How to communicate Canada’s new alcohol guidelines with patients

Your patient has just come to an appointment in a panic about their health because of the new alcohol guidelines. What do you do?

Canada grasped the world’s attention in early 2023 by announcing new alcohol guidelines that having two drinks a week can lead to increased health issues including cancer. One of the goals of these changes is to remind patients that alcohol use is not benign. The research indicates that individuals who consume alcohol have higher rates of fatal diseases.

These guidelines may be quite concerning for patients who understood that a glass of wine with dinner was healthy and have been doing so for years. Now, they might be wondering if the commonly believed “glass of red wine at night” means they have an alcohol use disorder and are not sure what to do anymore. 

The right kind of doctor-patient communication is key to exploring the relationship between substance and alcohol use and getting better outcomes for your patients. But the way a lot of physicians talk to their patients can lead to more problems than not.

How much alcohol is too much?

The immediate and drastic change in alcohol guidelines has presented physicians with an array of new information about healthy consumption and ‘how much is too much.’ Additionally, some sources are questioning the validity of the research being done and many Canadians have been reluctant to change their drinking habits so dramatically. 

This pushback makes it difficult to counsel patients that may be skeptical about the change. However, as physicians, our job is to walk alongside our patients, provide options and educate them on how to achieve better health outcomes.  

“Canada has been ignoring the costs of over-consumption of alcohol for far too long,” says Cardiologist Dr. Christopher Labos. “Red wine is not good for your heart. Red wine increases your blood sugar. There is a reason we call it a beer belly not celery belly.”

While research attempts to answer the question of how many drinks can lead to disease, we must also consider the impacts of alcohol use on the individual. We inquire with patients about increasing use, using more than intended, having cravings for alcohol and being unsuccessful at cutting down. These are just some of the criteria for an alcohol use disorder which also include using in risky situations, impacts on social relationships or fulfilling obligations, developing a tolerance and/or experiencing withdrawal. When patients are struggling with dependence, we encourage them to speak with their physician to discuss the need for medical detox, any desire for treatment, and currently available anti-craving medications.

Why would your patient trust you? Just because you’re a doctor?

The healthcare system has faced public scrutiny and criticism over the past couple of years which may lower patient trust. Research indicates that this mistrust can have harmful effects on the doctor and patient equally. 

Public trust in healthcare systems is declining. This can be problematic because: 

• Patients may be more reluctant to seek medical help if they do not trust the system;
• Distrust may lead to negative health outcomes for patients;
• Doctors may be discouraged to provide care due to negative public opinion and induce burnout;
• Distrust may erode the doctor-patient relationship

Building trust is essential for effective doctor-patient communication, not just for conversations around alcohol use, but all interactions. But why should they trust us? Due to constant misinformation in the media, they feel talked down to and rushed during appointments — there’s no shortage of reasons why patients won’t trust their doctor.

So if we want to help our patients and discuss their drinking, we need to communicate in a way that builds trust at the same time.

Providing care that helps your patient feel respected

If you want your patient’s respect, no matter what they’ve come in for, doctors need to treat their patients with compassion and put themselves in their patient’s shoes.

These new alcohol guidelines have given us (physicians) an opportunity to revisit the topic of alcohol use during medical visits. They may even be the trigger that some patients need to make a change in their behaviour. 

When your patient comes in and you ask why they are here, listen to them. Don’t be fixated on reviewing their chart in front of them, give them your undivided attention. Acknowledge that you’ve heard what they’ve said by paraphrasing it back to them and make an agenda for the appointment.

“I have patients with alcohol use disorder who choose not to discuss it with me. Every once in a while I check in with them about it, but always ask for their permission,” says Dr. Marcus Greatheart. “It can take many ‘nos’ until a patient can feel comfortable to discuss their alcohol use, and I want to develop trust that they know I will be non-judgemental in my assessment when we finally do discuss it.”

If you are concerned about more severe alcohol use, you need to ask about alcohol use patterns and triggers, such as experiences with hangovers, blackouts, getting the shakes and legal charges related to alcohol use. This should elicit an alcohol use disorder pattern as outlined in the DSM-V. 

Listening and providing guidance to our patients is something that we do every day; there is no reason why the new alcohol guidelines will change that fundamental job. 

More information:

To learn more about Dr. Greatheart, check out his new TikTok channel or his recent interview on the Just Medicine podcast. For more information, visit Dr. Greatheart’s resource page for free alcohol-use resources.