tag:theconversation.com,2011:/us/topics/heavy-drinking-86600/articlesHeavy drinking – The Conversation2023-06-08T03:22:56Ztag:theconversation.com,2011:article/2069852023-06-08T03:22:56Z2023-06-08T03:22:56ZAustralia should follow Ireland’s lead and add stronger health warning labels to alcohol<figure><img src="https://images.theconversation.com/files/530553/original/file-20230607-15-bbcsrb.jpg?ixlib=rb-1.1.0&rect=8%2C172%2C5742%2C3656&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/beer-bottles-on-conveyor-belt-191643152">Shutterstock</a></span></figcaption></figure><p>From <a href="https://www.foodstandards.gov.au/industry/labelling/Documents/q-and-a-pwl-requirements-sep-2020.pdf">August 2023</a>, Australian beer, wine, spirits and pre-mixed drinks have to warn of the <a href="https://theconversation.com/australia-has-some-of-the-highest-rates-of-drinking-during-pregnancy-its-time-to-make-labelling-mandatory-142645">harms of drinking alcohol while pregnant</a>. But they don’t have to mention the other harms of alcohol for the wider population. </p>
<p>Ireland <a href="https://www.theguardian.com/world/2023/may/22/ireland-to-introduce-world-first-alcohol-health-labelling-policy">recently signed legislation</a> to introduce tougher alcohol warning labels, to warn about the risks of liver disease and fatal cancers from drinking alcohol. These will be in place from 2026. </p>
<p>Considering the ongoing efforts of the industry to undermine the introduction of <a href="https://www.sciencedirect.com/science/article/pii/S2214109X21005702">effective alcohol labelling</a> worldwide, the Irish example is an important victory for public health. </p>
<p>In Australia, it’s time to put consumer health and rights before commercial interests and warn people drinking and buying alcohol of the risks. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/trying-to-cut-back-on-alcohol-heres-what-works-179664">Trying to cut back on alcohol? Here's what works</a>
</strong>
</em>
</p>
<hr>
<h2>Educating consumers about the health risks</h2>
<p>Alcohol causes <a href="https://www.who.int/news-room/fact-sheets/detail/alcohol">more than 200 diseases, injuries and other health conditions</a>. </p>
<p>There is strong evidence that from the first drink, the risk of various cancers (of the breast, liver, colon, rectum, oropharynx, larynx and oesophagus) <a href="https://adf.org.au/insights/alcohol-cancer-risk/">increases</a>. This is <a href="https://www.cancervic.org.au/cancer-information/preventing-cancer/limit-alcohol/how-alcohol-causes-cancer">because</a>:</p>
<ul>
<li><p>ethanol (pure alcohol) and its toxic by-product acetaldehyde damages cells by binding with DNA, causing cells to replicate incorrectly</p></li>
<li><p>alcohol influences hormone levels, which can modify how cells grow and divide</p></li>
<li><p>direct tissue damage can occur, increasing the absorption of other cancer-causing substances.</p></li>
</ul>
<p>Alcohol use kills <a href="https://www.abs.gov.au/statistics/health/causes-death/causes-death-australia/2021">more than four Australians</a> a day (the highest rate in the past decade) and results in <a href="https://ndri.curtin.edu.au/ndri/media/documents/publications/T302.pdf">A$182 million of avoidable costs</a> per day. </p>
<p>Yet only half of Australians know drinking alcohol <a href="https://adf.org.au/insights/alcohol-breast-cancer/">can cause cancer</a>. </p>
<p><a href="https://www.jsad.com/doi/10.15288/jsad.2020.81.249">Research shows</a> mandatory health labelling is an important way to increase awareness and should form part of a comprehensive <a href="https://fdslive.oup.com/www.oup.com/academic/pdf/openaccess/9780192844484.pdf">alcohol control strategy</a>. </p>
<figure class="align-center ">
<img alt="Person pours wine into a glass at a lunch" src="https://images.theconversation.com/files/530732/original/file-20230607-17-hl3pvs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/530732/original/file-20230607-17-hl3pvs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/530732/original/file-20230607-17-hl3pvs.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/530732/original/file-20230607-17-hl3pvs.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/530732/original/file-20230607-17-hl3pvs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/530732/original/file-20230607-17-hl3pvs.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/530732/original/file-20230607-17-hl3pvs.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Many people are unaware of the link between alcohol and cancer.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/making-sure-glasses-stay-full-shot-2151108503">Shutterstock</a></span>
</figcaption>
</figure>
<h2>Countering industry influence</h2>
<p>The alcohol industry currently uses alcohol labels and packaging as a marketing and branding tool. Alcohol warning labels help counter these marketing messages.</p>
<p>Alcohol industry interests have so far succeeded in exempting alcoholic drinks from the usual <a href="https://fdslive.oup.com/www.oup.com/academic/pdf/openaccess/9780192844484.pdf">consumer information requirements</a>. Under the <a href="https://www.fao.org/fao-who-codexalimentarius/en/">international labelling guidelines</a>, all processed foods must have all ingredients listed on the label. But alcohol industry interests have so far succeeded in these rules <a href="https://movendi.ngo/wp-content/uploads/2021/08/Hepworth-et-al-2020.pdf">not being applied to alcoholic beverages</a>. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/no-more-than-10-standard-drinks-a-week-or-4-on-any-day-new-guidelines-urge-aussies-to-go-easy-on-the-booze-151595">No more than 10 standard drinks a week, or 4 on any day: new guidelines urge Aussies to go easy on the booze</a>
</strong>
</em>
</p>
<hr>
<p>In Australia, the alcohol content and number of standard drinks must be <a href="https://www.foodstandards.gov.au/consumer/labelling/Pages/Labelling-of-alcoholic-beverages.aspx">listed on the product’s label</a>. However, there is no requirement, as for other foods and drinks, that ingredients (except for certain allergens such as milk or gluten) and nutritional information (energy, carbohydrates, and so on) be listed. </p>
<p>Aside from warnings to pregnant women to abstain from alcohol, there is no provision for consumer information about the risks of alcohol consumption on alcohol packaging. Yet such warnings are required for other hazardous substances taken into the body, such as tobacco.</p>
<h2>How Ireland is leading the charge</h2>
<p>Ireland is leading the world with its alcohol labelling. From 2026, drinks containing alcohol will have to inform consumers about the specific risks of liver disease and fatal cancers. </p>
<p>Labels will also have to notify buyers of the alcohol risks to pregnancy, the calorie content of the beverage, and the number of grams of alcohol it contains. </p>
<figure class="align-center ">
<img alt="People walk past a pub in Ireland" src="https://images.theconversation.com/files/530734/original/file-20230607-16366-8nixs9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/530734/original/file-20230607-16366-8nixs9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/530734/original/file-20230607-16366-8nixs9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/530734/original/file-20230607-16366-8nixs9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/530734/original/file-20230607-16366-8nixs9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/530734/original/file-20230607-16366-8nixs9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/530734/original/file-20230607-16366-8nixs9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Health warning labels will be mandatory in Ireland from 2026.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/dublin-ireland-july-11-2021-outdoor-2007076256">Shutterstock</a></span>
</figcaption>
</figure>
