GUIDELINE 1: REDUCING THE RISK OF LONG-TERM ALCOHOL-RELATED HARM
- To have some non-drinking days every week to minimize tolerance and habit formation.
- Not to increase drinking to the upper limit, since health benefits are greatest at less than 1 drink per day.
- That adults with reduced tolerance (whether due to low body weight, being under 25, or over 65, or not being accustomed to drinking alcohol) should not exceed the upper limit.
GUIDELINE 2: REDUCING THE RISK OF SHORT-TERM ALCOHOL-RELATED HARM
- The risk of injury increases with each additional drink in many situations.
- To drink at the upper limit only occasionally and always stay within the weekly limits.
- To drink with meals and not on an empty stomach.
- To have no more than 2 standard drinks in any 3-hour period.
- To alternate alcoholic drinks with caffeine-free, non-alcoholic beverages.
- To avoid risky situations and activities.
GUIDELINE 3: CONTRAINDICATIONS
Alcohol should be avoided in these situations.
Advise patients to abstain from alcohol when:
- Operating any kind of vehicle, machinery or tools.
- Using medications or other drugs that interact with alcohol.
- Engaging in sports or other potentially dangerous physical activities.
- Making important decisions.
- Responsible for the care or supervision of others.
- Suffering from serious physical illness, mental illness or alcohol dependence.
GUIDELINE 4: PREGNANT WOMEN
For women who are pregnant, or planning to be pregnant or nursing.
- The safest option during pregnancy or when planning to become pregnant is not to drink alcohol at all.
- Alcohol in the mother’s bloodstream can harm the developing foetus. While the risk from light drinking during pregnancy appears very low, there is no threshold for alcohol use in pregnancy that has been definitively proven to be safe.
- Nursing mothers should not drink alcohol right before a feeding, as some of the alcohol passes into the breast milk and may affect the baby.
- Women who plan to drink alcohol can prevent or limit alcohol from reaching their babies by nursing or pumping breast milk before they drink.
For more information, see Pregnancy and Drinking: Your Questions Answered, co-published by Collège des médecins du Québec and Éduc’alcool.
GUIDELINE 5: ALCOHOL AND YOUNG PEOPLE
Advise patients that alcohol can affect healthy physical and mental development in children and adolescents.
For youth (up to age 18), advise patients that:
- Many young people do not drink.
- They should delay starting to drink until they are 18.
- If they have decided to start drinking, they should do so in a safe environment, under parental guidance and limit their intake to 1-2 standard drinks no more than once or twice per week.
For young adults (age 18 to 24), advise patients that:
- From age 18 to 24, women should never have more than 2 drinks per day and men should never have more than 3 drinks in one day.
For more information, see The Effects of Early Alcohol Use, published by Éduc’alcool.
Suggest that patients read the general-public version of Low-Risk Drinking 2340.
COMMUNICATING ALCOHOL-RELATED HEALTH RISKS
This section is meant to assist pharmacists in discussing with their patients the risks of several serious illnesses associated with different levels of alcohol consumption.
Tables 1, 2 and 3 on the following pages – taken from the technical, scientific report that provided the basis for Canada’s Low-Risk Alcohol Drinking Guidelines – show changes in the risk for a selected number of serious alcohol-related illnesses based on how many drinks a person has, on average, per day. These estimates are based on an analysis of a comprehensive database of scientific studies commissioned as an internal document by the Centre for Addiction and Mental Health.
Table 1 summarizes the risks for 12 serious illnesses, including seven types of cancer, which apply equally for men and women under 70. Of note from this table:
- Having just one drink per day increases a person’s risk of getting any one of nine of the conditions highlighted in yellow by up to 42%. For these nine conditions, the risk rises with the number of drinks consumed per day.
- Tuberculosis is the only condition for which there is no significant change in risk until a particular “threshold” drinking level (namely, three or more drinks per day).
- A person is 14-19% less likely to get ischemic heart disease when drinking up to 3-4 drinks per day, with zero risk at 5-6 drinks per day and increased risk with greater consumption.