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Daily Maverick
6 days ago
- Health
- Daily Maverick
The hidden dangers of even moderate drinking and the need for moderation
Telling most South Africans they can't drink is a non-starter. But what we all do need to know is just how dangerous it is — and what we can do to curb it. It sounds macho, but there's science behind the idea that bigger men are better at holding their drink. Size matters. A larger person absorbs more alcohol into their body tissue so that means that less goes to their brain, which is when you start to feel its effects. Sex matters, too. It generally takes less alcohol for a female to get drunk than a male. This is due to a combination of factors. Women have lower body water content, which means the alcohol is more concentrated in their bodies. They also have fewer enzymes to help break down alcohol in the stomach, while their different hormones also can worsen intoxication. Other genetic factors, or the characteristics your parents pass down to you, also play a part in determining an individual's tolerance to alcohol. But those aren't the only reasons it's hard to predict exactly how much alcohol you can safely drink. It also depends on how long it will take for your body to process it and the amount of pure drinking alcohol (ethanol) that is in your drink. That is measured by alcohol-by-volume, or ABV, something you can normally find on the labels of cans and bottles. In South Africa, a standard drink is assumed to contain about 15ml of pure alcohol (ethanol), which is typically found in one 340ml can of beer (4.5% alcohol-by-volume or ABV), 150ml of wine (12% ABV) or 40ml of whisky (40% ABV). A useful guide to safer drinking is a blood alcohol content (BAC) calculator, which measures how much alcohol is in your blood at any given moment. The higher your blood alcohol content number, the more drunk you are. For example, I weigh 85kg. An hour after drinking two glasses of wine, my blood alcohol content is about 0.03%, low enough for me to legally drive home. But if my wife, who weighs 61kg, drinks two glasses of wine over the same time, her blood alcohol content would be 0.056%, which is above the legal drinking limit. While you may only feel really drunk at a blood alcohol content of about 0.1 grams per 100ml of blood (0.1%), drinking far less alcohol can have serious health risks. No safe amount In fact, the World Health Organization (WHO) has concluded that there is no safe level of alcohol, because it is a toxin that can cause cancer and damage to organs such as the liver, pancreas and heart, even at low levels. Many people are willing to tolerate a little extra risk for the enjoyment of it, but most don't fully appreciate how much risk they are taking on. The Canadian Centre on Substance Use and Addiction has produced an excellent report detailing the precise odds of cancer and other illnesses at different levels of consumption. For some conditions, like mouth and throat cancer, the risk is already 1½ times greater at just two drinks a day. A 2025 report on alcohol and cancer risk from the US Surgeon General calculates that the total chance you'll develop alcohol-related cancers over your entire lifetime increases with the amount you drink. It found that about five more women and three more men out of every hundred will develop cancer if they consume two standard alcoholic drinks a day, compared to those who have less than one drink a week. Heavy drinking In a 2024 global report on alcohol and health, the WHO estimated that one-third of South African adults say they drink alcohol. But those that do drink consume a lot — an average of five drinks per day. A study published in the South African Medical Journal in 2018 found that 43% of drinkers reported binge drinking, which the researchers defined as five or more drinks in one day. But, as the researchers note, these numbers are likely even higher due to the stigma of reporting drinking habits. Young people are at especially high risk. Using figures from the South African Demographic and Health Survey, I calculated that more than 80% of 15- to 34-year-old males who drink, report that they drank more than five drinks in one day. The adolescent brain continues to develop until about the age of 25 years and, even if the drinking episodes are infrequent, binge drinking in young people can lead to long-term cognitive and psychological damage. But it's the immediate effects of any heavy drinking that are most devastating for both the individual and society. In a global analysis of alcohol and risk of injuries, researchers found that after having four or five drinks, you're at high risk of being either the cause or the victim of vehicle crashes, sexual or physical assault or murder. The risk curve for alcohol is exponential, meaning that the rate of harm increases with every drink. A multi-country study found that the risk of fatal traffic injury can almost double with every 0.02% — about one drink — increase in blood alcohol content. In the Western Cape, 45% of victims of homicide were found to have a blood alcohol content over 0.05%, suggesting that homicide rates could be much reduced if heavy drinking were curtailed. But every legal drink also contributes to jobs, tourism and taxes. In fact, a ccording to a 2024 study published in the South African Journal of Economic and Management Sciences, if you disregard its harm, the liquor industry would contribute more than 2.5% to South Africa's gross domestic product, or GDP, which is the value of everything a country