<p>The new labelling move <a href="https://www.cancer.ie/about-us/news/irish-cancer-society-statement-on-the-introduction-of-health-warning-labels-on-alcohol-products">demonstrates</a> the government has prioritised reducing alcohol-related disease and has widespread support. A recent <a href="https://academic.oup.com/eurpub/article/33/2/323/7067991">household survey</a> in Ireland found 81.9% of the more than 1,000 participants supported the introduction of health warning labels on alcohol.</p>
<h2>Barriers to overcome in Australia</h2>
<p>In 2020, in the face of intense pressure from industry groups, the Australian government decided on new labelling requirements for alcoholic beverages, but only to warn about the <a href="https://theconversation.com/australia-has-some-of-the-highest-rates-of-drinking-during-pregnancy-its-time-to-make-labelling-mandatory-142645">risks of drinking during pregnancy</a>. From a public health point of view, this was a mediocre compromise.</p>
<p>Australia is currently considering introducing energy content (kilojoule) labelling on alcoholic beverages. This would be a positive step and but it is as far as Australia seems willing to go for now. There are no plans for Australia to follow Ireland’s lead. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/to-reduce-harm-from-alcohol-we-need-indigenous-led-responses-204030">To reduce harm from alcohol, we need Indigenous-led responses</a>
</strong>
</em>
</p>
<hr>
<p>Some countries seem to be <a href="https://www.ibec.ie/drinksireland/news-insights-and-events/news/2023/05/16/strong-international-opposition-to-irelands-alcohol-labelling-proposals">gearing up</a> to use the World Trade Organization’s processes to oppose Ireland’s new labels. </p>
<p>Australia <a href="https://pubmed.ncbi.nlm.nih.gov/22716074/">previously opposed</a> enhanced alcohol warning labels Thailand proposed, at the same time Australia was seeking international support for its tobacco plain packaging laws. This time, Australia should prioritise the public’s health over commercial interests and support Ireland’s alcohol warning messages in the World Trade Organization.</p><img src="https://counter.theconversation.com/content/206985/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>In the last five years, Emmanuel Kuntsche has received funding from La Trobe University, the Australian Research Council, the Victorian Health Promotion Foundation, the University of Bayreuth Centre of International Excellence "Alexander von Humboldt", the Veski Foundation, the Foundation for Alcohol Research and Education, the Swiss National Science Foundation, Queensland Mental Health Commission, New South Wales Department of Family and Community Services, and the Netherlands Organisation for Scientific Research.</span></em></p><p class="fine-print"><em><span>Paula O'Brien has received funding from the University of Melbourne, the Foundation for Alcohol Research and Education, the Victorian Health Promotion Foundation, and the National Health and Medical Research Council. Paula is employed by the University of Melbourne and the Victorian Government, The views expressed here do not reflect those of either of her employers. </span></em></p><p class="fine-print"><em><span>Robin Room has received funding from the Australian Research Council; the NHMRC; the US National Institutes of Health; the Centre for Addiction and Mental Health in Ontario, Canada; Victoria, New South Wales and Western Australia state agencies; the World Health Organization; Stockholm University; La Trobe University; and the California Public Health Institute. </span></em></p>Ireland recently passed legislation to introduce clearer alcohol labels to warn about the risks of liver disease and fatal cancers from drinking alcohol. Australia should do the same.Emmanuel Kuntsche, Director of the Centre for Alcohol Policy Research, La Trobe UniversityPaula O'Brien, Associate Professor in Faculty of Law, The University of MelbourneRobin Room, Professor, Centre for Alcohol Policy Research, La Trobe UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1896672022-08-31T20:19:55Z2022-08-31T20:19:55ZCanada’s low-risk alcohol use guidelines have been slashed to 6 drinks per week. Here’s why.<figure><img src="https://images.theconversation.com/files/481979/original/file-20220831-1977-ixc18l.JPG?ixlib=rb-1.1.0&rect=7%2C464%2C4985%2C3023&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Canada's previous low-risk drinking guidelines were much more generous, allowing significantly more drinks per week.</span> <span class="attribution"><span class="source">THE CANADIAN PRESS/Darryl Dyck</span></span></figcaption></figure><iframe style="width: 100%; height: 100px; border: none; position: relative; z-index: 1;" allowtransparency="" allow="clipboard-read; clipboard-write" src="https://narrations.ad-auris.com/widget/the-conversation-canada/canada-s-low-risk-alcohol-use-guidelines-have-been-slashed-to-6-drinks-per-week--here-s-why-" width="100%" height="400"></iframe>
<p>New <a href="https://ccsa.ca/update-canadas-low-risk-alcohol-drinking-guidelines-final-report-public-consultation-report">Canadian guidelines</a> for reducing risks to health from alcohol use were released for public comment this week. Key messages include:</p>
<ul>
<li>drinking less alcohol is better for health;</li>
<li>health risks escalate quickly above six standard drinks per week, especially for women;</li>
<li>do not exceed two drinks on any one day to minimize risks;</li>
<li>alcohol is a carcinogen;</li>
<li>alcohol containers should carry prominent health warnings.</li>
</ul>
<p>You may be asking, who took it upon themselves to give this advice to the public and upon what basis? I am a scientist at the <a href="https://www.uvic.ca/research/centres/cisur/">Canadian Institute for Substance Use Research</a> and was a member of the panel that generated this advice. I have also advised or been a panelist on four previous guideline committees over the past 30 years including for Australia, the United Kingdom and Canada. </p>
<p>I try to explain here some of the underlying science and how it has evolved, principally why drinking guidelines internationally have lowered definitions of “low-risk” alcohol use.</p>
<h2>Why have the guidelines changed?</h2>
<p>The new guideline development was led by the Ottawa-based Canadian Centre on Substance Use and Addiction (CCSA) with funding from Health Canada. The previous <a href="https://www.ccsa.ca/sites/default/files/2020-07/2012-Canada-Low-Risk-Alcohol-Drinking-Guidelines-Brochure-en_0.pdf">2011 guidelines</a> were far more generous: low-risk drinking was defined as up to 10 standard drinks per week for women and 15 for men. </p>
<figure class="align-center ">
<img alt="A shopping cart with several bottles of liquor in it" src="https://images.theconversation.com/files/481982/original/file-20220831-24-as8lc9.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/481982/original/file-20220831-24-as8lc9.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=428&fit=crop&dpr=1 600w, https://images.theconversation.com/files/481982/original/file-20220831-24-as8lc9.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=428&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/481982/original/file-20220831-24-as8lc9.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=428&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/481982/original/file-20220831-24-as8lc9.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=538&fit=crop&dpr=1 754w, https://images.theconversation.com/files/481982/original/file-20220831-24-as8lc9.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=538&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/481982/original/file-20220831-24-as8lc9.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=538&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">In Canada, alcohol containers do not state how many standard drinks they contain.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Darryl Dyck</span></span>
</figcaption>
</figure>
<p>A standard drink is a <a href="https://doi.org/10.3109/16066359.2014.955480">mystery to many people</a>, not least because unlike in some other countries (e.g. <a href="https://www.foodstandards.gov.au/consumer/labelling/Pages/Labelling-of-alcoholic-beverages.aspx">Australia and New Zealand</a>) alcohol containers here do not state how many standard drinks they contain. In Canada, a standard drink is defined as 13.45 grams of ethanol, which corresponds to typical serve sizes of average strength beer, wine and spirits: </p>
