THE RISE OF BINGE DRINK­ING

More than 15 per cent of Cana­di­ans are reg­u­larly binge­ing on booze, to the detri­ment of their re­la­tion­ships and their well-be­ing. We take stock of the causes, the health risks and what can be done to curb con­sump­tion.

Reader's Digest (Canada) - - Front Page - BY KATHER­INE LAID­LAW PHOTO-IL­LUS­TRA­TION BY JUSTIN POULSEN

In the 1970s, Jackie Rai was a young mother with a se­ri­ous drink­ing prob­lem. She was 23 years old and had a phys­i­cally tax­ing job work­ing on the as­sem­bly line of a seat belt–man­u­fac­tur­ing plant in An­gus, Ont. She came from an East Coast fam­ily and had al­ways drunk heav­ily—by her own ac­count, she’d been a binge drinker since age 18.

Ev­ery week­end started the same way. She’d drop her son off at her moth­erin-law’s house and drive to the liquor store to get a bot­tle of rye and a case of beer. The week­ends passed in a fog. She would ar­rive, hun­gover and weary, on her mother-in-law’s doorstep to pick up her son on Mon­day nights.

After nearly a decade of binge drink­ing, Rai quit cold turkey in 1979. But she’s been pay­ing the health costs for nearly four deacdes. She suf­fered from anx­i­ety and de­pres­sion into her 40s. And, like many peo­ple who drink danger­ously, Rai de­vel­oped type 2 di­a­betes, which the 67-year-old will live with for the rest of her life.

Ac­cord­ing to global health guide­lines, to qual­ify as a binge drinker, a man has to im­bibe five or more drinks over a cou­ple of hours and a woman four or more. If that sounds high, con­sider that two pints of beer put a fe­male drinker just un­der that thresh­old.

And though the per­cep­tion has long been that binge drink­ing is a pat­tern rau­cous twen­tysome­things de­velop be­fore they grow out of it, re­search shows that this is not the case. Ac­cord­ing to Sta­tis­tics Canada data from 2016, nearly six mil­lion Cana­di­ans are binge drink­ing at least once a month. The largest per­cent­age of these peo­ple are within the ages of 18 and 34 (34 per cent of male heavy drinkers and 23 per cent of fe­males), but 27 per cent of men who re­port binge drink­ing are 35 to 49 and 13 per cent of women who re­port are 50 to 64.

While binge drink­ing and al­co­holism can over­lap, the two are not the same. Binge drink­ing is de­fined as a pe­riod when, at least once a month, some­one’s blood-al­co­hol level reaches .08 per cent. And while ex­ces­sive drink­ing can lead to ad­dic­tion, al­co­holism is a med­i­cal con­di­tion with a phys­i­cal de­pen­dence on the sub­stance and with­out a set num­ber of drinks.

“Ex­ces­sive drink­ing is one of the big­gest health prob­lems we have in this coun­try,” says Jür­gen Rehm, the se­nior direc­tor for the In­sti­tute for Men­tal Health Pol­icy Re­search at Toronto’s Cen­tre for Ad­dic­tion and Men­tal Health (CAMH). “If you want to die pre­ma­turely, con­tinue binge drink­ing.”

RATES OF BINGE DRINK­ING are ris­ing so steadily in the United States that the au­thors of a com­pre­hen­sive 2017 study called it a pub­lic-health cri­sis. Around the world, women are binge drink­ing more, and more heav­ily. One study, pub­lished last year in Al­co­holism,

found that binge drink­ing among U.S. women over 60 is in­creas­ing by 3.7 per cent ev­ery year. An­other found that the num­ber of Cana­dian women who iden­ti­fied as binge drinkers dou­bled from 1996 to 2013. In Canada, af­flu­ent white peo­ple are im­bib­ing in greater quan­ti­ties, as are peo­ple liv­ing in ru­ral ar­eas.

WHETHER YOU BINGE OR NOT, DRINK­ING HEAV­ILY

CAN RE­DUCE YOUR LIFE­SPAN BY

UP TO 25 YEARS.

