A middle-aged man walked into the doctor’s office for a routine check-up and was asked about his alcohol intake.
The patient said he just drinks socially, with the guys on the weekend, recalls Dr. Danielle Manis, who has been practising family medicine for more than 20 years.
But Manis remembered an old lesson from med school — if someone says they have five drinks a week, it’s likely closer to 10.
“It’s amazing what people will consider normal if their peers are all doing the same,” said Manis, now chief of the Department of Family and Community Medicine at North York General, who nudged him on what he considered social drinking.
“I learned he was drinking a two-four of beer every weekend,” or nearly 100 drinks a month, she recalled.
Alcohol is deeply woven into Canadian culture, a mainstay of social gatherings and family functions across traditions. But it’s also a Group 1 carcinogen, meaning there is conclusive evidence that it causes cancer, as well as heart and kidney diseases, and for which the World Health Organization says there is no level of safe consumption.
Doctors who spoke to the Star said they frequently see patients who don’t realize they’re drinking too much, are unfamiliar with Canada’s low-risk guidelines and aren’t aware their intake is linked to other ailments such as anxiety, depression, insomnia and high-blood pressure.
They’re calling for a shift in how Canadians think about their alcohol consumption, as well as in how alcohol is depicted in ads and other media and discussed in social circles.
The notion that Gen Z (ages roughly 14-29) is drinking less than previous generations is challenged in a new paper, with the rate rising from 66 per cent three years ago to 74 per cent, putting them on par with the total adult population. IWSR’s Bevtrac survey of consumer behaviour surveyed people in 15 countries (including Canada), and found millennials reported the highest alcohol consumption, at 81 per cent, while boomers were the lowest (71 per cent).
While this shows young people won’t provide a safety valve for the health, economic and safety implications of alcohol use in society, there is a silver lining — Gen Z drinkers, at 49 per cent, were the most likely to heed government guidance on alcohol intake.
Patients who come in and say they have a drinking problem are the “rare ones,” Manis said, noting it’s usually triggered by a life event like losing their job, legal challenges or criminal charges, family rupture, or frequently, by visible weight gain.
She said she often sees patients seeking help with other physical and mental ailments who don’t realize that alcohol is the hidden, underlying cause.
“People are very surprised to learn that alcohol is a huge risk factor and that alcohol’s actually making their sleep worse or causing their blood pressure to be high or putting them at risk of a heart arrhythmia.”
Canada’s alcohol guidelines
In 2023, the Canadian Centre on Substance Use and Addiction (CCSA) issued new drinking guidelines, which have not been officially adopted by Health Canada, as a continuum of harm. It advised zero to two drinks a week to keep the risk of health issues low. The measure was somewhat controversial, attracting media coverage and spawning memes, as it largely departed from the more permissive limit of 15 standard drinks per week for men and 10 for women, which is still listed on the federal website.
In a statement, Health Canada said it works closely with the CCSA and advises that any reduction in alcohol use is beneficial for health, and to not start drinking alcohol if you don’t already.
The doctors who spoke to the Star all said they recommend patients try to abide by the new low-risk guide. But Dr. Anita Srivastava, medical director of addictions and a family physician at St. Joseph’s Health Centre, said many patients are still under the impression that a glass of wine every day is perfectly acceptable or even healthy.
“Most people are not aware of these guidelines and are quite surprised when I tell them,” she said.
Encouraging abstinence is not always effective, Manis acknowledged, so she aims for “easy wins,” like being mindful of alcohol intake, gradually reducing drinking and lifestyle changes such as exercising more and maintaining a more balanced diet.
Promotion and media portrayal
Manis said alcohol is socially acceptable, accessible and deeply embedded in our social fabric, especially “this culture of moms and wine and cocktails,” like the hard-working mom justifying a glass of wine (or two or three) after finishing work and finally putting the kids to bed.
“It’s been really glorified as a fun, feminine bonding kind of lifestyle thing, which I would really like to see start to unravel,” she said, whereas among men, drinking is more associated with going to the bar and watching the game.
Srivastava said activities like “mimosas on the weekend,” or drinking excessively at parties, or binge drinking at bars and clubs, are “romanticized” in popular culture.
For some, this can make it hard to curb their drinking, because “they’re giving up the alcohol, but they’re also giving up a lifestyle,” Srivastava added.
Dr. Gabilan Sivapatham, a family physician at University Health Network and addictions doctor at Women’s College, said there’s a “disconnect” between how alcohol is advertised in Canada, in commercials and billboards and elsewhere, compared to substances like tobacco and cannabis, as well as in Ontario’s recent expansion of alcohol to convenience stores and gas stations.
“When you think about the risk factor and all the steps that we’ve taken as a society to limit availability of other things, and then to have something like this available as free as it is, it doesn’t add up,” he said.
How do you know if you’re at risk?
When Manis learns people are drinking more than recommended, her first question is “Why are you drinking?” She said if they identify stress, anxiety or insomnia, it’s a red flag they’re self-medicating and could benefit from lifestyle changes or may need to seek therapy or medication.
Srivastava said she explores if the patients attach a lot of emotion and importance to drinking, for example, fantasizing about pouring a glass as soon as they get home from work.
“One of the things I say is, do you think you could go for a week without a drink? And it’s a question that often startles people,” and makes them question their relationship with alcohol, she said.
Sivapatham said if people notice their drinking is affecting their mental and physical health, their ability to function or show up to work and school, a loss of control over their drinking, or causing concern among friends or loved ones, they should seek help.
“There are medications and forms of psychotherapy and supports available. I think we’re constantly surprised by the number of patients who didn’t realize that there could be something more done.”