<ul>
<li>341 millilitres of beer or cider (5 per cent alcohol), </li>
<li>142 millilitres of wine (12 per cent alcohol) or </li>
<li>43 millilitres of spirits (40 per cent alcohol.</li>
</ul>
<p>What has changed in the past 11 years? Why is an expert committee now recommending much lower guidelines? I was also a member of the panel for the 2011 guidelines, which were based upon the simple idea that low-risk drinking was a level that didn’t increase health risks above that of an abstainer. </p>
<h2>Criticism of the old guidelines</h2>
<p>In compiling the 2011 guidelines, we looked at comprehensive reviews of the link between alcohol use and risk of premature death. These almost invariably showed that light and moderate drinkers had less risk than abstainers but, above a break-even point, health risks quickly escalated. Many observational studies have suggested low-volume drinkers are “protected” from heart disease, type II diabetes and some kinds of stroke. This evidence is <a href="https://world-heart-federation.org/wp-content/uploads/WHF-Policy-Brief-Alcohol.pdf">now questioned</a>.</p>
<p>Based on the best quality systematic review available at that time we noted that at two drinks per day for women and three for men, mortality risks were equal to those for abstainers. We recommended at least two days of abstinence a week ending up with the 2011 guideline of 10 drinks per week for women and 15 per week for men.</p>
<p>This approach has <a href="https://doi.org/10.1111/dar.12866">been criticized</a> from many angles. Studies in such reviews are from all over the world, albeit with a North American and European bias, but estimates should be tailored more precisely for any specific country. Another criticism is that estimates of the association between level of alcohol use and death from all causes will be heavily confounded by other lifestyle factors. </p>
<p>A better approach, these critics argue, is to estimate risks from alcohol use for a select number of diseases and types of injury known to be caused by alcohol, such as liver disease, breast cancer, road crash injuries, etc. </p>
<p>When such an approach is used, this break-even point (the point at which potential benefits and risks cancel each other out) is at a much lower level than from the all-cause mortality studies. My colleagues and I <a href="https://www.jsad.com/doi/10.15288/jsad.2020.81.352">recently estimated</a> this would be at about one drink per day, even assuming some protection against heart disease.</p>
<h2>Risk levels</h2>
<p>With the net risk of alcohol-related harm increasing at even low levels of consumption, guideline committees in other countries (such as <a href="https://www.gov.uk/government/publications/alcohol-consumption-advice-on-low-risk-drinking">the U.K.</a> and <a href="https://www.nhmrc.gov.au/about-us/publications/australian-guidelines-reduce-health-risks-drinking-alcohol">Australia</a>) have resorted to defining an “acceptable” level of risk from alcohol. </p>
<p>For external risks such as from air pollution or radiation from a nuclear power reactor, acceptable risk is generally taken as being an increase in mortality risk of less than <a href="https://doi.org/10.1186/s12916-014-0189-z">one in a million</a>. If an equivalent risk for external factors was taken for alcohol, I calculate that would mean, on the basis of the new guideline risk estimates, not drinking more than one drink every 20 years!</p>
<p>For personal behaviours such as sexual risk-taking, smoking and alcohol use, people are prepared to accept higher levels of risk, for example, up to one in 100.</p>
<h2>New Canadian guidelines</h2>
<p>The new Canadian guidelines followed strict procedures for making as impartial and up-to-date an estimate as possible. Committee members were public health, medical and epidemiology experts who had no financial interests in the manufacture or sale of alcohol. </p>
<p>An independent team used strictly defined search criteria to locate the latest high quality published studies on alcohol risks for health conditions specified by the World Health Organization’s <a href="https://doi.org/10.1016/S0140-6736(18)31310-2">Global Burden of Disease</a> study group. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/481981/original/file-20220831-24-vv8pto.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Three cocktails with garnishes: an orange beverage in a wine glass, a red beverage and a yellow beverage in short glasses" src="https://images.theconversation.com/files/481981/original/file-20220831-24-vv8pto.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/481981/original/file-20220831-24-vv8pto.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=420&fit=crop&dpr=1 600w, https://images.theconversation.com/files/481981/original/file-20220831-24-vv8pto.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=420&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/481981/original/file-20220831-24-vv8pto.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=420&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/481981/original/file-20220831-24-vv8pto.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=528&fit=crop&dpr=1 754w, https://images.theconversation.com/files/481981/original/file-20220831-24-vv8pto.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=528&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/481981/original/file-20220831-24-vv8pto.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=528&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Drinking at the new guideline levels will still shave off two or three months of life expectancy — or about five minutes per drink.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Justin Tang</span></span>
</figcaption>
</figure>
<p>When these risk relationships were collected and applied to Canadian data on causes of death and life expectancy, it was estimated that lifetime mortality risk from alcohol was less than one in 100 for men and women consuming no more than six drinks per week. Risks were elevated even at two drinks per week, at a risk level just under one in 1,000.</p>
<p>These new guidelines are provided on the basis of the latest science, guided by the principle that citizens have a right to know potential health effects of products. This <a href="https://doi.org/10.15288/jsad.2020.81.284">is especially true</a> for products distributed and sold directly by Canadian governments in most provinces and territories. </p>
<h2>Alcohol and heart health</h2>
<p>The careful review process identified much weaker evidence than before for the hypothesis that low doses of alcohol can protect against heart disease. This finding is also consistent with a <a href="https://world-heart-federation.org/news/no-amount-of-alcohol-is-good-for-the-heart-says-world-heart-federation/">World Heart Federation</a> statement released earlier this year, advising that the science underlying this hypothesis is now highly contested and, at best, extremely weak.</p>
<p>My colleagues and I are keen to see how these new guidelines are received. There is still much more work to be done, including determining the acceptable level of risk from alcohol for most people. We have calculated that drinking at these new guideline levels will still shave off two or three months of life expectancy — or about five minutes per drink. Is this acceptable to most people? It’s a conversation we need to continue.</p><img src="https://counter.theconversation.com/content/189667/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Tim Stockwell currently receives funding from:
The Canadian Institute for Substance Use Research at the University of Victoria employs me as a part-time scientist;
The Canadian Institutes for Health Research to estimate the impact of alcohol policies on cancer-related illness;
The Public Health Agency of Canada to model the impacts of alcohol policies on alcohol-related illness and death.
