Significant Harm is Associated With Drinking Within Recommended Weekly Guidelines

Many countries have established lower-risk drinking guidelines; Canada’s guidelines have relatively high cut-offs compared with other high-income countries.* This study estimated the proportion of alcohol-related deaths and harms in 2014 among people in British Columbia who drink within and above guideline limits. The population (people aged ≥15; N=4 million) was divided into 4 categories of consumption: lifetime abstinence, formerly drinking (i.e., not in the past year), drinking within weekly guidelines, and drinking above weekly guidelines.

• 77% of the cohort had current alcohol use; 65% of these individuals drank within weekly guidelines. A higher proportion of men (18%) than women (7%) were drinking above weekly guidelines.
• 40% of deaths from alcohol-attributable injuries were among those drinking within guidelines, as were 19% of deaths from alcohol-attributable cancers and 31% of deaths from alcohol-attributable communicable diseases.
• More than 50% of deaths from alcohol-attributable cancers occurred among those formerly drinking and those drinking within guidelines. However, deaths from neuropsychiatric conditions (mostly alcohol use disorders) were found almost exclusively among those dinking above guidelines (99%).
• In total, alcohol was responsible for 2000 deaths and, of these, 38% were among those formerly drinking or those drinking within weekly guidelines.

* Canada’s low-risk drinking guideline cut-offs are 201.75 g ethanol/week for men (~15 standard drinks), 134.5 g for women (~10 standard drinks), compared with 100 g/week for men and women in France; 112 g/week for men and women in the UK; 168 g/week for men, 84 g for women in Germany; and 196 g/week for men, 98 g for women in the US.

Comments: Alcohol consumption within Canadian recommended guidelines is associated with significant harm. While Canadian guideline cut-offs are higher than those in parts of western Europe and the US, the drinking level with aligned risks between those drinking and abstaining is 12 g ethanol per day for men and 17 g for women, which is below most countries’ current guidelines. Based on results from this and other studies, conservative, gender-neutral recommendations should be adopted.

Nicolas Bertholet, MD, MSc

Reference: Sherk A, Thomas G, Churchill S, Stockwell T. Does drinking within low-risk guidelines prevent harm? Implications for high-income countries using the international model of alcohol harms and policies. J Stud Alcohol Drugs. 2020;81(3):352–361.