“People think we’re reducing the fun in their lives”: Meet the researcher suggesting that Canadians stick to two drinks per week
Catherine Paradis discusses the controversy over the new low-risk drinking guidelines, the latest science on booze and how it feels to be the bearer of bad news
Recent updates to our country’s low-risk drinking guidelines have left many Torontonians shaken and stirred as the recommended consumption limit has gone from two drinks a day to two drinks a week. Catherine Paradis is the interim associate director of research at the Canadian Centre on Substance Use and Addiction, the non-governmental agency that spent two and a half years combing about 6,000 studies to design the new recommendations. Here, she discusses the latest research on alcohol, how it feels to be the bearer of bad news, and the emotional connection between Canadians and cocktail hour.
Before we get to the new guidelines, what was so bad about the old ones, which advised no more than two to three drinks a day?
The previous guidelines were developed in 2011. We now have a better understanding of the relationship between alcohol and several diseases, including cancer and cardiovascular diseases. The methodologies are more refined, so we can get a more accurate picture. And the old guidelines looked strictly at physical health impacts, whereas we included some information on social harm and violence in our findings.
How was your methodology more refined?
When you look at the long-term effects of alcohol, you want to compare people who drink with those who abstain. But, in the past, there was no consideration of why the people in that second group were choosing not to drink. It turns out that some of them had stopped drinking because they had over-consumed in the past or because of illness. Obviously, light drinkers came off well when compared with people who didn’t drink because they were sick, but the information was misleading.
Your report included a number of findings and recommendations. Most people are fixated on the new low-risk consumption limit, which is just two drinks a week. Is that a little stingy?
That part has definitely gotten a lot of attention, but the CCSA’s main recommendation is that people should consider reducing their alcohol use. The more, the better, because even very moderate amounts of consumption come with some risk.
Right, but so does walking across the street.
Our objective was to provide a continuum of risk so that people can make decisions according to what they’re comfortable with. We determined that low risk for elective behaviours—drinking or smoking as opposed to, say, exposure to pollution—is around a one in 1,000 chance of premature death, which corresponds to two drinks a week. A more moderate risk of one in 100 is associated with three to six drinks a week. After seven a week, the risk of premature death is even greater.
When you say premature death, do you mean by months or by years?
On average, we mean a loss of 17.5 years of life—so people in the low-risk category (two drinks a week) have a one in 1,000 chance of that outcome.
Your report talks a lot about the correlation between alcohol consumption and cancer, but in some cases, the increased risk is for outcomes that are super rare in the first place.
We’ve been hearing that a lot: people saying, I’m not concerned about, say, an increased risk of larynx cancer because the risk itself is so minimal. But the prevalence of every disease was taken into account in our modelling. So heart disease and breast cancer, both quite common in Canada, have much more weight in our analysis than larynx cancer or tuberculosis. And then you’ve probably heard critics saying that some alcohol is actually good for your heart. The problem is that, when you have a glass of wine or a beer, you don’t get to direct it to your organ of choice.
Some of the recently updated guidelines in other countries seem quite a bit more relaxed than what the CCSA is suggesting. In France and Australia, it’s 10 drinks a week; in the UK, it’s 14.
Wrong, wrong and wrong. You have to understand that the places you mention have different ways of measuring a standard drink. In the UK, one unit is eight grams of alcohol. In Canada, it’s 13.45 grams. Once you make those conversions, the difference between our recommended consumption amounts isn’t as drastic.
Of the 5,915 studies your team reviewed, only 16 were used in your modelling. Why is that?
We wanted to use only the highest-quality evidence available, so we chose the best study relating to each of the diseases or injuries we looked at: six kinds of cancer, heart and stroke, certain respiratory infections, cirrhosis, road injuries and accidents. As I said, our goal was to include harm due to mental health impacts, but unfortunately, the research in those categories was not of a high enough quality to include in our modelling, so we tried to reference it elsewhere in the report.
Speaking of mental health, what about the potential positive effects of alcohol consumption that your work doesn’t account for, like blowing off steam?
We didn’t account for it because the evidence was not there. This is a strange criticism. When scientists study the efficacy of bicycle helmets, are they expected to take into account the wonderful feeling of the wind in your hair? With cigarettes, we don’t expect to hear about how smoking helps some people manage their anxiety. So why is it different for alcohol?
Our research has gotten a huge amount of attention and some very emotional reactions. I think, at least partly, that’s related to the role that drinking plays in our culture. It helps mark the difference between day and night, weekdays and weekends, work and play. I think some people see our recommendations as reducing the fun in their lives. That is not what we are saying—and you shouldn’t need alcohol to have a good time.
Have your own habits changed since you completed this research?
I am drinking less and less. There has never been a greater moment to experiment with sobriety for a day, a week, a month or longer. My friends and I have been trying all kinds of non-alcoholic options: gins and vodkas and beer. Some taste awful, and others are delicious. One thing I have been noticing—and this is just a personal observation—is that it has become more acceptable to not drink. We talk about stigma in terms of people who consume drugs and alcohol, but for a long time, there has also been a stigma about not drinking. For some people, being pregnant or sick are the only two acceptable reasons to refuse a drink.
You have probably seen the clip of the guy from St. Catharines who went viral for his less-than-favourable response to CCSA’s recommendations. Do you worry that a lot of people are hearing two drinks a week and just saying, “Screw that”?
We have completed step one, which is getting the information. Step two will be about how to best educate the public, and that will rely a lot on the government and how they choose to respond. In public health, even a small shift in people’s behaviour is a cause for celebration. We’re not expecting habits to change overnight.
This interview has been edited for length and clarity.