The Decibel - Canada’s new drinking guidelines

Episode Date: January 18, 2023

On Tuesday, Canada’s new guidelines for drinking and health were released from the Canadian Centre on Substance Abuse and Addiction (CCSA). The guidelines say that three to six standard drinks put you at a moderate health risk— and you might be surprised by how much counts as a “standard drink.”Dr. Catherine Paradis is a sociologist and the interim associate director of research at the CCSA. She’s back on the show addressing some of the questions listeners had after hearing her back in September, and outlining why she thinks labeling alcohol will help Canadians make more informed choices when drinking.Questions? Comments? Ideas? Email us at [e-mail]

Hi there. Do you mind if I ask you a quick question? I'm from the Globe and Mail. We're going to be doing an episode about drinking. A podcast on drinking? It's middle of the day. On Tuesday, we sent Decibel producer Cheryl Sutherland to the streets of Toronto to ask people about their drinking habits. In your opinion, how much do you think is considered a healthy amount to drink per week? Well, there's what's healthy and then there's what we do. So probably... You don't want to be a binge drinker, I guess.

So less than double digits, let's say. Yeah, I'd say five. Five is healthy. I'm in the doubles though, but yeah. In a way, it's horrible. I guess I'd be labeled a binge drinker because if I have a bottle of wine, if I open a bottle of wine, I will finish it. How many drinks do you think in one sitting is considered binge drinking? I read some number there being like four or something like that is binge drinking in a single session.

For men, it's five standard drinks in a single session, which is not a tall can. Canada's new low-risk drinking guidelines were released this week. It's the first update in more than a decade. And the recommendation is to reduce alcohol consumption by as much as you can. I'd say healthy is like two glasses of wine. Yeah, that'd probably be healthy, yeah. I don't do that, though. I can tell you that. How much do you drink per week?

Oh, how much do I? Like, if we're going, definitely every time I go, I definitely do. Okay, so how much do you go out time I go out, I definitely do. Okay, so how much do you go out per week then? Three to four. Three to four, yeah. And in those sittings, how many drinks do you have in that time? If we're talking tequila shots, minimum, I'm crazy though, minimum ten, because my tolerance is high. If I had to say like wine glasses, I'd say probably, like, three, max three wine glasses.

It's okay. Like, I'll have maybe three or four glasses of wine a week with dinner or something. It just makes a nicer, more social dinner hour. But I think as long as it's balanced and you're not overdoing it, it's okay. Usually one a day, maybe sometimes less, sometimes more. And so as you... Not to excess, but I mean, I guess under the new rules it's to excess. Previous recommendations said no more than 10 drinks per week for women and 15 for men.

But the new guidelines say that risks to your health increase after just three drinks per week. So what do you think about these new guidelines? I'm in trouble. I'm in trouble. I'm definitely, yeah, I'm in trouble. Those are some scary, I did not know that. I think, like me, I'm fully aware, like, what I'm doing. I'm aware that it is poison, but like, the way I always see it it is there's poison everywhere. The air that you breathe, like just pick it. You know what I mean? Everyone's got something. We first talked about these recommendations back in September when the findings were under review, and we got such a strong response from listeners that we thought we should talk about them again now that they're

official. So today, Catherine Paradis is back on the show. She's co-chair of the report that these new guidelines are based on, and she's also a sociologist and the Interim Associate Director of Research at the Canadian Centre on Substance Use and Addiction. I'm Manika Raman-Wellms, and this is The Decibel from The Globe and Mail. Catherine, thank you so much for joining me again on the show. Thank you for having me back, Minika. So Canada's new drinking guidelines are out now. Can you just lay it out for us here? What are the new low-risk drinking guidelines? So the main recommendation is that people who use alcohol should consider reducing their consumption as much as they can. This is informed by a continuum of risk where we are showing that the risk of harm from alcohol is low if you take one or two standard drinks per week. It is moderate if you

take between three to six standard drinks per week. And then it is high if you take seven drinks or more per week. And each drink increases that risk of harm. And you say standard drink there. So what is a standard drink? That's a million dollar question. So a standard drink in Canada, because it's not the same around the world, but in Canada, it is 13.45 grams of alcohol. Now, of course, you don't pour grams of alcohol into your glass. And so the way to convert that,