Mul­ti­ple fac­tors con­trib­ute to the in­crease in binge drink­ing. Some doc­tors cite the stresses that come with a dis­mal eco­nomic and po­lit­i­cal cli­mate, a cul­ture of over­work, a rise in men­tal health is­sues and grow­ing so­cial iso­la­tion. And drink­ing is ar­guably the world’s most so­cially ac­cept­able vice—a cus­tom­ary in­dul­gence at big cel­e­bra­tions, restau­rant dinners or just a reg­u­lar night at home.

As drink­ing be­comes not only a way to make merry but a way to cope with stress, it has been in­creas­ingly linked to par­ent­hood. Terms like “grown-up grape juice,” “mommy drink­ing” and “us­ing wine to cope with the whine” glibly of­fer par­ents per­mis­sion to soothe the burn of sleep de­pri­va­tion and anx­i­ety with al­co­hol.

While those fac­tors may ex­plain an uptick in the num­ber of peo­ple reach­ing for that first drink, it’s brain cir­cuitry that’s likely re­spon­si­ble for binge­ing be­hav­iours. A drink puts stress on cells in the brain’s extended amyg­dala, and those cells re­lease a stress hor­mone called cor­ti­cotropin-re­leas­ing fac­tor, which fires up the brain’s ven­tral­tegmen­tal-area neu­rons.

In other words, the brain’s re­ward cen­tre lights up and re­lays to its owner that tak­ing an­other drink is a great idea be­cause the more you con­sume, the greater the re­ward. And be­cause al­co­hol over­stim­u­lates cer­tain parts of the brain, you’re not as likely to con­sider its im­pact or to fo­cus on any­thing other than the im­me­di­ate task at hand: drink­ing. Your brain cir­cuitry en­cour­ages you to crack an­other beer, even if a sober you would know that it’s time to stop.

AT ITS PEAK, JAMES WILT’S drink­ing cost him $300 a month. He’d make the trek to the liquor store to buy a high­per­cent­age beer, a fancy bot­tle of bour­bon or a plas­tic mickey of cheap sherry. “It was dis­gust­ingly sweet, but it got me drunk,” he says.

As a free­lance writer, he worked and drank alone in his Win­nipeg apart­ment. It took five years for him to re­al­ize he’d de­vel­oped unhealthy drink­ing pat­terns. “I’d do the whole rou­tine,

say­ing I’m more cre­ative and I write bet­ter when I drink,” he says.

On hun­gover morn­ings, it would take him hours to get out of bed just to per­form ba­sic func­tions. There were gaps in his short-term mem­ory that weren’t there be­fore. He’d spend hours work­ing out ev­ery week and couldn’t seem to lose the ex­tra weight his body had packed on.

He knew heart dis­ease ran in his fam­ily and that the amount he was drink­ing would likely in­crease his risk. But it wasn’t un­til he quit, cold turkey, at age 26 that he learned about some of al­co­hol’s other dan­gers.

Let’s re­turn to the brain. Al­co­hol and de­pres­sion are in­ex­orably linked, with some clin­i­cians es­ti­mat­ing that be­tween 30 and 50 per cent of peo­ple with an al­co­hol de­pen­dence are also suf­fer­ing from clin­i­cal de­pres­sion. A study of the French pop­u­la­tion pub­lished this year re­vealed that al­co­hol use is the big­gest—and most pre­ventable—risk fac­tor for de­men­tia.

Next, there’s the heart. One study, pub­lished in 2017 by a doc­tor at the Univer­sity of Cal­i­for­nia, San Fran­cisco, found that on­go­ing al­co­hol abuse left its par­tic­i­pants 40 per cent more likely to suf­fer a heart at­tack. (And that’s after ac­count­ing for es­tab­lished risks such as di­a­betes, obe­sity and smok­ing.) Heavy drinkers are more likely to have strokes, and to have them at younger ages than lighter drinkers. Harm­ful drink­ing habits ac­counted for 77,000 Cana­di­ans’ hospi­tal ad­mis­sions from 2015 to 2016.

