Berkowitz: Your doctor’s going to ask about your drinking. Don’t be offended



As the smoke clears from the debate over the decriminalization of marijuana use, Canadians will soon find ourselves talking about the pros and cons of another widely used drug that’s been here with us, legal, celebrated and toasted, all along: alcohol.

Because there’s a building movement among public health organizations, including Ottawa Public Health, to dramatically change the discussion on booze and its social and health impacts.

It’s needed. I love craft beers, savour Californian merlots, and consider nursing a negroni a religious experience. This doesn’t change the fact that while other drugs are demonized, it’s alcohol in its many forms that’s causing the most personal, familial and societal damage across Canada.

The first place many of us will experience this new discussion is in our doctor’s office. New best-practice guidelines for GPs reframe the doctor-patient conversation on alcohol.

The old approach to booze and health was black and white: there were alcoholics and those who weren’t. It was insulting for your GP to raise the topic of your drinking – unless perhaps your liver was failing.

Now, the singular term “alcoholic” has been replaced by alcohol use disorders, ranging from teenage binge drinking to the parents’ nightly use of alcohol as “liquid therapy.”

And based on extensive medical research on the positive health benefits, physicians are counselled to use a simple questionnaire as a screening tool to talk to every patient about his or her drinking.

The guiding principle is similar to that with smoking: any amount of drinking is reason for thoughtful reflection and discussion. Based on Statistics Canada figures, this means four-in-five Canadians will be having the conversation.

There’s good reason for this shift.

It’s difficult to overstate the damage caused by alcohol. As a society, we are collectively like a functioning alcoholic.

The statistic that really jolts me is that in North America about one-third of all emergency room visits are alcohol-related. Emergency departments are filled with alcohol-related injuries from falls, vehicle collisions and violence.

While many people might still think of cirrhosis of the liver as alcohol’s central damaging health affect, this is missing the forest for a single tree

Alcohol is a major – and often the primary – contributor to a catalogue of chronic health problems including type II diabetes, obesity, heart disease, cancer, alcohol-induced dementia, cerebral hemorrhages and digestive disorders. Not to mention sleep problems and depression.

In the litany of alcohol-related health damage, there’s none more tragic than Fetal Alcohol Syndrome Disorder (FASD).

Prenatal alcohol exposure is the number one cause of preventable developmental disability in the world. In Canada, one of the world’s wealthiest countries, with one of the best health care systems, FASD affects at least one per cent of children. This is a brutal tragedy.

The societal damage caused by alcohol is a huge economic issue. According to the Canadian Centre on Substance Abuse, alcohol-related problems cost the Canadian economy about $15 billion a year in lost productivity, direct health costs and  “enforcement costs.”

Demonizing dope has provided an easy cover in our individual and political discussions about the health and social effects of alcohol use. It’s socially fine to debate the merits of legalizing dope while downing a bottle of pinot noir.

The heart of the challenge in dealing with alcohol is that it’s about moderation, nuance and the public recognition of a topic we’d still rather keep behind closed doors. It’s a topic that’s notoriously difficult to navigate in family conversations and this is magnified in public health and political ones, and probably in the doctor’s office.

But it’s a topic that needs attention. Our current situation is summed up by the title of a 2015 commentary in the Canadian Medical Association Journal on the state of public policy, alcohol and health titled: “A systematic failure to address at-risk drinking and alcohol use disorders.”

So, if your doctor asks about your drinking, don’t be offended. It could be a rare opportunity to improve your health, and that of your family, community and country.

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