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Wednesday, 7 December 2011

Alcohol - lower risk consumption guidelines released

Before the main item, an acknowledgement to the National Day of Remembrance and Action Against Violence against Women in recognition of the 22nd anniversary of the l'École Polytechnique de Montréal  tragedy.

In a recurring theme, addictions and psychoactive substances once again make the blogosphere headlines.  This time it is that substance that over 80% of us use regularly, alcohol.  The document is an attempt at converging a variety of differing recommendations on harm reduction approaches to the use of alcohol as a legal, addictive, psychoactive substance for which national per capita use is increasing about 1% per year. 

It is also the one substance for which positive population health attributes are noted (tobacco, cannabis and other substances have much less, if any,  evidence of a population or net individual level benefit).

The guidelines build on previous national work that called for a national strategy on harm reduction for alcohol, a subject this blog addressed previously (October 7, 2011 alcohol national strategy need.) 

The document is as much a science review of the current knowledge of risk and benefit associated with alcohol, and as such is recommended reading for public health practitioners to stay current (and trainees preparing for exams) in a relatively rapidly changing environment.   Amazingly, and to the credit of the authors, they have summarized the data into three readable tables on pages 28-30 of the report.  It is as much out of respect for the quality of the work that they aren’t replicated here and the reader is urged to follow the link below to the full report.

This national effort is done despite at least 4 different existing low risk guidelines currently in place in Canada. It will result in an increase for consumption above existing Ontario and Quebec weekly guidelines, and align more closely with those in place in the provinces on the two coasts. 

There are two downsides to be noted that reflect the policy environment in Canada. While this is a superb reference and report and its authors are recognized academic leaders in the country, it carries no weight of government support or willingness to adopt, and secondly, while the report is published it has not undergone the level of public scrutiny to date that such guidelines might best be subjected. As a first step, the “keepers” of the existing guidelines should link to this material and if they are unwilling to migrate to the single set of recommendations, then justify why five different Canadian guidelines should be propagated. As a second step, Health Canada and PHAC should transparently review and consider incorporation of the guidelines as a step in the development of a national alcohol strategy rather than continuing the current approach to outsourincing quasi-national policy to an arm's length organization, in this case the Canadian Centre on Substance Abuse (http://www.ccsa.ca/) .

Despite the policy development gaffs, quality efforts such as this may meet the ultimate tests, that of professional acceptability and of time.   Kudos to the National Alcohol Strategy Advisory Committee who have released the document and continue to push for a national alcohol control strategy.  Low risk alcohol consumption guidelines 

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