Canadian guidelines for the diagnosis and treatment of hazardous alcohol use

While Lynn, a 53-year-old Vancouver resident, considered herself a "casual drinker" and consumed half a bottle of wine a day, she was also taking a prescribed antidepressant medication. However, after a few months, she saw no signs of improvement but noticed an increased craving for alcohol.

She recounted, "I was drinking faster, I was drinking more. I was getting up to go to the liquor store to start my day."

Two papers published in the Canadian Medical Association Journal (CMAJ) on Monday highlight the risks associated with high-risk alcohol use, similar to Lynn's case. The first paper explains that high-risk alcohol use often goes unnoticed and provides guidelines for its treatment. The second paper reveals that certain types of antidepressant medications can lead some alcohol users to drink more.

High-risk alcohol use often goes unrecognized. Lynn's initial daily intake of half a bottle of wine would classify her as a high-risk drinker, according to Canada's updated alcohol and health guidelines issued in January. The fact that she considered it "casual" may indicate how common this level of drinking has become, as more than 50% of people aged 15 and above in Canada consume more than the recommended amount, according to the newly released guidelines on Monday.

(No amount of alcohol is currently considered safe in Canada. To avoid serious health consequences, it is recommended that no more than two alcoholic drinks be consumed per week.) The new findings also show that high-risk drinking often goes unrecognized and untreated, as does alcohol use disorder (AUD), defined as ongoing alcohol use with difficulty controlling consumption, even in the face of consequences.

"Approximately 95 to 99% do not receive effective medications for alcohol craving or medications that can help prevent a relapse into alcohol use," said Dr. Evan Wood, co-author of the guidelines published on Monday and Canada Research Chair in Addiction Medicine at the University of British Columbia.

These guidelines were developed by a committee of experts and individuals with lived experience. They represent the first national guidelines for high-risk alcohol use ever published in Canada.

They provide 15 recommendations for family physicians, nurse practitioners, and other healthcare providers, including how to inquire about a patient's alcohol use, manage withdrawal symptoms, and treat AUD over the long term.

More than 6 drinks a week lead to higher health risks, a new report suggests, especially for women. Dr. Tim Naimi, director of the Canadian Institute for Substance Use Research at the University of Victoria and a primary care physician, pointed out that we all have different trajectories when it comes to alcohol consumption, but few are asked about it by their family doctors, if they have one.

"There are many people who drink to the point of impairment on a fairly regular basis who may not meet the criteria for alcohol use disorder," said Naimi, who was not involved in developing the guidelines. "But they contribute to domestic violence, injuries, and stomach problems."

In 2017 alone, alcohol was associated with 18,000 deaths and cost Canadian healthcare systems $5.4 billion.

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