Understanding the Health Risks of Alcohol

You’ve likely heard that one drink per day, particularly a glass of red wine, may provide health benefits, like reducing heart attacks and strokes. 

However, the latest research suggests that the health benefits of alcohol use are likely non-existent and even low levels of consumption increase the risk of accidents, injuries, certain cancers and other diseases.

That’s the message of Canada’s updated Guidance on Alcohol and Health, introduced in January of 2023. It suggests that more than two drinks per week place Canadians at elevated risk.

I wasn’t directly involved with those guidelines, but was a part of creating the new national guidelines for individuals struggling with excessive alcohol use and described best practices for the treatment of high risk drinking and alcohol use disorder (AUD) that was funded by Health Canada. My experience comes from actively working and researching substance use and addiction with all levels of government as well as with family groups and people in recovery.

How did Canadians react to learning that alcohol increases the chances of health issues, including cancer, heart problems, liver disease, and getting hurt or causing harm to others?

To many, identifying one to two drinks a week as “low risk” might seem like a far cry from the 2011 guidance, which recommended no more than 15 drinks for men and 10 drinks for women per week to avoid long-term health risks. 

How Canadians responded to the new guidelines

As suspected, considerable confusion and even outrage accompanied the publication of the final report of the new guidance. According to one Ipsos poll, nearly three-quarters of respondents said they wouldn’t change their drinking habits in light of the new guidelines, with more than half saying that “two drinks per week was so low that they thought that it lacked credibility.”

The authors of the new guidance do not recommend consuming a maximum of two alcoholic drinks a week. Rather, the recommendation is that Canadians consider reducing their alcohol use by providing “people with the information they need to make their own choices about their health.”  The takeaway here is that the more you drink, the higher your risk. 

Focusing on evidence 

Unlike the 2011 guidance, which provided little context for its findings, the 2023 update puts scientific evidence front and centre by assessing the risks associated with drinking. It’s based on nearly 6,000 peer-reviewed studies and involved an expert panel of 23 scientists from 16 organizations.

In some ways, drinking alcohol is like any risky activity: the more you ski, for instance, the higher your risk of injury while skiing. 

But unlike skiing, excessive alcohol use has been conclusively linked to serious health issues that increase dramatically with the number of drinks consumed each week:

• 1-2 drinks per week represent a low risk
• 3-6 drinks per week represent a moderate risk
• 7 or more drinks represent a high risk

Understanding the main health risks of drinking alcohol

We now know more than ever how alcohol can hurt your health. Recent studies show that around 3 million people worldwide die every year from the harmful use of alcohol.

In the United States, alcohol accounts for approximately 1 in 5 deaths among U.S. adults aged 20 to 49. Much like the new Canadian recommendations, the World Health Organization recently published a statement indicating that, when it comes to alcohol consumption, there is no safe amount that does not affect health. 

Health risks from alcohol include:

Cancer: Nearly 7,000 cases of Canada’s leading cause of death–cancer–are caused by using alcohol each year, with most cases being breast or colon cancer, followed by cancers of the rectum, mouth and throat, liver, esophagus and larynx. 

According to the Canadian Cancer Society, drinking less alcohol is among the top 10 behaviours to reduce cancer risk. 

Heart disease: Research shows that drinking alcohol neither decreases nor increases the risk of ischemic heart disease. However, it is a risk factor for most other types of cardiovascular disease, including hypertension, heart failure, high blood pressure, atrial fibrillation, and hemorrhagic stroke. 

Liver disease: Drinking a large amount of alcohol, even for just a few days, can lead to a build-up of fat in the liver. This is called alcohol-associated fatty liver. 

A more severe form of alcohol-related liver disease is called alcohol-associated hepatitis, which is generally caused by alcohol abuse or, less commonly, when people consume large amounts of alcohol in a short period of time (binge drinking). 

Eventually, ongoing alcohol-related liver injury can lead to the development of scar tissue in the liver, termed fibrosis, which can lead to life-threatening cirrhosis and liver cancer. 

Violence and injuries: Consuming alcohol increases the risk of various injuries and violence, including self-harm. It’s frequently associated with violent and aggressive behaviour, including intimate partner violence, male-to-female sexual violence, and aggression and violence between adults. Alcohol can also increase the severity of violent incidents.

Drinking also increases the chances of accidents causing physical injury or worse. It’s estimated that between 1,250 and 1,500 people are killed, and more than 63,000 are injured each year in Canada in alcohol-related car crashes.

Other health consequences

The latest research suggests that alcohol is toxic to many organ systems, which is why it contributes to oral and stomach cancers.

There’s also the fact that sugary and high-calorie drinks, like cocktails made with soft drinks, juice or cream, can pack on the pounds. Beer is also heavy on calories, with a regular can having about the same amount as a can of pop. 

Alcohol also impairs attention, concentration, and judgement, can contribute to memory loss, and has been shown to disrupt both the quality and quantity of sleep. Unhealthy alcohol use can also directly contribute to mental health problems such as anxiety and depression.

Simple ways to cut back on drinking

Use these tips and strategies to be more mindful of your drinking habits.

• If you often have a drink after work, go for a walk instead since exercise triggers the same feel-good sensations alcohol can provide.
• Instead of having a drink before bed to help you sleep, listen to a meditation app.
• Look for healthy ways to handle stress, like calling a friend, taking the dog for a walk, and getting enough sleep.
• Try quenching your thirst with alcohol-free drinks like sparkling water, alcohol-free beer and mocktails.
• Eat something before your first drink to avoid drinking on an empty stomach.
• Find ways to hang out with friends that don’t involve drinking, like going for a hike or taking a yoga class.
• Laugh it off when you feel the urge to drink. Laughing releases the feel-good dopamine hormone. An easy way to do this is to watch some funny videos.
• If you’re bored or stressed, do something physical instead of drinking.
• Limit or avoid time spent with friends who drink heavily when trying to cut back.

The bottom line

When it comes to your health, the latest science is clear that more than two drinks per week results in a growing risk of harm the more you drink.  

Put in context, if you have three drinks per week, your risks still remain very low, whereas drinking at “lower risk” levels prescribed in the outdated 2011 low risk drinking guidelines (which was 15 standard drinks a week for men and 10 for women), increases risk substantially.

The recommendations aren’t meant to impose restrictions on your life but are there to provide you with information to make your own health decisions. For many of us, that means being more aware of our own risk threshold and preferences. For example, someone with a strong family history of cancer might take the alcohol-attributable cancer risks more seriously. 

There are many ways to access support if you’re concerned about how much alcohol you drink. Informing yourself about the latest guidelines is a great starting point, as is exploring counselling and speaking with your doctor about safe, effective medication. The key is to ask for help.

If you are concerned that you drink too much and have problems with cutting down or stopping, visit the helpwithdrinking.ca website. 

The website offers reliable information based on the complimentary guidelines I put together, the Canadian Guideline for the Clinical Management of High-Risk Drinking and Alcohol Use Disorder, that describe best practices for the treatment of high risk drinking and alcohol use disorder (AUD).