“Two drinks a week is practically personal prohibition”: This professor is taking Canada’s new alcohol guidelines to task

“Two drinks a week is practically personal prohibition”: This professor is taking Canada’s new alcohol guidelines to task

Medical historian Dan Malleck weighs in on the risks of promoting restricted drinking habits and the benefits of booze

Photograph by Bonnie Tompkins

In January, the Canadian Centre on Substance Use and Addiction released new and considerably curtailed guidelines for safe alcohol consumption, prompting a national uproar. The idea that many of us could stand to reconsider our relationship with alcohol is not controversial, but two drinks a week? For some, the suggestion has been a harsh wake-up call. And it’s not one we need to answer, according to Dan Malleck, a health professor and historian at Brock University who has taken the CCSA to task on Twitter. Malleck says the new recommendations aren’t presented with enough context and that they bear more than a passing resemblance to ones promoted by the 19th century temperance movement. Plus, he says, they fail to account for the benefits of moderate drinking.

You’re a medical historian specializing in drug and alcohol policy, so let’s start by putting the new updated guidelines in historical context.
I’ve spent a long time researching the beliefs and assumptions underlying drug and alcohol policy, particularly the idea that all drinking will lead to social disaster. So I’ve learned to look out for arguments or instructions that suggest moderation but are not actually moderate. When we look back to the beginning of the Canadian temperance movement in the early 1900s, we see an evolution from promoting moderate consumption of alcohol (which is what the word temperance actually means) to a full-blown prohibition. And now, with these new guidelines, I’d say two drinks a week is as close as you get to personal prohibition. The CCSA will say, “Oh, we’re just presenting the information so that people can make their own decisions.” But it feels like they’re using scare tactics.

Related: “People think we’re reducing the fun in their lives”: Meet the researcher suggesting that Canadians stick to two drinks per week

For example?
The way that the researchers present relative risk rather than absolute risk can make certain findings sound more alarming than they are. For example, the report states that your risk of larynx cancer increases by 100 per cent after 3.5 drinks per week, but it doesn’t tell you that larynx cancer was diagnosed in only 0.0197 per cent of Canadians and is largely related to smoking. I don’t want to give the impression that cancer risk isn’t serious—my dad died of cancer—but using it to scare people is not okay. Look at the report’s infographics, which are done in this blood-red shading. Or some of the language: the final report says that eight or more drinks a week “radically” increases your risk of harm. That word, it sounds very—

Right—you would assume scary, frightening levels of risk, but that is actually not what the data in the report is indicating. And, in some cases, such as with heart disease and stroke, a certain amount of alcohol consumption remains protective, meaning that people who consume up to seven drinks a week are less likely to have a heart attack than those who drink nothing. There are quite a few theories as to why this is: with wine, for example, there is the suggestion that it has a thinning effect on blood, but that discussion is really outside of my wheelhouse. What’s important is that the outcome has been measured, yet the report makes no mention of it. So, overall, there’s a distortion of the data: we’ll present you something that you won’t totally understand so that we can tell you what it means in a way that suits our agenda.

Which is what, exactly? Anti-booze? Anti-fun? Anti–free will?
I don’t think it’s necessarily anything nefarious. It’s more that the CCSA is looking at the effects of drinking through a harm framework, which is a narrow scope. They are looking for harm, so that’s what they’re finding. But I would argue that we need to be looking at alcohol consumption—and particularly moderate, responsible consumption—in a more holistic way. Drinking is not just the act of consuming a certain amount of ethanol. It often takes place in a social space, and it’s a way for humans to form connections, celebrate, mourn and stave off loneliness and isolation, which we know from the pandemic can have real medical consequences. The CCSA’s report does not recognize the ways that harms done by alcohol can be offset by its benefits—ones that aren’t necessarily as quantifiable.

Adrian Wyld

You mean that there is not the same kind of data-driven, analytical evidence to support the benefits of drinking?
That’s right. Tracking harm is not difficult. We have hospital data, vital statistics, police reports, court records. It’s a lot harder to track softer social benefits. Nobody ever asks someone, “Does your drinking have mental health benefits? Did you not quit your job because you’re able to decompress with colleagues over a couple of beers?” We know that these rituals around alcohol can promote well-being: you go to a party with a bottle of wine or you meet up with a friend for a drink because they had a bad day. To suddenly pathologize that behaviour is to remove something more than just drinking from people’s lives. Imagine if someone was like, “Yeah, I’m not going to go out with my friends because I’ve already had two drinks this week.”

Okay, but if you can’t hang out with your friends without alcohol, is that not maybe a sign that these guidelines are for you?
I am absolutely in favour of sober socializing, and I’m a big advocate of non-alcoholic beers. I just think we need to be very wary of this idea of health—defined by a very specific set of criteria—as a form of moral measurement. We see this a lot in the shaming of people who are “overweight,” where we look at their diet choices as indications of their goodness or responsibility. The result is increased stigma, which we know is not effective in changing behaviour but tends to drive it underground. So, in terms of the example of someone who isn’t going to meet friends at the bar because they don’t want to be perceived as over-consuming, are they drinking alone at home instead? In the Victorian period, when it was considered unrespectable for a woman to drink, you ended up with all of these women drinking in secret, which led to problems.

Do you think that the new guidelines, in their rigidity, may be counterproductive?
Well, you saw that guy in St. Catharines who was just like, “Yeah, not in this country!” That’s gone viral because it’s funny but also because so many people agree with him. As a professor of health sciences, it’s troubling to think that people will completely disregard health recommendations, even if I don’t support these particular ones.

Do you support the CCSA’s recommendations for mandatory labelling?
I’m not in favour of labelling around a connection to illness, such as cancer. We can say that alcohol is a carcinogen, but so is bacon. In order to assess risk, we need to look at context and lifestyle factors. As for labels that would inform consumers about how many “standard drinks” are in whatever they are purchasing—a beer, a bottle of wine—I have no problem with people being informed. I just think there is so much judgment related to this topic that relaying neutral information feels impossible.

The federal government plans to raise taxes on alcohol by 6.3 per cent starting in April. Thoughts?
High taxes on alcohol disproportionately affect people with lower incomes. Some people say, “Well, good—if they’re poor, they shouldn’t be wasting their money on beer.” But that vicious attitude denies the autonomy of the individual, who should be allowed to make decisions about their own life. So it’s inequitable and illiberal, but it’s not atypical considering the way alcohol is seen as easily problematic if the “wrong people” consume it. I think that, in a period of high inflation, it would be right and compassionate for the government to do the opposite and reduce this tax. Why shouldn’t someone who is stressed and needs a simple relaxant be able to have a few beers and take the edge off once in a while?

This interview has been edited for length and clarity.