Canada’s Guidance on Alcohol and Health: Final Report
January 2023
Public summary
Drinking less alcohol is better
We now know that even a small amount of alcohol can be damaging to health.
Science is evolving, and the recommendations about alcohol use need to change.
Research shows that no amount or kind of alcohol is good for human health. It doesn’t matter what kind of alcohol it is – wine, beer, cider or spirits.
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 alcohol, it’s better to drink less alcohol.
Alcohol consumption per week
Drinking alcohol has negative consequences. The more alcohol a person drinks per week, the more the consequences add up.
People should not start to use alcohol or increase their alcohol use for health benefits. Any reduction in alcohol use is beneficial. This applies even for those who are unable or unwilling to reduce their risk to low or moderate levels. In fact, those consuming high levels of alcohol have even more to gain by reducing their consumption by as much they are able.
Aim to drink less alcohol
Drinking less alcohol benefits the consumer and others. It reduces the risk of injury and violence, and many health problems that can shorten life.
Here is a good way to consume less alcohol
- Count how many alcoholic drinks you have in a week.
- Set a weekly alcohol consumption target. If you’re going to drink alcohol, make sure you don’t exceed 2 alcoholic drinks on any day.
Good to know
You can reduce your alcohol consumption in steps! Every alcoholic drink counts: any reduction in alcohol use has benefits.
It’s time to pick a new target
Tips to help people stay on target
- Stick to the limits you’ve set for yourself.
- Drink alcohol slowly.
- Drink lots of water.
- For every drink of alcohol, have one non-alcoholic drink.
- Choose alcohol-free or low-alcohol beverages.
- Eat before and while you’re drinking alcohol.
- Have alcohol-free weeks or do alcohol-free activities.
Notes on a Standard Alcoholic Drink
In Canada, a standard alcoholic drink is 17.05 millilitres or 13.45 grams of pure alcohol, which is the equivalent of:
- A bottle of beer (12 oz., 341 ml, 5% alcohol)
- A bottle of cider (12 oz., 341 ml, 5% alcohol)
- A glass of wine (5 oz., 142 ml, 12% alcohol)
- A shot glass of spirits (1.5 oz., 43 ml, 40% alcohol)
Technical Summary
Alcohol is a psychoactive substance used by about three-quarters of people living in Canada. It is often used in connection with social events or to mark special occasions. However, alcohol can cause harm to the person who consumes it and to others around them. Alcohol is a leading preventable cause of death, disability and social problems, including certain cancers, cardiovascular disease, liver disease, unintentional injuries and violence.
In 2017, alcohol caused 18,000 deaths in Canada.
That same year, the costs associated with alcohol use in Canada were $16.6 billion, with $5.4 billion of that sum spent on health care.
People living in Canada must be aware of important information about alcohol and health to assess their personal risk and consider reducing their alcohol use. Taken together, overwhelming evidence confirms that when it comes to drinking alcohol, less consumption means less risk of harm from alcohol.
Canada’s Guidance on Alcohol and Health
To reduce the risk of harm from alcohol, it is recommended that people living in Canada consider reducing their alcohol use.
The reasons to do so derive from the following facts:
- There is a continuum of risk associated with weekly alcohol consumption where the risk of harm from alcohol is:
- Low for individuals who consume 2 standard alcoholic drinks or less per week;
- Moderate for those who consume between 3 and 6 standard alcoholic drinks per week; and
- Increasingly high for those who consume 7 standard alcoholic drinks or more per week.
- Consuming more than 2 standard alcoholic drinks per alcohol consumption occasion is associated with an increased risk of harms to self and others, including injuries and violence.
- When pregnant or trying to get pregnant, there is no known safe amount of alcohol use.
- When breastfeeding, not consuming alcohol is safest.
Sex and Gender
Above the upper limit of the moderate risk zone for alcohol consumption, the health risks increase more steeply for females than males.
