Epidemiology – Alcohol Use in Canada
Prevalence: Approximately 75% of Canadians aged 15 and above consume alcohol.
Heavy Drinking: In 2022, nearly 6.5 million Canadians engaged in heavy drinking.
Hospitalization Rates: Between 2022 and 2023, the average hospitalization rate in Canada solely
attributable to alcohol was 262 per 100,000 people, with men having significantly higher rates than
women.
Economic Impact: In 2020, alcohol-related harms accounted for nearly 40% of the estimated $49.1
billion economic cost of substance use in Canada.
Youth Risk: Adults aged 18 to 34 years were more likely to report heavy drinking compared to other age
groups.
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III. Assessment Tools
A. CAGE Questionnaire
Purpose: A brief screening tool to identify potential alcohol misuse.
Questions:
1. Have you ever felt you should Cut down on your drinking?
2. Have people Annoyed you by criticizing your drinking?
3. Have you ever felt bad or Guilty about your drinking?
4. Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover
(Eye-opener)?
Interpretation: Two or more affirmative answers suggest a need for further assessment.
B. AUDIT (Alcohol Use Disorders Identification Test)
Developed by: World Health Organization
Structure: A 10-item questionnaire assessing alcohol consumption, drinking behaviors, and alcohol-
related problems.
Scoring:
0–7: Low risk
8–15: Hazardous drinking
16–19: Harmful drinking
20+: Possible alcohol dependence
Usefulness: Effective in identifying individuals at risk for alcohol use disorders.
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IV. Investigations and Their Use
Liver Function Tests (LFTs): Assess liver damage or disease.
Complete Blood Count (CBC): Detect anemia or infection.
Electrolyte Panel: Identify imbalances due to alcohol use.
Thiamine Levels: Evaluate for deficiency, which can lead to Wernicke-Korsakoff syndrome.
Carbohydrate-Deficient Transferrin (CDT): Monitor chronic heavy drinking.
Gamma-Glutamyl Transferase (GGT): Detect liver disease and alcohol consumption.
Psychiatric Evaluation: Assess for co-occurring mental health disorders.
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V. Management Strategies
A. Pharmacological Treatment
Disulfiram: Causes adverse reactions when alcohol is consumed, deterring drinking.
Naltrexone: Reduces alcohol cravings and the pleasurable effects of drinking.
Acamprosate: Helps maintain abstinence by stabilizing chemical signaling in the brain.
Benzodiazepines: Used to manage withdrawal symptoms and prevent seizures.
B. Psychosocial Interventions
12-Step Programs (e.g., Alcoholics Anonymous): Provide peer support and a structured approach to
recovery.
Cognitive Behavioral Therapy (CBT): Helps individuals identify and change harmful drinking behaviors.
Motivational Interviewing: Enhances motivation to change drinking habits.
C. Inpatient Referral
Indications:
Severe withdrawal symptoms.
Co-occurring medical or psychiatric conditions.
Failure of outpatient treatment.
Benefits: Provides intensive monitoring and support during detoxification.
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VI. Alcohol Intoxication and Its Management
Symptoms:
Euphoria, impaired judgment, slurred speech, ataxia, nystagmus.
Management:
Ensure airway protection and monitor vital signs.
Administer intravenous fluids to correct dehydration and electrolyte imbalances.
Provide glucose if hypoglycemia is suspected.
Avoid further alcohol consumption.
In severe cases, consider gastric lavage or activated charcoal if ingestion was recent.
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VII. Delirium Tremens (DTs)
Definition: A severe form of alcohol withdrawal characterized by confusion, agitation, hallucinations,
and autonomic instability.
Onset: Typically 48–72 hours after the last drink.
Management:
Administer benzodiazepines (e.g., diazepam) to control agitation and prevent seizures.
Provide thiamine to prevent Wernicke-Korsakoff syndrome.
Correct electrolyte imbalances and dehydration.
Monitor in a calm, well-lit environment with orientation cues.
Avoid physical restraints; use them only if absolutely necessary.
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VIII. Problem Drinking
Definition: Alcohol consumption that leads to negative consequences but does not meet the full criteria
for alcohol use disorder.
Characteristics:
Regularly exceeding recommended drinking limits.
Experiencing blackouts or memory lapses.
Engaging in risky behaviors while intoxicated.
Management:
Encourage self-monitoring of drinking patterns.
Provide education on low-risk drinking guidelines.
Refer to counseling or support groups if necessary.
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IX. Role of Family Physicians
Screening and Early Detection: Regularly assess patients for signs of alcohol misuse using tools like CAGE
or AUDIT.
Brief Interventions: Provide brief counseling to motivate patients to reduce or cease alcohol
consumption.
Referral: Refer patients to specialized addiction services when appropriate.
Monitoring: Regularly follow up with patients to assess progress and adjust treatment plans.
Support: Offer support to families affected by alcohol use disorders.
