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The Washington Post recently featured an article on the normalisation of heavy drinking for women. Citing targeted advertising and multiple media, particularly to girls on social media, the article outlines the dangers in this trend of treating alcohol as a lifestyle rather than a drug. The obvious dangers are that normalising heavy drinking will increase the number of alcohol-exposed pregnancies and have a negative impact on girls’ and women’s health. Advertising exploits the positive connections women seek with each other, making it about drinking together and promoting it on t-shirts, cups, cards and even wine labels.
The liquor industry is attempting to link drinking with gender equality. But there is nothing equal or liberating about the risks women and girls face, or the distain that is heaped upon them for drunkenness. A recent article in the Daily Mail supported public shaming of binge drinking by young women in particular, and featured numerous denigrating photos of them on New Year’s Eve. Many pointed out the hypocrisy of moralising (Suzanne Moore, The Guardian). A different dialogue is needed: one that focuses on facts, health, education, and creates platforms of conversation and support.
It’s science not sexism that reveals the risks and consequences of heavy drinking for women and girls, and ways to reduce harm. We have learned why women may drink, the effectiveness of non-judgmental approaches to reducing harm, and best practices and policies for promoting health. The facts are not as confusing as some suggest and by focusing on them, we can counter normalising and moralising.
- Women’s bodies process alcohol differently, so woman’s alcohol level will be higher than a man drinking the same amount. Canada’s low-risk drinking guidelines reflect this sex difference.
- Men, in general, are riskier drinkers than women as evidenced by rates of alcohol-related injury and mortality, but women have more chronic health risks related to heavy drinking (Wilsnack & Wilsnack, 2013).
- Beyond the risk of addiction, Jennie Cook’s research found a causal link between drinking and at least 7 forms of cancer for both sexes (Connor, 2017).
- Claims of protective factors for cardiovascular disease are coming under scrutiny and skepticism even as these claims remain a core industry research topic and argument for drinking (Chikritzhs, Fillmore, & Stockwell, 2009)
- How and when we present the facts of drinking alcohol to women and their partners makes a difference to the health of women and their families (See 10 Fundamental components of FASD Prevention from a women’s health determinant perspective).
- Prevention of alcohol harms requires a tiered response in policy, practice, and messaging (See FASD Prevention: Canadian Perspectives)
- Comprehensive and integrated programs that build relationships work best for supporting women in making healthy choices for themselves and their families (See Mothercraft’s Mother-Child Study)
Chikritzhs, T., Fillmore, K., & Stockwell, T. I. M. (2009). A healthy dose of scepticism: Four good reasons to think again about protective effects of alcohol on coronary heart disease. Drug and Alcohol Review, 28(4), 441-444. doi:10.1111/j.1465-3362.2009.00052.x
Coalescing on Women and Substance Use. http://coalescing-vc.org/virtualLearning/section2/documents/GirlsAlcoholPregnancyinfographic7.pdf
Connor, J. (2017). Alcohol consumption as a cause of cancer. Addiction, 112(2), 222-228. doi:10.1111/add.13477
Wilsnack, R. W., & Wilsnack, S. C. (2013). Gender and alcohol: consumption and consequences. In P. B. Peter Boyle, Albert B. Lowenfels, Harry Burns, Otis Brawley, Witold Zatonski, Jürgen Rehm (Ed.), Alcohol: Science, policy and public health (pp. 153-160). Oxford, England: Oxford University Press.
Some of you might be familiar with Dr Mike Evans and the great work of the Evans Health Lab. The Evans Health Lab “fuses clinicians and creatives, filmmakers and patients, social entrepreneurs and best evidence to create “edutaining” healthcare information.”
In 2011, his YouTube video “23 and 1/2 Hours: What is the single best thing we can do for our health?” went viral. To date, the video has been viewed 7.5 million times and translated into eight languages, including Arabic and Gaelic.
The latest video in his “Whiteboard Med School” series is called “A ReThink of the Way We Drink.” In this video, he explores some of the recent research on alcohol and health. He touches on low risk drinking guidelines and sex-specific differences. He also talks about why many health care providers are often reluctant to ask about alcohol use due to fears about alienating patients or appearing judgmental.
Check out this video and others here.
Last week, the Canadian Centre on Substance Abuse (CCSA) released Cancer and Alcohol, the first in a series of summaries of topics covered in Canada’s Low-Risk Alcohol Drinking Guidelines. These summaries were created to address specific health concerns or to discuss how to apply the low risk drinking guidelines for certain populations.
The CCSA will release the next summary topic, Youth and Alcohol, on Friday, January 31, 2014, which will address why youth up to the age of 25 should minimize their alcohol consumption. The following Friday, February 7, they will release a Women and Alcohol summary that will address the unique effects of alcohol on females and why the low-risk drinking limits differ for women and men.
The Cancer and Alcohol summary was developed on behalf of the National Alcohol Strategy Advisory Committee (NASAC) in collaboration with the Canadian Cancer Society. It highlights how drinking an average of one drink a day can increase the risk of developing certain types of cancers.
