are a moderate risk; and seven or more are a high risk – with every extra drink increasing the risk of harm.
Dr. Catherine Paradis, a sociologist, is co-chair of the group behind these new guidelines and interim associate director of research at the CCSA. She spoke with The Decibel’s Menaka Raman-Wilms about her research findings and the report’s recommendations to Canadians.
So what is a standard drink?
That’s the million-dollar question. So a standard drink in Canada, because it’s not the same around the world, is 13.45 grams of alcohol. So if you would like to know how much standard drink there is in a bottle of wine, you would need today to multiply the millilitres by the percentage of alcohol that is featured on that bottle and divide that by 17.05. Now, of course, besides me and hopefully my kids, no one else in this country does that. That’s why Canadians should have access to that information. And therefore, mandatory labelling with the number of standard drinks should be a priority.
And so essentially that would look like: You buy a bottle of wine and it tells you how many drinks are in that bottle?
Exactly. So it would say, “This bottle of wine contains five standard drinks,” or six. And for beer, it would be wonderful; the alcohol content of those craft beers varies so much. So currently on the market, you have beers that contain as little as 0.3 standard drinks, and others go all the way up to four.
In a single can?
A single can. But consumers don’t know that.
And you say seven-plus per week is in the high-risk category. Does it matter if you spread your drinks out throughout the week? Is it better if you have one drink a day versus having them all in one or two days?
Absolutely. Make sure you don’t exceed two standard drinks on any day. So if you’re saying. “I’m going to be comfortable with the moderate-risk zone, you know, and I would like to stick to six drinks per week,” that’s wonderful. But then you would need to spread that over minimally three to six days so that you never exceed two standard drinks on any day.
What kind of reaction have you been getting to these recommendations?
We were, of course, anxious about how this would be received by the public. Why? Well, you know, because the numbers we are suggesting are much lower than the ones we obtained a decade ago. And I mean, many Canadians love their alcohol. But the response has been quite favourable. So it looks like people are ready to have that conversation. And also, there’s good news in there: If you would like to improve your health and your well-being, it’s a very quick fix. Simply reduce your alcohol use and you’re going to achieve that.
And that’s also the beauty of this new guidance – it very much emphasizes the fact that any reduction in alcohol use is beneficial. Anyone who is willing to reduce their alcohol use is going to experience those benefits, and even more so for those who drink at very high level. So you’re taking 30 drinks per week right now and you’re willing to go down to 28, 25? That’s wonderful. You’re going to be experiencing benefits. So this new guidance is for everyone, regardless of their current drinking patterns.
This may be a simple question, but why is drinking bad for our health?
In the last decade, our knowledge about the relationship between alcohol and several diseases has increased tremendously. We now have a much better understanding of the relationship between alcohol and cancer. The WHO [World Health Organization] has now concluded that alcohol causes seven types of cancer. It’s not just an association, there really is a causality here. And among those types of cancer, there’s breast cancer and colon cancer, which are two very prevalent types of cancer in our country.
There’s also the relationship between alcohol and cardiovascular disease. I mean, for years we heard that a little alcohol was good for your heart. Well, the most recent data we have no longer supports that.
That’s what people always quote, that a glass of red wine a day is good for your heart. Several of our listeners brought that up to us after your last time on the show. Why has that research in particular changed so much?
In the past when researchers were trying to assess the relationship between alcohol and heart disease, they would take a group of people who have one drink per day and compare them to people who don’t drink and then see what was the risk.
However, what we now know is that those abstainers were misclassified. Not only did you have people who had never used alcohol for personal or religious beliefs, or for whatever reason. That group included people who could no longer drink because they had drunk too much. People who were sick and therefore could not use alcohol. So people were already sick in that group. So of course, when you were comparing them to healthy people who were just having a drink or two per day, this low-drinking group seemed to be doing better. But in fact, you were comparing them to sick people.
The most recent studies now ensure that in that abstainers group you only have people who just do not use alcohol, not for medical reasons, but they just don’t. You know, we have 20 per cent abstainers in this country. And when you do that, well, suddenly the protective effect is no longer there.
