Statistical Overview of Alcohol Use

Global Burden of Disease

Alcohol Consumption

Health & Social Impacts

Economic Costs & Benefits

Rates of Consumption, Drinking Patterns & Alcohol-Related Harm

Alcohol Distribution & Management

Social Responsibility

Retail Alcohol Monopolies

Public Opinion

Effective Alcohol Policies & Interventions: 10 Best Practices

Introduction

Research has shown a connection between rates of drinking across the general population and rates of alcohol-related problems. For example, if sales figures indicate that more alcohol is being consumed compared to ten years ago, then statistics will likely show more alcohol-related injuries and deaths, other factors being equal.

Research has also demonstrated the effectiveness of certain policies in controlling the average level of drinking. When they control drinking levels, these policies, in effect, also control problem rates. Effective policies include such measures as minimum legal purchase age, a government monopoly system of retail sales, restrictions on hours of sale, and alcohol prices that keep pace with the cost of living.

The relationship between drinking rates and patterns, alcohol-related problems, and alcohol policy are discussed in detail in Alcohol Policy and the Public Good by Edwards et al. (1994)¹, and Alcohol: No Ordinary Commodity by Babor et al., (2003)².

Global Burden of Disease     Top

• A 2002 study sponsored by the World Health Organization indicated that alcohol is one of the leading risk factors for cumulative damage, disease and death.
• In developed countries, such as Canada, it is just below tobacco and blood pressure, and higher than cholesterol, body mass index, low fruit and vegetable intake, physical inactivity and illicit drugs in terms of its contribution to the burden of disease
• Disability adjusted life years (DALYS) is a way of measuring the disability, disease or death on a population from a risk factor.
• Here are the percentages for total DALYS for leading risk factors for developed countries; 12.2% tobacco, 10.9 blood pressure; alcohol 9.2%; cholesterol 7.6%; body mass index 7.4%; low fruit and vegetable intake 3.9%; physical inactivity 3.3%; illicit drugs 1.8%; unsafe sex 0.8%; and iron deficiency 0.7%.
• On a global basis, alcohol is estimated to contribute to 7% of all DALYS for malignant neoplasm (cancers); 385 of neuro-psychiatric conditions; 7% of cardiovascular diseases, 8% of other non-communicable disease (such as diabetes and liver cirrhosis), 28% of unintentional injuries (drunk driving crashes, falls, fires, etc.); and 12% of intentional injuries (e.g. suicide, homicide, sexual assault, other violence).

We can expect an increase in alcohol-related burden for several reasons: The disease categories related to alcohol are increasing on relative basis: chronic disease, accidents and injuries. Alcohol consumption is increasing in the most populous parts of the world. And high risk drinking patterns are stable, and may be getting worse.(Resources: Babor et al. 2003³ ; Rehm, 2003⁴ ; Rehm et al., 2003a⁵ ; Room & Rehm, 2004⁶ ).

