Want to cut back on your drinking? Here’s some expert advice

It’s a tradition to raise a glass to toast the new year. And for most Canadians, that glass usually contains alcohol.

But some people may be rethinking that drink in light of national guidelines on alcohol and health, released in January 2023.

“The new guidance essentially says if you drink more than two drinks a week, you’re probably elevating the risk of health and social harms in your life,” Dr. Evan Wood told Dr. Brian Goldman, host of CBC’s The Dose.

Canada’s previous low-risk drinking guidelines recommended no more than 10 drinks a week for women and 15 for men.

But the evidence now shows that more than two standard drinks a week can increase the risk of some types of cancer and is also associated with a greater risk of harm to self and others, including injuries and violence.

If you’d like to cut back on drinking, experts say there are many ways to do it — or to assess whether your relationship with alcohol has become a problem.

What’s the risk? 

It’s important to weigh the risks of more than two drinks per week against your own personal risk, said Wood, an addiction medicine specialist and professor of medicine at the University of British Columbia in Vancouver.

“For somebody who has a family history of cancer, that 10 per cent increase might be very meaningful,” he said.

Someone with no family history of cancer may face less risk overall.

But for those with a history of low moods or suicide, alcohol could be particularly risky, he said.

The risk also depends on how many drinks you have.

“Once you get to five drinks a week, for liver disease like cirrhosis, that starts to go up really dramatically,” Wood said. 

How can I cut back on my drinking? 

Reducing our drinking can be tricky because alcohol is embedded in our culture, said Kara Thompson, an associate professor of psychology at St. Francis Xavier University in Nova Scotia.

“Particularly this time of year around the holidays, we see alcohol sales skyrocket because we use alcohol to celebrate,” said Thompson, who was a scientific member on the panel that developed the new alcohol and health guidelines.

Thompson and Wood both recommend trying some of the many new non-alcoholic beverages on the market.

“It lets you still feel like you’re having a drink that’s special and that you’re still part of the celebration, without the alcohol,” Thompson said.

She also suggests asking a friend to cut back with you — whether it’s just for one night or for a longer period of time — which can help keep you accountable. 

Using alcohol to deal with stress

For Canadian wine writer Natalie MacLean, the warning signs began during a stressful year when she found herself using wine to cope.

In 2012, MacLean, who has been a wine writer for 25 years, found cocktail hour was arriving earlier and earlier.

Dealing with stress from her divorce and anxiety from cyberbullying, “I started relying on wine too much as a crutch,” she said.

MacLean said she remembers one dinner party when she wandered into her home office and passed out on the couch after drinking too much.

“That was probably rock bottom for me,” she said.

MacLean started therapy and taking antidepressant medication — and realized she was using alcohol to deal with stress.

She shares strategies based on her own experience in her book, Wine Witch on Fire: Rising from the Ashes of Divorce, Defamation, and Drinking Too Much.

Her first piece of advice is to deal with the underlying issues in your life that may be causing you to drink. Specifically, identify the thought that comes before you think, “I need a drink,” MacLean said.

If that thought is about stress, try to find another way to cope with it.

Warning signs you have a problem with alcohol 

MacLean said she considered quitting alcohol altogether but decided that for her and her career, harm reduction was the right choice.

“Now I feel I am in a really good place with wine,” she said.

For those who may be struggling with their relationship with alcohol, it’s less about how much you are drinking and more about how it’s negatively affecting you, Thompson said.

WATCH | Many Canadians not being treated for high-risk drinking:

New guidelines on how to recognize and treat high-risk drinking

Two papers published in the Canadian Medical Association Journal address the problem of high-risk drinking — one on how often alcohol use disorder goes unrecognized and offers guidelines for treating it, the other showing that certain kinds of antidepressants can drive some alcohol users to drink more.

Alcohol use disorder affects someone who uses alcohol even though it causes them harm, and they try to cut back or quit and struggle to do so, said Wood, who sat on the committee for the new Canadian guidelines for high-risk drinking.

“It may be that they’re not sleeping well or maybe that they’re anxious — or it may be that their blood pressure has become elevated,” he said.

Thompson suggests starting with “Dry January” if you want to try to cut back or quit alcohol. “I’m going to be doing it myself, and it’s a great opportunity to connect with other people who are on a similar journey as you,” she said.

If you are drinking heavily, however, it can be unsafe to quit cold turkey, said Thompson, who recommends first talking to a medical professional. 

How to treat alcohol use disorder 

There are effective treatments for people with severe alcohol use disorder, including cognitive behavioural therapy and medications such as acamprosate and naltrexone, Wood said.

But those medications are rarely prescribed in Canada, he said.

“There just hasn’t really been the pharmaceutical industry push to have it normalized, and there’s lots of stigma,” Wood said.

Many people suffering from alcohol use disorder are prescribed antidepressants, frequently selective serotonin reuptake inhibitors (SSRIs), he said.

There is evidence to show that for some people, SSRIs may not only be ineffective but can cause them to drink more than when taking a placebo.

“If you go to your average physician in Canada, they have no idea that they may actually be giving a medication that will make people’s drinking habits worse,” Wood said. 

‘Drastic change’  

The new data around alcohol and risk of cancer and other harms may be difficult to face if you drink regularly, Thompson said, especially when alcohol is so culturally accepted in our society.

But the evidence on alcohol-related risk has advanced significantly in the past 12 years, she said.

“The evidence linking alcohol to things like cancer and diabetes and liver disease has strengthened,” Thompson said.

“The drastic change is a reflection of that advance in science.”