By: Lauren Cutler
On January 17, 2023, Canadian health officials from the Centre on Substance Abuse and Addiction released new guidelines for alcohol consumption, replacing a previous set from over ten years ago. These guidelines are reflective of “growing evidence, after decades of sometimes conflicting research, that even small amounts of alcohol can have serious health consequences.” In the technical summary, the Centre states that the costs associated with alcohol use in Canada in 2017 were a whopping $16.6 billion. $5.5 billion of that sum was attributable to healthcare costs.
Just prior to the release of these guidelines, on January 4, 2023, the World Health Organization (“WHO”) published an article with the headline “No level of alcohol consumption is safe for our health.” In it, WHO write that “[r]isks [posed by alcohol] start from the first drop,” contradicting previous messaging regarding “potential beneficial effects of light and moderate drinking on cardiovascular diseases and type 2 diabetes.” As of now, no studies have shown “a particular threshold at which the carcinogenic effects of alcohol start to manifest in the human body,” meaning that “no safe amount of alcohol consumption for cancers and health can be established.”
These statements, both by the WHO and the Canadian Centre on Substance Abuse and Addiction, are a stark departure from past recommendations based on research on alcohol’s protective benefits as well as the United States’ current ones, which advise not drinking or drinking in moderation and limiting intake to two or fewer drinks per day for men and one or fewer drinks per day for women.
Despite the novelty of such statements, knowledge of the risks alcohol poses is not new; alcohol was labeled a Group 1 carcinogen by the International Agency for Research on Cancer decades ago. This group includes asbestos, radiation, and tobacco. Likewise, studies in 2009 concluded that alcohol was responsible for approximately 20,000 cancer deaths in 2009 alone. Alcohol is an associated risk factor for the development of specific cancers, such as those of the mouth, throat, liver, colon, rectum, and breast. The data seems clear on this point: more alcohol consumed, the greater the risk.
Binge drinking, however, is still a serious problem. The Center for Disease Control and Prevention states that one in six adults in the United States binge drinks and 25% do so weekly. This issue has only been exacerbated during the Covid-19 pandemic; a study by the National Institute on Alcohol Abuse and Alcoholism showed that “alcohol consumption in November 2020 was 39 percent higher than in February 2020, with a 30 percent rise in binge drinking.” Additional research by the Institute also revealed a 2.9% per capita consumption of alcohol in 2020, which was the fastest rate seen since 1968. Even more alarmingly, “alcohol-related deaths increased 25 percent between 2019 and 2020.” These statistics seem surprising given the growing wealth of research on the harmful effects of alcohol, but it is possible that stronger messaging from countries themselves may be necessary to change public behavior. Such messaging may need to emphasize the dangers of even light to moderate alcohol consumption, which poses significant risks in and of itself.
It is unclear what, if any, legal implications this new research may have, but it is certainly plausible to think that there will be some in the future. It may be worthwhile to look to restrictions on the tobacco industry to predict possible future legislation given that research has shown that drinking one bottle of wine per week is equivalent to smoking five cigarettes per week for men or ten cigarettes per week for women. There exist numerous state and federal laws directed at smoking and at tobacco companies, including “[h]eavy taxes, advertising bans, plain packaging containing explicit health warnings, and a ban on smoking in public places.” These government-mandated changes have reduced smoking prevalence from 46% in 1974 to 19% in 2014, and in 2019, “over 70% of the population now understand smoking to be a major cause of cancer compared with 40% in 1966.” These statistics seem to suggest that legally mandated messaging is incredibly effective. This is especially significant given that relatively recently research has shown that drinking has similar effects on the body to smoking.
As further research is conducted and public health messaging becomes more blunt, it is possible that countries may issue guidelines or warnings similar to those in Canada. The severity of such warnings will likely depend on each country’s approach to public health and prevention, which vary significantly as evidenced by the Covid-19 pandemic. Whether the alcohol industry becomes as heavily regulated as the tobacco industry remains to be seen, but in the meantime, all eyes will be on Canada to see whether its updated guidelines have any effect on behavior or legislation.
Lauren Cutler is a Staff Editor at CICLR.
 Michael Levenson, Canada’s New Guidelines for Alcohol Say ‘No Amount’ Is Healthy, N.Y. Times (Jan. 18, 2023), https://www.nytimes.com/2023/01/18/world/americas/canada-alcohol-health-guidelines.html [https://perma.cc/C56G-VCGL]; Canadian Centre on Substance Use and Addiction, Canada’s Guidance on Alcohol and Health: Final Report (Jan. 2023), https://www.ccsa.ca/sites/default/files/2023-01/Canada%27s%20Guidance%20on%20Alcohol%20and%20Health%20Final%20Report.pdf [https://perma.cc/Y7Y5-ETRA].  Levenson, supra note 1.  Canadian Centre on Substance Use and Addiction, supra note 1,at 6.  Id.  No Level of Alcohol Consumption is Safe for our Health, World Health Org. (Jan. 4, 2023) [hereinafter Alcohol Consumption], https://www.who.int/europe/news/item/04-01-2023-no-level-of-alcohol-consumption-is-safe-for-our-health [https://perma.cc/U7NN-6NKM].  Id.  Benjamin O. Anderson et al., Health and Cancer Risk Associated with Low Levels of Alcohol Consumption, 8 The Lancet Pub. Health e6 (2023).  Tanya Chikritzhs, Kaye Fillmore & Tim Stockwell, A Healthy Dose of Scepticism: Four Good Reasons to Think Again About Protective Effects of Alcohol on Coronary Heart Disease, 28(4) Drug Alcohol Rev. 441 (2009).  Levenson, supra note 1; Dietary Guidelines for Alcohol, Ctrs. for Disease Control & Prevention (Apr. 19, 2022), https://www.cdc.gov/alcohol/fact-sheets/moderate-drinking.htm [https://perma.cc/C6GD-MCKW].  Alcohol Consumption, supra note 5.  Id.  Dafna Kanny, The Surprising Link Between Alcohol and Cancer, Ctrs. for Disease Control & Prevention (Apr. 14, 2014), https://blogs.cdc.gov/cancer/2014/04/14/the-surprising-link-between-alcohol-and-cancer/ [https://perma.cc/5ND9-X52K].  Dietary Guidelines for Alcohol, supra note 9.  Binge Drinking, Ctrs. for Disease Control & Prevention (Nov. 14, 2022), https://www.cdc.gov/alcohol/fact-sheets/binge-drinking.htm [https://perma.cc/22TY-Y26M].  Id.  Alvin Powell, Sifting the Damage of Pandemic-era Drinking, The Harvard Gazette (June 14, 2022), https://news.harvard.edu/gazette/story/2022/06/harvard-specialists-sift-damage-of-pandemic-era-drinking/ [https://perma.cc/AQ63-3328].  Id.  Id.  Anderson, supra note 7.  Vivien Williams, Mayo Clinic Minute: Is Alcohol the New Smoking?, Mayo Clinic (May 3, 2019), https://newsnetwork.mayoclinic.org/discussion/mayo-clinic-minute-is-alcohol-the-new-smoking/ [https://perma.cc/N7LT-QU3K].  Theresa J. Hydes et al., A Comparison of Gender-Linked Population Cancer Risks Between Alcohol and Tobacco: How Many Cigarettes are There in a Bottle of Wine?, 19 BMC 316 (2019).  Id.  Id.