The Great Lime Shortage

Health care providers could spot individuals who drink at levels that are harmful before such patients would consider cutting back or seeking treatment. (Associated Press)

Do you drink beer, wine, coolers or other alcoholic beverages?

That's a question Canadians could hear more often as doctors try to get us to think about the risks of drinking.

Alcohol-related causes are responsible for seven per cent of all deaths in Canada and substantial disability, according to researchers. The consequences include fractures and other injuries from falls, vehicle collisions and accidents and injuries from violence or alcohol-induced suicides.

Recognizing that 15 per cent to 20 per cent of Canadians do meet the criteria for alcohol disorders, Dr. Anne Moyer of  Stony Brook University in New York and Dr. John Finney of the VA Palo Alto Health Care System in Menlo Park, Calif., conducted a review of alcohol misuse. It was published in Monday's issue of the Canadian Medical Association Journal.

Moyer said health care providers such as family physicians and nurse practitioners can spot individuals who drink at levels that are harmful before such patients would consider cutting back or seeking treatment.

Current Canadian guidelines for low-risk drinking recommend:

  • No more than 10 drinks a week for women (with no more than 2 drinks a day on most days).
  • A maximum of 15 drinks a week for men (with no more than 3 drinks a day on most days).
  • Abstinence for pregnant women.

A standard drink is defined as: 

  • 341 mL or 12 ounces of beer with five per cent alcohol.
  • 142 mL or 5 ounces of wine with 10 to 12 per cent alcohol.
  • 85 mL or 3 ounces of fortified wine  with 16 to 18 per cent alcohol.
  • 43 mL or 1.5 ounces of liquor with 40 per cent alcohol.

The authors of the review suggest health care professionals ask patients if they consume alcohol and if so, how many days a week and how many drinks per day.

If risky behaviour is identified, then counselling and feedback can be offered in five to 15 minutes with or without follow-up to help people cut back. If drinking habits worsen, then patients can be referred to specialized treatment.

"Screening and brief intervention may reduce the toll of risky or harmful drinking," the pair conclude.

Canada's national alcohol strategy, published in 2007, also calls for widespread screening and brief interventions, which some doctors already do.

But a commentary published with the review calls the Canadian health care system's current approach to at-risk drinking a "systematic failure."

Dr. Sheryl Spithoff, a family physician at Women's College Hospital, and Dr. Suzanne Turner from St. Michael's Hospital, both in Toronto, agree with the authors of the review that family doctors can be well suited to provide addiction care compared with the high no-show rates at specialized clinics.

"The milder group, they tend to have stabler lives, they have jobs, relationships, they tend to be binge drinkers, so they're not drinking heavily every day," Spithoff said. "They are drinking intermittently, once a week, once a month. They tend not to experience significant harm from their drinking pattern at present, but they are at risk of harm."

Their recommended policy changes include:

  • Add training on alcohol misuse to medical education for medical students and residents.
  • Implement screening at hospitals and primary care clinics and create pathways to connect those with more severe alcohol-use disorders to treatment for addiction.
  •  Provinces and territories should fund medications for alcohol use disorders (naltrexone and acamprosate) and make them widely accessible.

They also suggest resources for physicians to use.  

"For some reason, this information just isn't permeating," Spithoff said, noting physicians may feel uncomfortable asking the questions and may not be aware of how effective the interventions are.