I have previously received grants from many research councils, and government agencies. The latter includes government-owned alcohol distribution and retail agencies in Scandinavia (Systembolaget and Alko) and Canada (BC government) for studies of alcohol and public health. I do not receive funding from alcohol industry sources.</span></em></p>Canada’s new alcohol guidelines cut the number of drinks per week in the ‘low-risk’ category by almost half for women, and by more than half for men. Here’s how researchers came to these conclusions.Tim Stockwell, Scientist, Canadian Institute for Substance Use Research and Professor of Psychology, University of VictoriaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1751742022-01-21T12:16:14Z2022-01-21T12:16:14ZHeavy drinkers increased their alcohol consumption the most during lockdown – new research<figure><img src="https://images.theconversation.com/files/441957/original/file-20220121-27-u0hsh1.jpg?ixlib=rb-1.1.0&rect=118%2C189%2C5098%2C3319&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-man-supermarket-chooses-alcohol-wine-1779629234">Deman/Shutterstock</a></span></figcaption></figure><p>When the UK was placed into its first COVID lockdown in March 2020, many of us may have been tempted to reach for a drink. The country was about to enter an extraordinary period, with no idea of what would happen next, how bad things might get or when it might end. It was unheard of. It was worrying. It was huge.</p>
<p>And as part of that first lockdown, pubs, restaurants and bars closed completely, remaining closed until July. As a team of researchers, we were keen to find out what happened to UK drinking habits during that period. What impact did pub closures have on drinking and therefore our health? Did people drink more or less at home as a result? And were these trends the same across society?</p>
<p>We used information from Kantar’s WorldPanel shopping survey to map out drinking habits over time, <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0261609">analysing</a> around 5 million purchases of alcohol from almost 80,000 households between 2015 and 2020.</p>
<p>Our first look at the data showed us that alcohol buying in England, Scotland and Wales didn’t increase significantly overall between March and July 2020, once missing sales from pubs and restaurants were taken into account. However, <a href="https://alcoholchange.org.uk/blog/2020/drinking-in-the-uk-during-lockdown-and-beyond">public health surveys reported</a> that many of us felt we had drunk more during lockdown, and official government statistics showed a <a href="https://theconversation.com/alcohol-deaths-up-almost-19-during-the-pandemic-the-greatest-increase-since-2001-170972">sharp rise</a> in deaths directly linked to alcohol misuse in 2020 – an 18.6% increase compared to 2019 and the highest year-on-year rise in 20 years.</p>
<p>This created a puzzling paradox. How could alcohol sales have stayed stable when deaths linked to alcohol had risen so sharply? To unravel this, we looked at the shopping data again, this time linking it to how much alcohol households would normally buy before lockdown, where those people lived and how much they earned.</p>
<h2>Heaviest drinkers bought much more</h2>
<p>Our <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0261609">new analysis</a> shows that after pubs and restaurants closed in March 2020, some households increased the amount of alcohol they bought in shops and supermarkets much more than others. </p>
<p>Households that before the pandemic bought the most alcohol in shops increased their shop purchases during lockdown much more than those households that previously bought the least. The difference was stark. The increase in alcohol buying by the top fifth of pre-pandemic household consumers was 17 times greater than the increase by the bottom fifth.</p>
<figure class="align-center ">
<img alt="An empty shelf in a supermarket's alcohol aisle, in Rutland, England" src="https://images.theconversation.com/files/441958/original/file-20220121-23-mlm8hi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/441958/original/file-20220121-23-mlm8hi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/441958/original/file-20220121-23-mlm8hi.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/441958/original/file-20220121-23-mlm8hi.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/441958/original/file-20220121-23-mlm8hi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/441958/original/file-20220121-23-mlm8hi.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/441958/original/file-20220121-23-mlm8hi.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">With pubs closed, increased purchases in shops led some to run short of supplies during the first lockdown.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/oakham-rutlandengland-march-20-2020-tesco-1679601553">JessicaGirvan/Shutterstock</a></span>
</figcaption>
</figure>
<p>In simple terms, drinkers who already bought high amounts of alcohol in shops, and so who were already at most risk of harm, were the group that increased the amount of alcohol they bought by the greatest amount. The very lightest drinkers generally appeared to increase their shop purchases the least.</p>
<p>Once lockdown had begun, the average weekly purchase per adult within this top-fifth group was much higher than in any other group, at around 38 units per week – so just under a litre of vodka or four bottles of wine per person, each week. In many individual cases it would have been much higher.</p>
<p>We also saw that households in the north-east of England and Yorkshire and Humber increased their purchases more than those in other parts of Britain. And households in the most deprived communities – a group already more vulnerable to alcohol-related harm – increased the amount of alcohol they bought more than affluent groups.</p>
<p>This paints a worrying picture, where those already at risk of health harms from higher levels of drinking seem to have increased their drinking even more during lockdown. It’s likely that the big jump in deaths we’ve seen in 2020 will have been among those with a previous history of alcohol misuse or dependence.</p>
<p>This is especially concerning given that <a href="https://www.theguardian.com/society/2022/jan/17/millions-in-uk-drinking-harmful-levels-of-alcohol-at-home-experts-warn?CMP=Share_iOSApp_Other">new government figures</a> have shown that around 8 million people in England are drinking so much at home that it’s harmful to their health, with a big increase in the numbers of people drinking at levels considered to be dangerous.</p>
<figure class="align-center ">
<img alt="A man drinking whiskey, with a glass and bottle in front of him" src="https://images.theconversation.com/files/441962/original/file-20220121-27-1hr09l5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/441962/original/file-20220121-27-1hr09l5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/441962/original/file-20220121-27-1hr09l5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/441962/original/file-20220121-27-1hr09l5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/441962/original/file-20220121-27-1hr09l5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/441962/original/file-20220121-27-1hr09l5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/441962/original/file-20220121-27-1hr09l5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Heavy drinking is associated with an increased risk of heart disease, liver damage and cancer.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/alcoholism-concept-young-man-drinking-alcohol-1713939607">Pormezz/Shutterstock</a></span>
</figcaption>
</figure>
<p>These levels of drinking that we’re now seeing have potentially serious consequences for individual health outcomes, not to mention for health services including primary care, mental health services, addiction support services, acute care and more. And importantly, of course, harmful drinking can have devastating consequences for the families of heavy drinkers and the wider community.</p>
<h2>Breaking the habit</h2>
<p>We don’t know for sure what would happen to UK drinking habits if we experienced another extraordinary event like a lockdown, but we can guess they might follow the same patterns.</p>
<p>So it’s even more important that we do more to support vulnerable, heavy drinkers. Steps to take could include alcohol harm prevention strategies, such as <a href="https://www.gov.uk/government/publications/preventing-ill-health-commissioning-for-quality-and-innovation/guidance-and-information-on-the-preventing-ill-health-cquin-and-wider-cquin-scheme">supporting brief interventions</a> or encouraging time off drinking, as well as policies that limit very low pricing of alcohol – like the <a href="https://arc-nenc.nihr.ac.uk/news/mup-50p-impact-study/">minimum unit price</a> in Scotland and Wales.</p>