produces and sells in a year. But the oft-obscured point is that the net positive economic benefits of the industry occur at lower levels of consumption — higher levels cost the economy more than it gains. Moderation The findings present a dilemma for public health advocates in South Africa. On the one hand, we must inform the public that even one drink a day can have serious health consequences for an individual. On the other, drinking patterns here are so extreme that a call for such drastic reduction in drinking would be scoffed at. While there is no doubt that heavy drinking is both bad for society and bad for the economy, we don't need to smash the liquor industry to combat heavy drinking. But we must intervene to optimise its social and economic benefits. Based on the best international studies, here are three ways we can reduce heavy drinking: Limit the advertising and promotion of alcohol, which influences young people to drink heavily at a time when their brains are highly vulnerable. Advertising restrictions have been shown to work. It won't be easy, especially as the industry uses influencers on social media, but it must be done. Close on-consumption liquor outlets (taverns and bars) at midnight, as required by the National Liquor Norms and Standards (2015). A modelling study commissioned by the DG Murray Trust, the organisation I head up, shows that, over a 20-year period, a midnight closure would reduce injuries and deaths by a factor of up to 15 compared to letting them stay open until 2am. Introducing minimum unit pricing so that liquor cannot be sold extra cheaply in poorer communities, which bear the brunt of heavy drinking. The National Treasury has made proposals in this regard and is currently reviewing submissions received through public submissions. Its involvement is significant, because it gets to see both the income and expense side of the equation. Inequality in South Africa is so severe that it's hard to make a dent in the armour-proofed vehicles of violence — crime, toxic masculinity, and the devaluation of human life. But we can starve them of their fuel, if our political leaders are informed and brave enough to act, to change our culture of heavy drinking in South Africa to one of moderation. DM
CBC
23-02-2025
- Health
- CBC
Struggling to get a good night's sleep? There's an alternative to meds, experts say
For more than 30 years, Faye Dickieson battled the exhausting effects of insomnia. She turned to sleeping pills in an attempt to get a peaceful night's rest, but found no relief — only its lingering side effects. "I would just toss and turn, toss and turn," Dickieson, who lives in Alberton, P.E.I., told The Current 's host Matt Galloway, noting she'd typically get just two hours of sleep "I wouldn't go back to sleep. It would just put me in a fog, and then I'd get to work, and I thought, 'Oh God, I don't even remember driving here.'" One in six Canadians suffers from insomnia, according to a phone survey of 4,037 Canadian adults published last year in the journal Sleep Medicine. The researchers found there's an "increasing use of various medications and substances to cope with this health issue." In particular, survey results suggested that use of medications, alcohol and cannabis for sleep is now 1.5 to two times higher than it was 16 years ago. But the Canadian Centre on Substance Use and Addiction warns that sedatives for insomnia, like benzodiazepines, are addictive and can cause harmful side effects, including amnesia, liver damage and tolerance toward the drug — leading people to increase their dose to achieve the desired effects. Dickieson found an alternative treatment for her insomnia at a sleep seminar led by David Gardner, a psychiatry professor at Dalhousie University, where she was introduced to cognitive behavioural therapy for insomnia (CBT-I). It's a non-pharmaceutical approach that can help with insomnia, but it can also be expensive and hard to access. Now, some doctors are trying to change that. The therapy route Dickieson says, for her, the results of CBT-I were transformative. "I was getting four and five hours [of] sleep with no pills," she said. "I feel full of energy, and so much more happier, and not in a fog anymore." CBT-I is a drug-free treatment that helps patients recognize and change old thoughts, behaviours and emotions that perpetuate insomnia into new approaches that bring on sleep naturally, says Gardner. This is done by having patients keep sleep diaries to track sleep habits and patterns, and learn a variety of sleep-enhancing techniques. Those include relaxation exercises, good sleep hygiene practices like setting a regular bedtime and wake time, and strategies for managing anxious thoughts. "So you layer on all of these different techniques, and … we see a four- to eight-week program resolving 20 or 30 years of sleep problems and they don't come back," said Gardner. A certified psychologist helps guide this, and it can be done either one-on-one or in a group setting. According to a 2022 study involving 62 participants, half to two-thirds of people with insomnia responded to CBT-I, showing improvement in their self-reported sleep quality over three months. However, people who may be biologically predisposed to insomnia might be less responsive to the treatment, and in such cases, "some medications may be more useful," said neurologist Thanh Dang-Vu, a professor in the department of health, kinesiology and applied physiology at Concordia, where he is also research chair in sleep, neuroimaging and cognitive health. "The