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 milliliters 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. You know, no one can count standard rate. So that's why really a Canadian should have access to that information. And therefore, mandatory labeling with the number of standard drinks should be a priority. And so that would essentially look like you buy a bottle of wine and it tells you how many drinks are in that bottle, like right on the label. Is that what it would look like? Exactly. So it

would say this bottle of wines contain five standard drinks or six. And for beer, it would be wonderful, especially with the rise of the craft movement. You know, we have so many craft beers now. The alcohol content of those craft beer varies so much. So currently on the market, you have beers that contain as little as 0.3 standard drinks and others that go all the way up to four. In a single can? In a single can. But consumers don't know that. And I mean, I've had, you know, friends with whom, you know,

because I'm always there with my little formula, you know, I thought, well, it's 2.5 in that can. And they go, are you kidding? And I'm like, no, that's what it is, 2.5. So you need to have access to that information so that if you want to count your drinks, you can. And you say, so seven plus per week is kind of in the high risk, you are in the high risk category there. I wonder, though, does it matter if you spread your drinks out throughout the week, Katrin? Like, is it better if you're saying, I'm going to be comfortable with the moderate risk zone, 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 days, three to six days so that you never exceed two standard drinks on any day. So these new guidelines replace Canada's previous low-risk drinking guidelines.

You put out the first report in August, actually. You did some consultations. Canadians were even asked to weigh in. And now we have the final version. But I'm curious, 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, of course, the about how this would be received by the public. Why? Well, you know, because, of course, the numbers we were suggesting were much lower than the ones we obtained a decade ago. And I mean, many Canadians love their alcohol, you know, so we were a bit anxious about how that would be received. But the response has been quite favorable. We are currently doing an analysis of the media coverage that was around the launch

of the public consultation. 871 articles or reportage have been dedicated to this topic in the fall. 74% were either neutral, factual, I mean, it's just presenting the facts, or favorable and welcoming this new guidance. So it's only a quarter that were negative. And also in Quebec, just before Christmas in Quebec, l'Association de Santé Publique du Québec did a survey asking people what they considered moderate drinking. And 78% of people responded five drinks or less per week. Among 18 to 34 years old, that proportion went as high as 82%. So it looks like people are, you know what, very receptive. They're ready to have that conversation. And also there's, I mean,

there's some good news in there. If you would like to improve your health and your well-being, there'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 is that 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 those who drink at very high levels. 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 here, 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, seven types of cancer. The WHO has now concluded that alcohol causes those seven types of cancer. It's not just an association, there really is a causality here. And among those 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. So there is that. 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 support that fact. The World Heart Foundation last year came out with a policy statement saying that no alcohol use was good for the heart. Right.

That's what people always quote about how a glass of red wine a day is actually good for your heart. And I know we heard from several of our listeners, actually, the last time you were on the show, Katrin, about that. So maybe I can just ask you directly here, why has that research in particular changed so much? Well, because in the past, when researchers were trying to assess the relationship between alcohol and heart disease,

they would take a group of people, for example, take 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. In there, not only did you have people who never used alcohol for personal religious belief, whatever reason, you know, you didn't just have pure abstainers. That group was made of a bunch of mismatched people, including people who could no longer drink because they had drank too much. People 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 taking 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. Whoa. So the people who are classified as non-drinkers could have been drinking very heavily before and then stopped and they're classified as non-drinkers could have been drinking very heavily before and then stopped and they're classified as non-drinkers there. Yeah, or they could have been people who have severe diseases, you know, where they take a lot of medication and that for them alcohol use is absolutely not a possibility. The most recent studies now ensure that in that abstainer 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% of 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 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. I think a doctor told me the youngest he's seen was a 23-year-old girl entering the hospital with that. 23 with liver disease. Yeah. Because what people do not know is that while it's true that liver disease develops after years of heavy drinking, it can also develop after a series of binge drinking events. And that's what we are seeing now. So people need to be aware of those risks. And then there are the social harms also. And of

course, in 2022, 2023, we are not yet able to fully capture in the type of modeling that we're doing all the types of social harms that are caused by alcohol. But we did look at violence. We did do a review on this topic. And I mean, this is something that we need to bring into the conversation. 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, whether there's a fight outside of a bar, whether it's sexual violence, whether it's verbal violence, impatient people, that comes with drinking. 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? I mean, this would be wonderful. These are the type of harms that this guidance puts forward. We'll be right back. What's the financial impact of the way that we drink now?

