ALCOHOL CONSUMPTION IN CANADA - Health

5ALCOHOL CONSUMPTION I N CANADAFigure 1:WHAT PSYCHOACTIVE DRUGS ARE CANADIANS USING?TotalMen100WomenESTIMATED PERCENTAGE806040200AlcoholTobaccoMarijuanaOther illicit drugsEstimated percentage of Canadians 15 years of age and older in 2013 who consumed alcohol, marijuana and otherillicit drugs in the previous year and/or regularly smoke tobacco.1What are Canadians using? Alcohol, tobacco,caffeine, marijuana, cocaine, heroin, hallucinogens,and various prescription drugs are all examplesof psychoactive drugs. In Canada, alcohol is themost widely consumed psychoactive drug (seeFigure 1)1 except for caffeine. After water, coffee(which contains caffeine) is the second mostconsumed beverage in Canada.40How can alcohol be harmful? Drinking alcoholwas the third highest risk factor for global diseaseburden in 2010, moving up from being rankedsixth in 1990. It was also the top risk factor forpoor health in people ages 15 to 49 years.41Risky drinking can result in a wide range of negative impacts on society, including increased ratesof premature death, disability and disease, impaireddriving, reduced productivity, a burdened healthcare system, and high financial burden to both theindividual and society.e.g.,6, 8, 9, 42–48A SNAPSHOT OF ALCOHOL’SIMPACTS ON CANADIANS: In 2002, 4,258 deaths in Canada wererelated to alcohol abuse, representing1.9% of all deaths.6 Costs related to alcohol in Canadaequalled approximately 14.6 billionin 2002.6 From April 2013 to March 2014, 20.5 billion worth of alcohol was soldin Canada.7 In 2008, impaired driving was the leadingcause of criminal death in Canada.8 Among psychoactive drugs, alcoholrelated disorders were the top causeof hospitalizations in Canada in 2011.9

6CPHO REPORT 2015DOSE-DEPENDENT HEALTH EFFECTSINCREASED HEALTH RISKTable 1: AN OVERVIEW OF THE DOSE-DEPENDENT HEALTHAND BEHAVIOURAL IMPACTS OF ALCOHOL CONSUMPTIONDIRECT EFFECTSDISEASE ANDCONDITIONSRisky drinking can cause: Alcohol use disorders Amnesia (e.g.,Korsakoff’s syndrome) Memory loss andblackouts Delirium due toa severe formof withdrawal Fetal AlcoholSpectrum Disorder(FASD)Drinking alcohol islinked to: Other drug usedisorders Brain damage Liver disease Various cancers Pancreatitis Mental health disorders Suicide Stomach ulcers Hypertension Stroke Cardiovascular disease Diabetes Sexually transmittedinfectionsFUNCTIONS ANDSYSTEMSDrinking alcohol affectsthe following systems: Immune Stress Memory, cognition Digestion Heart, blood, lungs Brain Hormones Muscles Fertility Skin DevelopmentBEHAVIOURRisky drinking canlead to: Risky behaviour Impulsivity Violence Injury Poor memory Impaireddecision-making Lack of coordination Poor academicperformance Impaired socialand occupationalfunctioningReferences: 4, 42, 49, 51–127At the individual level, alcohol affects a widevariety of biological systems in a dose-dependentmanner, leading to impacts on health, well-being,and behaviour over both the short and long term(see Table 1).For example, the International Agency for Researchon Cancer (IARC) of the World Health OrganizationGlobally, alcohol was linked to over3 million deaths per year in 2012,slightly more than lung cancer andHIV/AIDS combined.48–50(WHO) has classified alcoholic beverages, ethanolin alcoholic beverages and acetaldehyde associated with the consumption of alcoholic beveragesas carcinogenic to humans. This means thatalcohol consumption is capable of increasingthe incidence of cancer in a population. It canalso reduce the length of time cancer is presentbut inactive in the body, increase cancer’sseverity, and increase the number of tumoursor types of cancer present.51The IARC’s World Cancer Report 2014 and theCanadian Cancer Society state that there is no“safe limit” of alcohol consumption when itcomes to cancer prevention.

