Problematic alcohol use and alcohol use disorder result in a substantial amount of preventable illness and premature death in Ontario, and better identification and treatment could improve and save many lives. Almost 80% of Canadians 19 years of age and older consume alcohol, and most do so in moderate amounts. However, problematic alcohol use is common, and in 2015 approximately 3% of Canadian adults met the criteria for alcohol use disorder.
The negative consequences of alcohol consumption are a major health concern and a common cause of death and injury: alcohol accounts for more than half of hospitalizations attributed to substance use in Canada, with about 86,000 hospitalizations resulting from alcohol use in 2018/19. The economic costs of alcohol-related harms in Canada were estimated to be $14.6 billion in 2014 ($5.34 billion in Ontario), and of that $4.23 billion was direct health care costs ($1.47 billion in Ontario).
In 2018 in Ontario, approximately 17.6% of people 12 years of age and older reported heavy alcohol consumption on one occasion at least once a month in the previous year. Alcohol use—both alcohol consumption that exceeds the low-risk drinking guidelines and alcohol use disorder—is estimated to account for 9.3% of disability-adjusted life-years lost and 7.1% of all premature deaths in Canada. Alcohol use is the top risk factor for disease burden worldwide for people between the ages of 15 and 49 years, and it is ranked 6 of the top 10 risk factors for disease burden for all Canadians.
Alcohol consumption is associated with significant harms: it can lead to impaired motor skills and judgment; cause illness and death; and have negative effects on social, economic, housing, and living conditions that affect a person’s health (i.e., the social determinants of health). The short-term risks associated with problematic alcohol use include an increased risk of suicide, death from overdose (usually in conjunction with a sedating drug, but occasionally due to alcohol alone), transmission of sexually transmitted diseases, and preventable injuries. Long-term health risks include increased risks of cancer, liver cirrhosis, diabetes, and cardiovascular disease. Problematic alcohol use or patterns of alcohol consumption that cause health problems can lead to absenteeism, unemployment, food insecurity, and unstable housing, and may contribute to an increase in crime. Members of disadvantaged groups (e.g., low-income, newcomer, and homeless populations) experience greater harms from their alcohol use than advantaged individuals who consume the same amount of alcohol but have better access to resources.
There is a significant stigma associated with alcohol use disorder when people access health care services, creating additional obstacles to accessing treatment. People who identify as women tend to experience stigma in relation to their problematic alcohol use more than people who identify as men, a factor that may affect women’s willingness to seek treatment.
Health care professionals and service providers should be aware of the ways in which sex and gender may play a role in the negative impacts of alcohol use. Sex-related biological characteristics (such as a higher fat-to-muscle ratio and lower body weight) can cause differences in how alcohol is metabolized and how the effects of alcohol are experienced, while gendered expectations at work, at home, and in the community may influence patterns of consumption. There are also potential consequences associated with alcohol use during pregnancy among people of reproductive age.
The literature shows that adverse experiences or dysfunctional households in childhood, including those in which someone exhibits problematic alcohol use, are associated with poorer health outcomes in adulthood. People who have experienced childhood trauma are more likely to develop problematic alcohol use or alcohol use disorder at an earlier age than those without this history. Those who have, or who have previously had, post-traumatic stress disorder are more likely to have problematic alcohol use that can lead to alcohol use disorder.
There are challenges associated with screening for alcohol use disorder, and questions about alcohol use are asked less frequently by health care professionals than questions about other potential health concerns. The follow-up time required when a person screens positive for problematic alcohol use is a barrier to appropriate screening. It can be challenging for health care professionals to engage and establish a rapport with those who screen positive for problematic alcohol use because of the fear of stigma and potential implications associated with disclosing problematic alcohol use.
Ontario is implementing a Roadmap to Wellness, a comprehensive strategy to support a mental health and addictions system that enables access to high-quality services across a person’s lifespan. The new Mental Health and Addictions Centre of Excellence within Ontario Health will lead system management and coordination of services, and guide quality improvement initiatives to support the implementation of the roadmap. The quality standard for problematic alcohol use and alcohol use disorder can be used to support Ontario’s mental health and addictions strategy.
Based on evidence and expert consensus, the 10 quality statements in this standard provide guidance on high-quality care for people with problematic alcohol use and alcohol use disorder to help close the gaps in care identified across the province.