Alcohol Consumption     Top

• Some 2,667 million litres of alcoholic beverages were sold in Canada in 2001/02, up 3.3% from the previous year. In per adult terms, this worked out to 84.7 litres of beer, 12.4 litres of wine and 7.1 litres of spirits for every Canadian aged 15 and older (Statistics Canada, 2002⁸).
• In Ontario 987.9 million litres of alcoholic beverages were sold in 2001/02, and increase of 3.1% over the previous year. By main beverage, the rates per person aged 15 and older were: 81.9 for beer, 10.9 for wine and 8.2 for spirits (Statistics Canada, 2002 ).
• Of particular significance is the increase in overall rate of consumption in recent. In 2001/02 the per adult rate in terms of absolute alcohol, was 7.7 for Canada and 7.6 for Ontario. Since 1997/98 this rate has increased by 5.5% for Canada, and 7.0% for Ontario. (Absolute alcohol refers to the amount of pure alcohol, or ethanol, in beer, wine and distilled spirits beverages.) (Statistics Canada, 2002⁹ ).
• According to the 2004 Canadian Addiction Survey (Canadian Centre on Substance Abuse [CCSA], 2004¹⁰), 79% of Canadians over the age of 15 years are current drinkers. A current drinker is defined as someone who had a drink in the past 12 months. About 7% of current drinkers are "heavy frequent" drinkers (5 or more drinks per occasion at least once a week). Young adults and males generally consume more alcohol than other groups.
• This current drinker, or drinking prevalence estimate, is up from 72% in 1994¹¹ and similar to 78% in 1989¹² (CCSA, 2004¹³).
• This national survey also showed that 7% were lifetime abstainers, and 13.5 were former drinkers.
• It noted that 22.6% of past year drinkers exceeded the low-risk drinking guidelines, with males, persons aged 18 to 24 years of age, and single persons most likely to have exceeded thse guidelines.
• Also, about 17% of current drinkers (and 13.6% of all Canadians) engage in high risk or hazardous drinking, as indicated by their score on the Alcohol Use Disorders Identification Test (AUDIT), which assesses drinking styles, hazardous drinking, alcohol dependence and some specific consequences of such drinking.
• It was noted that "more than 30% of those under 25 scored 8 or more on the AUDIT, compared with less than 5% for people aged 65 or older." (CCSA, 2004, p. 4¹⁴ )
• Among Canadian university students: 87% drank alcohol in the past 12 months. In the first 8-12 weeks of the Fall semester, 63% reported drinking 5 or more drinks on a single occasion, and 35% reported consuming 8 or more drinks. Men were significantly more likely than women to report heavy drinking as measured by 5 or more (71% versus 56%), and 8 or more drinks (47% versus 25%) on a single occasion at least once since September. Most of the students' drinking occurred off campus, and the highest level of consumption was reported when the reason for drinking was to get drunk (8.9 drinks). Also, alcohol consumption increased with an increase in the size of the group involved in the drinking occasion. (Gliksman et al., 2000¹⁵).
• About 66% of Ontario high school students reported drinking in 2003 (Adlaf and Paglia, 2003¹⁶), up from 60% in 1997 . The proportion of those who had 5 or more drinks on one occasion in the month before the survey was 27%, down from 41% in 1997 (Ontario Student Drug Use Survey, CAMH, 1998¹⁷).