7ALCOHOL CONSUMPTION I N CANADAMany factors influence how alcohol affects aperson’s health, including how much and howoften a person drinks, that person’s specific riskfactors, and what they are doing while they aredrinking. Although controversial, studies haveshown that alcohol may also have beneficialeffects. However, benefits are dose-dependentand apply to a select set of diseases, conditions,situations, and segment of the population.53, 54, 56,57, 59, 61, 63–65, 69, 73, 76–80, 84, 87, 89, 90–92 Given that manypeople who drink underestimate how much theydrink,38, 39, 128–130, their perceived potential forharm or benefit may also be inaccurate.Is alcohol consumption the sameas alcohol abuse? No. Payingattention to drinking patterns,knowing what factors contributeto health risks, and recognizingsigns can help reduce or preventhealth risks, risky drinking, alcoholabuse, alcohol dependence, andalcohol use disorders and theirassociated harms.EXAMPLES OF POTENTIAL HEALTH PsychosisVisionRisky essionBrain damageStrokeMental healthHeart diseaseHypertensionPancreatitisStomach ulcersFatty liver diseaseHepatitisCirrhosisFertilityInjuryMotor controlSkinMusclesHormonesImmune systemStress systemAlcohol poisoningReferences: 4, 42, 46–49, 51–127.CancerSexually transmitted infectionsAlcohol and other drug use disorders

8CPHO REPORT 2015WHAT THISREPORT COVERSThis report focuses on the health impacts ofalcohol consumption, including how theydevelop and are modified by drinking patternsand risk factors. Included in this report arethe following sections:1.2.Impacts on Canadians explores how muchCanadians are drinking and what are theresulting major impacts on health and society,including potential benefits.Pathways to Impacts : From Brain toBehaviour outlines examples of how drinkingpatterns can lead to impacts on the brain andthrough behaviour.3.Influencing Factors describes how differentrisk and protective factors can influence therisks for impacts from alcohol consumption.4.Population Health Perspective provides threeexamples of specific populations in Canada:youth, women, and Aboriginal populations.5.Reducing Health Impacts provides highlightson how public health can address the issue ofalcohol consumption in Canada, with a focuson primary prevention.

9IMPACTS ONCANADIANSIdentifying how much and how often people drink is a first step inunderstanding consequences, benefits, and harms of alcohol consumptionon a particular population. Currently, data on alcohol consumption andrelated costs and harms, particularly for trends, are limited in Canada. Thismakes it difficult to capture a true picture of the impact on Canadians.Drinking in CanadaIn 2013, an estimated 22 million Canadians15 years of age and older, almost 80% of thepopulation, drank alcohol in the previous year,with the highest percentage of past year drinkersfound in 30 to 34 year olds (see Figure 2a). Thehighest percentage of risky drinkers, based ondrinking over the previous week, was found inyoung adults (ages 20 to 29) (see Figure 2b).1These data only capture risky drinking in theweek previous to the survey, meaning it is alimited snapshot.1From April 2013 to March 2014, Canadians boughtalmost 76 litres of beer, 16 litres of wine, 5 litresof spirits, and 4 litres of other alcoholic beveragesper person.7 Proportionally, Canadians drinkmore beer (51%) than spirits (27%) or wine (22%)(see Figure 3).48Drinking is more common in men than women,as is risky drinking. For every year between 2003and 2010, approximately one in three men andone in five women aged 15 years and older whodrink reported that they drank risky amounts ofalcohol at least once a month. In the same period,approximately 50% of young men and women(ages 18 to 24) who drank reported undertakingrisky drinking on a monthly basis.131Risky drinking is currently on the rise amongwomen, especially those 35 years of age andolder. In 2013, 56% of women aged 15 years andolder reported binge drinking (four drinks or morein one sitting) at least once in the previous yearcompared to 44% in 2004.1, 2, 132Risky Drinking: The impacts of alcoholare dose-dependent. In 2011, the CanadianCentre on Substance Abuse releasedCanada’s Low-Risk Alcohol DrinkingGuidelines. These guidelines identifyhow much is too much: 42 Drinking more than 15 standard drinksa week for men or 10 a week for womenwith more than 3 drinks a day for men or2 for women on most days increases therisk for long-term negative impacts onhealth. Drinking more than 4 standard drinks formen or 3 for women in an occasionincreases the risks for short-term injuryand harm.There are no health benefits to alcoholconsumption for youth. The potential healthbenefits from alcohol do not begin untilmiddle age.The evidence used to develop theseguidelines can be found at this link.Rates of past-year drinking among Canadiansaged 15 years and older have been decreasingfrom 79% in 2004 to 76% in 2013. For Canadiansaged 15 to 24, rates of past year drinking droppedfrom 78% in 2004 to 73% in 2013.1, 2, 132 Anestimated 24% of Canadians — almost 7 million— aged 15 years and older reported that they didnot drink in 2013.1, 2

