Making It Easier to Talk about Drinking Too Much

Canada has a drinking problem.

The country is wealthy, has a culture of drinking, has easy access to alcohol and most people have to work less than 20 minutes to be able to afford a beer, said Jürgen Rehm, senior scientist in the Institute for Mental Health Policy Research at the Centre for Addiction and Mental Health.

On Monday a new national guideline was published to help family doctors talk with their patients about alcohol use disorder and problematic drinking. The website Help with Drinking was also launched to help people, their loved ones and doctors better understand problematic drinking and how to reduce or quit alcohol.

Health Canada got the Canadian Research Initiative in Substance Misuse and the BC Centre on Substance Use to develop the guideline, which brought together 36 people with expertise and lived experience to develop 15 recommendations to help doctors address alcohol use.

This is the first national guideline to be published on alcohol use disorder, said Rehm, who co-chaired the guideline writing committee.

Currently less than two per cent of Canadians with alcohol use disorder get prescribed effective medication, which Rehm said is due to stigma.

Stigma means patients don’t want to ask their doctors for help and the doctor doesn’t want to ask a patient about their drinking, he said.

He hopes the guideline will change that by training doctors to ask about a patient’s alcohol use at least once a year, in a similar way that they would ask about diet, exercise or smoking.

Rehm said alcohol and alcohol-related harms are the number 1 cause of death in the world for people aged 15 to 49, and are known to cause 200 health consequences, including everything from liver failure to car crashes.

In Canada, 18 per cent of adults will have alcohol use disorder in their lifetime, which is a disease clinically defined as an inability to control your drinking, Rehm said. This can include feeling the need to drink more, repeatedly drinking more than planned or sweating and trembling while sober.

Stigma against people who can’t control their drinking is “really sad” because it “leads to a perception amongst the public that there’s nothing that can be done, and that’s totally inconsistent with the evidence,” said Evan Wood, Canada Research Chair in addiction medicine at the University of British Columbia, who co-chaired the guideline writing committee with Rehm.

“When people get effective treatment they can do really well,” he added.

Medications, effective and not

Rehm and Wood told The Tyee they hope the new guidelines will help clinicians better understand, identify and diagnose alcohol use disorder and better understand what medications to prescribe.

There are two highly effective generic medications approved by Health Canada that can help people reduce their drinking or quit alcohol, Wood said. The medications are proven, cheap and readily available in Canada — but many doctors don’t know about them.

At the same time, for some patients, some antidepressant medication such as selective serotonin reuptake inhibitors, or SSRIs, can impact their relationship with alcohol, making them more likely to drink more, drink more often and spend less time sober, Wood said.

He added alcohol use can impact your physical health, for example causing dementia, liver disease and high blood pressure, and your mental health, affecting people’s sleep and causing depression and anxiety.

And when a patient tells their doctor they’re feeling depressed and not sleeping, a doctor’s go-to move may be to prescribe an SSRI. Wood said he hopes the new guidelines will help retrain doctors to ask more questions and avoid certain antidepressants if they think alcohol could be part of what is making a patient unwell.

As well as combating the social stigma that prevents people from talking about problematic drinking, Wood said he hopes the new guide will help combat some of the structural and academic stigma around alcohol.

If you have a heart attack, you will be taken to the hospital, be seen by several specialists, be given excellent care in a health-care setting and have plenty of followup care, Wood said. But if you show up at the ER begging for help because of your alcohol use, you will likely be turned away, he added.

Wood works at the Vancouver Coastal Health Detox Centre and said “there has been a decades-long failure of institutions to address the needs of people that struggle with alcohol.”

An example of that is how, despite the high number of people who struggle with alcohol, Vancouver Detox is the only public facility available for them. Wood said people will wait for weeks to get in and be “desperate for treatment for their alcohol addiction.” He’ll then have to break the news to them that the facility doesn’t offer treatment, just withdrawal management, which helps people safely get off alcohol in four to five days.

The only other option is private treatment, which Wood said is extremely expensive, comparing it to a mortgage.

Moral judgments don’t help

Canadian drinking culture means alcohol is at the centre of sporting events, celebrations and status. But if a person doesn’t want to drink and says it is because they cannot control themselves, people will make a moral judgment about their character, Rehm said. Women are judged especially harshly, he added.

Many Canadians cannot imagine a life without alcohol, he said. But many places in the world can. More than half the people in the world didn’t drink at all last year, and many European countries, like Italy and Sweden, have lower per-person drinking rates than Canada.

Canada’s drinking guideline says drinking fewer than two standard drinks per week means you’re likely to avoid negative health outcomes related to alcohol.

One standard drink is: 341 millilitres or a 12-ounce sleeve of five per cent beer or cider; 142 millilitres or a five-ounce glass of 12 per cent wine; or 43 millilitres or 1.5 ounces of a 40 per cent spirit.

That means two 20-ounce pints or half a bottle of wine per week is considered to be “moderate risk,” which increases a person’s chances of developing certain types of cancer like breast or colon cancer.

High-risk drinking is seven standard drinks per week or more, which increases a person’s risk of stroke or heart disease. That translates to just over four 20-ounce pints or about 1 1/3 bottles of wine per week.

Every drink more “radically” increases the risks associated with alcohol, the guideline notes.

Around half the country drinks more than two drinks per week, Rehm said.