<p>And crucially, we need to start focusing on this now – before our lockdown drinking patterns become normalised habits.</p><img src="https://counter.theconversation.com/content/175174/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Peter Anderson has received funding from the AB InBev Foundation but not in relation to the work discussed in the article.</span></em></p><p class="fine-print"><em><span>Amy O'Donnell and Eileen Kaner do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>With pubs closed during lockdown, many British people opted to drink more at home.Eileen Kaner, Professor of Public Health and Primary Care Research, Newcastle UniversityAmy O'Donnell, Senior Research Associate in Population Health, Newcastle UniversityPeter Anderson, Professor of Substance Abuse, Newcastle UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1722252021-12-23T20:51:52Z2021-12-23T20:51:52ZWhy are young people drinking less than their parents’ generation did?<figure><img src="https://images.theconversation.com/files/436296/original/file-20211208-133881-17hyvka.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C1000%2C667&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>As we head towards the end of the year, office get-togethers, Christmas lunches and New Year’s parties are upon us. It seems like a prime opportunity for young people to be drinking the night away.</p>
<p>But something unexpected has happened since the start of this century. Young people in Australia, the UK, Nordic countries and North America have, on average, been <a href="https://academic.oup.com/eurpub/article/31/2/424/5981990?login=true">drinking significantly less alcohol</a> than their parents’ generation did when they were a similar age.</p>
<p>During COVID lockdowns, some surveys indicate <a href="https://theconversation.com/forget-the-stereotypes-our-survey-shows-many-young-people-are-drinking-less-alcohol-in-lockdown-145832">this fell even further</a>.</p>
<p>Our research suggests this is <a href="https://www.jsad.com/doi/full/10.15288/jsad.2021.82.76">unlikely to be due simply to government efforts</a> to cut youth drinking. Wider <a href="https://academic.oup.com/eurpub/article/31/2/424/5981990?login=true">social, cultural</a>, technological and <a href="http://eprints.lse.ac.uk/103847/1/politicsandpolicy_young_people_and_the_post_crisis.pdf">economic changes</a> seem to be key to these declines. </p>
<p>Researchers conducting interview-based studies with young people in a range of countries have identified four main reasons for declining youth drinking.</p>
<p>These are: uncertainty and worry about the future, concern about health, changes to technology and leisure, and shifting relationships with parents.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/forget-the-stereotypes-our-survey-shows-many-young-people-are-drinking-less-alcohol-in-lockdown-145832">Forget the stereotypes. Our survey shows many young people are drinking less alcohol in lockdown</a>
</strong>
</em>
</p>
<hr>
<h2>Uncertain futures</h2>
<p>What it’s like to be young in developed countries is very different today than it was for previous generations. From <a href="https://theconversation.com/ten-years-to-1-5-c-how-climate-anxiety-is-affecting-young-people-around-the-world-podcast-171566">climate change</a> to planning a career and being able to afford a house, young people are aware their futures are uncertain.</p>
<p>Pressures to perform academically are starting earlier and <a href="https://theconversation.com/youth-anxiety-and-depression-are-at-record-levels-mental-health-hubs-could-be-the-answer-154722">rates of mental ill health are on the rise</a>.</p>
<p>Many young people are thinking about the future in ways previous generations didn’t need to. They are trying to gain a sense of control over their lives and secure the futures they aspire to. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/youth-anxiety-and-depression-are-at-record-levels-mental-health-hubs-could-be-the-answer-154722">Youth anxiety and depression are at record levels. Mental health hubs could be the answer</a>
</strong>
</em>
</p>
<hr>
<p>A couple of decades ago, getting really drunk was widely regarded by many young people as a “rite of passage” into adulthood and a good way of taking time out from the <a href="https://journals.sagepub.com/doi/abs/10.1177/1741659005057641">routines of work and study</a>.</p>
<p>Now, young people feel pressure to present as responsible and independent at an earlier age and some fear drinking to intoxication, and the loss of control it entails, will <a href="https://www.sciencedirect.com/science/article/pii/S0955395918303025">jeopardise their plans for the future</a>.</p>
<p>This emphasis on the future means young people <a href="https://journals.sagepub.com/doi/full/10.1177/00380385211008370">limit how much time they spend partying and drinking</a>.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1462615200331227141"}"></div></p>
<h2>Young people are health conscious</h2>
<p>Health and well-being also seem to be increasingly important to young people.</p>
<p><a href="https://journals.sagepub.com/doi/abs/10.1177/0264550504048220">Research</a> from 15-20 years ago found young people viewed the consequences of heavy drinking (vomiting, unconsciousness) positively, or at least ambivalently.</p>
<p>More recent studies suggest this has <a href="https://www.sciencedirect.com/science/article/pii/S0955395917303250">changed</a>, with young people <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/1467-9566.13237">expressing concerns about risks to mental health</a> and long-term physical health related to their alcohol use.</p>
<p>However, <a href="https://pubmed.ncbi.nlm.nih.gov/33635553/">Australian</a> and <a href="https://www.sciencedirect.com/science/article/pii/S0955395920301663">Swedish</a> research also found some young people regard the social benefits of drinking as important to their well-being.</p>
<p>For many young people, however, this seems to involve moderate alcohol consumption, in place of the “<a href="https://www.sciencedirect.com/science/article/pii/S0955395906000910">determined drunkenness</a>” observed in the 1990s and early 2000s.</p>
<h2>What if my employer sees that?</h2>
<p>Technology has reshaped how young people socialise, with contradictory effects on youth drinking.</p>
<p>Social media provides new (less regulated) avenues for alcohol companies to promote their products. Holding a drink is <em>de rigueur</em> for a photo on social media celebrating a night out.</p>
<p>Yet, young people are also <a href="https://www.sciencedirect.com/science/article/pii/S0955395918301117">careful to manage their online images</a>.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"601250131518877696"}"></div></p>
<p>Our research found young people worry about who might see images of them <a href="https://www.tandfonline.com/doi/full/10.1080/13676261.2020.1778658">drunk on social media</a> (such as friends, family and future employers), a risk that is unique to this generation. </p>
<p>The internet exposes young people to a wider range of possibilities for their lives, including new perspectives from which to reflect on their drinking choices. </p>
<p>It also offers social alternatives that are less likely to involve drinking, including <a href="https://www.tandfonline.com/doi/full/10.1080/13676261.2020.1746757">video games and other digital media</a>. </p>
<h2>Changing family relationships</h2>
<p>Styles of raising teenagers and managing their introduction to alcohol have <a href="https://www.tandfonline.com/doi/full/10.1080/16066359.2019.1663831">evolved over a generation</a>.</p>
<p>Many parents monitor their children on a night out and appear to oversee their drinking more closely than in previous generations, which is enabled by the mobile phones most young people in high-income countries now possess.</p>
<p>Young people also spend more time with their parents, potentially <a href="https://www.sciencedirect.com/science/article/pii/S0955395918303025">developing more communicative relationships</a> that reduce their need to drink and rebel.</p>
<h2>Binge drinking not as ‘cool’ anymore</h2>
<p>There are also a host of other reasons why young people limit alcohol consumption, including culture and religious affiliations, health conditions and personal motivations.</p>