Far more injuries, violence and deaths result from men’s alcohol use, especially in the case of per occasion drinking.
Risk Associated with Alcohol Use Per Occasion
On any alcohol drinking occasion, the risk of acute outcomes such as unintentional injuries and violence is strongly associated with cognitive and physical impairment from consuming too much alcohol. The risk of negative outcomes begins to increase with any alcohol use and consuming more than 2 standard alcoholic drinks per occasion is associated with a significant increased risk of harms to self and others.
Binge alcohol use, usually defined as consuming five or more standard alcoholic drinks in one setting for men, or four or more standard alcoholic drinks in one setting for women, is a pattern of consumption that results in legal impairment for most people. It is a well-established risk factor for death from any cause, including unintentional injuries, violence, heart disease and high blood pressure, and inflammation of the gastrointestinal system, and for developing an alcohol use disorder (i.e., alcohol dependence).
Many of the complications arising from acute impairment and binge alcohol use involve second-hand effects that affect someone other than the person who consumes alcohol (e.g., violence, road crashes, child abuse and neglect).
Risk when Pregnant, Trying to Get Pregnant or Breastfeeding
Alcohol is a teratogen or agent that can cause malformation of the fetus. It can lead to learning, health and social effects with lifelong impacts on the fetus as well as brain injury, birth defects, behavioural problems, learning disabilities and other health problems typically referred to as fetal alcohol spectrum disorder (FASD). These adverse effects are also observed at low levels of exposure or short-term exposure to high levels of consumption.
For this reason, when pregnant or trying to get pregnant, there is no known safe amount of alcohol use. Reproductive health is compromised by alcohol use.
Possible impacts of alcohol on pregnancy and delivery outcomes include increases in miscarriage, hypertensive disorders of pregnancy and placental abnormalities.
Alcohol consumption can also negatively impact breastfeeding by causing a decrease in milk production, early cessation of breastfeeding and effects on infant sleep patterns.
Moreover, alcohol enters breast milk through passive diffusion meaning that breastfeeding infants, who are less able to metabolize alcohol, can be exposed to it.
Therefore, when breastfeeding, no alcohol use is safest for the baby.
Consuming a standard alcoholic drink on occasion can be okay, as long as it is planned. It takes about two hours for the alcohol contained in a standard alcoholic drink to be eliminated from the body and leave the breastmilk.
Risk for Women
The physiological differences between females and males at low levels of alcohol use have only a small impact on lifetime risk of death. However, it is unequivocal that above the upper limit of the moderate risk zone for alcohol consumption (above 6 standard alcoholic drinks per week), the health risks increase more steeply for females than for males.
Enzymes, genes, lean body weight and size, organ function and metabolism are important in processing alcohol and are affected by sex-related factors. These biological factors enhance the impact of alcohol on females, causing higher blood alcohol levels, faster intoxication, more risk for disease, including breast cancer, and more long-term harm, such as liver damage and injury.
Risk for Men
Men drink more alcohol than women and are more likely to consume alcohol in excess. Consequently, they are more likely to be involved in alcohol-impaired driving collisions, to be treated in hospitals and hospitalized for alcohol-related medical emergencies and health problems, to be diagnosed with an alcohol use disorder and to die from alcohol-related causes. Alcohol is also more strongly associated with perpetration of violence for men than for women.
Men are also more likely than women to take other risks (e.g., use other substances, drive under the influence) that when combined with alcohol further increase their likelihood of experiencing and causing alcohol-related harms. Overall, far more injuries, violence and deaths result from men’s alcohol use, especially in the case of per-occasion drinking.
Youth
Alcohol use is a leading behavioural risk factor for death and social problems among youth and young adults, and alcohol is the most common psychoactive substance used by this age group. A high proportion of alcohol consumed by youth is in the form of binge alcohol use with its attendant risks of injuries, aggression, violence and other age-important consequences such as dating violence and worsening academic performance.
