The Canadian Center on Substance Use and Addiction (CCSA) offers Canadians updated low-risk drinking guidelines. In our opinion, they have the right to be informed about the risks and benefits of alcohol consumption in order to support informed decision-making. Although it tends to be commoditized, alcohol is not an ordinary consumer product; it is a psychoactive substance which acts in particular on the central nervous system and which can lead, for certain people, to serious health problems.
The CCSA Expert Committee has done a major job of analyzing the potential negative impacts of alcohol consumption. This work is based on recognized methods. The fruit of his work provides scientific support for the notion of “drinking less is better”. Moreover, although it tends to emphasize individual responsibility with regard to alcohol by giving too few details on collective responsibilities (e.g. minimum price of alcohol, rules on advertising), we welcome and support the recommendation that labeling of the number of standard drinks included in alcoholic products should be mandatory.
This labeling is necessary to enable individuals to make informed decisions about the amount of alcohol consumed, given the wide variety of alcoholic products and formats available on the market. However, this report misses the mark, in our view, on five important points.
Context, benefits, risks and confusion
First, the guidelines issued to the public are based solely on the notion of risk to physical health, without considering elements related to psychological well-being and socialization, which does not allow the public to make informed decisions. In the formulation of these recommendations, it is essential to take into account the contexts in which this consumption takes place as well as all the associated benefits and risks, in particular on the psychosocial level.
Second, it is very difficult to understand the magnitude of the risks associated with the thresholds of more than two or six drinks per week presented by CCSA. The consumer summary states that “even in small doses, alcohol has consequences for everyone”. This brings confusion. It should rather read that at these thresholds, there is a risk, a relatively small possibility, of shortening one’s life. We believe it is necessary to clearly present the various potential impacts of exceeding various standards for an individual so that he can make informed choices, on a continuum of risk.
Third, the formulation of the CCSA guidelines is based on a positioning that tends towards the recommendation of abstinence, which contrasts not only with the previous CCSA standards, published in 2011, but also with the alcohol consumption standards advocated currently by several other groups of international experts, such as the NIAAA in the United States, or by government authorities in Australia or the United Kingdom. This positioning risks stigmatizing a large majority of Canadians who choose to consume alcohol, as consuming more than two drinks a week is now considered “out of the norm”.
The prescriptive formulation of this new consumption norm, centered solely around the risk of developing physical health problems and reflecting an approach that tends towards abstinence, seems counterproductive in terms of prevention. Among young adults, who are often not very motivated to change their habits based on long-term risks, taking into account short-term benefits and consequences is recognized as central to effective prevention approaches.
Fourth, the choice to establish norms on the basis of weekly rather than daily consumption also leads to a risk of confusion and completely evacuates the risks associated with concentrated consumption in a single episode. Drinking six drinks in a single episode is not equivalent in risk to having one drink at a time on six days of the week.
Fifth, the norms put forward ignore the functions of consumption and their contexts in the lives of individuals. They evacuate the beneficial aspects yet documented such as pleasure and socialization. Remember that health is not just the absence of disease, but a “complete state of physical, mental and social well-being” (WHO). This global perspective is essential so that the messages communicated to the public make sense to individuals and can help them change their behavior if they wish.
Complete and nuanced information
In this sense, we believe it is crucial to provide Canadians with the means to achieve their goals of reducing alcohol consumption, for those who make this choice. We are thinking of various prevention programs, including, for example, My choices, and its aboriginal component, Sage Usage, which need to be better publicized.
In the 1980s, Canada adopted a harm reduction approach to working with people who use substances. This approach recognizes that a substance-free and safe society does not exist and that people have the right and the power to make choices for themselves. In this sense, judgmental approaches to prevention are doomed to failure.
It is important to provide the public with complete and nuanced information about alcohol, as well as to label the number of standard drinks on alcoholic products, in order to support informed decision-making.
* Also signed this text (in alphabetical order):
Vincent Marcoux, Executive Director, Quebec Association of Addiction Intervention Centers (AIDQ)
Sandhia Vadlamudy, Executive Director, Association of Addiction Workers of Quebec (AIDQ)
Céline Bellot, Ph.D., Full Professor, School of Social Work, University of Montreal; collaborating researcher, IUD
Magaly Brodeur, Ph.D., MD, CCMF, physician and professor, Faculty of Medicine and Health Sciences, University of Sherbrooke; collaborating researcher, IUD
Natacha Brunelle, Ph.D., Full Professor, Department of Psychoeducation, University of Quebec at Trois-Rivières; scientific director of (RE)SO 16-35; regular researcher, IUD, RISQ and CICC
Jorge Flores-Aranda, Ph.D., professor, School of Social Work, University of Quebec in Montreal; regular researcher, IUD, RISQ
Mathieu Goyette, Ph.D., Professor, Department of Sexology, University of Quebec in Montreal; regular researcher, IUD, RISQ
Michel Landry, Ph.D., collaborating researcher, IUD, RISQ
Myriam Laventure, Ph.D., Full Professor, Department of Community Health, University of Sherbrooke; regular researcher, IUD, RISQ
David-Martin Milot, MD CM, M.Sc., FRCPC, medical specialist in public health and preventive medicine; Assistant Professor, Department of Community Health Sciences, University of Sherbrooke; regular researcher, IUD
Johana Monthuy-Blanc, Ph.D., head of the Loricorps research unit of the Research Center of the University Institute of Mental Health of Montreal and UQTR
Louise Nadeau, Ph.D., Professor Emeritus, Department of Psychology, University of Montreal; collaborating researcher, IUD, RISQ
Chantal Plourde, Ph.D., Full Professor, Department of Psychoeducation, University of Quebec at Trois-Rivières; regular researcher, IUD, RISQ
Marianne Saint-Jacques, Ph.D., Associate Professor, Department of Community Health Sciences, University of Sherbrooke; collaborating researcher, RISQ
Annie-Claude Savard, Ph.D., Associate Professor, School of Social Work and Criminology, Laval University; regular researcher, IUD
Vincent Wagner, Ph.D., establishment researcher at IUD; Associate Professor, Department of Community Health Sciences, University of Sherbrooke; regular researcher, RISQ