Daily drinking and harm

Most guidelines on low-risk drinking suggest at least one day per week with no alcohol consumption (e.g., Ashley et al., 1994; British Medical Association, 1995). The ARF-CCSA joint policy statement based on the International Symposium on Moderate Drinking and Health states explicitly: 6. To minimize any risk of dependence, there should be at least one day per week when no alcohol is consumed. (Ashley et al., 1994) The only reason given is that "many studies have shown a relationship between daily drinking and high volume consumption" (Ashley et al., 1994). This reasoning is not very convincing, since it does not directly support the argument of the guidelines (that daily drinking rather than drinking only six days per week minimizes the risk of dependence), and since the problem of high volume consumption had already been addressed as the key point of the guidelines ("persons should not drink more than two standard drinks in any day"; see Ashley et al., 1994). This paper looks at the empirical evidence on the risks of daily-drinking versus non-daily-drinking patterns. Besides the issue of potential dependence and other chronic disease resulting from assorted drinking patterns, we address the relationship between patterns of drinking and social harm. Although social harm was originally gauged when evaluating alcohol problems (Room, 1995), it has been largely overlooked lately because of the shift to chronic somatic diseases in alcohol epidemiology (e.g., see the emphasis in Edwards et al., 1994, on this theme compared with Bruun et al., 1975). However, more recent efforts have reintegrated social harm as a major consideration in developing guidelines (Room, Bondy & Ferris, 1995; Joint working group of the British Royal College of Physicians, Royal College of Psychiatrists and Royal College of General Practitioners, 1995). This paper addresses both potential problematic types of consequences from consumption: chronic disease and social harm. Methodology Data Two data sets are used to examine the issues of social harm and mortality. To measure the relationship between patterns of consumption and social harm, data were obtained from the National Alcohol and Other Drug Study (NADS) conducted by Statistics Canada for Health and Welfare Canada in March 1989 (Eliany et al., 1992). In total, 11,634 Canadians age 15 and over were randomly selected and interviewed over the telephone. The response rate for the survey was 79%. Data are weighted to account for non-response, houses without telephones, houses with multiple telephones, census projection counts, and age and sex of the population. The analysis of social harm restricts attention to those who had seven or more drinks in the week prior to the survey (n=1,538), and to the subgroup who drank between seven and 14 drinks (n=1,081 ). Respondents were questioned about their consumption of alcoholic drinks for every day in the week before the survey. Subsequently we were able to calculate the number of drinks consumed in the previous week and the number of days on which alcohol was consumed. This was recoded into the following categories: (1) consumption of alcohol on one to four days in the past week; (2) on five to six days in the past week; and (3) on seven days in the past week. The other covariables were sex and age. Social harm was measured by having respondents answer positively or negatively to the following questions: (1) Have you ever had police contact due to your drinking? (2) Has your alcohol use ever been harmful to your friendships? (3) Has your alcohol use ever been harmful to your health? (4) Has your alcohol use ever been harmful to your happiness? (5) Has your alcohol use ever been harmful to your home life? (6) Has your alcohol use ever been harmful to your work or studies? (7) Has your alcohol use ever been harmful to your finances? To measure the relationship between patterns of consumption and mortality, data from the NHEFS cohort were used. …