Are you drinking TOO much? Alcohol is the most commonly used potentially addictive substance in our society. Alcohol is responsible for over half of the $267 million dollars of substance related hospital costs in Canada. Problematic alcohol use significantly impacts individuals, families, and our community, but many struggle to know if they have a problem and where to go for help. Learn more: http://www.theroyal.ca/mental-health-centre/news-and-events/newsroom/13411/alcohol-how-much-is-too-much/

1. Conversations at the Royal
Alcohol: How Much is Too
Much?
Dr. Kim Corace, Director Program Development & Research
Dr. Melanie Willows, Clinical Director
Substance Use and Concurrent Disorders Program
November 19, 2015

2. Outline/Learning Points
• How to tell if you or a loved one has a problem with
alcohol
• The relationship between alcohol use and mental
health disorders
• Treatment options for alcohol use disorders,
including where to seek help

3. Who has an alcohol problem?
• 55 year old homeless man drinking hard liquor
from morning to night
• 39 year old woman executive drinking 1 litre of
wine every night after work
• 25 year old man who binges every weekend has
had 2 impaired driving charges and has lost several
jobs for not showing up

4. The total societal cost of alcohol abuse
in Canada is estimated to be
$14.6 billion or
$463 for every Canadian
*The Costs of Substance Abuse in Canada 2002 (Rehm et al., 2006)

5. Source: CCSA, 2014

6. Source: CCSA, 2014

7. Source: CCSA, 2014

8. Most people in need of treatment for
alcohol use problems do not get it

9. WHAT IS “NORMAL” DRINKING?

10. 341 ml (12 oz.) bottle
of 5% alcohol beer,
cider or cooler
142 ml (5 oz.) glass
of 12% alcohol
wine
43 ml (1.5 oz.)
serving of 40%
distilled
What is “One Standard Drink”?
(equivalent to 13.6 grams of alcohol)

11. Calculating How Much I am Drinking
• Wine
– 750ml bottle = 5 standard drinks
– 1 L bottle = approx. 8 standard drinks
– 1.5 L bottle = 10 standard drinks
• Beer
– Size? 341ml, 355ml, 473ml, 500ml, 600ml, 710ml
• Hard Liquor
– 13 oz (mickey) 375ml = 8 standard drinks
– 26 oz bottle 750ml = 17 standard drinks
– 40 oz bottle 1140ml = 26 standard drinks

12. Canadian Guidelines for Low Risk Drinking*
Recommendation 1
• Reduce your long-term health risks by drinking no
more than:
• 10 drinks a week for women,
with no more than 2 drinks a day most days
• 15 drinks a week for men,
with no more than 3 drinks a day most days
• Plan non-drinking days every week to avoid developing
a habit.
**Guidelines are intended for individuals 25 to 65

13. Canadian Guidelines for Low Risk Drinking
Recommendation 2
• Reduce your risk of injury and harm by drinking no
more than 3 drinks (for women) and 4 drinks (for
men) on any single occasion.

14. Canadian Guidelines for Low Risk Drinking
Recommendation 3
Do not drink when you are:
– driving a vehicle or using machinery and tools
– taking medicine or other drugs that interact with
alcohol
– doing any kind of dangerous physical activity
– living with mental or physical health problems
– living with alcohol dependence
– responsible for the safety of others
– making important decisions

15. Canadian Guidelines for Low Risk Drinking
Recommendation 4
If you are pregnant, planning
to become pregnant, or
before breastfeeding, the
safest choice is to drink no
alcohol at all.

16. Canadian Guidelines for Low Risk Drinking
Recommendation 5
If you are a child or youth, you should:
• Delay drinking until your late teens
• Talk with your parents about drinking.
Alcohol can harm the
way your brain and
body develop.
• If you are drinking, plan ahead, follow local
alcohol laws and stay within the limits
outlined in Guideline 1

17. HOW MUCH IS EVERYBODY ELSE
DRINKING?

18. Past Year Drug Use (%) for the Total Sample, and by
Sex and Grade, 2013 OSDUHS (CAMH)
Total Male Female G7 G8 G9 G10 G11 G12
Alcohol 49.5 49.8 49.1 9.9 24.6 37.1 53.5 67.9 74.4
Cannabis 23.0 25.3 20.6 1.7 7.0 14.6 24.5 33.5 39.2
Binge Drinking 19.8 21.3 18.3 3.7 8.5 18.1 29.5 39.2
Opioid Pain
Relievers (NM)
12.4 12.8 12.0 8.8 8.9 11.8 13.0 12.1 16.1
Cigarettes 8.5 9.6 7.3 3.3 9.1 12.9 15.4