Harms associated with alcohol are costing Canadians $16.6 billion annually. That is, of course, way much more than what opioid or cannabis is costing us. It's even more than tobacco now in some provinces. And I think that the next iteration is probably going to show that now alcohol is costing more than tobacco in general in this country. So a huge amount of money. Yeah, $16.6 billion with the general costs associated and actually $5.4 billion of that sum is spent on health care. That was in 2017. But that's a significant burden on our health care system. the winter. And he was saying 60% of hospital visits are related to preventable diseases, like disease that could be avoided if you change your health behaviors. Well, of course,

alcohol is one of them. And if we were to collectively reduce our alcohol use, we would see a sharp impact on our hospitals. Some of the pushback to your report, Catherine, was that it doesn't address the potential benefits that people often associate with drinking, like things like the social aspects, right? Feeling relaxed, feeling connected to other people. Did you look at those potential benefits of alcohol use at all? So I'll respond to this in different manners. First of all, I'm sure that there's a lot of tobacco smokers out there would tell you that when they smoke, they do feel relaxed. They do feel better. I mean, that's the image we have of lighting a cigarette. Why? You stress, you light a cigarette. We know that. Do we factor that in when we produce research or result about tobacco? No, we don't. This is just not the way that we do our research when we think about the health impacts. The other thing is that, yeah, of course, we did not take into account the positive mental health impact

that alcohol could have on our health. But the reason why we did not do that is that 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. And I think that if we would have done so, the result might have been even more depressing to our critique. I'll put it this way. According to Statistics Canada, this is data from 2021, 60% of Canadians age 15 or older are in the low to moderate risk zones of drinking. So they drink less than six drinks per week. And that means, of course, that 40% 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. Science is you can only provide advice and recommendation based on the highest quality data that are currently available. That's what we're doing right now. This is a status of knowledge that we have that 40% of Canadians estimate, let's put it this way, estimate that they take 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, you know, and we asked, did we miss anything? Is there something that should have been specified? We received several suggestions to include a section on youth. So we decided to go ahead and do just that. We are now simply reminding people that alcohol use is a leading behavioral 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.

Just before I let you go here, Catherine, 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 questions that I want to talk about here. The first question was, quote, all levels of alcohol are associated with some risk, so drinking less is better for everyone. And almost 80% of respondents either strongly agreed or agreed with that. And then in another question, you asked if the information presented, quote, is likely to make people reconsider their alcohol drinking habits. And here, only 58% of people strongly agreed or agreed. So from these responses, it seems as though even though people agree that drinking is bad for you, that 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. I think that what people are telling us here is that they are open to this new information, they hear it, but that they're honest in saying, but you know what? It's going to be difficult. I'm not sure that I'll be able to change my behavior. 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

I take, the calories in there, and the standard 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. Katrin, thank you so much for taking the time to talk to me today. Thank you very much. Thank you for inviting me. Before you go, I want to let you know about Report on Business's Best Executive Awards. If you know an executive in HR, sales and marketing, finance, operations, or technology who's doing outstanding work, you can nominate them today at tgam.ca slash bestexec. Nominations are now open and they'll be open until January 27th.

That's tgam.ca slash bestexec. That's it for today. Thanks to everyone who spoke to us and shared their thoughts about drinking. I'm Mainika Raman-Wellms. Our producers are Madeline White, Cheryl Sutherland, and Rachel Levy-McLaughlin. David Crosby edits the show. Kasia Mihailovic is our senior producer, and Angela Pachenza is our executive editor. Thanks so much for listening, and I'll talk to you tomorrow.