On to the liver, where links be­tween al­co­hol and hep­ati­tis, liver can­cer and cir­rho­sis (scar­ring of the liver) are wellestab­lished. If you’re find­ing your beer belly par­tic­u­larly per­sis­tent, note that stud­ies have shown that heavy drink­ing con­trib­utes di­rectly to weight gain and obe­sity, re­gard­less of what kind of drinks you’re swill­ing. And doc­tors have linked heavy drink­ing to a slew of other can­cers, in­clud­ing breast, colon, neck, lar­ynx and esophageal. In 2012, re­searchers es­ti­mated that 3.3 mil­lion deaths world­wide were caused by al­co­hol con­sump­tion.

IN THE LAST 50 YEARS, THE AL­CO­HOL IN­DUS­TRY HAS ES­CAPED LEG­ISLA­TIVE PUSHES THAT HAVE CRACKED DOWN ON OTHER VICES.

If that’s not enough to scare a drinker into tee­to­talling, con­sider this: a re­cent study by the Univer­sity of Cam­bridge that ex­am­ined the health of 600,000 drinkers found that peo­ple who con­sume more than one drink a day are more likely than those who drink less to die of any cause at all.

In gam­bling, your chances of win­ning go up the more fre­quently you buy

in. The same is true of binge drink­ing’s health con­se­quences. “Binge drink­ing—or how you drink—is at least as de­struc­tive as the over­all quan­tity of drink­ing,” Rehm says, meaning that binge drink­ing six cock­tails in one night is worse for your health than drink­ing one cock­tail a night over six days. And drink­ing heav­ily over time, whether you binge or not, can re­duce your life­span by up to 25 years. “Heavy drink­ing is more likely to kill us than traf­fic, ski­ing or any­thing else,” he says.

AND YET, SOME­HOW, we tol­er­ate it any­way. Prob­lem drink­ing can be hard to spot and even harder to ad­dress if you’re con­cerned about a loved one. When for­mer at­tor­ney gen­eral Michael Bryant was in the throes of his al­co­holism, after years of bingedrink­ing be­hav­iour, a po­lit­i­cal col­league ap­proached him one day to tell him, gen­tly, that he thought Bryant may be drink­ing too much.

“He was right, and it was hard for him to say, and I was fu­ri­ous,” says Bryant, who is now 52 and has been sober for 12 years. “The de­nial and anger that rose up in me were se­vere.”

For Bryant, that in­ter­ven­tion, along with a fam­ily doc­tor who asked him to jour­nal his drink­ing, helped him re­al­ize he had a prob­lem and com­mit him­self to a 12-step pro­gram. “Most peo­ple are cu­cum­bers, but I’m a pickle. And once you be­come a pickle, you can’t go back,” Bryant says. But re­search in­di­cates that doc­tors still can’t clearly pin­point which treat­ment op­tions will work for which pickles.

In 2005, re­searchers at the Univer­sity of Mi­ami Miller School of Medicine con­ducted what is still the largest al­co­hol-treat­ment study in the world, as­sess­ing pa­tients in fa­cil­i­ties across the U.S. over a span of eight years. The re­sults were dis­ap­point­ing. Three dif­fer­ent treat­ment op­tions—cog­ni­tive be­havioural ther­apy, a 12-step pro­gram and mo­ti­va­tional en­hance­ment ther­apy—pro­duced nearly iden­ti­cal suc­cess rates, and each was de­ter­mined to be fairly in­ef­fec­tive. Alcoholics Anony­mous op­ti­misti­cally pegs their suc­cess rate at 50 per cent, with other peer-re­viewed stud­ies es­ti­mat­ing the pro­gram’s suc­cess sit­ting be­tween five and 10 per cent. For oth­ers, there’s re­hab, talk ther­apy, ab­sti­nence or a mix of other treat­ments to help the 17 per cent of Cana­di­ans drink­ing so much that they’re en­dan­ger­ing their long-term health.