19. Canadian Alcohol and Drug Use Monitoring Survey 2012
(CADUMS)
Pattern of Drinking Percent Reporting
Exceed chronic guideline (>10 drinks per
week or more than 2 drinks per occasion for
women or >15 drinks per week or more than
3 drinks per occasion for men)
9.2%
Exceed acute guideline (3 or more per
occasion for women or 4 or more per
occasion for men)
14.4%
Past year any consumption of alcohol 78.4%
Youth (15-24) rates exceeds adults
Males rates exceed Females

20. HARMFUL EFFECTS OF ALCOHOL

21. Effects of Drinking Alcohol
• Impaired thinking and judgement
• Speech
• Vision
• Balance
• Co-ordination
• High blood levels of alcohol can cause your
breathing rate and heart rate to decrease and may
even cause death in nontolerant individuals

22. Binge Drinking
• Definition
– MEN: consuming 5 or more drinks on any one occasion
– WOMEN: consuming 4 or more drinks on any one occasion
• OSDUHS study of high school students:
– No gender differences in binge drinking;
– 18% of students could not remember what had happened
while they were drinking on at least 1 occasion (last month);
– 8% report that they or someone else was injured as a result
of their drinking;
– 4% of drivers (grade 10-12) report driving after consuming 2
or more drinks

23. Risks of Binge Drinking
• Addiction
• Problems in school, relationships, work
• Injuries
• Legal issues
• Sexually transmitted infections
• Unintended pregnancy
• Breast cancer, heart disease
• Death (accident, overdose)

24. ALCOHOL WITHDRAWAL IS A MEDICAL
ISSUE: IT IS POTENTIALLY LIFE
THREATENING

25. What is Alcohol Withdrawal?
• Occurs within 4 to 12 hours after last drink
• Most severe symptoms peak 48 to 72 hours after last
drink
• Withdrawal symptoms typically improve by the 5th day
• Most common symptoms: elevated blood pressure,
sweating, hand tremor, anxiety, difficulty sleeping
• Potentially life threatening with more serious symptoms:
seizures, delirium, elevated blood pressure and heart
rate

26. Could you be at risk of serious alcohol
withdrawal?
• Previous history of alcohol withdrawal seizures
• Previous history of delirium tremens
• Daily drinking more than 6 drinks per day
• Drinking throughout the day
• Unsuccessful attempts to stop drinking for more
than two or three days
• Previously required medication to withdraw from
alcohol
• Previously sent to ER for alcohol withdrawal
management
• Cirrhosis of the liver (advanced liver disease)
26

27. Can alcohol withdrawal be treated?
• Yes!
• The serious complications of alcohol are
preventable with “medical withdrawal
management”
• There are medications that can help.
• Talk to your doctor or nurse practitioner to help
you

28. HOW DO I KNOW IF I MIGHT HAVE
A PROBLEM?

29. Alcohol Use Disorders Identification Test
(AUDIT; Saunders et al., 1993)
1. How often do you have a drink containing alcohol?
Never
(0)
Monthly or less
(1)
2 to 4 times a
month
(2)
2 to 3 times
per week
(3)
4 or more times
per week
(4)
2. How many drinks containing alcohol do you have on a typical day when drinking?
1 or 2 3 or 4 5 or 6 7 to 9 10 or more
3. How often do you have six or more drinks on one occasion?
Never Less than
monthly
Monthly Weekly Daily or Almost
daily
4. How often during the last year have you found that you were not able to stop drinking
once you had started?
Never Less than
monthly
Monthly Weekly Daily or Almost
daily
5. How often in the last year have you failed to do what was normally expected from you
because of drinking?
Never Less than
monthly
Monthly 2 to 3 times
per week
4 or more times
per week

30. 6. How often during the past year have you had a drink in the morning to get yourself
going after a heavy drinking session?
Never
(0)
Less than
monthly
(1)
Monthly
(2)
Weekly
(3)
Daily or almost
daily
(4)
7. How often during the last year have you had a feeling of guilt or remorse after drinking?
Never Less than
monthly
Monthly Weekly Daily or almost
daily
8. How often during the last year have you been unable to remember what happened the
day before because of drinking?
Never Less than
monthly
Monthly Weekly Daily or almost
daily
9. Have you or someone else been injured because of your drinking?
Never Yes, but not in
the last year
Yes, during the
last year
10. Has a relative, friend, doctor, or other health care worker been concerned about your
drinking or suggested you cut down?
Never Yes, but not in
the last year
Yes, during the
last year

31. AUDIT: What does my score mean?
• Score of 8 or more: harmful/hazardous
drinking
• Score of 13 or more in women; 15 or more in
men indicates likely alcohol dependence
*This is just a screening tool, so be cautious when
interpreting your score. If you have any concerns,
talk to your doctor, nurse, or a health professional.