<p>Altogether, these changes mean many young people do not regard heavy intoxication as “cool” and no longer see it as a <a href="https://www.sciencedirect.com/science/article/pii/S0955395918303025">key marker of independence and adulthood</a>.</p>
<p>Alcohol abstinence has become more <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/add.15611">socially accepted among young people</a>, along with choosing to consume alcohol moderately.</p>
<figure class="align-center ">
<img alt="Two people cheersing glasses of water with lemon" src="https://images.theconversation.com/files/436603/original/file-20211209-172173-1snq2gt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/436603/original/file-20211209-172173-1snq2gt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/436603/original/file-20211209-172173-1snq2gt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/436603/original/file-20211209-172173-1snq2gt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/436603/original/file-20211209-172173-1snq2gt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/436603/original/file-20211209-172173-1snq2gt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/436603/original/file-20211209-172173-1snq2gt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Drinking less, or not at all, is more accepted by young people today than it used to be.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p>These factors play out differently for young men and women. Some research points to loosening of gendered expectations of drinking, with new opportunities for men to demonstrate masculinity <a href="https://www.sciencedirect.com/science/article/pii/S0955395918303025">without drinking heavily</a>.</p>
<p>Yet, differences remain in how young men and women use alcohol, with women having to navigate a range of gendered risks (such as unwanted sexual attention) and being judged more harshly when they are seen to be drunk (<a href="https://journals.sagepub.com/doi/10.1177/2056305116628889">including online</a>).</p>
<p>Of course, some young people continue to drink a lot and there will always be blips in alcohol use around holidays such as Christmas and New Year’s Eve.</p>
<p>But whether alcohol consumption among young people continues its overall decline may have more to do with the wider contexts of their lives than the sometimes <a href="https://oxford.universitypressscholarship.com/view/10.1093/acprof:oso/9780199551149.001.0001/acprof-9780199551149">poorly selected policies their governments implement</a>.</p><img src="https://counter.theconversation.com/content/172225/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sarah J MacLean receives funding from the Australian Research Council and the Victorian Responsible Gambling Foundation. In the past she has also received funding from the National Health and Medical Research Council, the Victorian Health Promotion Foundation, the Foundation for Alcohol Research and Education and the National Drug Law Enforcement Research Fund</span></em></p><p class="fine-print"><em><span>Amy Pennay has received funding from the Australian Research Council, the National Health and Medical Research Council, Beyond Blue, the National Drug Law Enforcement Research Fund, the Victorian Health Promotion Foundation, the Victorian Responsible Gambling Foundation, the Foundation for Alcohol Research and Education, and various state and local governments.</span></em></p><p class="fine-print"><em><span>Gabriel Caluzzi has received funding from the Australian Research Council and the Foundation for Alcohol Research and Education.</span></em></p><p class="fine-print"><em><span>John Holmes receives funding from the Wellcome Trust (208090/Z/17/Z), the National Institute for Health Research, Economic and Social Research Council, UK Prevention Partnership, Cancer Research UK, other Government bodies and third sector organisations working to improve public health. </span></em></p><p class="fine-print"><em><span>Jukka Törrönen has received and receives funding from the Swedish Research Council for Health, Working Life and Welfare, under Grants no. 2016-00313 and 2020- 00457.</span></em></p>Researchers have identified four main reasons young people in high-income countries are drinking less.Sarah J MacLean, Associate professor, La Trobe UniversityAmy Pennay, Research Fellow, La Trobe UniversityGabriel Caluzzi, Postdoctoral Research Officer, La Trobe UniversityJohn Holmes, Professor of Alcohol Policy, Sheffield Alcohol Research Group, University of SheffieldJukka Törrönen, Professor, The Centre for Social Research on Alcohol and Drugs, Stockholm UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1614032021-05-27T20:41:13Z2021-05-27T20:41:13ZHow to ‘build back better’ health habits after the pandemic year<figure><img src="https://images.theconversation.com/files/402731/original/file-20210525-23-qzcmgh.jpg?ixlib=rb-1.1.0&rect=18%2C91%2C6098%2C3274&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">People around the country are ready to celebrate.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/multi-ethnic-laboratory-team-cheering-at-workplace-royalty-free-image/1275317177?adppopup=true">janiecbros/Getty Images</a></span></figcaption></figure><p>The U.S. is in far different shape today than it was last Memorial Day, and many Americans are, too. </p>
<p>According to a recent survey by the American Psychological Association, <a href="https://www.apa.org/news/press/releases/stress/2021/one-year-pandemic-stress">undesired changes in weight</a> driven by pandemic stress are widespread: 42% of adults reported gaining weight, with a median weight gain of 15 pounds, while 18% reported undesired weight loss. About 66% of people reported changes in their sleep habits, and 23% of respondents reported an increase in alcohol use.</p>
<p>In addition, many people have delayed routine medical and dental maintenance: <a href="https://dx.doi.org/10.1016%2Fj.rcl.2020.09.008">Think mammograms</a>, <a href="https://www.cdc.gov/mmwr/volumes/69/wr/mm6919e2.htm">childhood immunizations</a> and <a href="https://doi.org/10.1038/s41415-020-2404-y">teeth cleaning</a>. There’s also a mental health pandemic underway <a href="https://www.who.int/teams/mental-health-and-substance-use/covid-19">in parallel with</a> increased substance use, which must also be addressed.</p>
<p>I am a <a href="https://scholars.msu.edu/scholar/stack/16156/CLAUDIA-FINKELSTEIN">physician and associate professor of medicine at Michigan State University’s College of Human Medicine</a>. In my role as the director of wellness, resiliency and vulnerable populations, I hear the concerns of faculty and staff regarding returning to on-site work.</p>
<p>The switch that got flipped in March 2020 to social distancing, remote schooling, mask-wearing and long-distance work – or no work – is switching back almost as abruptly. With little preparation time, many people are faced with wanting to be in top form for reentry. Resuming – or beginning – healthier habits is a wonderful goal. Trying to get back to normal too quickly, however, may be hard on joints and hearts. Here is a guide to help you get back in shape without hurting yourself.</p>
<h2>Attitude matters</h2>
<p>It is vital to begin with acceptance of your current state while you plan and implement changes. It may be necessary to hold two seemingly contradictory truths at once – a core tenet of <a href="https://behavioraltech.org/resources/resources-for-clients-families/">dialectical behavioral therapy, or DBT</a>. A classic example of DBT is when a therapist tells a client, “I love you exactly the way you are, and I’m here to help you change.” The statements are simultaneously in opposition to each other and true.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/403206/original/file-20210527-20-ho8t5n.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Hand using pen to write checklist on notebook." src="https://images.theconversation.com/files/403206/original/file-20210527-20-ho8t5n.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/403206/original/file-20210527-20-ho8t5n.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/403206/original/file-20210527-20-ho8t5n.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/403206/original/file-20210527-20-ho8t5n.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/403206/original/file-20210527-20-ho8t5n.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/403206/original/file-20210527-20-ho8t5n.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/403206/original/file-20210527-20-ho8t5n.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Setting concrete, actionable goals can help make them feel more achievable.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/RLw-UC03Gwc">Glenn Carstens-Peters/Unsplash</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