While the Low Risk Drinking Guidelines overall suggest that women consume no more than 10 drinks a week and no more than two drinks a day most days in order to reduce long-term risks for multiple chronic illnesses, women who are interested in reducing their risk of developing cancer should drink less than one drink a day.
That said, even small amounts of alcohol increase the risk of certain cancers, so the less alcohol you drink, the more you reduce the risk of developing cancer. Any type of alcohol — beer, wine or spirits — increases the risk of cancer.
All the summaries are available from the CCSA website at this location: http://www.ccsa.ca/Eng/Priorities/Alcohol/Canada-Low-Risk-Alcohol-Drinking-Guidelines/Pages/default.aspx. The guidelines and summaries are available in French.
For more on Canada’s Low Risk Drinking Guidelines, see previous posts:
Based on Canada’s Low Risk Drinking Guidelines, the campaign does not encourage individuals to stop drinking but rather to rethink their drinking and find a healthier relationship with alcohol.
The website includes downloadable posters and fact sheets on different aspects of the guidelines. “Size Matters” helps individuals to understand what is a standard drink. “Time Matters” describes the importance of spacing drinks and drinking slowly. “Choice Matters” describes impairment, injury and alcohol myths. “Sex Matters” looks at sex-specific differences in the guidelines and why women are more vulnerable to the effects of alcohol. “Everything Matters” examines the long-term risk of alcohol use including stroke, cancer and other chronic disease.
The Rethink Your Drinking website has a section specific to women. (The Low Risk Drinking Guidelines have different suggested limits for women and men and suggest avoiding alcohol altogether when pregnant, planning a pregnancy, or about to breastfeed).
For more on Canada’s Low Risk Drinking Guidelines, see previous posts:
FASD prevention resource from the Government of Manitoba
Healthy Child Manitoba has developed a resource called Girls, Women and Alcohol: Making Informed Choices which is designed to help women make healthy and well-informed choices about their alcohol use. The resource was written and reviewed by women for women to provide useful information about alcohol.
The resource is 16 pages and has six sections:
- Low Risk Drinking
- Risks of Heavy Drinking
- Individual Responses to Alcohol
- Other Factors
- Support for People Close to You
The resource states: “There is no known safe amount of alcohol, at any stage of pregnancy, that will completely prevent the risk of having a child with FASD.” (p. 10)
Alcohol Screening, Brief Intervention and Referral: Helping Patients Reduce Alcohol-related Risks and Harms is a resource for Canadian family physicians, nurse practitioners and other healthcare professionals developed by the College of Family Physicians of Canada and the Canadian Centre on Substance Abuse.
The online resource, available in both English and French, uses a three-step alcohol screening, brief intervention, and referral process. The resource section includes information on seven sub-populations, including women, alcohol and pregnancy, and alcohol and breastfeeding.
Research evidence supports screening and brief interventions for alcohol misuse as efficacious and cost-effective in a variety of settings.
There are a range of screening tools out there (see posts listed below for more); this resource incorporates Canada’s Low-Risk Alcohol Drinking Guidelines which were released in November 2011.
For more on screening in primary care settings, see previous posts:
- FASD Prevention in Sweden (June 4, 2012)
- “No Alcohol, No Risk” Film for Midwives (May 22, 2012)
- Women and alcohol resources from the American College of Obstetricians and Gynecologists (ACOG) (March 29, 2012)
- Addiction Toolkit: Alcohol Use in Pregnancy (September 26, 2011)
- Targeting Health Professionals in Western Australia (February 9, 2011)
- Ask, Advise, Assist – new guide for health professionals published by New Zealand Ministry of Health (September 15, 2010)
- SOGC releases new clinical guidelines on alcohol use and pregnancy (August 12, 2010)
The Danish national health board, Sundhedsstyrelsen, has been running an annual fall campaign with print, TV and billboard ads to promote moderate drinking.
Sundhedsstyrelsen suggests that women should drink no more than 7 drinks per week and that men should drink no more than 14 drinks a week.
This year, the campaign has a focus on the link between cancer and alcohol, including detailed information on breast cancer.
In terms of alcohol use during pregnancy, the campaign website recommends that women who are pregnant or trying to conceive avoid alcohol. “There is no lower limit for maternal consumption of alcohol during which it is safe to say that alcohol consumption will be harmless to the fetus.”
As a way of supporting the campaign, Sundhedsstyrelsen is asking that everyone ‘Stick a Cork in it” on Thursday, October 11th and completely abstain from drinking.
For more on low-risk drinking/moderation campaigns in other countries, see previous posts:
- “Alcohol? Know Your Limit” campaign from Germany (September 24, 2012)
- 2-3-4-0 Campaign in Quebec (September 17, 2011)
- Alcohol Think Again Campaign in Western Australia (June 19, 2012)
- First FebFast and debates about alcohol labeling in New Zealand (February 1, 2011)
Risky drinking declining faster in girls than boys?