And then there’s alcohol and liver diseases. Of course, most people know that if you know you have an alcohol-use disorder and have been drinking a lot over many years, you’re likely to develop a severe liver disease. What is new, though, is that liver diseases are on the rise in Canada, especially since the pandemic, and doctors are seeing more and more patients, very young patients, very young, female patients, entering the hospital with liver disease. We’ve never seen that before.
One doctor told me the youngest he’s seen was a 23-year-old girl entering the hospital with liver disease, because what people do not know is that while it’s true that liver disease develops after years of heavy drinking, it can also after a series of binge-drinking events. And that’s what we are seeing now.
And, of course, in 2020 to 2023, we are not yet able to fully capture in the type of modelling that we’re doing, all the types of social harms that are caused by alcohol. But we did look at violence. I think that way too many people take it for granted, accept it as a normal fact that drinking too much would sometimes lead to violence. You know, whether there’s a fight outside of a bar, or it’s sexual violence.
Well, let’s have a conversation about that. Is that really something that we should accept as a fact? Can’t we just discuss that perhaps that by reducing our alcohol use, we would have less violence in this country?
Some of the pushback to your report is that it doesn’t address the potential benefits that people often associate with drinking: feeling relaxed, feeling connected to other people. Did you look at those potential benefits of alcohol use?
I’m sure that there’s a lot of tobacco smokers out there who would tell you that when they smoke, they do feel relaxed. They do feel better. Do we factor that in when we produce research about tobacco? No, we don’t. The other thing is we found no studies on the relationship between mental health and alcohol that met our quality criteria. So yes, we didn’t factor in pleasure, but we didn’t factor in depression and anxiety either.
According to Statistics Canada, and this is data from 2021, 60 per cent of Canadians age 15 or older are in the low to moderate risk zones of drinking, so they drink fewer than six drinks per week. And that means, of course, that 40 per cent of Canadians drink more than that. But your report also pointed out that people don’t really know what a standard drink is, as we talked about earlier. So how do we know that people are properly reporting those numbers?
We don’t. And that’s science. Let’s put it this way, they estimate that they have six drinks or more per week. And we are now encouraging those people to consider reducing their alcohol use so that they could move toward the low and moderate risk zone.
I want to ask you about youth and drinking, because your final report included a new section about youth and drinking. Why was that important to include?
We did a public consultation, and we asked: Did we miss anything? We received several suggestions to include a section on youth. We are now simply reminding people that alcohol use is a leading behavioural risk for death and social problems among youth and young adults. It is the most used psychoactive substance among this group also, and it is associated with problems and harms – injuries, violence, sexual violence, relational problems.
So for all those reasons, the recommendation to never use more than two standard drinks on any date does not apply to youth under the legal drinking age. For them, the main message should be: Delay, delay, delay for as long as possible.
I want to ask you again about perceptions of this report. Canadians were asked to weigh in before the final report was released. And you asked them how much they agreed with two very interesting quotes that I want to talk about here. The first was: “All levels of alcohol are associated with some risk, so drinking less is better for everyone.” And almost 80 per cent of respondents either strongly agreed or agreed with that. And then you asked if the information presented is likely to make people reconsider their alcohol-drinking habits. Only 58 per cent of people strongly agreed or agreed they would. So from these responses it seems that even though people agree that drinking is bad for you, they’re not sure that people will reconsider their drinking habits. What do you make of that?
I think that’s a call to action for our government. What people are telling us here is that they are open to this new information. They hear it, but that they are honest in saying, “You know what? It’s going to be difficult. I’m not sure that I’ll be able to change my behaviour. I’m bombarded with alcohol advertising and marketing. Alcohol is available everywhere, and I have no indication on my alcohol containers about the nutritional aspect of the drinks.”
So the environment right now is not set up for people to follow this guidance. So really, those results are a clear call to action for our government.
This interview has been edited and condensed