current hypothesis is that maybe that some people [whose] cause of insomnia is more biological in nature, would be less likely to respond," said Dang-Vu, who is also a researcher at Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal. "This is still an ongoing investigation." Many different factors can contribute to insomnia. Stressful events, such as losing a loved one, medical conditions like chronic pain and heart failure, and medications such as steroids, antidepressants and over-the-counter allergy medicines can all be potential contributors. WATCH | The risks of benzodiazepines: Warnings about the overprescription of Benzodiazepines 1 year ago Duration 2:48 A Radio-Canada investigation into the use and side-effects of benzodiazepines such as Ativan and Xanax reveals the drugs are often overprescribed and there isn't enough education for doctors or patients about the risks — including falls, fractures and addiction. Why aren't more people using CBT-I? Though sleep experts recognize CBT-I as effective — and the preferred first-line treatment, ahead of medication — it's not accessible to many people. Each session of CBT-I typically costs between $100 and $250, with most patients requiring six to eight sessions, says Dang-Vu. Additionally, most CBT-I providers are located in private psychology clinics, and in many provinces, the treatment is not covered by the provincial healthcare system. Qualified psychologists in CBT-I are also in short supply, because it's not typically offered in the core curriculum of clinical psychology programs, according to Dang-Vu. Specialized training is often required, and it's available only through a limited number of programs. Dr. Mike Simon says the responsibility of administering the treatment then falls on the shoulders of family doctors like himself. "Trying to get counselors and therapists [is] like pulling teeth … because A, there's not much around, and B, those around [have] a huge waiting list," said Simon, who works in Saint John. Many of his patients also approach overcoming insomnia with the expectation of a quick fix. "When patients come in, they're tired, they're fatigued." "[They'll say], 'Doc, look, I don't have time, can I just have pills for a couple of weeks?'" Increasing awareness and accessibility Last November, Dang-Vu co-authored an open letter published in the Montreal Gazette, signed by over 50 sleep medicine researchers and clinicians from across the country. It called on policymakers to prioritize public reimbursement for CBT-I. The letter urged the government to include the treatment in public health plans, making it accessible to all Canadians, regardless of their socioeconomic status. In addition to policy changes, the researchers are working to make it more accessible to the public through a self-help approach. For a geriatric research centre in Montreal, Dang-Vu developed an online version of the program aimed at older adults. The program is currently being tested in research trials before being launched to the public. The goal is to make the resource freely accessible, Dang-Vu said. For Dalhousie University, Gardner created a website called Sleepwell that features a curated list of resources, including books and apps to help individuals begin their CBT-I treatment in their own time and place. A good night's sleep is essential for mental and physical well-being, says Dang-Vu. That's why he says it's crucial to recognize signs of sleeplessness, and know that drug-free treatments exist. "It's very important now to consider sleep as not a minor problem, but it can be a catalyst for more serious health consequences," he said. "That's how we can get the word out that it's important to diagnose and treat."
Yahoo
30-01-2025
- Health
- Yahoo
Death of 15-year-old from synthetic opioid should be 'sounding the alarm,' says Quebec coroner
A Quebec coroner says the 2023 death of 15-year-old Mathis Boivin should be "sounding the alarm" on the importance of preventing opioid use and dependency among young people. Coroner Stéphanie Gamache found that the Montrealer died Dec. 22, 2023 of N-desethyl-isotonitazene poisoning — a potent synthetic opioid — and suffered bilateral pneumonia. Following her investigation, she found the approaches to tackle drug use in schools are inconsistent across the board. While some schools are aware of the risks among teens and make naloxone kits available on site through the regional health authority, others have no established links with public health authorities. "Do they not feel concerned by the problem?" questions Gamache. She says "red flags" were raised concerning Mathis's drug use months leading up to his death and that detection might have led him to be referred to specialized front-line workers. "Mathis might also have been able to recognize signs of an overdose on the evening of December 21, 2023, and his death might have been possibly avoided," said Gamache. While she says it's not under her mandate to question schools' approaches to the prevention of opioid use, she reminded them of its importance as deaths from drug intoxication are on the rise across North America, including Quebec. Addressing the stigma that accompanies drug abuse, she said public health must continue its efforts to prevent drug dependency in school settings and offer life-saving tools. "All schools must also recognize the problem and its complexity if they are to participate fully in prevention efforts," she said. 