Alcohol and Health Should I Change My Drinking Behavior

Most of us are willing to accept some level of risk in our day-to-day lives. We delve into a bucket of fries or get behind the wheel of a car despite the health or safety risks associated with these behaviors, as they bring us joy, and ease, and are a part of the fabric of daily life. And like almost anything in life, consuming substances, such as alcohol and drugs, comes with a level of risk.

The Canadian Centre on Substance Use and Addiction (CCSA) recently released new guidelines for alcohol consumption that outline amounts of alcohol that increase your risk for social and health consequences.

The new guidelines have taken a spectrum approach to risk:

• Low risk is 2 or fewer units per week
• Moderate risk is 3-6 units per week
• High risk is 7 or more units per week

A unit refers to 5 ounces of wine, a bottle of beer (5%), or 1.5 ounces of hard liquor. These guidelines apply to both biologically female-born and male-born people. It is recommended that you do not consume any alcohol if you are pregnant or breastfeeding. The Canadian guidelines have not been updated since 2012, and these new recommendations reflect the most up-to-date science. As a psychologist, the Clinical Director of a substance use program, and a person who likes wine, these new guidelines can be difficult to ingest.

WHAT DO THE NEW GUIDELINES SAY?

From a health perspective, no amount of alcohol is without risk. Alcohol is a known level 1 carcinogen (meaning it’s as deadly as tobacco and asbestos) linked to 7 different types of cancers, including breast and bowel cancer. Risks are particularly elevated for women who have a physiological makeup that renders alcohol more toxic. Alcohol is linked to heart disease, including coronary artery disease and heart attacks, heart failure, high blood pressure, atrial fibrillation, and strokes. These guidelines focus on severe health consequences but do not delve into other health effects such as what alcohol does to your skin, gut microbiome, sleep quality, body mass index, cell repair capability, stress response, or mental health.

The truth is most medical professionals such as oncologists and cardiologists will tell you this is old news. It is accepted that people tolerate a certain level of risk to enjoy life. The problem is that previous research told us that alcohol in moderation was good for us. Turns out that the research was flawed. It included former drinkers (aka people who had problems and quit) in the “non-drinkers” category, where many of these people would have already experienced negative health consequences. This error made it look like drinking a bit was less harmful than not drinking. Another myth commonly circulated was that resveratrol (an antioxidant in red wine) is good for health without the indication that you would have to be drinking toxic amounts of alcohol to get any significant benefit. It is much better to get your antioxidants from food. And what about the Mediterranean diet that includes wine as a protective factor? In North America, we like to parse out pieces of a Mediterranean lifestyle to suit our needs. The beneficial aspect of this lifestyle is likely moderation, where alcohol is consumed in small amounts with a meal, not binged on a Friday night.

WHAT ARE STRATEGIES I CAN USE TO REDUCE HARM FROM ALCOHOL USE?

You’re probably familiar with the concept of harm reduction when it comes to food intake, even if you don’t call it by that term. When you choose treats that have less sugar or fat, you are engaging in a harm-reduction strategy. When you decide to forgo a second helping of dinner, that is harm reduction. Harm reduction is any strategy that reduces the negative consequences of a behavior.

Here are some specific strategies that you can use to reduce the harms of alcohol use:

• Drink mindfully: When you are offered a drink at a restaurant or gathering, think about whether you really want to drink, or whether a non-alcoholic beverage will do the trick.
• Sip mindfully: When you are drinking an alcoholic beverage, savor each sip. This may sound counterintuitive, but research shows we ingest less (of food or alcohol) when we create a greater sensory awareness of the experience.
• Track your drinking: Tracking behavior works well to create awareness, whether it is calories, steps, or drinks. People tend to drink more than they estimate.
• Pace your drinking: Many people do well by setting boundaries around their intake. Maybe that means setting a start and stop time. Maybe it means one per hour or water between each drink.
• Stick within the guidelines: If you are trying to stick to 6 drinks per week, it requires that you make choices about when you will drink. These guidelines can be a good starting point for creating awareness about when and how often you crave alcohol.
• Be aware of why you are drinking: We generally consume alcohol to decrease emotional pain (including feelings like stress, boredom, or loneliness) or to increase pleasure. Challenge yourself to drink only when it enhances pleasure and not to numb the pain.
• Try a mocktail: There are several new and innovative mocktail companies and craft beer creators that have developed products that mimic the taste of alcohol. You may even experience the placebo effect of feeling a little buzzed. This effect has been documented in research studies, where people think they are consuming alcohol but are not.
• Choose lower alcohol content beverages: If you want to lower your “units” but enjoy a beverage, move to lower alcohol content beer, mix your wine with water or juice, or make cocktails with small amounts of hard liquor.
• Only drink on weekends: Some people do better with an all-or-nothing approach to days of the week. The caveat is that you can’t drink all your units on Friday. Binge drinking (4 drinks or more for women, 5 drinks for men) is a well-established risk factor for health and social consequences.
• Ride the craving: One of the best ways to decrease alcohol consumption is to find ways to ride out the craving. This strategy was well established for people wanting to quit smoking. Cravings generally only last for a set timeframe and will pass more quickly with practice.

SO SHOULD I CHANGE MY DRINKING BEHAVIOR?

Ultimately that is up to you. I have heard feedback from my friends speculating that this new research is just the flavor of the day, like avocados or skinny jeans. Rest assured, this research is solid, based on global evidence from previous reports, mathematical modeling, and a comprehensive review of the current literature. For me, it means a growing awareness that my alcohol consumption could be harming my health, making an informed choice about engaging in a behavior that I enjoy and choosing a harm-reduction approach to risk. This means being more mindful about when I choose to drink and shifting my behavior most weeks to stay within recommended limits. Sadly, this means I can no longer believe that wine is making me healthier or ignore the fact that it is harmful. The most important information this report gives us is the option of informed choice. Like anything in life, I have the sticky conundrum of deciding between the risk and reward that comes from everyday decisions, but at least now I have the information to make that choice wisely.

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Terri-Lynn Mackay, Ph.D., R. Psych. is the Clinical Director of ALAViDA: A LifeSpeak Company, a virtual health solution for substance use disorders. She is a clinical psychologist with expertise in providing strategic direction, clinical leadership, and system transformation in mental health and addiction. Dr. MacKay is the Provincial Director of Innovation and partnerships for the Canadian Mental Health Association (Manitoba) and serves as an advisor with The Decision Lab. Previously, Dr. Mackay served as the Director of Operations for the Canadian mental health pandemic response, Associate Director of Counselling Services at the University of British Columbia, and Associate Professor at the University of Nevada, Las Vegas. 

She has been a consultant for government and private industry for over a decade with a focus on providing social justice approaches to transformational system change.

Dr. Mackay holds a Ph.D. in Clinical Psychology and a Master’s degree in Behavioural Neuroscience. Her research has been featured in journals such as Canadian Psychology, Neuropsychologia, Computers in Human Behavior and International Gambling Studies.