10CPHO REPORT 2015Figure 2a:DRINKING RATES IN CANADA IN 2013ESTIMATED PERCENTAGE10080604020015–19 20–24 25–29 30–34 35–39 40–44 45–49 50–54 55–59 60–6465 AGE GROUPSEstimated percentage of Canadians 15 years of age and older who had consumed alcohol in the year previous to a2013 survey.1Figure 2b:RISKY DRINKING RATES IN CANADA IN 2013Risk for ShortTerm ImpactsESTIMATED PERCENTAGE35Risk for LongTerm Impacts30252015105015–1920–24 25–29 30–34 35–39 40–44 45–49 50–54 55–59 60–6465 AGE GROUPSEstimated percentage of Canadians 15 years of age and older who had consumed alcohol in the week prior to a 2013survey in amounts that exceeded the guidelines for risks for short- or long-term impacts.1

11ALCOHOL CONSUMPTION I N CANADAHow much alcohol do Canadians really drink?Most people tend to underreport how muchalcohol they drink. Not only do people tend tounderestimate how much they and others drink,they also tend to underestimate how harmfulalcohol is.37–39, 129, 133–148 In some cases, drinkingon special occasions, which is not well capturedby many surveys, can partially explain this discrepancy.149 Some surveys only capture a shortperiod of consumption (e.g., one week), leadingto a limited picture of consumption.1Surveys tend to focus on drinking of regulatedalcoholic beverages (e.g., beer, wine, liquor),meaning data on consumption of home brewand other sources of alcohol are not captured.Estimates on the proportion of home brewconsumed as part of the total consumptionof alcohol in Canada vary widely and dependon the source of data used and how data areanalysed.150–152Attempts have been made to account for underreporting.e.g., 37, 129, 153–155 In Canada, under-reportingoccurred more often for spirits than for beer orwine. Canadians under the age of 45 were morelikely to under-report their alcohol consumption aswere low-risk drinkers of any age. Men and womenwere similar in terms of the extent to which theyunder-report their consumption of alcohol.129How much does alcohol contribute to dailycaloric intake? Unlike many other drugs,alcohol can count towards daily caloric intake(see Table 2).45 The National Institutes of Healthin the United States has an alcohol caloriecalculator for a variety of different types ofalcohol. For example: 1 drink of regular beer (12 ounces) is153 calories. 1 drink of red wine (5 ounces) is 125 calories,while 1 glass of white wine (5 ounces) is121 calories. 1 drink of gin, rum, vodka, whisky, or tequila(1.5 ounces) is 97 calories. This does notaccount for calories in added ingredients,such as carbonated beverages or juice.Figure 3:TYPE OF DRINK CONSUMEDBY CANADIANS IN 2010(PERCENTAGE OF ALCOHOLCONSUMPTION PER CAPITAIN LITRES)48WINE22%SPIRITS27%BEER51%Adjusted rates for risky drinking: To adjustCanadian drinking data from 2008 to 2010 forunder-reporting, data on drinking over theprevious year and sales data were incor porated. These adjusted data suggest that:155 Estimates of the average rates of pastyear risky drinking among Canadians ages15 years and older who drink rose from16.7% to 38.6% for short-term harm andfrom 6.8% to 27.3% for long-term harm. Most underage drinking and drinking byyoung adults occurs in bouts of heavydrinking (i.e., exceeding the short-termguidelines) rather than in a low level ofdrinking spread out over several days.