Over the last 50 years, al­co­hol has es­caped the leg­isla­tive pushes that have cracked down on other vices, like co­caine and LSD. This is, in part, due to the ef­fec­tive­ness of a pow­er­ful lobby fi­nanced by an­nual al­co­hol sales of over $20 bil­lion in this coun­try alone. Last year, a Health Canada pilot project that would have seen large warn­ing la­bels af­fixed to liquor bot­tles—sim­i­lar to pub­lic ser­vice an­nounce­ments on packs of cig­a­rettes—in the Yukon was

called off after al­co­hol lob­by­ists threat­ened le­gal ac­tion against the govern­ment for defama­tion and dam­ages.

But other coun­tries are ready to carry out mean­ing­ful changes. In France, health min­is­ter Agnès Buzyn has ig­nited a na­tional de­bate over the coun­try’s in­sa­tiable thirst for wine. “The real mes­sage we should be send­ing to­day is that al­co­hol is bad for your health,” she told a French TV sta­tion this spring. A num­ber of the coun­try’s doc­tors have ral­lied around her call for tougher reg­u­la­tions, prompt­ing an out­cry from the coun­try’s ro­bust wine in­dus­try. In Jan­uary, the govern­ment of Lithua­nia, which was un­til two years ago the heav­i­est­drink­ing coun­try in the world (since re­placed by the Re­pub­lic of Moldova), in­tro­duced a ban on al­co­hol ads across do­mes­tic and for­eign me­dia. It also raised the drink­ing age from 18 to 20 and in­creased taxes on al­co­hol in an ef­fort to curb con­sump­tion.

Back at CAMH, Rehm says he’d like to see an in­crease in Cana­dian al­co­hol taxes, higher min­i­mum prices and an abo­li­tion of al­co­hol mar­ket­ing. By the time some­one reaches age 16, he says, they’ve al­ready seen about 15,000 al­co­hol ads.

In the mean­time, on­go­ing re­search at CAMH shows that there’s one sim­ple change that could help Cana­di­ans curb their drink­ing: screen­ing dur­ing appointments with their fam­ily doc­tor. Ev­i­dence from or­ga­ni­za­tions such as the WHO has shown that fam­ily

doc­tors can ef­fec­tively raise aware­ness of dan­ger­ous drink­ing sim­ply by ask­ing about their pa­tients’ drink­ing habits and ex­press­ing con­cern for con­sump­tion ex­ceed­ing stan­dard lowrisk guide­lines. Find­ings from screen­ing and in­ter­ven­tion ser­vices in the U.S. have shown that adults who had these kinds of con­ver­sa­tions with their doc­tors ex­pe­ri­enced a 12 per cent re­duc­tion in binge-drink­ing episodes and were 11 per cent more likely to keep to the con­sump­tion guide­lines.

For now, screen­ing is rec­om­mended by Canada’s Na­tional Al­co­hol Strat­egy but is rarely en­forced. “Most fam­ily doc­tors don’t like to talk about al­co­hol,” Rehm says. “We’re try­ing to show how many lives we would save if they would.” JACKIE RAI HAS LIVED much of her adult life com­pletely sober, but she doesn’t dis­miss binge drink­ing as youth­ful folly. She now works as the ex­ec­u­tive direc­tor of the Vesta Re­cov­ery Pro­gram in Ot­tawa, a treat­ment fa­cil­ity that sup­ports women suf­fer­ing from ad­dic­tion. The preva­lence and ac­cep­tance of al­co­hol abuse still sur­prises her. “For years, I used to go home to New Brunswick for vis­its and I’d take an empty beer bot­tle and fill it up with wa­ter. My fam­ily could not un­der­stand how any­body could go to a party and not have a beer,” she says.

“I think I was very blessed,” she says of her re­cov­ery. “In AA, I watched peo­ple laugh­ing and hav­ing a good time with­out drink­ing. I be­lieved it was pos­si­ble.”

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