new research on alcohol

New research shows even moderate drinking isn't good for your health

A new analysis of over 100 studies debunks beliefs about benefits of alcohol.

Drinking a glass of wine a day will not help you live longer, according to a new analysis of alcohol research that debunks a longstanding belief about the possible health benefits of drinking alcohol moderately.

The analysis, published recently in JAMA Network Open , looked at over 100 studies with nearly 5 million participants in all.

It found not only no significant health benefit to moderate alcohol consumption, but also that drinking a daily serving of alcohol of less than 1 ounce for women and around 1.5 ounces for men increased the risk of death.

"When you talk about risk versus benefit, it's one thing to say there is no benefit," said Dr. Jennifer Ashton, a board-certified OB-GYN and ABC News chief medical correspondent, who was not involved in the research. "It's another thing, at certain levels, to find a risk, and that's what this new research found."

For women, a moderate alcohol intake per week is defined as seven servings of alcohol or less. For men, it is 14 servings of alcohol or less per week, according to the U.S. Centers for Disease Control and Prevention .

Heavy drinking is typically defined as consuming eight drinks or more per week, according to the CDC.

One serving of alcohol is defined as 5 ounces for wine and just 1 1/2 ounces for hard alcohol, far less than what is typically served in bars, restaurants and people's homes.

The new analysis found that people who drank more than 2 ounces of alcohol a day had the highest risk of death, about 35% higher than people who drank more moderately.

The risk of death was also found to be greater for women, with a 61% increased risk for women who drink more than 2 ounces of alcohol per day.

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Previous research has already shown that just as women metabolize alcohol differently than men, they also face more serious health consequences.

Women are more susceptible to alcohol-related heart disease than men; alcohol misuse produces brain damage more quickly in women than in men; women may be more susceptible than men to alcohol-related blackouts, or gaps in memory; and women who regularly misuse alcohol are more likely than men who drink the same amount to develop alcoholic hepatitis, a potentially deadly condition, according to the National Institute on Alcohol Abuse and Alcoholism.

Data shows that even casual drinkers face a greater risk of cancer , most commonly liver and throat cancers but also colon and head and neck cancers, in addition to breast cancer.

Drinking alcohol is listed by the Department of Health and Human Services as a known human carcinogen.

In 2020, the American Cancer Society updated its guidelines to say that cutting alcohol out of a person's diet completely is best for cancer reduction and prevention.

MORE: Taking a one-time pill may help curb binge drinking, study finds

Ashton said that it's important for people to talk to their healthcare providers about their alcohol consumption to make the most informed decisions.

"Alcohol is a known carcinogen. We know it's associated with an increased risk of cancer," Ashton said. "But it's also part of our social fiber and our culture, so it's not an easy decision."

Ashton also noted though that the data is "crystal clear" that abstaining completely from alcohol is best for a person's overall health.

For questions and concerns about alcohol use, SAMHSA , the Substance Abuse and Mental Health Services Administration, has a 24/7 free and confidential helpline available at 1-800-662-HELP (4357), and online at samhsa.gov/find-help/national-helpline .

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New research shows even moderate drinking isn't good for your health

Drinking a glass of wine a day will not help you live longer, according to a new analysis of alcohol research that debunks a longstanding belief about the possible health benefits of drinking alcohol moderately.

The analysis, published recently in JAMA Network Open , looked at over 100 studies with nearly 5 million participants in all.

It found not only no significant health benefit to moderate alcohol consumption, but also that drinking a daily serving of alcohol of less than 1 ounce for women and around 1.5 ounces for men increased the risk of death.

"When you talk about risk versus benefit, it's one thing to say there is no benefit," said Dr. Jennifer Ashton, a board-certified OB-GYN and ABC News chief medical correspondent, who was not involved in the research. "It's another thing, at certain levels, to find a risk, and that's what this new research found."

For women, a moderate alcohol intake per week is defined as seven servings of alcohol or less. For men, it is 14 servings of alcohol or less per week, according to the U.S. Centers for Disease Control and Prevention .

Heavy drinking is typically defined as consuming eight drinks or more per week, according to the CDC.

One serving of alcohol is defined as 5 ounces for wine and just 1 1/2 ounces for hard alcohol, far less than what is typically served in bars, restaurants and people's homes.

The new analysis found that people who drank more than 2 ounces of alcohol a day had the highest risk of death, about 35% higher than people who drank more moderately.

The risk of death was also found to be greater for women, with a 61% increased risk for women who drink more than 2 ounces of alcohol per day.

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• Apr 07, 2022

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• Jun 09, 2020

MORE: Dry weddings become increasingly popular. What to know about the nonalcoholic trend

Previous research has already shown that just as women metabolize alcohol differently than men, they also face more serious health consequences.

Women are more susceptible to alcohol-related heart disease than men; alcohol misuse produces brain damage more quickly in women than in men; women may be more susceptible than men to alcohol-related blackouts, or gaps in memory; and women who regularly misuse alcohol are more likely than men who drink the same amount to develop alcoholic hepatitis, a potentially deadly condition, according to the National Institute on Alcohol Abuse and Alcoholism.

