The high cost of alcohol abuse

'No. 1 problem substance in Canada'

Do you ever drink to escape from your worries or troubles?

If you answer yes, you might need help.

The message this time of year in the glitzy holiday cocktail guides is: Drinking is good. Drinking is glamorous. Sexy, desirable people drink.

Across Canada, per capita consumption of our favourite legal psychoactive substance has increased more than 11 per cent over the past decade.

People are drinking more frequently, more heavily, and more women are starting to drink like men. Women who pick up a bottle on the way home from work. Women who don't have sober sex. Teachers and administrators and nurses and doctors' wives who sit in group therapy sessions in rehab with former sex workers and drug addicts fighting to get their children back, wondering, "How did I get here?"

Meanwhile, a prosperous economy, an increase in the availability of alcohol nationwide, longer drinking hours, more concentrated hot spots where bars compete and offer discount drinks and sometimes less-than-strict serving practices are fuelling the consumption, experts say.

And as our bond with booze grows, so too will hospital stays for alcohol-related violence, road crashes and attempted suicides; cirrhosis of the liver and drink-related cancers that follow alcohol's path from the lips and mouth down through the body's many systems.

In 2005, there were 25,194 alcohol-related injuries and illnesses in B.C. needing hospitalization, compared with 4,817 related to illicit drug use. A Canadian study found that 42 per cent of those with violent injuries had a blood-alcohol level above the legal limit.

"Alcohol has always been, and will continue to be for a long time, the No. 1 problem substance in Canada for men and women," says Gail Malmo, of the Aurora Centre at B.C. Women's Hospital and Health Centre. The largest women's-only addictions treatment centre in B.C. treats about 300 patients a year.

"We like to think of it as 'other' people. By focusing on the heroin users and the cocaine users you can keep addiction away from you," Malmo says.

A drinker's response to a second question -- Do you drink to build up self-confidence? -- can also be telling.

If you answer yes to this question, and if you also answered yes to the question about drinking to escape your worries, chances are you are an alcoholic. That's according to a recognized test used by Johns Hopkins University Hospital in Baltimore.

Despite warnings that alcohol use and misuse is substantial, Canada has no national drinking guidelines.

"If you just tell somebody, drink responsibly, what's it mean? We have no idea. We've never told anybody what it means," says Doug Beirness, manager of research and policy for the Canadian Centre on Substance Abuse.

"We tell people, well, you know you shouldn't get drunk. But what does it mean to drink responsibly? Does it mean not drunk?"

Health Canada is expected to issue in the new year responsible drinking limits that would essentially be the equivalent of Canada's Food Guide, for drinking.

After one to three drinks, skin flushes, the heart speeds up and people become more talkative. At four to six drinks, judgment is slower. People are giddy, and their coordination impaired.

It usually takes less for women to get drunk, because of their proportionately higher ratio of fat to water than men. It's worse over the holiday season, when women court anorexia to squeeze into cocktail dresses.

There's a critical third question -- Do you drink alone? -- that can indicate a cause for concern.

If you say yes to that question -- and if you also say that you drink to escape worries and to build up self-confidence -- you are an alcoholic, according to Johns Hopkins.

Heavy drinking, defined as five or more drinks on a single occasion for men and four or more drinks for women on a monthly or more frequent basis, is considered the strongest predictor that someone will get into trouble with alcohol.

Approximately 3.3 million Canadians are high-risk drinkers. Among youth, 46 per cent are drinking heavily at least once a month.

But doctors aren't asking patients about their drinking, waiting lists for publicly funded treatment programs are growing and most provinces don't pay for medications to treat heavy drinking. Meanwhile, the drain on the Canadian economy from lost productivity from sickness and premature death, health care and patrols for impaired drivers and other law enforcement costs was nearly $15 billion in 2002 alone.

A new national alcohol strategy makes 41 recommendations to move the country toward a "culture of moderation" and a new way of thinking about booze. The strategy calls for visible labels that list the number of standard drinks in each container of beer, wine or liquor, better screening for risky drinkers, improved access to addiction services, minimum retail prices for alcohol and public awareness campaigns.

So, are calls for a "nation of moderation" just a new cultural war, or a sort of puritan way of what the world should look like? The norms around alcohol have become tighter and tighter, says sociologist Ron Roizen. One sign? "Lower and lower levels of drinking have become defined as problematic."

Binge drinking, he says, has become institutionalized within the research industry as five drinks per sitting for men, four for women, "more or less independent of the length of the sitting, the size of the drinker and their experience."

"That is not what ordinary language regards as a binge. A binge is a protracted episode of drinking that may stretch across days with no periods of non-drinking, save for sleeping or unconsciousness.

"An awful lot of people are very light drinkers. Alcohol is used with remarkable temperance by most people who use it," Roizen says. "What is a 'problem' that's worthy of the public's concern? I don't think it's necessarily true that because people report that their wife gets angry with them about their drinking now and then that that's something public policy should be interested in."

Alcohol exists in virtually every segment of society in some form or another: beers at the hockey game, a toast to the bride. During the holiday season, "you can hardly go to any social function anywhere without there being alcohol," Beirness says. "Not that there's anything wrong with that. That's how ingrained it is. It's everywhere."

Not only is it available, there's an implicit expectation that you will partake, that you will drink.

"When we talk about a culture of moderation, that's where we have to make the changes, so that even if alcohol is there, you don't have to have any," Beirness says.

"Or, you can have one, or two. You don't have to have six."


The following simple test is used at Johns Hopkins University Hospital in Baltimore to help determine whether a patient is an alcoholic.

Answer yes or no to the following 20 questions:

1. Do you lose time from work due to drinking?

2. Is drinking making your home life unhappy?

3. Do you drink because you are shy with other people?

4. Is drinking affecting your reputation?

5. Have you ever felt remorse after drinking?

6. Have you ever had financial difficulties as a result of drinking?

7. Do you turn to lower companions and an inferior environment when drinking?

8. Does your drinking make you care less of your family's welfare?

9. Has your ambition decreased since drinking?

10. Do you crave a drink at a definite time?

11. Do you want a drink the next morning?

12. Does drinking affect your sleeping?

13. Has your efficiency decreased since drinking?

14. Is drinking jeopardizing your job or business?

15. Do you drink to escape from worries or troubles?

16. Do you drink alone?

17. Have you ever had a complete loss of memory as a result of drinking?

18. Has your physician ever treated you for drinking?

19. Do you drink to build up self-confidence?

20. Have you ever been to a hospital or institution because of drinking?

If you answer yes to any one of the questions, that is a warning you may be an alcoholic.

If you answer yes to any two, chances are you are an alcoholic

If you answer yes to three or more, you are an alcoholic.

How to get help:

If you need emergency help, go to your local emergency department or call 911.

Distress or crisis phone lines are open 24 hours a day if you need to talk to someone.

For a list of Alcoholics Anonymous meetings in Canada, go to

For a list of Al-Anon/Alateen meetings for anyone whose life has been affected by someone else's drinking, go to You can also call 1-888-4AL-ANON (1-888-425-2666) Monday through Friday, 5 a.m. to 3 p.m. To find local meetings, check the white pages of your phone book under Al-Anon.

source: CanWest News Service © The Vancouver Sun 2007