Text adapted in 2022 from The Primary Care Addiction Toolkit (online only). A complete list of Toolkit authors, editors and contributors is available here.
Canada’s Guidance on Alcohol and Health (2023) describes a continuum of drinking risk that ranges from no risk (defined as drinking no alcohol), to low risk, moderate risk, and increasingly higher risk.
The levels of risk are based on two types of risk: one is acute (e.g., unintentional injury, violence, impaired driving) and the other is chronic (e.g., cancers, cardiovascular disease, liver disease). Low risk refers to a 1 in 1000 chance of premature death, and correlates to drinking one or two standard alcoholic drinks per week. Moderate risk refers to a 1 in 100 chance of premature death, and is associated with between three and six standard drinks per week. Increasingly higher risk refers to seven or more standard drinks per week, with each additional drink “radically increas[ing] the risk of these alcohol-related consequences” (CCSA, 2023, p.5)
A lower level of alcohol consumption is recommended for women because they reach a higher blood alcohol level and have more health consequences than men for the same rate of consumption, particularly at consumption levels that exceed the moderate risk threshold of six drinks per week (Stokkeland et al., 2008; CCSA, 2023).
There are also circumstances where no alcohol use is considered the safest option:
- Pregnant, trying to get pregnant, or breastfeeding
- Driving a motor vehicle
- Using machinery and tools
- Taking medicine or other drugs that interact with alcohol
- Doing any kind of dangerous physical activity
- Being responsible for the safety of others
- Making important decisions
- Have a medical condition that may be worsened by alcohol (e.g., seizure disorder, cirrhosis, active ulcer)
- Have a past history of more severe alcohol use disorder
- Have a history of alcohol-related violence
At-risk Drinking
At-risk drinking is drinking behaviour that does not meet criteria for an alcohol use disorder, but puts a person at-risk for developing one.
In the past, at-risk drinking was more precisely defined as drinking that exceeded the previous Canada’s Low-risk Alcohol Drinking Guidelines (2011), which had a threshold of 10 standard drinks for women per week and 15 standard drinks per week for men.
Today, at-risk refers generally to harmful alcohol use that could develop into an alcohol use disorder over time.
Alcohol use disorder
In the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the American Psychiatric Association (2013) defines alcohol use disorder as clinically significant impairment or distress caused by alcohol use.
The DSM-5 alcohol use disorder diagnosis replaces the DSM-IV diagnoses of alcohol abuse and alcohol dependence. A DSM fact sheet developed by the U.S. National Institute on Alcohol Abuse and Alcoholism explains other changes in diagnosing alcohol use problems.