'A societal responsibility,' says coroner Highlighting statistics from the Canadian Centre on Substance Use and Addiction, Gamache noted that 94 per cent of deaths from opioid use are accidents, "and therefore preventable." "It is also a societal responsibility to recognize that the prevention of opioid intoxication and other psychoactive substances concerns us all," said Gamache. "Mathis's death should be sounding the alarm because we can't wait for the accumulation of deaths among young people to make this observation." Boivin, who was previously healthy, had missed classes at his school the afternoon before his death to purchase between five and seven tablets of what he believed to be oxycodone, says Gamache. Although his parents knew he used cannabis, they had discussed the subject of hard drugs. Christian Boivin hopes the story of his son's death can help prevent more teen overdoses. (Rowan Kennedy/CBC) A few months before his death, a friend of Mathis contacted his father by text message, expressing his concerns about Mathis's hard drug use, but Mathis denied "having a problem." After dinner with his family on Dec. 21, Mathis played an online game with a friend and informed the friend that he had consumed one or more tablets, said the coroner. "He also said he felt itching on his body, like mosquito bites," said Gamache. "The friends parted ways by saying 'see you tomorrow.'" Mathis Boivin died after consuming on a synthetic opioid, thinking it was oxycodone. (Submitted by Christian Boivin) His father, Christian Boivin, found him the next morning and the 15-year-old was confirmed dead just before 9:30 a.m. at the Montreal Children's Hospital. Since his son's death, Boivin has spoken publicly in schools to spread awareness about the dangers of opioids. He said he hopes governments are more active and spend more money to prevent similar deaths. "Are we going to wait for other teens like Mathis to die every day?" he said, following the arrest of two suspects charged with trafficking offences in connection to his son's death. "It's too late for my son, but maybe we can save others."
CBC
30-01-2025
- Health
- CBC
Death of 15-year-old from synthetic opioid should be 'sounding the alarm,' says Quebec coroner
A Quebec coroner says the 2023 death of 15-year-old Mathis Boivin should be "sounding the alarm" on the importance of preventing opioid use and dependency among young people. Coroner Stéphanie Gamache found that the Montrealer died Dec. 22, 2023 of N-desethyl-isotonitazene poisoning — a potent synthetic opioid — and suffered bilateral pneumonia. Following her investigation, she found the approaches to tackle drug use in schools are inconsistent across the board. While some schools are aware of the risks among teens and make naloxone kits available on site through the regional health authority, others have no established links with public health authorities. "Do they not feel concerned by the problem?" questions Gamache. She says "red flags" were raised concerning Mathis's drug use months leading up to his death and that detection might have led him to be referred to specialized front-line workers. "Mathis might also have been able to recognize signs of an overdose on the evening of December 21, 2023, and his death might have been possibly avoided," said Gamache. While she says it's not under her mandate to question schools' approaches to the prevention of opioid use, she reminded them of its importance as deaths from drug intoxication are on the rise across North America, including Quebec. Addressing the stigma that accompanies drug abuse, she said public health must continue its efforts to prevent drug dependency in school settings and offer life-saving tools. "All schools must also recognize the problem and its complexity if they are to participate fully in prevention efforts," she said. 'A societal responsibility,' says coroner Highlighting statistics from the Canadian Centre on Substance Use and Addiction, Gamache noted that 94 per cent of deaths from opioid use are accidents, "and therefore preventable." "It is also a societal responsibility to recognize that the prevention of opioid intoxication and other psychoactive substances concerns us all," said Gamache. "Mathis's death should be sounding the alarm because we can't wait for the accumulation of deaths among young people to make this observation." Boivin, who was previously healthy, had missed classes at his school the afternoon before his death to purchase between five and seven tablets of what he believed to be oxycodone, says Gamache. Although his parents knew he used cannabis, they had discussed the subject of hard drugs. A few months before his death, a friend of Mathis contacted his father by text message, expressing his concerns about Mathis's hard drug use, but Mathis denied "having a problem." After dinner with his family on Dec. 21, Mathis played an online game with a friend and informed the friend that he had consumed one or more tablets, said the coroner. "He also said he felt itching on his body, like mosquito bites," said Gamache. "The friends parted ways by saying 'see you tomorrow.'" His father, Christian Boivin, found him the next morning and the 15-year-old was confirmed dead just before 9:30 a.m. at the Montreal Children's Hospital. Since his son's death, Boivin has spoken publicly in schools to spread awareness about the dangers of opioids. He said he hopes governments are more active and spend more money to prevent similar deaths. "Are we going to wait for other teens like Mathis to die every day?" he said, following the arrest of two suspects charged with trafficking offences in connection to his son's death.
