Two glasses a week? Why Canada’s new alcohol guidelines have us rethinking our relationship with risk (2023)

It was dance night at the roller rink. The lights were low; the ’80s tunes cranked high. And Laura Mack was back on skates after a nearly 40-year absence.

Unlike in her youth, the 62-year-old’s wrists, knees and elbows were wrapped in protective padding, a helmet snug on her head. With a few lessons under her belt, she was ready for some fun.

It had been a difficult few years. Her husband, Andrew, died of complications from cardiovascular disease in January 2021. During his year-long decline, and hospitalizations that separated the couple, Mack, who previously enjoyed a drink of wine with Andrew at dinner, often found herself alone and grieving her husband’s impending loss with a couple of “quarantinis.” A couple too many, and enough to leave her questioning, and ultimately, giving up alcohol.

But roller skating? The fun seemed worth the risk. So on this night last fall, in a newly opened rink in Vancouver and eight months into sobriety, Mack busted a move. Then she busted her hip — to “smithereens.”

“(Roller skating) brought me joy until it didn’t,” said Mack who required surgery and two months of convalescing in bed. “And I can say exactly the same thing of alcohol — it brought me a lot of joy until it didn’t.”

In weighing the risks she has taken in her life, Mack may regret her fancy footwork — “I have decided I’m selling the roller skates,” she said — but at one year sober she is buoyed by recent guidance from the Canadian Centre on Substance Use and Addiction (CCSA) which strongly stated: no amount of alcohol is good for your health, and anything beyond two glasses a week increases your risk for alcohol-related consequences, from injury to cancer.

“I’m quite firmly and comfortably in the percentage of people who are celebrating these guidelines as an affirmation of the decision we’ve made of being alcohol-free,” said the Courtenay, B.C., resident who has found the guidelines to be the talk of her online sober support communities.

But for others, the report has been nothing but a killjoy.

For the past dozen years, Canada’s advice was to stick to no more than 10 drinks a week for women and 15 for men. Above that, you were putting your long-term health in jeopardy. Below was considered low-risk. While not exactly a free-for-all, the threshold, set in 2011, allowed people to have a glass a day and maybe a couple of extra beers on the weekend. Of the 23.7 million Canadians who drink alcohol, according to 2019 data, three-quarters reported doing so within those limits.

The updated recommendations, funded by Health Canada and based on new evidence, mathematical modelling and consultation, call for a radical reduction.

And while they may reflect a global shift in thinking among researchers, including the World Health Organization which earlier this month declared there is no safe amount of alcohol, the new guidelines landed like last call at a boisterous bar when the night seems still so young.

There was disbelief, displeasure, denial.

“Two drinks a week?! That’s just not feasible, not in this country!” said a man in a CHCH TV news video that has gone viral for his candour, channelling the Canadian beer-loving legacy of SCTV’s Bob and Doug McKenzie.

From call-in shows and social media discourse, and in news coverage and opinion pieces, people have criticized the CCSA’s conclusions, accused Canada of being out of line with other countries, and in some cases, rejected the advice outright.

“For me, it sounds ridiculous, it’s so shocking,” said Yashy Murphy, a Toronto mom of two and content creator for Parenting to Go, a multi-platform brand that “encourages urban parents to maintain the pre-kid lifestyle post-kid.” A martini glass is integrated into the site’s logo.

Murphy had already cut back a little on alcohol due to concerns about her family history and the amount of drinking she had done at industry events in a past career in the beverage business. She now makes mocktails for the odd change of pace, and for her kids. But she can’t see giving up hosting girlfriends for drinks or doing her annual 12 pubs of Christmas crawl.

“This news is not going to alter those occasions for me,” she said. “I still want to go have fun. I still want to go out, have a few cocktails.”

In response to the backlash, Catherine Paradis, the CCSA’s interim associate director, research, and co-chair of the report, insists the non-governmental organization “is not the red wine squad going around and issuing tickets to people who drink above a certain level.”

The new guidelines don’t dictate a way of life, she said. “We came out with information that people can decide to integrate into their way of life, if they’d like to.”

Canadians have a gap in their alcohol literacy, she added, with many believing you either had an alcohol disorder or no problems at all, failing to realize there could be consequences for even low-level consumption.

“So, we felt people had a right to know.”

But like a hangover, the report’s conclusions have people fretting about their past intake and re-evaluating their relationship with alcohol. In the cold hard light of day, we’re all confronting the same question: is a glass of wine still a risk worth taking?

“Research shows no amount or kind of alcohol is good for your health. Drinking alcohol, even a small amount, is damaging to everyone, regardless of age, sex, gender, ethnicity, tolerance for alcohol or lifestyle. That’s why if you drink, it’s better to drink less.”

That CCSA warning comes with what is described as a “continuum of risk” — a colour-coded chart the centre hopes people will use to weigh the consequences of their weekly alcohol consumption: two standard drinks a week is considered low risk; three to six is moderate; anything over seven is increasingly high.