Health & Social Impacts     Top

• There were 6,701 deaths and 86,076 hospitalizations attributed to alcohol in Canada in 1992. Motor vehicle crashes accounted for the largest number of alcohol-related deaths while falls were responsible for the largest number of alcohol-related hospitalizations and days spent in hospital (Single et al, 1996¹⁸).
• Those who lose their lives to alcohol die on average 28 years prematurely largely as result of car crashes, preventable injuries, poisonings, suicide, murder and various drinking-related health problems (Single et al, 1996¹⁹ ).
• A 1992 Canadian economic cost study found that alcohol played a role in preventing some 7,401 deaths, due to its beneficial effects on ischemic heart disease and stroke. Those most likely to benefit from one or two drinks a day are men over 40 and women past menopause (Single et al, 1996²⁰).
• According to Transport Canada (Mayhew et al., 2002²¹ ), in 2000, there were 1,069 fatal alcohol-related crashes in Canada. This means alcohol was involved in 34% of total traffic deaths that year. More than 80% of those who died in alcohol-related crashes were males and one-quarter were 26-35 years old. The majority who died as a result of an alcohol-related crash were drivers, but about one-fifth were passengers and one-tenth, pedestrians. Over 18,000 drivers were involved in crashes that resulted in serious injuries; of these about 20% were alcohol-related.
• In Ontario, in 2000, 958 persons died in motor vehicle crashes. One-third (319) were alcohol-related. Of those killed in alcohol-related crashes, 34 were 16-19 years old. Almost 80% were male. A blood alcohol concentration (BAC) over the legal limit of 80 mg% was found in 80% of fatally injured drinking drivers. Over 5000 drivers were involved in crashes that resulted in serious injury; of these, one-fifth were alcohol-related (Mayhew et al., 2002²²). Impaired driving is a major cause of death in Canada. Among fatally injured drivers, 45% had some alcohol in their blood and 38% were over the legal limit of .08% Blood Alcohol Concentration (Single and McKenzie, Canadian Profile 1997, CCSA²³ ). According to Ontario's Ministry of Transportation²⁴, 42% of drivers killed on Ontario roads-approximately 350 people each year-had been drinking.
• Approximately three quarters (74%) of snowmobile fatalities in Ontario are alcohol-related. Underage drinking is a significant factor in snowmobile fatalities involving 16-18 year olds. Approximately 53% of those killed in this age category had been drinking. Most fatalities occur after dark, on unsanctioned trails between mid December to late February (Ontario Federation of Snowmobile Clubs, 1997²⁵ )
• The most serious consequence of driving while impaired is the death of an innocent driver, passenger, cyclist or pedestrian. In 1996, 133 persons were charged with impaired driving causing death in Canada. This number has remained relatively constant during the 1990's (Statistics Canada, 1997²⁶).
• In a 2004 national survey (CCSA, 2004), one-quarter of former and current drinkers said their drinking had caused harm to themselves and others at some point in their lives. One-tenth of current drinkers experienced harm from their own drinking in the past 12 months.
• About 5% reported health problems and 3%, social problems. One-third of respondents age 18 years and older (33%) said they had been harmed by other people's drinking in the past 12 months. These harms included insults (22%), serious quarrels (16%), being pushed (11%), and family problems (11%). Married respondents reported fewer harms than unmarried respondents.
• In 2001, 15% of licensed Ontario high school students said they had driven within an hour of consuming 2 or more drinks in the past 12 months (Adlaf et al., 2003²⁷). About 32% had been a passenger in a car with a drinking driver in the past 12 months (Adlaf et al., 2003²⁸).
• Canadian students reported a wide range of problems or consequences of drinking since the September period. Students were most likely to mention having a hangover (38%), regretting their actions (13%), memory loss (11%), missing classes due to a hangover (11%), missing classes due to drinking (7%).
• Hazardous drinking behaviours were noted by some students in the 8-12 weeks prior to the survey: about 7% mentioned unplanned sexual relations; 5% driving a car after drinking too much; 3% driving while drinking; and about 3% having unsafe sex.
• About 30% of students mentioned experiencing at least one consequence of dependent drinking. Reports of alcohol dependence were significantly more likely among first year students (34%) and those living on campus (39%). (Gliksman et al. 2000²⁹).
• According to a 1993 survey students with D averages were 3.2 times more likely to drink 15 or more drinks a week than students with A averages. Ten percent reported drinking and driving, and 15% reported cutting class after drinking. Students also experienced problems as a result of other people's drinking. Forty-three per cent reported being insulted or humiliated, 24 per cent said they had been physically assaulted, and 38 per cent reported arguments in the year prior to the survey (Gliksman et al., 1995³⁰).
• Traffic crashes are the primary cause of death for teens aged 15 to 19: 34% of all teenage males and 38% of teenage females who die each year are victims of a road crash (Mayhew and Simpson, 1999³¹).
• Battered women are at increased risk of mental health and addictions problems. According to a 1993 study (Ratner³²) 16% of women who were physically abused were also alcohol dependent - a rate eight times higher than in women who had never been abused (Kerr and McLean, 1996³³).
• There is still much to be learned about the impact of alcohol consumption during pregnancy. Researchers have found a link between relatively high levels of alcohol consumption and distinctive physical characteristics typically associated with Fetal Alcohol Syndrome. There is growing evidence that alcohol can also damage the fetus, resulting in such problems as mental retardation, hyperactivity, and poor memory . This type of damage is permanent(CAMH, 1996³⁴).
• According to National Population Health Survey 1996-7, people who reported growing up with an alcoholic parent had more than twice the odds of reporting that they abuse alcohol themselves (Statistics Canada, 1998³⁵).
• In 1994, there were 10 cooking wine-related deaths in Ontario. (Luciano, 1996³⁶).

Economic Costs & Benefits     Top

• The average Canadian age 15 or older spent $567 on alcoholic beverages in 2001/02. The value of alcohol sales totalled more than $14.5 billion, up 6.8% from the year before. Meanwhile, the net income of liquor control authorities and revenue from the control of alcoholic beverages by provincial and territorial governments was $3.9 billion (Statistics Canada, 2002³⁷).
• In 2002-03, the Ontario alcohol industry generated some $5.38 billion in alcohol-related profits, fees and taxes for the federal, provincial and municipal governments. Of this 1,99 Billion went to Ontario, 698 Million to the Federal government, and 2.69 to the Ontario municipalities - i.e. grants in lieu of business and reality taxes (LCBO, 2003³⁸).
• In addition to sales of legal alcoholic products, smuggled alcohol spirts, beer or wine that is illegally produced also contributes to consumption in Ontario. According to the LCBO, it is estimated that $455 million or 5.8 per cent of the annual $7.89 billion provincial beverage alcohol market is lost annually to the underground economy (LCBO, 2002-03³⁹).
• It is estimated that substance abuse cost more than $18.4 billion in Canada in 1992, representing $649 per capita, or about 2.7% of the total Gross Domestic Product. Tobacco accounted for more than $9.5 billion in costs, while alcohol cost the Canadian economy approximately $7.5 billion ($2.8 billion in Ontario), and illicit drugs an additional $1.4 billion. The largest economic costs of substance abuse are the result of lost productivity due to illness and premature death, direct health care services and law enforcement (Single et al, 1996⁴⁰).
• The economic costs of drinking and driving are high and amount to approximately $1.3 billion each year in Ontario alone (MTO, 1997⁴¹).

