Canada: The Problem: Health, social impacts of alcohol abuse dwarf opioid crisis (excerpt)
With so much attention focused on deadly addictions to opioids and meth, alcohol has been overshadowed, despite that it costs society more — in dollars and deaths. Continuing today, Postmedia examines the Southwestern Ontario toll in a three-part series: The Drinker, The Problem and The Solution.
By Trevor Wilhelm
July 1, 2019
It puts more people in the hospital than heart attacks and kills more people than opioids.
With fears over deadly drug addictions taking the spotlight across Canada, alcohol has slipped under the radar while continuing to cause a tide of health woes and social turmoil that dwarfs the opioid crisis.
“It pretty much destroys your life,” said Kay, 54, a recovering Windsor alcoholic who didn’t want his last name used. “You become very withdrawn. Your social life collapses.”
“You spend your night chasing that feel-good feeling, but then, of course, it catches up to you the next day.”
From April 2017 to March 2018, there were 156,108 hospital stays in Canada for harm caused by substance use, according to the Canadian Institute for Health Information. Alcohol caused 82,740 of those visits. Opioids were responsible for 19,279 hospital stays.
During the same period in Ontario, 50,863 hospital visits were tied to substance use. Alcohol was responsible for 26,952 them. Opioids accounted for 6,012.
“Of course, we know that some deaths that come from substance use, like opioid overdoses, often never reach the hospital for treatment,” said Kathleen Morris, CIHI’s vice-president of research and analysis. “Overall, both in terms of hospitalizations and mortality, alcohol is a big piece of the story and it’s responsible for the most number of hospitalizations in every province and territory. It’s something that’s quite widespread across the country.”
Addictions specialists fear the destructive effects of alcohol will get worse with the provincial government’s loosening of regulations around drinking.
The Progressive Conservative government has already expanded hours of operation for The Beer Store, LCBO, and licensed grocery stores. It introduced legislation in late May to tear up its contract with The Beer Store and end that organization’s stranglehold on beer sales in the province.
The Ford government also announced in June it will expand alcohol sales to hundreds of new stores starting this summer, including 87 more grocery stores and more than 200 new “LCBO Convenience Outlets.”
Ontario’s Ministry of Health and Long-Term Care said in an email it expects people to drink responsibly.
“While the government trusts Ontarians to make smart, mature and responsible choices when it comes to alcohol use, it maintains a strong commitment to social responsibility,” the ministry said.
The government said that includes “educating the public about preventing the harms associated with alcohol use.” The ministry said it funds ConnexOntario, a 24/7 live-answer service offering information about provincially-funded addiction treatment services.
The province also said it will invest $1.9 billion over 10 years for mental health and addictions services. That will match an investment from the federal Liberal government for a total of $3.8 billion.
Despite that, studies have shown increased access to alcohol leads to increased health and social problems, said Patrick Kolowicz with Hotel-Dieu Grace Healthcare.
In British Columbia they increased the privatization of alcohol, which also increases its availability, said Kolowicz, the director of adult mental health and addictions. “They associated it with an increase in alcohol related mortality.
“The more that it’s available for people, the more people you’re going to have misuse it and become dependent on it.”
Misuse and dependence are the two basic categories of alcohol abuse, said Dr. Robert McKay, an addictions specialist and president of the Erie-St. Clair Clinic, a local treatment facility.
Misuse means you drink too much and wake up with a hangover, but you can get through the next day without a drink.
Alcohol dependence goes beyond that.
“If you stop drinking alcohol you’re going to get very sick, that’s alcohol dependence,” he said.
Kolowicz said the impacts of alcohol abuse and dependence have “always been No. 1” among other drugs and substances.
“What you hear in the addiction community is alcohol is very destructive to families and people, and that it continues to be the most destructive substance that is misused within the addictions sector,” he said.
And drinking rates are on the rise, said Morris.
“That’s not just in Canada,” she said. “We see that internationally. The rate of growth for women is actually a little bit higher than that for men.”
She said the exact reason for the increasing number of women drinkers is unknown. Women are better at seeking care and advice than men, said Morris, so they might just be entering the healthcare system more often. Changing societal norms could also be at play.
“We see in the youngest age group girls outnumber men,” said Morris. “It could be that it’s more culturally acceptable for women to drink today than it would have been 50 years ago when some of the older group was starting.”
That wide societal embrace of alcohol is likely part of the reason the harm it causes gets less attention than opioids.
“Alcohol is very accepted in society,” said McKay. “You have a drink. I have a drink. Everybody, basically, has some alcohol. It’s an accepted beverage, an accepted mind altering substance.”
Kolowicz said another likely reason that more concern gets focused on opioids is they “kill people fast.”
“With alcohol it’s over time,” he said. “It’s more chronic exposure that leads to death. A lot of times the death isn’t necessarily from drinking. It might be a secondary cause. The person has a seizure or they fall and they have a brain bleed. So a lot of times it may not be attributed to alcohol or people don’t think about it as a direct correlation. So I think that’s why it gets downplayed.”
Dr. Tony Hammer, who treats alcoholics with medication at the Erie-St. Clair Clinic, said “denial” is also a factor for many alcoholics.
“Many can function for a long time consuming considerable quantities,” said Hammer, who sees a couple new clients every month for alcohol and renews prescriptions for dozens more. “Depending on their job and their domestic situation, they can function or be tolerated.”
Hammer treated Kay, the recovering Windsor alcoholic, with what’s called the Sinclair method.
Kay takes a pill before his first drink of the day. The medication blocks the pleasure pathways associated with alcohol so he is more likely to drink less.
For the last two decades, Kay drank about 20 ounces a day.
“Vodka shots with whatever chaser,” he said. “Typically beer. Some kind of beer and then just shot after shot of vodka.”
He tried abstinence-based recovery programs. They didn’t work.
Kay kept up his hard drinking ways until medical tests revealed he has liver damage.
“The social consequences had set in fully for me, and now physical consequences were occurring,” he said.
After doing some research, he sought out Hammer in January. With the medication, Kay said he went from having 20 drinks a day to 10 or 15 on a Friday and stopping for the rest of the week. He said the reduced amount of drinking, while still a lot for most people, drastically improved his life.
He started making friends again, and he stopped spending every moment thinking about his next drink.
“I was no longer in a hurry to leave work and hit the bar,” said Kay. “You start rediscovering life.”