“Alcohol is a carcinogen that can cause at least seven types of cancer,” the report starkly concludes.

“When you make a blanket, unnuanced statement that (alcohol) increases your risk of cancer, that is really going to frighten people,” said Dr. Meldon Kahan, an addiction physician at Women’s College Hospital. “It also doesn’t put it into context. There’s a lot of things that have been shown to increase the risk of breast cancer, for example: red meat in the diet, deficiency of vitamin D, obesity, and by far the most important, our family history.”

For those diagnosed with cancer, these guidelines will cause tremendous guilt, said Kahan. And those who are drinking more than two drinks a week and doing just fine, they are just not going to listen.

“People don’t react well to being lectured to and to what feels like an attempt to frighten them.”

Kahan and others have questioned the report and its panel of experts on everything from the way they conveyed individual risk to the number of studies the report reviewed. For someone trying to navigate the recommendations, the criticisms are enough to make a head spin.

Among them:

But the new guidelines are aimed at putting some control in an individual’s hands — even if the simple colour-coded “continuum of risk” belies the complexity and seeming confusion of what’s behind them.

“More information is always better. And I’m a firm believer in evidence-based medicine,” said associate professor Jessica Mudry, director of the Healthcare User Experience Lab at Toronto Metropolitan University.

“But the second we quantify the consumption of anything … you create a framework for people to moralize others and to moralize themselves,” even if that one night out is a lifeline for someone craving social contact.

“On a cellular level, is alcohol a toxin? Absolutely. Will it kill you? Yes. So will sugar. So will meat. Life is pretty toxic.”

But, Mudry added, “is (alcohol) also an excuse for human connection? Yes. Is human connection vital to happiness and well-being and longevity? Yes.”

Paradis acknowledges the social importance alcohol holds for people and understands how they might now feel like their lifestyle choices are under scrutiny. “They thought that this was fun and harmless, and they’re not happy to know that it could hurt them.”

Most people tend to think their risk is lower than it really is, said Taryn Grieder, a psychology professor at the University of Toronto, who acknowledges the skydiving she loves to do might seem riskier than drinking to some. “We have this idea that we’re almost indestructible, especially males, and the younger a person is.”

She holds up the students in her classes as an example. When recently discussing the new guidelines, the students brushed off any thoughts of giving up or doing less partying.

“The older and wiser we get, the more risk-averse we become,” Grieder said. “We’ve learned through our experiences and through other people’s unfortunate ones that we aren’t immune to harms.”

But having lived through the pandemic, people from all walks may be more accepting of risk as the price for enjoying life again. “We know what it’s like to be cooped up in our houses and not to socialize or go out to bars and have our friends over for a night,” said Grieder.

And perhaps it doesn’t help that these new recommendations have landed just as society is suffering from message fatigue.

“The pandemic has substantially affected the way we digest public health recommendations,” said James MacKillop, the Peter Boris Chair in Addictions Research at McMaster University. COVID-19 regulations moved at “the speed of evidence,” often changing in ways that confused people, leaving them feeling like the guidance was unreliable, he said. “And I think that it may be that people are less willing to accept public health guidelines unquestioningly.”

For people who thought they were safely imbibing within the old drink limits set in 2011, they would be rightly surprised to discover they are suddenly categorized as a moderate- or high-risk drinker, said MacKillop. Meanwhile, patients with alcohol-related concerns will find their intake well beyond the colour-coded chart. “It is not clear how a clinician would use the guidelines to treat patients,” said MacKillop.

Dr. Kahan agrees. “I think physicians will be reluctant to tell a 30-year-old woman who is drinking four or five drinks per week that she should cut down to two drinks otherwise she could get breast cancer.”

The way Paradis sees it, any reduction in alcohol use is beneficial. If someone is at 35 drinks a week, she said, but gives up their Tuesday drinking, moving down to 32 beers, “that’s brilliant.”

She accepts that people may need more of a nudge than the new guidelines or the discussion around them can provide. They’ll need a supportive environment. That’s why part of the CCSA recommendations include a call for warning labels on bottles, echoing the successful deterrents on cigarette packaging. The organization also states it is aiming to “change Canada’s drinking culture and curb the normalization of harmful alcohol use in society.” At a time when there’s never been more choice for alcohol-free beers, wines and spirits but Ontario is also expanding access to liquor, that’s a challenging message to absorb.

“I think people are afraid,” said Mack, whose son is two months into his own drug-free journey. “Alcohol is such a crutch for so many people. And in a reasonable amount, it’s thoroughly enjoyable. People don’t want to lose that.

But for the leadership development facilitator and executive coach, the pros of her decision, are clear.

“I sleep better. I’m less anxious. I’m less reactive. I’m supporting my son in his sobriety. I’m more present for my clients. All of those things. Plus I’m reducing my cancer risk.”