"Cheers!"
This is a common refrain during the holiday season for many.
Even folks who don't drink most of the year will likely indulge in a drink at this festive time.
But with an increasing understanding that alcohol can be problematic for our health in more ways than one, how can we manage our drinking during this festive time of year?
How it is going
Most of us drink.
About 80% of Canadians have consumed alcohol in the last year, according to the Alcohol and Drugs Survey (CTADS).
About one in five Canadian men and one in 10 Canadian women report lifetime harms from alcohol use, notes Dr. Launette Rieb, a family physician certified in addiction medicine and a clinical associate professor in the Department of Family Practice at the University of British Columbia (UBC).
Known harms of alcohol use
So what are these harms?
As of 2018, alcohol has become the number one cause of hospitalization in B.C., Rieb said.
It costs $18 billion per year federally, and alcohol is the second leading cause of preventable death worldwide.
"We always talk about the opioid crisis, but, really, we have a substance use crisis in Canada," Rieb said. "Most people who end up using opioids actually start with alcohol, tobacco, and cannabis. So those three are all risk factors to end up using opioids, and people don't realize that."
Beyond the risk for addiction, there are mental and physical health problems and seven cancers that alcohol can cause or contribute to, she said.
For example, 20% to 30% of breast cancer in Canadian women is attributable to alcohol.
"Thus, there are no medically defensible grounds to suggest people should drink alcohol for health reasons," Rieb said.
Debunking myths
Many folks may have heard that some alcohol, red wine, for example, is good for the heart. But early studies on cardiovascular health were flawed, Reib said.
"It's not protective to drink."
Other folks believe that drinking before bed will help them sleep, but that isn't actually the case, Rieb said.
"Even though the lived experience is that if you drink, you'll get sleepy, relaxed, and you can go to bed early ... what happens is when you shove your neurochemistry in one direction, then when that substance comes out of your body, your mind and body will rebound in an equal and opposite direction," she said.
"So, as sedated as you are, you will get that activated as it comes out of your system. And if you're asleep, when it starts coming out of your system, what it does is it contributes to you waking frequently at night, having nightmares that wake you up. And, at a bare minimum, you have to get up and pee if you've had a lot to drink before bed. It actually disturbs the rest of your sleep even though it can put you to sleep."
There is a similar misunderstanding around alcohol and pain.
While it may start out dulling pain, it quickly does the opposite, Rieb said.
"The lived experience, which is totally true, is that alcohol has a dose-dependent effect on pain. So, the more you drink, the less you feel your pain. The problem is that even within five days of drinking, you can sensitize your nervous system [so that] when you don't have alcohol on board, you actually feel more pain."
This is the case for physical and emotional pain, she added.
"Both anxiety and PTSD symptoms rise, even though the lived experience of the patient is when I drink, I feel better," she said.
Here are some of Rieb's tips to help reduce the risk of potential alcohol-related harms:
• Know what you are drinking
A standard beer contains 5% alcohol per 350 ml (12 oz) bottle. A glass of wine contains 12% alcohol per 150 ml (5 oz, 3 oz for fortified wine); that is two-thirds of a cup.
One shot of spirits contains 40% alcohol per 50 ml (1.5 oz).
• Be aware of the new guidelines
Drinkers should be aware of the new, updated Canadian drinking guidelines, Rieb said.
According to the new guidelines, there is no amount of alcohol that is safe if you are underage, pregnant, have significant mental health issues, physical health issues or take medications that make drinking contraindicated, have alcohol use disorder (AUD) or another substance use disorders or a history of violence, Rieb said.
For your average adult:
Low risk: 1 to 2 drinks per week
Mod risk 3 to 6 drinks per week
High risk: 7 or more drinks per week
Rieb said to reduce these numbers if you are over 65 or involved in safety-sensitive work or play.
• Load up on food and water before you go to the event where alcohol will be served.
"That's really important. A lot of that initial drinking when you get somewhere; you're dehydrated, you're tired, you've been rushing around, and you get to a party, and you're thirsty. But if you can drink two cups of water before you go, you're less thirsty; you're more likely to sip your drink than to pound back your first alcoholic beverage before you get on to the second one."
• If excessive drinking has been a problem for you, plan to arrive late, leave early, and pre-book your pick-up time.
• Keep control of your own beverage the entire event. Bring, open, pour and retain your drink. That way, you know exactly what you are drinking.
• Empty your glass completely before having another; it avoids top-ups where folks may lose track of how much they are drinking.
• Alternate non-alcoholic beverages with alcoholic beverages.
• Eat food with your beverage, even light snacks. The alcohol will digest slower.
• Choose non-carbonated mixers.
"The deal with carbonation is that if your alcohol is mixed with carbonation, let's say a rum and coke, the carbonation actually facilitates the absorption of alcohol so you can get drunk a little faster. On the other hand, carbonation tends to fill people up, so they sometimes can't drink as much," she said.
• Sip and savour — do not chug; go for taste pleasure versus intoxication.
• Practice refusing drinks – you don't have to drink what is offered.
• Bring special non-alcoholic beverages, such as sparkling juices and non-alcoholic wine or beer.
These days, non-alcohol alternatives are quite tasty, Rieb noted.
•Arrange childcare, even if the party is at home. This way, you avoid neglecting your children, kids getting into alcohol, and unwanted advances on children by intoxicated guests.
"One of the sources of child abuse that people suffer is drunken friends of your parents ... It's a horrible thing to even have to think about, but that is a reality."
• If a drinking friend is unconscious, and you can't rouse them, call 911.
•Do not let an intoxicated person walk home in the cold alone.
"That's how people die," Rieb said. "The person feels warm, but they're losing tons of heat ... People often remove scarves or don't zip up their jacket — because they feel warm ... They're stumbling home, and then they just start getting sleepy. And then they lay down for just a minute in a snowbank, and they're found in the morning—dead."
• If going out, arrange safe travel
Buses are often free on New Year's Eve or call a taxi or a sober friend or family member.
It is so vital that folks don't drink and drive that Rieb says to take the keys from intoxicated friends if they insist on trying to get behind the wheel.
Call the police if they still persist, she said.
"Never get into a vehicle with a driver who may be intoxicated — even if that is your parent or spouse," she said.
Signs of trouble
One in seven Canadians have Alcohol Use Disorder (AUD), meaning what we typically call alcoholism: continuing to drink even though it is causing problems in your life.
Know the signs that you have a problem with drinking, Rieb said.
"Loss of control over [alcohol] use despite consequences, having cravings or compulsive use, these are all some of the many signs of an alcohol use disorder.”
There is help. There are medications to treat AUD that can help reduce relapses and cravings.
Withdrawal management may be needed if you previously experienced Delirium tremens (D.T.s), seizures, or felt very shaky when stopping, or if you drink eight or more drinks per day.
Call 211 — the Alcohol and Drug Information and Referral line — for publicly funded resources in B.C.
Recovery support groups like Alcoholics Anonymous can be found close by in almost any community in Canada.
Go to www.vancouveraa.ca to find out where a meeting is near you.