12CPHO REPORT 2015Table 2: EXAMPLES OF HOW DAILY CONSUMPTION OFALCOHOL CAN CONTRIBUTE TO DAILY CALORIC INTAKECALORIESAPPROXIMATE %OF RECOMMENDEDDAILY CALORIC INTAKEFor men between the ages of 19 to 50 years who are somewhat active(recommend daily calories: 2600–2700)4 drinks of regular beer61223%4 drinks of red wine50019%4 drinks of white wine48418%4 drinks of gin, rum, vodka, whisky, or tequila38814.5%For women between the ages of 19 to 50 years who are somewhat active(recommended daily calories: 2000–2100)3 drinks of regular beer45922.5%3 drinks of red wine37518.5%3 glasses of white wine36317.5%3 glasses of gin, rum, vodka, whisky, or tequila29114%Note: These calculations are based on recommendations from Canada’s Low-Risk Alcohol Drinking Guidelines andCanada’s Food GuideCosts of Alcohol in CanadaCosts related to alcohol consumption can beexplored through sales and the overall cost tosociety. Sales can provide an indirect measureof consumption and cost to the individual, whileoverall cost shows the high financial burden ofalcohol in Canada.Sales of Alcoholic Beverages: Sales of alcoholicbeverages can indirectly reflect how muchCanadians are drinking. They also show howmuch Canadians are spending on alcoholicbeverages. Sales continue to increase in Canada.From April 2013 to March 2014, Canadians bought 20.5 billion worth of alcohol, which was 1.1% higherthan the previous year. Sales of ciders, coolers, andother refreshment alcoholic beverages accountedfor most of this increase, although sales of wineand spirits are also increasing. Beer remains themost popular alcoholic beverage in Canada.7The alcohol industry ensures that regulatedalcoholic beverages are available to Canadianswhile sales contribute to the Canadian economy.For example, production and sales provideemployment while taxes and pricing providerevenue for provincial and federal governments.156Net income and government revenue fromthe control and sale of alcoholic beverageswas 10.5 billion in 2013/2014.7 In most provinces,revenue from alcohol does not exceed societalcosts from drinking.156Overall Costs: The estimated cost of alcoholabuse in Canada in 2002 was 14.6 billion (seeFigure 4).6 This information is dated and thecost has likely changed over time. In fact, morerecent data show that the cost of hospitalizationsfor substance use disorders from psychoactivedrugs has been increasing, reaching 267 millionin 2011, over half of which was due to alcohol.9These data do not fully capture hospitalizationsfrom alcohol consumption as they are limited toalcohol use disorders.9Impaired driving also creates a high financialburden, through both law enforcement and damagefrom accidents. When the health and social costsfor deaths, injuries and damage to vehicles areincluded, costs related to impaired driving (including alcohol and other drugs) were estimated atover 20.6 billion a year in 2010.157

