Turning to alcohol to relieve pandemic stress? Don't, addictions doctor says

Is the COVID-19 pandemic driving you to drink? 

Public health officials have been reminding Islanders of increased risks of alcohol and cannabis use during these uncertain times, from stress of the economic downturn and the blurring of daily and weekly routines. 

"I think that alcohol is an enormous issue in Prince Edward Island," said Dr. David Stewart, who has been practising medicine on P.E.I. for 43 years — the past seven years as the medical officer at the provincial addictions facility in Mount Herbert just outside Charlottetown. 

"Alcohol has sort of flown under the radar for a number of years," he said. "It's been such a part of our culture in our society and we just really have not been carefully introspective enough to analyze just what it is doing to us." 

One look at the number of Islanders published in the local newspaper for drinking and driving is an indicator that alcohol remains a problem on P.E.I., he said. 

Another indicator is that well over half of the 900 people a year Stewart helps admit at Mount Herbert are there for help with addiction to alcohol, as opposed to drugs, he said. Many of those are return patients — some have detoxed more than 40 times — but many are new patients. The facility includes 16 beds for detox and 18 for follow-up treatment in the transition rehabilitation program.

There are no definitive statistics on just exactly how prevalent alcohol addiction is on P.E.I., but Stewart said population estimates from other jurisdictions suggest 14 per cent of the drinking-age population is dependent on alcohol.

"If you do the math for Prince Edward Island that's an enormous number of people — almost 17,000 people," he said. "That's a tremendous number of people who are afflicted with a disorder and require alcohol."

Statistics Canada's most recent survey in 2018 suggested the proportion of Islanders over age 12 classified as "heavy drinkers" was about the same as the national average of 19 per cent. For men, heavy drinking means having five or more drinks per occasion, at least once a month during the past year. For women, heavy drinking means having four or more drinks per occasion, at least once a month during the past year.

The same year, StatsCan reported Islanders spend less money on alcoholic beverages than anyone else in Canada

How do you know you have a problem?

There are 11 criteria for alcohol-use disorder, Stewart explains, including developing a tolerance, cravings to drink, spending a lot of time and energy to obtain, use and recover from alcohol, continuing to drink despite it interfering with work, school, family and other relationships, and drinking despite being physically or psychologically ill from it. 

Just because we sell bottles of liquor in 26 ounces doesn't mean you should drink it that way.— Dr. David Stewart

"Probably the simplest definition would be, it's a dogged compulsion to use alcohol despite the negative consequences that may accompany it," Stewart said. 

Most of the patients he admits for treatment meet all 11 criteria, he said — in other words, they are severe cases. 

"That leads me to believe there are many, many, many people out there in the population who have some of the criteria, but in whom alcohol has not caused such havoc and destruction in their life that they would be interested in treatment at this point." 

One sign you may have a problem, Stewart said, is if you drink more than Canada's low-risk drinking guidelines for adults. Those are:

• 15 standard drinks a week for men, with no more than 3 drinks per occasion.
• 10 standard drinks a week for women, with no more than 2 drinks per occasion. 

It's when alcohol use turns to misuse that it becomes a problem, Stewart said — one sign of misuse is how repetitive it is. 

"If you find yourself needing to have a drink five or six times a week you need to have a good hard look at what you are doing in your life, the stresses you are under, and how you are managing those stresses."

"Alcohol is really not in the long run a useful drug for relieving stress," he said, noting many people with anxiety do use drinking for that purpose. "It tends to make things worse in the long run."

Alcohol abuse may also be linked to where you live, Stewart said, noting "there are pockets of increased cultural use of alcohol in different locations in P.E.I." 

Stigma still 'a huge blocker'

Stewart said there has been a "slight uptick" in the last few weeks in the number of people admitting themselves for treatment at Mount Herbert, particularly for alcohol addiction. He said it's hard to make a direct connection between increased alcohol abuse and the pandemic, but he notes businesses being closed has resulted in people being home, out of work and tempted to drink.

He has worked in addictions for about 25 years and said in the early 1990s, alcohol was the big issue on P.E.I. In the early 2000s, opioids became a severe problem and took up much of the health system's time, energy and treatment capacity. However now there are about 1,000 Islanders being successfully treated with opioid replacement therapy, pressure on addictions treatment has eased and the system is seeing more requests for treatment from people with alcohol problems. 

Stigma around having a problem with alcohol does remain "a huge blocker" for people seeking therapy, he said. 

He'd like to see more public health education about the dangers of alcohol, and is a proponent of placing Canada's low-risk drinking guidelines on bottles and menus — like tobacco warnings.

He'd also like Canada to consider adopting stricter low-risk drinking guidelines like those in the United Kingdom, which recommend no more than six or seven drinks a week for both men and women, and recommend spreading those drinks over several days, ensuring several drink-free days as well. 

"Just because we sell bottles of liquor in 26 ounces doesn't mean you should drink it that way," he said. 

The P.E.I. government did launch a $25,000 campaign in June 2016 to urge Islanders to follow Canada's low-risk drinking guidelines, called Should I Have Another? 

What happens when you seek help

"There is a gigantic problem out there and it seems that the more and better therapy we provide, the more people are coming in for treatment," he said.

People addicted to alcohol who wish to quit must first detox safely — about half go through significant withdrawl when they stop drinking, Stewart said. Detox is best done in a professional setting like the addictions treatment facility at Mount Herbert or other hospitals, where nurses can manage symptoms such as nausea, headache, hallucinations and seizures. This takes an average of six days. Then patients may stay for a rehab program, or return to their community with support from an addictions counsellor and possibly programming such as Alcoholics Anonymous or Smart Recovery. 

The drug Naltrexone is also often prescribed to reduce patients' interest in and urge to drink, Stewart said. 

"It's not a silver bullet ... but in a disease which causes such misery and suffering, there are only a couple of drugs which are useful, and Naltrexone is one of them and we're using it more and more." The government helps many people over 65 or on income support pay for the cost of the drug, Stewart said.

For those considering seeking help, Stewart recommends Islanders talk to their family doctor, who may also prescribe Naltrexone. P.E.I.'s mental health walk-in clinics are available online, as are addictions counsellors. 

What's the harm?

Stewart said it's difficult to find good medical evidence for exactly how many drinks a day will lead to health problems such as cancer, cardiovascular disease or nervous system damage — but said drinking does increase the risk of those illnesses. There is no safe amount for pregnant women, he added.

"The harms can develop over many years — usually it take 10 to 20 years of drinking alcohol to cause medical issues which can be various cancers, strokes, heart disease, liver disease, damage to the brain and nervous systems," Stewart said. These can show up suddenly in someone who has been drinking for many years without apparent consequences, Stewart said. With age, bodies become less able to handle alcohol effectively and he said "more consequences will emerge." 

Stewart urges moderation for heavy drinkers, or really anyone who drinks.

He always encourages people to cut back, at least to Canada's low-risk drinking guidelines — even patients he sees at Mount Herbert who have been diagnosed with alcohol-use disorder. Many of them aren't able to cut back safely and must abstain altogether, he said. 

Stewart also urges drinkers to have at least one alcohol-free day a week, to allow their body to take a break and recover, he said. 

"There needs to be a public health education program on alcohol. I think it is certainly our largest issue with addictions, comes from alcohol. We just have to be reminded."

More from CBC P.E.I.