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<p>Doing this in terms of pandemic-driven changes involves three steps:</p>
<ul>
<li><p>Take note of the current reality, such as, “I am up 10 pounds,” “I am drinking more than before the pandemic,” or “I’m not getting enough exercise anymore,” but without negative self-judgment.</p></li>
<li><p>Make realistic, measurable goals for change: “I want to lose a pound in four weeks,” “I want to climb a flight of stairs without becoming breathless,” or “I will drink alcohol only when out with friends.”</p></li>
<li><p>Create a plan to achieve these goals. </p></li>
</ul>
<p>Also, wanting to take good care of oneself, rather than wanting to look or be a certain way, is an important focus. A little self-knowledge goes a long way here. People who tend to go “all in,” rather than doing things gradually, need to be sure their plans are safe by seeking professional guidance from a reliable source, such as getting weight loss advice from a family doctor rather than from people or companies that a New York Times opinion writer recently described as “<a href="https://www.nytimes.com/2021/05/05/opinion/culture/dieting-covid-weight-loss.html">weight-loss profiteers</a>.”</p>
<p>How can this process be applied to some common pandemic-driven health problems? Here are some suggestions.</p>
<h2>Sleep</h2>
<p>One of the most effective and “simple but not easy” ways to normalize sleep is to pay attention to one’s <a href="https://www.sleepfoundation.org/sleep-hygiene">sleep hygiene</a>. Good sleep hygiene includes having a distraction-free, dark, quiet place to sleep. This may require using a sleep mask, blackout curtains or a white noise machine, and having no TV in the bedroom. </p>
<p>Even parents of very young children who may find these steps unrealistic can make some changes to help improve sleep, such as avoiding naps, sticking to a schedule, developing a routine, and engaging in some physical activity to tire oneself out before bedtime. Having a cutoff time for caffeinated beverages, as well as avoiding late night dining and too much alcohol, also help. </p>
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<a href="https://images.theconversation.com/files/403211/original/file-20210527-13-i1nwod.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Arm entangled in bedsheets reaching towards a pair of glasses." src="https://images.theconversation.com/files/403211/original/file-20210527-13-i1nwod.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/403211/original/file-20210527-13-i1nwod.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/403211/original/file-20210527-13-i1nwod.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/403211/original/file-20210527-13-i1nwod.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/403211/original/file-20210527-13-i1nwod.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/403211/original/file-20210527-13-i1nwod.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/403211/original/file-20210527-13-i1nwod.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Small behavior changes can help build healthy sleep habits.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/kHHwYNA1lnM">Matheus Vinicius/Unsplash</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
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<p>If excessive snoring is a problem, or getting very sleepy and dozing off throughout the day, or any other unusual symptoms, consulting a doctor should be part of the plan. </p>
<h2>Alcohol</h2>
<p>There are many shades of alcohol consumption between <a href="https://www.niaaa.nih.gov/alcohols-effects-health/alcohol-use-disorder">complete abstinence and full blown alcohol use disorder</a>. If the goal is to stop drinking alcohol entirely, it’s important to stay alert to signs of alcohol withdrawal, which can range in severity from symptoms of a mild hangover to <a href="https://www.webmd.com/mental-health/addiction/alcohol-withdrawal-symptoms-treatments#1">delirium tremens (experiencing a sudden and severe state of confusion), seizures and delusions</a>. The good news is that <a href="https://dx.doi.org/10.1097%2FHRP.0000000000000079">there are now medications</a> in addition to behavioral and support groups that can help. </p>
<p>If you’re concerned, try a brief <a href="https://auditscreen.org/check-your-drinking/">self-screening test</a> and talk with your physician.</p>
<h2>Physical activity</h2>
<p>To come up with a safe exercise plan, start with an honest self-assessment. This includes looking at your current age and physical condition (particularly knees, hips, lungs, heart and balance); weight and weight changes during the pandemic; and activity levels before and during lockdown. The National Academy of Sports Medicine offers a <a href="https://www.acsm.org/docs/default-source/files-for-resource-library/par-q-acsm.pdf">downloadable questionnaire</a> that can help with making this self-assessment.</p>
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<a href="https://images.theconversation.com/files/403208/original/file-20210527-22-5lqbhf.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Legs of someone wearing orange and gray shoes walking up concrete steps." src="https://images.theconversation.com/files/403208/original/file-20210527-22-5lqbhf.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/403208/original/file-20210527-22-5lqbhf.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/403208/original/file-20210527-22-5lqbhf.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/403208/original/file-20210527-22-5lqbhf.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/403208/original/file-20210527-22-5lqbhf.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/403208/original/file-20210527-22-5lqbhf.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/403208/original/file-20210527-22-5lqbhf.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Checking in with your body can help you safely and effectively reach your health targets.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/PHIgYUGQPvU">Bruno Nascimento/Unsplash</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>Remember there are weight bearing, aerobic and stretching types of exercises. With each, begin at a level of comfort and gradually go slightly further. For example, if the goal is to start running, consider starting small, with a 30-minute routine a few days a week that involves a jog for one minute followed by walking for four minutes. Each week up the ante, such as shifting on the second week to jogging for two minutes then walking for three.</p>
<p>If the goal is to start walking, setting a time limit can help to achieve tangible goals: a 10-minute walk a few days the first week, 15 minutes the next week and so on, until the walk lasts 30 minutes and happens a few times a week. Then focus on increasing the pace.</p>
<p>Chest or arm pain, dizziness or extreme discomfort, are all signs to stop. While it’s useful to get to know <a href="https://www.self.com/story/how-to-know-the-difference-between-good-post-workout-soreness-and-potential-injury">what it feels like to be a little sore</a> from working hard and how that differs from pushing it too far, it’s also a good idea to become familiar with the <a href="https://www.heart.org/en/health-topics/heart-attack/warning-signs-of-a-heart-attack">warning signs of a heart attack</a>.</p>
<p>Whether they involve mental or physical health - while this tends to be an artificial separation - post-lockdown behavior changes should begin with an accurate assessment of how things are, a realistic goal for what they will become, and a plan to get there. All of these should reflect care and love for one’s self and one’s body.</p>
<p>Have a happy - and safe - reentry!</p><img src="https://counter.theconversation.com/content/161403/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Claudia Finkelstein does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>A doctor offers tips on how to safely get exercise, sleep and drinking habits back into shape as the pandemic wanes.Claudia Finkelstein, Associate Professor of Medicine, Michigan State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1376982020-05-08T02:48:10Z2020-05-08T02:48:10ZAlcohol can make coronavirus worse – so why was it treated as essential in New Zealand’s lockdown?<figure><img src="https://images.theconversation.com/files/333258/original/file-20200506-49569-1wh0q1l.jpg?ixlib=rb-1.1.0&rect=103%2C230%2C5200%2C2751&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>New Zealand has won <a href="https://www.nytimes.com/2020/04/30/opinion/coronavirus-leadership.html">international praise</a> for its <a href="https://covidtracker.bsg.ox.ac.uk/">strict</a> lockdown conditions and public health response to COVID-19, but there’s one glaring blindspot. </p>