Rates of Consumption, Drinking Patterns & Alcohol-related Harm     Top

• It is expected that damage from alcohol is likely to increase in Canada if the recent trend in rising consumption (Statistics Canada 2002⁴²) continues and if high-risk drinking does not decline.
• There is a well-established association between easy access to alcohol and overall rates of consumption and damage from alcohol (Edwards et al. 1994⁴³; Holder & Edwards, 1995⁴⁴).
• Examples of easy access or high availability of alcohol are the following: a low price relative to cost of living, high density of outlets, long hours of sale, low legal drinking age, e.g. compared to our neighbors, the US, inadequate server training programs, no challenge or refusal initiatives, and inadequate enforcement of liquor laws, to mention a few (see Babor et al. 2003⁴⁵for details).
• Recent research focusing on Canada has shown that changes in our overall rates of consumption are associated with changes in total mortality (Norström, 2004⁴⁶), traffic fatalities (Skog, 2003⁴⁷), alcohol-related mortality (Ramstedt, 2003⁴⁸), and liver cirrhosis deaths (Ramstedt, 2004⁴⁹). As we drink more as a province or nation, and drink in ways where more of our occasions involve heavy or high-risk drinking, our societal rates of damage are also likely to increase.
• Drinking patterns are also a matter for concern. In light of the high proportion that still drink in risky ways and because of the link of drinking patterns to both traumatic and chronic damage from alcohol (Rehm et al. 2003b⁵⁰) prevention measures need to address both overall rates of drinking and drinking patterns.
• A national study released in November 2004 included preliminary results from people surveyed in Ontario. It indicated that about 20% drank heavily once a month, 23% exceeded the low-risk drinking guidelines, and 17% were considered to drink in hazardous ways in the past year, with this rising to 30% for those under age 25. In addition, the authors noted that 32% of respondent reported that in the past year they had experiencing some harm due to drinking by others (Canadian Centre on Substance Abuse 2004⁵¹).

Alcohol Distribution & Management     Top

• In total, there were 1,628 retail alcohol outlets, in Ontario in 2003. This is where adults can go to buy alcohol to take home, or know as off-premise outlets. These include: 597 LCBO stores (36.7% of all retail outlets), 436 Brewers Retail stores (26.8%),; 384 Ontario winery stores (23.6%), 155 LCBO agency stores in communities too small to accommodate a full-fledged liquor store (9.5%); 39 on-site brewery stores (2.4%); 11 border-point duty-free stores (0.7 %); 3 on-site distillery stores (0.2%); 3 privately-operated airport duty-free stores (0.2%) (LCBO, 2003⁵²). In, addition about 300 U-Brew/U-Vint outlets operate in Ontario.
• An extensive network of restaurants, bars and other on- premise outlets is also evident in Ontario. There are about 17,000licensed establishments in Ontario, and another 66,000 licensed special events annually across Ontario (Alcohol and Gaming Commission of Ontario, 2003⁵³).
• Ontario's liquor monopoly, the Liquor Control Board of Ontario (LCBO) is the world's largest single purchaser of beverage alcohol in the world, retailing approximately 13,656 products through its network of stores or by special order. This includes 3,476 regular listings, 3,127 Vintages listings, 6,831 consignment warehouse and private stock listings, and 240 duty free listings (LCBO, 2003⁵⁴).

The LCBO conducts approximately 180,000 tests on 10,000 different alcoholic beverages each year. This ensures that all products sold by the LCBO as well as Brewers Retail and Ontario winery stores comply with the federal food and drug safety legislation (LCBO, 1998⁵⁵).

See also: Who's Responsible for What in Alcohol Sales in Ontario, a 2-page overview of the different agencies responsible for alcohol licencing and enforcement.

Social Responsibility     Top

• LCBO staff are trained in the Challenge and Refusal program which teaches staff to spot and refuse sales to minors or intoxicated persons. In 2001-02, LCBO store staff challenged nearly 1.1 million potential customers and nearly 70,000 were refused servic (LCBO, 2003⁵⁶).
• In 2002, Beer Store employees challenged 4.3 million potential customers and refused service to more than 230,000 who were either underage or appeared intoxicated⁵⁷.