13ALCOHOL CONSUMPTION I N CANADAFigure 4:BREAKDOWN OF ESTIMATED COSTS OF ALCOHOL ABUSEIN CANADA IN 20026LAW ENFORCEMENT 3.1 BILLIONHEALTH CARE 3.3 BILLIONTRAFFIC ACCIDENT DAMAGE 757 MILLIONFIRE DAMAGETOTAL 156 MILLION 14.6ADMINISTRATIVE COSTS 66 MILLIONBILLIONPREVENTION AND RESEARCH 53 MILLIONLOSSES ASSOCIATED WITHWORKPLACE DAMAGE 17 MILLIONLOST PRODUCTIVITY 7.1 BILLIONAlcohol-Related Mortalityand Morbidity in CanadaIn Canada, alcohol is one of the top ten riskfactors for disease among all Canadians and thetop risk factor for Canadians aged 15 to 49 years.158In 2002, 4,258 deaths in Canada were relatedto alcohol abuse.6 The majority of these deathswere due to alcoholic liver disease, motor vehicleaccidents and alcohol-related suicides.6In terms of health, consuming alcohol can havelong- and short-term effects on the body witheach having different underlying, althoughsometimes overlapping, causes. Drinking can alsoimpact well-being over both the short and longterm.Globally, alcohol contributes to: 48 100% of deaths and disability fromalcohol use disorders and fetal alcoholspectrum disorder; 50% of deaths and disability forliver disease; 20-30% of deaths and disability fromoral/pharynx cancer, laryngeal cancer,oesophageal cancer, pancreatitis,violence or self-harm; 10-15% of deaths and disability from livercancer, tuberculosis, epilepsy, haemorrhagic stroke, unintentional injuries, falls,traffic injuries, drowning or fires; and less than 10% of deaths and disabilityfrom breast cancer, heart disease,ischaemic stroke, lower respiratoryinfections or HIV.

14Long-term ImpactsLong-term impacts can be caused by a varietyof mechanisms that are usually disease-specific.Outlined below are examples of long-termimpacts of alcohol consumption, most of whichare dose-dependent:Alcoholic liver disease: The number of deaths inCanada from alcoholic liver disease has beenincreasing, from 1,104 in 2000 to 1,535 in 2011.159Risk factors for developing alcoholic liver diseaseinclude dose, frequency of drinking, type of drink,genetics, and the presence of other disorders. 160-162Fetal alcohol spectrum disorder (FASD): FASDis a lifelong chronic disorder that is the leadingknown cause of preventable developmentaldisability in Canada. 163, 164 It is estimatedthat more than 3,000 babies are born withFASD every year in Canada and that more than330,000 people in Canada are affected.165, 166Estimates suggest that 2% to 5% of people inwestern countries may be affected by FASD.167Higher rates have been estimated for someAboriginal communities in Canada. 168Alcohol is a teratogen (i.e., a substance thatcrosses the placenta in a pregnant woman to thebaby and can cause malformation of an embryo)that can permanently affect the development ofthe fetus, resulting in a child born with FASD.FASD includes physical and central nervoussystem defects with impacts ranging from mildto severe. The greatest effects are on the brain,resulting in cognitive, behavioural and emotionalimpacts.169CPHO REPORT 2015What about binge drinking and long-termhealth?The impact of binge drinking (or heavyepisodic drinking) on long-term health isa complex and evolving story. Evidencesuggests that binge drinking is linked tonegative impacts on the liver, the brain,cancer and cardiovascular health. 189-192In some cases, the impacts of binge drinkingare no different than drinking the sameamount over a longer period. 193, 194 Bingedrinking is also linked to higher rates ofbehaviours that put people’s health at risk(e.g., smoking).189, 193People with FASD experience difficulties withjudgment, planning, memory, impulsivity, communication, and other impairments. As a result, theyare at greater risk for experiencing problems atschool, mental health issues, problems with alcoholand other drugs, employment challenges, andinvolvement with the criminal justice system.170Experts recommend that the safest choice is tonot drink any type of alcohol at any time duringpregnancy or when planning to become pregnant.42This recommendation may be difficult to follow as50% of pregnancies are unplanned.171 Mothers arealso advised to limit alcohol consumption whilebreastfeeding and plan their breastfeeding schedule to ensure that alcohol is eliminated from theirsystem before breastfeeding.172, 173

ALCOHOL CONS

Celebrations and milestones like weddings, anniversaries, and awards are often "toasted" with alcohol. Our society condones, supports, and in some cases promotes . Canada's Low-Risk Alcohol Drinking Guidelines provide guidance on risky drinking patterns, including avoidance of alcohol in pregnancy. Low risk does not equal no risk.