<p>Last month, the World Health Organisation released a new <a href="http://www.euro.who.int/__data/assets/pdf_file/0010/437608/Alcohol-and-COVID-19-what-you-need-to-know.pdf?ua=1">factsheet on alcohol and COVID-19</a>, warning that heavy alcohol consumption increases the risk of respiratory failure, one of the most severe complications of COVID-19.</p>
<p>Yet alcohol was sold as an essential item, along with food, during New Zealand’s level 4 lockdown, even though <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/dar.12665">almost half of all alcohol in New Zealand</a> is drunk in heavy and binge drinking sessions.</p>
<p>While this isn’t a simple health issue to address – and <a href="https://www.nzherald.co.nz/nz/news/article.cfm?c_id=1&objectid=12330612">lockdown might not</a> have been the time to do it – it is an issue we can’t ignore. Alcohol is a risk factor not just for COVID-19 but many other conditions, including cancer.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/coronavirus-its-tempting-to-drink-your-worries-away-but-there-are-healthier-ways-to-manage-stress-and-keep-your-drinking-in-check-134669">Coronavirus: it's tempting to drink your worries away but there are healthier ways to manage stress and keep your drinking in check</a>
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</em>
</p>
<hr>
<h2>The World Health Organisation on alcohol and COVID-19</h2>
<p>The World Health Organisation’s comprehensive <a href="http://www.euro.who.int/__data/assets/pdf_file/0010/437608/Alcohol-and-COVID-19-what-you-need-to-know.pdf?ua=1">factsheet</a> stresses that alcohol weakens the immune system and heavy drinking increases the risk of acute respiratory distress syndrome, which leads to widespread inflammation in the lungs.</p>
<p>This link between heavy alcohol consumption and respiratory disease is not well known, despite a <a href="https://www.ncbi.nlm.nih.gov/pubmed/29288645">systematic review</a>, published in 2018, which concluded there is comprehensive evidence for it. </p>
<p>It is missing from the burgeoning research effort to quantify other COVID-19 risk factors <a href="http://www.tobaccoinduceddiseases.org/COVID-19-and-smoking-A-systematic-review-of-the-evidence,119324,0,2.html">such as smoking</a>. </p>
<p>This <a href="https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(20)30008-5/fulltext">global health blindspot</a> is reminiscent of the lack of awareness of alcohol as a cause of cancer, even though the WHO’s <a href="https://www.iarc.fr/">International Agency for Research on Cancer</a> stated in 2011 that alcohol is a <a href="https://publications.iarc.fr/122">class one carcinogen</a> – meaning it’s a known cause of cancer.</p>
<p>Despite this, alcohol supply was an essential service during New Zealand’s lockdown. This raised concerns, but they focused largely on the increased risk of intimate partner violence and likely <a href="https://www.healthcoalition.org.nz/wp-content/uploads/2020/04/HCA-open-letter.pdf">impact on families</a> in stressful lockdown situations. Potential effects on drinkers, such as an increased risk of dependence, were also discussed – but not the health risks from heavy drinking specifically associated with COVID-19.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-the-coronavirus-is-putting-our-relationship-with-alcohol-to-the-test-135460">How the coronavirus is putting our relationship with alcohol to the test</a>
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<h2>Access to alcohol during lockdown</h2>
<p>So why did the New Zealand government decide access to alcohol was essential during the lockdown? Given wine and beer are sold in supermarkets in New Zealand and supermarkets were selected to operate as essential businesses, it was unlikely wine and beer sales would be restricted – although some countries such as <a href="https://www.ctvnews.ca/health/coronavirus/thailand-bans-sale-of-alcoholic-drinks-in-war-on-covid-19-1.4891515">Thailand have banned alcohol sales</a>. </p>
<p>The question for New Zealand then became one of access to spirits and ready-to-drink premixed alcohol beverages. These have never been sold in supermarkets, but the decision was complicated by the fact there are some geographical areas, known as Licensing Trusts, where alcohol is not sold in supermarkets but only through local bottle shops. </p>
<p>One option would have been to allow only beer and wine sales from Licencing Trust outlets to create a level playing field with supermarkets elsewhere, but the government chose not to do this. As a consequence, people travelled outside of their area to buy spirits.</p>
<p>The government then allowed online sales of alcohol, initially restricted to existing online-only alcohol businesses but then extended to other premises, provided they consulted with their local council authorities. This increased potential availability from about 250 online-only businesses to around 1,000 physical bottle shops. And social media were used to promote online sales.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-do-we-keep-family-violence-perpetrators-in-view-during-the-covid-19-lockdown-135942">How do we keep family violence perpetrators ‘in view’ during the COVID-19 lockdown?</a>
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</em>
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<h2>Alcohol as an ordinary commodity</h2>
<p>One element of the government’s decision to treat alcohol supply as an essential service will have been concern for business interests. A second may have been concern for heavy drinkers and the possibility of withdrawal symptoms if they could not access alcohol. The latter is questionable given ongoing beer and wine sales and the availability of addiction support services online. </p>
<p>A third element was undoubtedly a framing of alcohol as an “ordinary commodity”. But this is not how alcohol is consumed in New Zealand. Almost half is consumed as <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/dar.12665">heavy and binge drinking</a> (defined as eight or more cans of premixed alcoholic drinks for men, and six or more cans for women). </p>
<p>For heavy drinkers, premixed drinks are a <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/dar.12495">source of cheap alcohol</a>, and there is every reason to expect much of the spirits and premixed drinks ordered online during this current period of restricted access will be consumed in this way.</p>
<p>Heavy drinking contributes to several diseases that likely exacerbate the effects of COVID-19. The government’s decisions projected the idea of alcohol supply as an essential business, and it appeared to favour commercial interests over public health. </p>
<p>This approach has influenced New Zealand’s policy response for many decades, before the present government took office. Evidence-based recommendations made by the <a href="https://www.lawcom.govt.nz/sites/default/files/projectAvailableFormats/NZLC%20R114.pdf">New Zealand Law Commission</a> in 2010 and supported by <a href="https://www.mentalhealth.inquiry.govt.nz/inquiry-report/">subsequent inquiries</a> have not been implemented, despite more than 800 deaths that can be attributed to alcohol and NZ$7.8 billion in costs each year. </p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/interactive-body-map-what-really-gives-you-cancer-52427">Interactive body map: what really gives you cancer?</a>
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<p>Going forward into a post-pandemic world, we should learn from the government’s science-based response to the threat of coronavirus to inform our response to persistent and ongoing harms from the marketing and over-supply of cheap alcohol.</p><img src="https://counter.theconversation.com/content/137698/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sally Casswell receives funding from the Health Research Council of New Zealand. She s affiliated with the Global Alcohol Policy Alliance and is director of a WHO Collaborating Centre.
</span></em></p>Despite World Health Organisation warnings that heavy alcohol consumption increases the risk of severe complications of COVID-19, alcohol was sold as an essential item during New Zealand’s lockdown.Sally Casswell, Professor of public health policy, Massey UniversityLicensed as Creative Commons – attribution, no derivatives.