Data shows that even casual drinkers face a greater risk of cancer , most commonly liver and throat cancers but also colon and head and neck cancers, in addition to breast cancer.

Drinking alcohol is listed by the Department of Health and Human Services as a known human carcinogen.

In 2020, the American Cancer Society updated its guidelines to say that cutting alcohol out of a person's diet completely is best for cancer reduction and prevention.

MORE: Taking a one-time pill may help curb binge drinking, study finds

Ashton said that it's important for people to talk to their healthcare providers about their alcohol consumption to make the most informed decisions.

"Alcohol is a known carcinogen. We know it's associated with an increased risk of cancer," Ashton said. "But it's also part of our social fiber and our culture, so it's not an easy decision."

Ashton also noted though that the data is "crystal clear" that abstaining completely from alcohol is best for a person's overall health.

For questions and concerns about alcohol use, SAMHSA , the Substance Abuse and Mental Health Services Administration, has a 24/7 free and confidential helpline available at 1-800-662-HELP (4357), and online at samhsa.gov/find-help/national-helpline .

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New Research Finds Drinking Alcohol More Dangerous to the Heart Than Previously Thought

By European Society of Cardiology May 22, 2022

Heart MRI scan.

How much alcohol is safe to drink? It sounds like a simple question, but it is hard to figure out from health authorities because there is such a wide discrepancy in advice between different countries.

It can get even more confusing because they don’t agree on how much alcohol is in a standard drink. For example, in Austria, a standard drink is a whopping 20 grams of alcohol, compared to just 8 grams in Iceland. In the United States, a standard drink is considered 14 grams of alcohol, which is around the amount contained in a 1.5-ounce shot of distilled spirits, a 12-ounce beer, or a 5-ounce glass of wine. Of course, you also have to pay attention to the specifics of your drink, because your favorite double IPA may have twice the alcohol content of a regular beer.

And even if you figure it out completely, the recommendations from your health authorities may be too high according to new research. In the study, scientists found that to minimize your risk to the heart, you should limit your consumption to less than 5 cans of 4.5% beer or less than one bottle of wine per week.

Levels of alcohol consumption currently considered safe by some countries are associated with the development of heart failure, according to new research presented at Heart Failure 2022, a scientific congress of the European Society of Cardiology (ESC). [1]

“This study adds to the body of evidence that a more cautious approach to alcohol consumption is needed,” said study author Dr. Bethany Wong of St. Vincent’s University Hospital, Dublin, Ireland. “To minimize the risk of alcohol causing harm to the heart, if you don’t drink, don’t start. If you do drink, limit your weekly consumption to less than one bottle of wine or less than three-and-a-half 500 ml cans of 4.5% beer.”

According to the World Health Organization (WHO), the European Union is the heaviest-drinking region in the world. [2] While it is well recognized that long-term heavy alcohol consumption can cause a type of heart failure called alcoholic cardiomyopathy, [3] evidence from Asian populations suggests that lower amounts may also be detrimental. [4,5] “As there are genetic and environmental differences between Asian and European populations this study investigated if there was a similar relationship between alcohol and cardiac changes in Europeans at risk of heart failure or with pre-heart failure,” said Dr. Wong. “The mainstay of treatment for this group is management of risk factors such as alcohol, so knowledge about safe levels is crucial.”

“To minimize the risk of alcohol causing harm to the heart, if you don’t drink, don’t start. If you do drink, limit your weekly consumption to less than one bottle of wine or less than three-and-a-half 500 ml cans of 4.5% beer.” — Dr. Bethany Wong

This was a secondary analysis of the STOP-HF trial. [6] The study included 744 adults over 40 years of age either at risk of developing heart failure due to risk factors (e.g. high blood pressure, diabetes, obesity) or with pre-heart failure (risk factors and heart abnormalities but no symptoms). [7] The average age was 66.5 years and 53% were women. The study excluded former drinkers and heart failure patients with symptoms (e.g. shortness of breath, tiredness, reduced ability to exercise, swollen ankles). Heart function was measured with echocardiography at baseline and follow-up.

The study used the Irish definition of one standard drink (i.e. one unit), which is 10 grams of alcohol. [8] Participants were categorized according to their weekly alcohol intake: 1) none; 2) low (less than seven units; up to one 750 ml bottle of 12.5% wine or three-and-a-half 500 ml cans of 4.5% beer); 3) moderate (7-14 units; up to two bottles of 12.5% wine or seven 500 mL cans of 4.5% beer); 4) high (above 14 units; more than two bottles of 12.5% wine or seven 500 ml cans of 4.5% beer).

The researchers analyzed the association between alcohol use and heart health over a median of 5.4 years. The results were reported separately for the at-risk and pre-heart failure groups. In the at-risk group, worsening heart health was defined as progression to pre-heart failure or to symptomatic heart failure. For the pre-heart failure group, worsening heart health was defined as deterioration in the squeezing or relaxation functions of the heart or progression to symptomatic heart failure. The analyses were adjusted for factors that can affect heart structure including age, gender, obesity, high blood pressure, diabetes, and vascular disease.

