Dan Malleck is a professor in the Department of Health Sciences at Brock University, a medical historian who specializes in drug and alcohol regulation and policy, and the author of books including Liquor and the Liberal State: Drink and Order Before Prohibition.
Two drinks a week. That guidance for low-risk drinking has dominated the headlines around the latest advice Canadians have received about how much alcohol they should consume.
The new Health Canada-funded guidelines, which were released by the Canadian Center on Substance Use and Addiction (CCSA) this week, recommend revising safe drinking limits, arguing that beyond one to two drinks a week, you are increasingly at risk of a range of conditions, including heart disease, stroke and cancer.
But before you throw out your wine collection, let’s try some perspective.
First, a caveat: I am not an anti-public health zealot. I am a scholar who studies alcohol in its social and cultural environment. But I am also wary of generalized recommendations of behavior change based upon narrowly selected evidence from a cohort that sounds increasingly like the 19th-century temperance movement.
Although reports have suggested that the guidelines are based on nearly 6,000 peer-reviewed studies, strict criteria ruled all but 16 systematic studies out from being used in the mathematical modelling. In other words, the CCSA is basing its recommendations on a relatively narrow understanding of how alcohol functions.
Often, too, these kinds of studies involve looking at a broad cohort of people and seeing if those with a certain condition were more likely to have been drinkers. If researchers are only looking for drinking as a factor, it can be easy to miss other potential contributors. We don’t know, for instance, whether they spent their time drinking in smoky bars or restaurants (back when that was allowed), or did so while eating less healthy foods; these factors are often marginalized when alcohol becomes the focus.
The CCSA also presents the relative risk, rather than the absolute risk, of developing the various conditions. According to its data, consuming three and a half drinks a day increases your risk of developing larynx cancer by nearly 100 per cent, which sounds shocking, and is presented in a table with scary red shading. But larynx cancer, which is mostly related to smoking, was diagnosed in roughly 0.0197 per cent of Canadians in 2022. Many of the other cancers the CCSA associates with alcohol also have low incidence rates. And everyone has a different level of risk for various conditions, based on factors including lifestyle and genetics.
Alcohol’s association with cancer is important to examine, and the disease should not be disregarded. But it also needs context. After all, life is about making choices – and it helps to be fully informed.
We should also consider a researcher perspective. The CCSA is focused on harm-first, which is less a criticism than a fact: Although its name emphasizes “substance use and addiction,” its focus is on the negative side of “use.” Its job is to look for harm in the name of health. Through this lens, potential benefits don’t track.
And indeed, the CCSA made its recommendations without consideration of the potential (and well-documented) positive effects of alcohol on the lives of individuals, nor the potential harms caused by excessive and patronizing recommendations in the name of “for your own good” science .
These are important considerations, because human research on a population level (as compared with studies where all complicating factors are controlled in a lab, something you can’t do with long-term human research for legal and ethical reasons) is a point of contention among scholars. Although the CCSA does mention, near the end of the report, the considerable limitations to its conclusions, they do not seem to affect the urgency or excessiveness of its recommendations.
Meanwhile, persistent research results suggest that withdrawal can cause greater health harm than moderate alcohol consumption. Furthermore, alcohol can enhance lives in positive social ways: For many people, it is a way to celebrate or commiserate, to rejoice or mourn, to relax or blow off steam. There is robust research on the benefits of such social connectedness to health, showing that having positive social relationships can be more protective from long-term health harm than quitting smoking. Calling for significant lifestyle changes creates a stigma around something that can contribute to good health.
The CCSA has presented data that are largely removed from actual human behaviour, interactions and experiences – that is, the things that give life meaning. When you reduce human activity to a simplistic interpretation of biological processes, you are no longer looking at humanity. You’re just looking at numbers.
Without considering the potential dangers of such advice, and the potential benefits around moderate drinking, the CCSA recommendations seem worse than useless. They’re reckless.