Last updated: 15-Jan-2007
Alcohol
Excessive alcohol consumption can be considered separately as a risk factor or as a species of unhealthy diet or substance abuse / addiction. It is a complex topic to tackle, both for socio-political reasons and because the health status associated with the consumption of alcohol is ambivalent. Regular, moderate alcohol consumption has recently been identified as having health benefits. This does not take away from the need to monitor and moderate the impact of excessive drinking, as dietary guidelines routinely acknowledge.
Alcohol is one of the most common psychoactive substances consumed in Canada. [1] About 80% of British Columbian adults consume alcohol in a given year. Of this population, 56% identify themselves as regular drinkers, [2] with men more likely than women to be in that category. [3], [4] This rate of regular drinking is among the highest in Canada, second only to Quebec. [5] BC also has the highest alcohol-related mortality rate in Canada, with 27 deaths per 100,000. By comparison, Newfoundland has the lowest alcohol-related mortality rate in Canada (23 deaths per 100,000). [6] Although the rate of per capita alcohol consumption in British Columbia has been declining, the rate of regular, heavy drinking is increasing. [7]
Of great concern is the fact that alcohol consumption is not just confined to the adult population. One study estimated that 47% of boys and 41% of girls in BC have tried alcohol by age 13, and 80% of both genders have tried alcohol by age 17. [8]
Moderate alcohol consumption [9] (no more than 2 standard drinks on any one day, with no more than 9 drinks a week for women and 14 a week for men) has recently been demonstrated to have a beneficial impact on people over the age of 45. [10] Health benefits can include reduced risk of coronary heart disease, [11] ischemic stroke, [12] type II diabetes, [13] peripheral vascular disease, [14] dementia, and osteoporosis. [15] This risk reduction has been attributed to increased concentrations of HDL-cholesterol and inhibition of blood coagulation caused by the presence of alcohol. Contrary to popular perceptions, moderate drinkers can exhibit improved mental health status characterized by decreased depression and stress, as well as lower absenteeism from work. [16]
Although most people drink moderately, excessive alcohol use can contribute to several chronic physical, psychological and behavioural problems. [17], [18] The health risks of alcohol abuse are well known and include cirrhosis, alcoholism, a variety of cancers, injuries, and death. [19] Excessive alcohol use can result in family violence, verbal or physical abuse, property damage, traffic collisions, child neglect and death, and foetal alcohol syndrome. [20], [21]
In 1999, British Columbia’s annual healthcare costs related to excessive alcohol consumption were an estimated $179 million. When law enforcement, fire damage, traffic accidents, loss of productivity and other indirect costs are factored in, alcohol-related costs balloon to almost $1 billion annually. [22]
Excessive alcohol use is of considerable concern to public health. Intervention programs include counselling, [23] emergency department screening, brief on-site advice and referral, [24] pharmacological treatments, and other psychosocial approaches. Successful programs individualize alcohol intervention and prevention to accommodate the needs of the targeted person or population. [25] Community action programs and educational strategies have the potential to be beneficial in the long-run. [26] Legislative and regulatory controls on alcohol prices and marketing also have a large role to play in reducing excessive alcohol consumption.
[2] Advisory Committee on Public Health. Statistical report on the health of Canadians 1999.
[3] Kendall PRW. Public Health Approach to Alcohol Policy: A Report of the Provincial Health Officer. BC Ministry of Health Planning, 2002.
[4] Nolen-Hoeksema S. Gender differences in risk factors and consequences for alcohol use and problems Clinical Psychology Review 2004; 24(8): 981-1010.
[5] Kendall PRW. Public Health Approach to Alcohol Policy: A Report of the Provincial Health Officer. BC Ministry of Health Planning, 2002.
[6] Prevention Source BC: Statistical Summaries. Available at http://www.preventionsource.bc.ca /statsheets/alcohol _injury.html (accessed November 2004).
[7] Kendall PRW. Public Health Approach to Alcohol Policy: A Report of the Provincial Health Officer. BC Ministry of Health Planning, 2002.
[8] The McCreary Centre Society. Healthy Connections: Listening to BC Youth. Highlights from the Adolescent Health Survey II. The McCreary Centre Society, 1999.
[9] Kendall PRW. Public Health Approach to Alcohol Policy: A Report of the Provincial Health Officer. BC Ministry of Health Planning, 2002.
[10] Ellison RC. Balancing the risks and benefits of moderate drinking Annals of the New York Academy of Sciences 2002; 957: 1-6.
[11] Meister KA, Whelan EM, Kava R. The health effects of moderate alcohol intake in humans: an epidemiologic review Critical Reviews in Clinical Laboratory Sciences 2000; 37(3): 261-96.
[12] Hillborn M. Alcohol consumption and stroke: benefits and risks Alcoholism-Clinical and Experimental Research 1998; 22(7 Suppl): S352-8.
[13] Wannamethee SG, Shaper AG, Perry IJ et al. Alcohol consumption and the incidence of type II diabetes Journal of Epidemiology and Community Health 2002; 56(7): 542-8.
[14] Goldberg DM, Soleas GJ, Levesque M. Moderate alcohol consumption: the gentle face of Janus Clinical Biochemistry 1999; 32(7): 505-18.
[15] Standridge JB, Zylstra RG, Adams SM. Alcohol consumption: an overview of benefits and risks Southern Medical Journal 2004; 97(7): 664-72.
[16] Goldberg DM, Soleas GJ, Levesque M. Moderate alcohol consumption: the gentle face of Janus Clinical Biochemistry 1999; 32(7): 505-18.
[17] Chronic diseased and associated risk factors in Australia, 2001. Available at http://www.aihw.gov.au/publications/phe/cdarfa01/cdarfa01-c02a.pdf (accessed November 2004).
[18] Kendall PRW. Public health approach to alcohol policy: a report of the provincial health officer Ministry of Health Planning 2002.
[19] Thun MJ, Peto R, Lopez AD et al. Alcohol consumption and mortality among middle-aged and elderly US adults The New England Journal of Medicine 1997; 337(24): 1705-14.
[20] Chronic diseased and associated risk factors in Australia, 2001. Available at http://www.aihw.gov.au/publications/phe/cdarfa01/cdarfa01-c02a.pdf (accessed November 2004).
[21] Kendall PRW. Public Health Approach to Alcohol Policy: A Report of the Provincial Health Officer. BC Ministry of Health Planning, 2002.
[22] Kendall PRW. Public Health Approach to Alcohol Policy: A Report of the Provincial Health Officer. BC Ministry of Health Planning, 2002.
[23] Helmkamp JC, Swisher-McClure S, Manley WC et al. A brief summary of alcohol intervention research at West Virginia University from 1998-2003 West Virginia Medical Journal 2004; 100(4): 143-6.
[24] Hungerford DW, Pollock DA, Todd KH. Acceptability of emergency-based screening and brief intervention for alcohol problems Academic Emergency Medicine 2000; 7(12): 1383-92.
[25] Marlatt GA, Witkiewitz K. Harm reduction approaches to alcohol use: health promotion, prevention, and treatment Addictive Behaviour 2002; 27(6): 867-86.
[26] Kendall PRW. Public Health Approach to Alcohol Policy: A Report of the Provincial Health Officer. BC Ministry of Health Planning, 2002.