32. Ottawa Public Health: Check Your Drinking
http://www2.checkyourdrinking.net/

33. WHAT ABOUT ADDICTION?

34. Addiction is a developmental disease that
starts in adolescence and childhood1
1NESARC , 2003

35. Addiction is a Disease
• Primary, chronic disease of brain reward,
motivation, memory and related circuitry
• Characterized by inability to consistently
abstain, impairment in behavioural control,
craving, diminished recognition of
significant problems with one’s behaviours
and interpersonal relationships, and a
dysfunctional emotional response
ASAM, 2011

36. What is addiction?
• Like other chronic diseases, addiction often
involves cycles of relapse and remission
• Addiction is progressive and can result in
disability or premature death
ASAM, 2011

37. The “4 C’s” of Addiction
• CRAVING
• Loss of CONTROL
• Use despite CONSEQUENCES
• COMPULSIVITY

38. Alcohol Use Disorder* is a Mental Health
Disorder
• A problematic pattern of alcohol use leading to
clinically significant impairment or distress, as
manifested by at least two of the following, occurring
within a 12 month period.
• Criteria fit within the overall groupings of:
– Impaired Control (criteria 1-4)
– Social Impairment (criteria 5-7)
– Risky Use (criteria 8-9)
– Pharmacological (criteria 10-11)
*DSM-V

39. Risk Factors for Substance Use Problems
ADDICTION
Vulnerable
Host
Environment/
Sociocultural
Context
Repeated
substance
use

40. IS THERE A RELATIONSHIP BETWEEN
ALCOHOL PROBLEMS AND MENTAL
HEALTH PROBLEMS?

41. Concurrent Disorders
Mental Health Disorder
+
Substance Use Disorder
+
Physical Health Disorder
_____________________________________________________
Concurrent Disorder

42. Concurrent Disorders are the Norm
• People with alcohol use problems have higher
rates of mental health problems than the general
population
• People with mental health problems have higher
rates of alcohol use problems than the general
population
• 37% of people with an alcohol use disorder will
have a mental health disorder at some time in
their lives1
1Epidemiological Catchment Area study

43. Lifetime Comorbidity of Mental Health
Disorders and Alcohol Dependence
Mental
health
disorder
Individuals With Alcohol Dependence
Men Women
% Odds Ratio % Odds Ratio
Anxiety 35.8 2.2 60.7 3.1
Mood 28.1 3.2 53.5 4.4
National Comorbidity Survey (Kessler, et al, 1997)

44. Concurrent Treatment is Key
• Treating both mental health and alcohol use
problems together = Greater chance of success
• If mental health and alcohol use problems are
caught and treated early, people have a better
chance of a quicker and fuller recovery

45. IF I THINK I (OR MY LOVED ONE)
HAS A PROBLEM, WHAT CAN I DO?

46. Stages of Change
Contemplation
Pre-
Contemplation
Preparation
Maintenance

47. Safer Drinking Tips
• Set limits for yourself and stick to them
• Drink slowly. Have no more than 2 drinks in any 3
hours.
• For every drink of alcohol have one non-alcoholic
drink.
• Eat before and while you are drinking.
• Always consider your age, body weight and health
problems that might suggest lower limits
• Reducing risk of harm (i.e. drinking and driving)
• Gradual reduction to lower level of drinking, with
potential to work towards a safer quit attempt

48. What treatments are available?
• There are many treatment options available to help:
– Withdrawal Management
– Medication
– Psychotherapy (“Talk therapy”)
– Mental Health Treatment
– Physical Health Treatment
– Self-help groups
– Community or hospital based; residential treatment
• Treatments are not “one size fits all
• Talk to your doctor or nurse practitioner to get started

49. • Family Doctor or Nurse Practitioner
• The Royal’s Substance Use and Concurrent
Disorders Program
• Ottawa Withdrawal Management Centre
• OAARS: Ottawa Addiction Assessment and
Referral Service
• Self Help Meetings: AA, SMART Recovery
What services are available in Ottawa?

50. What are the resources for families?
• The Royal – Family Information Sessions
– Wednesday evenings information session from 6-8pm at
1145 Carling Avenue, option to attend via OTN
– Next one is December 2nd, 2015
• Family Groups: Al-anon; Al-ateen
• Rideauwood Addictions and Family Services
– Family Member Program provides education, crisis
support and counselling
• Serenity Renewal
• Family Doctor or Nurse Practitioner