Retail Alcohol Monopolies     Top

• Retail monopolies refers to a range of systems from government control of alcohol sales to mixed arrangements where both the government and private sectors are involved in alcohol management and retailing.
• Most Canadian provinces have such a system. Although retail sales in Alberta is full privatized, as of 1993-94, it is managed by the Alberta Gaming and Liquor Commission, which also manages the wholesale aspect of liquor distribution in that province.
• Retail monopolies have a strong potential to skillfully balance two main agendas of their underlying raison d'tre, mainly distributing alcohol in a responsible way while controlling the potential risks associated with it's use.
• Under a government run monopoly system the latter agenda is potentially facilitated through a number of strategies, such as: controlling hours and days of sale, number of outlets, floor prices, sales to minors, and monitoring overall rates of consumption.
• Given the policy and regulatory levers at its disposal, a government-run system can encourage that high priority is given to health and safety agendas. However, if marketing, promotion, and alcohol distribution become the main priorities, the potential for effective prevention is seriously under-mined.
• With the rising rate of consumption in Ontario, and other provinces, and likelihood that this will contribute to more health and social damage from alcohol, it is particularly important that alcohol monopolies give substantial attention to their control mandate, and seek steps to curtail the increase in drinking rates⁵⁸.

Public Opinion     Top

• In 1994, a representative survey of Canadians found that 74.4% supported increases in prevention programs, 75.5% supported server intervention programs and 64.6% supported increases in treatment programs. The same survey also found that 66.8% of Canadians opposed selling alcohol in convenience stores; 69.5% favoured placing warning labels on alcoholic beverage containers; 66.6% believed that beer and liquor store hours should stay the same and 45% believed that alcohol taxes should remain the same (Single and MacKenzie, Canadian Profile 1997⁵⁹).
• More than half of the Ontario university students surveyed in 1993 were in favour of more spot checks by campus police, more education programs and activities about alcohol, and not selling alcohol at campus sports events (Gliksman et al, CAMH, 1995⁶⁰).
• Ontario survey data show substantial levels of public support for alcohol controls, especially at the current level. For years, a majority has consistently supported such measures as taxation, legal drinking age, and preventing drunk customers from being served (Giesbrecht et al., 2001⁶¹). In 2003, 77% of Ontario adults wanted beer and liquor store hours to stay the same; 77% wanted hours of sale in bars to stay the same; and 94% supported government involvement in the prevention of alcohol-related problems (Anglin et al., 2004⁶²). In 1999, 73% disagreed with privatization of alcohol retail sales. Men, younger respondents and heavier drinkers show a pattern of less support for alcohol controls whereas women, older respondents and lighter drinkers show a pattern of greater support (Anglin et al., 2001⁶³; 2003⁶⁴).

Effective Alcohol Policies & Interventions: 10 Best Practices     Top

• In controlling the damage from alcohol, the most effective health promotion interventions are alcohol policies that focus on population-level interventions - such as access to alcohol, drinking contexts and drinking-related behaviours.
• This evidence was summarized by Babor et al. (2003, chapter 16⁶⁵). The international project team of 15 researchers reviewed and evaluated 31 interventions - grouped as follows: regulating physical availability - e.g., hours and days of sale, legal drinking age; pricing and taxation; altering the drinking context - e.g., server intervention, training, bar policies, etc; education and persuasion - e.g., mass media, 'counter-advertising campaigns, warning labels and signs, school-based education programs; regulating alcohol promotion -e.g. controls on alcohol advertising, advertising guidelines, bans; drinking and driving countermeasures - e.g., lower blood alcohol levels, random road-side spot checks; and treatment and early intervention.
• These 31 interventions were assessed according to four criteria: (a) evidence of effectiveness; (b) the quantity and consistency of the evidence; (c) whether the intervention had been tested in different cultures; (d) and monetary and other costs associated with implementing and sustaining the intervention.
• This assessment resulted in the following 10 best practices, selected from the 31 examined, being highlighted by the research team (Babor et al. chapter 16):
  • Minimum legal drinking age
  • Government monopoly of retail alcohol sales
  • Restriction on hours or days of sale
  • Outlet density restrictions
  • Alcohol taxes
  • Sobriety check points
  • Lowered BAC limits
  • Administrative license suspension
  • Graduated licensing for novice drivers
  • Brief interventions for hazardous drinkers