The risky use of alcohol is greatly underappreciated by society as a substantial source of harm to health and safety. A few points of clarification are required for the editorial by Flegel and colleagues.1
The rates of binge drinking reported by the Canadian Alcohol and Drug Use Monitoring Survey (CADUMS) should be seen as conservative, given that surveys of this type underestimate alcohol sales by 60% to 70%.2 When we compare what people tell us they drink with what is sold, we find that self-reported drinking accounts for only 30% to 40% of official sales.3
In 2007, an expert working group released recommendations for a national alcohol strategy, which is the first national strategy developed for alcohol in Canada.4 Many of the report’s 41 recommendations relate to the problem of binge drinking.
The National Alcohol Strategy Advisory Committee has since been working to implement several of the recommendations in the National Alcohol Strategy, including developing a national consensus on low-risk drinking guidelines and building capacity for alcohol screening and brief interventions in primary care. More information is available from the Canadian Centre on Substance Abuse (CCSA) (613 235-4048).
Although I agree that more research is needed to identify effective approaches to reduce the rates of binge drinking, there is already very good evidence for some interventions, including screening and brief interventions. The crucial need is to find creative ways to roll out these proven interventions at the scale needed to affect consumption patterns at the population level.
The economic burden of alcohol to Canadian society was estimated to be $14.6 billion in 2002, with direct costs accounting for $7.5 billion. A report soon to be published by CCSA shows that in most provincial and territorial jurisdictions, direct costs exceeded direct revenue from the sale of alcohol for fiscal year 2002–03.5