Last week, German Health Minister Daniel Bahr (FDP) and the Federal Centre for Health Education (BzgA) announced a country-wide decline in binge drinking in teenagers and provided an update on the “Alkohol? Kenn dein Limit” campaign.
In 2009, BZgA started a campaign called “Alkohol? Kenn dein Limit” (Alcohol? Know your limit), with financial support from an association of private health insurance companies (about 50 million Euros over three years). The campaign focuses on 16-20 year olds and aims to reduced binge drinking and risky patterns of alcohol use by increasing awareness about the risks and dangers of alcohol misuse. The campaign includes billboards, TV and cinema ads, brochures, and Facebook.
A year before the campaign started, researchers found that 20% of teenagers (ages 12-17) said they drank five alcoholic drinks or more once a month or more. A recent survey in 2011 suggests that this figure has dropped to approximately 15%. Health Minister Daniel Bahr reports that alcohol is the most widely used substance in Germany; in 2010, approximately 26,000 teenagers between 16 and 20 had been treated in hospital for acute alcohol poisoning.
Interestingly, there appears to be sex differences in the overall decline in teenagers. The decline appears primarily related to changes in drinking practices of girls and in 12-15 year old boys. In 2008, 34% of girls reported drinking more than five drinks at a time once a month; in 2011, this decreased to 22%. There was little change in rates for 16-17 year old boys, who drink the most (almost half drink 5 or more drinks once a month or more).
In the age 18-25 group, more than 50% of young men reported drinking more than five drinks in one night during the previous month – twice that of young women.
Due to these reported sex differences in drinking practices, the next stages of the campaign (which is currently planned to continue for another year) will switch its strategy and use different messages, images and design to target girls versus boys. Check out the campaign website here to take a look. The website does include information/brochures for download on pregnancy and alcohol although this is not a focus in the campaign.
For more coverage of the campaign, see:
- Teen drinking down – but still high (The Local, Germany’s News in English, September 17, 2012)
- Alkohol? Kenn Dein Limit. – Alcohol? Know your Limit. (Osocio blog, September 17, 2012)
- «Alkohol? Kenn dein Limit»: Weniger Rauschtrinken bei Mädchen (Berliner Zeitung, September 20, 2012)
Campaign promotes moderation for men and women
Since Canada’s first Low-Risk Alcohol Drinking Guidelines were released in November 2011, various provinces and organizations have been developing campaigns and tools to help publicize them. (For more, see previous posts Canada’s new Low-Risk Alcohol Drinking Guidelines and Fact Sheets for Women on Understanding Canada’s New Low-Risk Drinking Guidelines).
In January 2012, Éduc’alcool, an independent, not-for-profit organization launched a campaign based on the new low risk drinking guidelines. (Éduc’alcool’s motto is “Moderation is always in good taste” and promotes a “culture of taste as opposed to drunkenness.”). The campaign includes print, TV, movies, and web ads as well as social media such as Facebook and YouTube. The video above was designed to reach a younger audience. A free booklet on low risk drinking guidelines was made available at liquor stores, hospitals, and community health centres.
The campaign uses the formula 2-3-4-0 to help people apply the low risk drinking guidelines.
“Women who want to avoid long-term problems should limit themselves to two drinks a day and 10 a week. For men, the limits are three drinks a day and 15 a week. That’s the 2-3 part of the expression.
Of course, there is no harm in drinking a little more than that every now and then. On a special occasion, for example, women may have three drinks and men, four, provided, of course, that such “special occasions” don’t occur too frequently. That’s the 3-4 part.
Lastly, to avoid physical and psychological addiction, the recommendation is that everyone should abstain from drinking at least one day a week. That’s the 0.”
As the low risk drinking guidelines emphasize sex differences, the formula takes this into account. Interestingly, three of the six print ads developed for the campaign emphasize sex differences with the messages:
- “It’s not sexist. It’s science.”
- “2 for the Lady. 3 for the Gentleman.”
- “Men can take more.”
While the formula does not address pregnancy, the campaign answers the question “What about pregnant and nursing women?” by saying:
“While there appear to be only minimal risks related to very light drinking during pregnancy, no truly safe limit has been determined. It is therefore recommended that pregnant women and those wanting to become pregnant abstain from drinking. Nursing mothers should not drink before they nurse.”
Éduc’alcool also has a series of publications on “Alcohol and Health” which covers the topics:
- Pregnancy And Drinking: Your Questions Answered
- The Effects of Moderate and Regular Alcohol Consumption
- Alcohol and the Human Body
- Alcohol and Seniors
- The Effects of Abusive Drinking
- Low-Risk Drinking: 2-3-4-5-0
- Alcohol Combinations
You can also take a look at a resource developed by the Quebec Department of Health and Social Services in 2010 called “Pregnant? Alcohol and drugs – Be proactive” on the addictions section of the website. While the topic of FASD is treated separately within the publication, I thought it was interesting that the publication as a whole addressed alcohol and drugs together rather solely focusing on alcohol (makes sense but it’s usually not how the issue is treated).