In addition, even for the same number of alcoholic drinks consumed per alcohol consumption occasion, the risk of adverse outcomes from alcohol consumption is greater for youth than for adults. This may be due to several factors, including greater impulsivity and less emotional maturity among youth, lower body mass on average, less experience doing complex tasks that are made more dangerous by alcohol (e.g., operating a motor vehicle) and faster alcohol consumption speeds.
For this reason, recommendations related to the risks associated with weekly levels of alcohol use and alcohol use per occasion do not apply to youth under the legal age for alcohol use. For them, the main message should be to delay alcohol use for as long as possible.
When Zero’s the Limit
There are circumstances when no alcohol use is safest. For example, when:
- Driving a motor vehicle;
- Using machinery and tools;
- Taking medicine or other drugs that interact with alcohol;
- Doing any kind of dangerous physical activity;
- Being responsible for the safety of others; and
- Making important decisions.
Reasons for the New Guidance on Alcohol and Health
Alcohol and Cancer
Cancer is the leading cause of death in Canada. However, the fact that alcohol is a carcinogen that can cause at least seven types of cancer is often unknown or overlooked.
The most recent available data show that the use of alcohol causes nearly 7,000 cases of cancer deaths each year in Canada, with most cases being breast or colon cancer, followed by cancers of the rectum, mouth and throat, liver, esophagus and larynx.
According to the Canadian Cancer Society, consuming less alcohol is among the top 10 behaviours to reduce cancer risk.
Alcohol and Heart Disease
After cancer, heart disease is the second leading cause of death in Canada. For many years, the commonly held belief that alcohol use in moderation offered protection against coronary artery disease has been widely publicized.
Research in the last decade is more nuanced with the most recent and highest quality systematic reviews showing that drinking a little alcohol neither decreases nor increases the risk of ischemic heart disease.
Alcohol is a risk factor for most other types of cardiovascular disease, including, hypertension, heart failure, high blood pressure, atrial fibrillation and hemorrhagic stroke.
Alcohol and Liver Disease
Statistics show that liver disease is on the rise in Canada, and alcohol is one of its main causes.
Consuming a large amount of alcohol, even for just a few days, can lead to a build-up of fat in the liver. This is called alcohol-associated fatty liver.
A more severe form of alcohol-related liver disease is called alcohol-associated hepatitis, which is generally caused by heavy and chronic alcohol use or, less commonly, when people consume large amounts of alcohol in a short period of time (binge alcohol use). Eventually, ongoing alcohol-related liver injury can lead to the development of scar tissue in the liver, termed fibrosis, which can lead to life-threatening cirrhosis and liver cancer.
Alcohol and Violence
Alcohol is frequently associated with violent and aggressive behaviour, including intimate partner violence, male-to-female sexual violence, and aggression and violence between adults.
Alcohol can also increase the severity of violent incidents. No exact dose–response relationship can be established but consuming alcohol increases the risk of perpetrating alcohol-related violence.
It is therefore reasonable to infer that individuals can reduce their risk of perpetrating aggressive or violent acts by limiting their alcohol use. Based on consistent evidence, it is highly likely that avoiding drinking alcohol to intoxication will reduce individuals’ risk of perpetrating alcohol-related violence.
Policy Implications
To support people living in Canada who will want to drink less alcohol, governments, working in close collaboration with employers, healthcare providers and community stakeholders, need to implement policies that promote public health.
Such policies include:
- Strengthening regulations on alcohol advertising and marketing,
- Increasing restrictions on the physical availability of alcohol, and
- Adopting minimum prices for alcohol.
As a priority, people living in Canada need consistent, easy-to-use information at the point of pour to track their alcohol use in terms of standard alcoholic drinks.
They also have a right to clear and accessible information about the health and safety of the products they buy.
- A direct consequence of the current project is that a particular effective policy change could be the mandatory labelling of all alcoholic beverages with the number of standard alcoholic drinks in a container, Canada’s Guidance on Alcohol and Health and health warnings.
