Updated Canadian recommendations published in the Canadian Medical Association Journal (CMAJ) and funded by the Canadian Institutes of Health Research aim to totally reconfigure how health professionals talk to their patients about alcohol. Prior screening recommendations were rarely implemented and incompatible with the current understanding of the health risks of alcohol.
Prior research demonstrates most primary care providers and specialists do not undertake formal screening for harmful alcohol consumption. Explanations include complex and time consuming screening algorithms and practitioner discomfort initiating conversations about alcohol. Additionally, existing screening tools have recently been found to perform poorly, and were developed prior to the release of Canada’s Guidance on Alcohol and Health which identifies health harms emerging after more than two drinks per week. Critically, due to low screening rates, alcohol-related problems often go undetected, are misdiagnosed, or are only identified after serious health consequences have developed.
To address this gap, the Canadian Research Initiative on Substance Matters (CRISM) convened a national committee to update screening recommendations from the Canadian Guideline for the Clinical Management of High-Risk Drinking and Alcohol Use Disorder, first published in 2023.
The updated recommendations provide clinicians with a time-saving and practical approach to identifying alcohol-related risks and initiating conversations about alcohol use in routine care.
“Excessive alcohol use frequently underlies many reasons people see their doctor, such as poor sleep or anxiety, but this explanation routinely goes undetected in health care settings,” says Dr. Evan Wood, co-chair of the guideline writing committee and an addiction medicine specialist. “These updated recommendations set aside the older impractical approaches, and aim to support clinicians with a practical approach to initiating conversations about alcohol use and identifying those with potential problems earlier so patients can receive factual advice and care when needed.”
The updated recommendations were informed by a systematic review and critical appraisal of existing alcohol screening tools. The review found that many commonly used tools have poor ability to detect alcohol problems and are impractical to implement. The revised guidance seeks to address these limitations by focusing on practical approaches that allow clinicians to tailor conversations to a patient’s drinking patterns and risk profile.
The recommendations also reflect evolving evidence on alcohol-related health risks. Updated Canadian guidance indicates that drinking more than two standard drinks per week or during a single drinking episode are associated with increased health risks, underscoring the importance of routine discussions about alcohol use in health care settings.
“Despite the burden of alcohol-related harms, there remains a gap between what we know is effective intervention and treatment and the care many patients actually receive”, says Dr. Jürgen Rehm, co-chair of the guideline writing committee and senior scientist at the Centre for Addiction and Mental Health (CAMH). “Improving screening in primary care can help intervene in circumstances of excessive drinking and help identify alcohol problems earlier and connect people with effective treatments and supports.”
The updated recommendations aim to support primary care providers in initiating conversations about alcohol use while recognizing that patients present with diverse patterns of drinking and risk. The screening algorithm allows clinicians to focus their time on patients’ unique needs and circumstances allowing more time with those who may be experiencing alcohol-related harms and avoiding lengthy conversations about alcohol in those without concerns.
The recommendations were developed with input from researchers, clinicians, and individuals with lived and living experience of substance use from across Canada. They are intended to support the implementation of evidence-based screening and treatment approaches nationally.
*The updated screening recommendations are published in CMAJ and will be disseminated through clinical networks, professional organizations, and national partners to support adoption across Canada.*
About the Centre for Addiction and Mental Health (CAMH)
The Centre for Addiction and Mental Health (CAMH) is Canada's largest mental health and addiction teaching hospital and a world leading research centre in this field. CAMH combines clinical care, research, education, policy development and health promotion to help transform the lives of people affected by mental illness and addiction. CAMH is fully affiliated with the University of Toronto and is a Pan American Health Organization/World Health Organization Collaborating Centre. For more information, please visit camh.ca or follow @CAMHnews on Bluesky and LinkedIn.
MEDIA NOTE:
Guideline: https://www.cmaj.ca/lookup/doi/10.1503/cmaj.251759
Editorial: https://www.cmaj.ca/lookup/doi/10.1503/cmaj.260640
Media contact for guideline: Kathryn Sutton, Communications, BC Centre on Substance Use, Kathryn.Sutton@bccsu.ubc.ca
Media contact for guideline: Sabina Kukurudziak, Knowledge Translation and Communications, CRISM, sabina.kukurudziak@camh.ca
For interview requests with Dr. Jürgen Rehm, co-chair of the guideline writing committee: Public Affairs, CAMH, media@camh.ca
General media contact: Kim Barnhardt, CMAJ, kim.barnhardt@cmaj.ca
Please credit CMAJ, not the Canadian Medical Association (CMA). CMAJ is an independent medical journal; views expressed do not necessarily reflect those of its owner, CMA Impact Inc., a CMA company, or CMA.