Canada’s Low-Risk Alcohol Drinking Guidelines Presented by Name of Presenter(s) and Organization(s) On behalf of the National Alcohol Strategy Advisory Committee Event, Month ##, Year

National Alcohol Strategy Developed through consensus by the National Alcohol Strategy (NAS) Working Group, including 25 representatives from federal, provincial and territorial governments, non-governmental organizations, researchers and alcohol industry The 41 NAS recommendations collectively impact policies and behaviour to address alcohol harms 2

Implementing the NAS National Alcohol Strategy Advisory Committee (NASAC) 25 multi-sector experts lead the implementation, monitoring and evaluation of the NAS recommendations, including those dealing with: –Low-Risk Alcohol Drinking Guidelines (LRDGs); screening, brief intervention and referral; standard drink labels; price policies; and municipal alcohol policies Co-chaired by the Nova Scotia Department of Health and Wellness, Mothers Against Drunk Driving Canada and CCSA 3

Why LRDGs? These national guidelines were developed: To provide consistent advice to all Canadians to reduce long- and short-term health risks To increase awareness of safer drinking levels and to educate about standard drink sizes To reflect the latest scientific literature that identifies both significant risks and some possible benefits from low levels of alcohol consumption 4

History of LRDGs in Canada 5 SourceLimits for MenLimits for Women aLPHa, CAMH, OPHA (1997) 2 per day 14 per week 2 per day 9 per week CARBC (2007) 4 on single day 20 per week 3 on single day 10 per week CFPC (1994) 4 per day 12 per week 3 per day 12 per week Educ’alcool (2007) 5 on single occasion 14 per week 4 on single occasion 9 per week LRDGs (2011)3 per day 15 per week 2 per day 10 per week

Expert Advisory Panel Chaired by Dr. Peter Butt, College of Family Physicians of Canada Researchers from each Canadian organization that previously issued low-risk drinking guidelines: CCSA, Centre on Addiction and Mental Health (CAMH), Centre for Addictions Research of BC (CARBC), College of Family Physicians of Canada (CFPC) and Educ’alcool Peer Review: International experts and NASAC members 6 Evidence-informed Guidance: Expert Advisors

Search conducted on multiple bibliographic databases for: –Systematic reviews and meta-analyses on impact of alcohol on disease and injury (17 found) –Emergency department research examined for short-term or “acute” risk of injury after drinking within previous 6-hour period Critical appraisal of reviews and single studies Relative risk preferred to absolute risk All-cause mortality studies used to find balance point between risks and benefits 7 Evidence-informed Guidance: Literature Review

The complexity of risk and presence of health benefits complicate the analysis of risk The national LRDGs identify daily limits based on the point where the risk of dying prematurely because of alcohol-related causes is equal to that of lifetime abstainers 8 Criteria for “Low Risk” Drinking

If everyone in Canada followed the LRDGs and light drinkers did not increase consumption, then it is estimated that: Alcohol consumption would decrease by approximately 50% Alcohol-related deaths would decrease by approximately 4,600 per year 9 If Everyone Followed the LRDGs …

LRDG Brochure 10

LRDG Brochure 11

Why Do Limits Differ for Men and Women? Because of biological and other reasons, women's risk of many types of alcohol related harm are higher than men's for any given level of consumption For example, at even one drink per day on average, a woman's risk of getting liver cirrhosis increases by 139 percent as compared with 26 percent for males 12

13 Rehm, Kehoe, Taylor, & Patra (2009). Evidence base for the development of Canadian Drinking Guidelines. Rehm et al. 2003, 2006 and Risk of Premature Death (males)

14 Rehm, Kehoe, Taylor, & Patra (2009). Evidence base for the development of Canadian Drinking Guidelines. Rehm et al. 2003, 2006 and Risk of Premature Death (females)

15 A Drink Is …

Reduce your long-term health risks by drinking no more than: –Women 10 drinks a week 2 drinks a day most days –Men 15 drinks a week 3 drinks a day most days Plan non-drinking days every week to avoid developing a habit These are limits NOT targets! If you’re not drinking this much now, don’t increase Context is critical 16 Your Limits

Reduce your risk of injury and harm by drinking, on any single occasion, no more than: –Women 3 drinks –Men 4 drinks Plan to drink in a safe environment. Stay within the weekly limits outlined in Your Limits. 17 Special Occasions

18 Source: Butt, P., Beirness, D., Gliksman, L., Paradis, C., & Stockwell, T. (2010). Alcohol and health in Canada: A summary of evidence and guidelines for low-risk drinking. Ottawa: Canadian Centre on Substance Abuse. Consequences of Chronic Heavy Drinking

Do not drink when you are: Driving a vehicle or using machinery and tools Taking medicine or other drugs that interact with alcohol Doing any kind of dangerous physical activity Living with mental or physical health problems Living with alcohol dependence Pregnant or planning to be pregnant Responsible for the safety of others Making important decisions 19 When Zero’s the Limit

If you are pregnant, planning to become pregnant, or about to breastfeed, the safest choice is to drink no alcohol at all 20 Pregnant? Zero is Safest

Alcohol can harm the way the brain and body develop Teens should speak with their parents about drinking  If they choose to drink, they should do so under parental guidance; never more than 1-2 drinks at a time and never more than 1-2 times per week Teens should plan ahead, follow local alcohol laws and consider the Safer Drinking Tips 21 Delay Your Drinking

Daily Guidelines for Young Adults Daily guidelines for young adults are lower than for adults Risky drinking peaks in young adults with approximately 50% of drinkers consuming above the upper daily limit of the LRDG (i.e., more than four drinks per occasion for men and more than 3 for women) monthly or more often in the past year The new guidelines recommend that young adult males never exceed 3 drinks on a single occasion and women never exceed 2 drinks up to age 24 This lower threshold reflects growing evidence of the detrimental effects of risky alcohol use on the developing brains of young adults 22

Set limits for yourself and stick to them Drink slowly, no more than 2 drinks in any 3 hours For every drink of alcohol, have one non-alcoholic drink Eat before and while you are drinking Always consider your age, body weight and health problems that might suggest lower limits While drinking may provide health benefits for certain groups of people, do not start to drink or increase your drinking for health benefits 23 Safer Drinking Tips

Association of Canadian Distillers Association of Local Public Health Agencies Brewers Association of Canada BC Council of Substance Abuse BC Ministry of Health Canadian Association of Chiefs of Police Canadian Centre on Substance Abuse Canadian Medical Association Canadian Paediatric Society Canadian Public Health Association Canadian Society of Addictions Medicine Canadian Vintners Association Centre for Addiction Research of British Columbia Centre for Addiction and Mental Health College of Family Physicians of Canada Council of Chief Medical Officers of Health Educ’alcool MADD Canada Nova Scotia Department of Health and Wellness Public Health Physicians of Canada Society of Obstetricians and Gynaecologists of Canada 24 Official Supporters

Resources to Promote LRDGs 25

Resources (cont.) A new alcohol Screening, Brief Intervention and Referral (SBIR) web resource was developed based on the Low-Risk Alcohol Drinking Guidelines: Developed by CCSA and expert advisory committee Offers a simple, three-step process to family physicians and healthcare professionals for detecting and addressing problematic alcohol consumption CCSA transferred ownership of SBIR to College of Family Physicians of Canada in November

The SBIR Website 27

Questions for Participants Are you actively promoting the Guidelines? Do you have plans to promote the Guidelines? Do you need support? 28

Contact Information For further information on the National Alcohol Strategy, including the LRDGs, please contact: Canadian Centre on Substance Abuse 75 Albert Street, Suite 500 Ottawa, ON K1P 5E