A total of 201 (27%) patients reported no alcohol usage, while 356 (48%) were low users and 187 (25%) had moderate or high intake. Compared to the low-intake group, those with moderate or high use were younger, more likely to be male, and had a higher body mass index.

In the pre-heart failure group, compared with no alcohol use, moderate or high intake was associated with a 4.5-fold increased risk of worsening heart health. The relationship was also observed when moderate and high levels were analyzed separately. In the at-risk group, there was no association between moderate or high alcohol use with progression to pre-heart failure or to symptomatic heart failure. No protective associations were found for low alcohol intake.

Dr. Wong said: “Our study suggests that drinking more than 70 g of alcohol per week is associated with worsening pre-heart failure or progression to symptomatic heart failure in Europeans. We did not observe any benefits of low alcohol usage. Our results indicate that countries should advocate lower limits of safe alcohol intake in pre-heart failure patients. In Ireland, for example, those at risk of heart failure or with pre-heart failure are advised to restrict weekly alcohol intake to 11 units for women and 17 units for men. This limit for men is more than twice the amount we found to be safe. More research is needed in Caucasian populations to align results and reduce the mixed messages that clinicians, patients, and the public are currently getting.”

• The abstract ‘Moderate alcohol consumption is associated with progression of left ventricular dysfunction in a European stage B heart failure population’ will be presented during the session ‘Heart failure is a complex syndrome: look at comorbidities’ which takes place on 22 May at 09:40 CEST at Moderated ePoster 1.
• World Health Organization data and statistics: https://www.euro.who.int/en/health-topics/disease-prevention/alcohol-use/data-and-statistics.
• Piano MR. Alcoholic cardiomyopathy: incidence, clinical characteristics, and pathophysiology. Chest. 2002;121:1638–1650.
• Hung CL, Goncalves A, Lai YJ, et al. Light to moderate habitual alcohol consumption is associated with subclinical ventricular and left atrial mechanical dysfunction in an asymptomatic population: dose-response and propensity analysis. J Am Soc Echocardiogr. 2016;29:1043–1051.e4.
• Park SK, Moon K, Ryoo JH, et al. The association between alcohol consumption and left ventricular diastolic function and geometry change in general Korean population. Eur Heart J Cardiovasc Imaging. 2018;19:271–278.
• STOP-HF: St Vincent’s Screening TO-Prevent Heart Failure.
• Bozkurt B, Coats AJS, Tsutsui H, et al. Universal definition and classification of heart failure. J Cardiac Fail. 2021;27:387–413.
• The definition of a standard drink varies by country. In the UK, for example, one unit contains eight grams of alcohol.

Funding: This work was performed within the Irish Clinical Academic Training (ICAT) Program (Grant Number 203930/B/16/Z). Heartbeat Trust, a registered charity (Registered in Ireland No. 375112), also funded this study.

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45 comments on "new research finds drinking alcohol more dangerous to the heart than previously thought".

I call major bs on this, first of all alcohol in small quantities is not that is not risky but actually super healthy. Also it helps to chill and relax while if you stressed all the time is like 200x times more bad to you than alcohol, so no, this article is nonsense, I’ve known people, alcoholics that were drinking since 18 or less, that’s europe for you and even now at 60 70 and pushing getting that shot of vodka in a couple of times a day. If this were half true they would have died long time ago but what do I know a while ago they said eggs are unhealthy, milk you shouldn’t drink and stuff martians are invading…. the last one is a joke :))

Like Ricky Gervaise said, “the years from 80 to 90 suck” I don’t want to live at that age, and right now I enjoy eating , and drinking!

I’ve seen (with my own eyes) detrimental effects of alcohol. Its something you may not understand. My dad (Papa)drank to ease swollen muscles. Laboring to build roads. Then he drank to relax, then he drank to get through. What I learned is the cycle of alcohol. First it relaxes,then it takes your personality, then your family!!! I’ve drank but I always remember,I want my attention to be on myself and others. I want my family to not be scared. The impact of a drinker can be devastating to an entire community!!!

This is a study backed up by scientific data. You can’t just call BS on something because you don’t agree with. That’s not how science works.

Interesting study. Basically, it’s saying that alcohol increases your risk of heart muscle deterioration, if you have pre-existing heart abnormalities and risk factors.

Ever since the new wonder god magical perfect tech that DEFINITELY is NOT experimental came out it seems like EVERYTHING EXCEPT the new wonder tech causes heart issues….. The new wonder tech is sooooo great that even though it listed countless heart issues from day 1, it could never do that…. Dont drink. Dont shake your bed sheets. Avoid cold weather. Avoid hot weather. Im guessing soon we’ll learn oxygen causes myocarditis so dont breath, but im betting holding your breath prolly causes heart issues too so idk what to do…

A lesson here is that ‘ too much of everything is not good for you’

I have an honest question, not mocking this. I went through a 1/100 situation and divorce, just trust me on that. Have 2 kids, mid 40s, social anxiety so I’ve been “alone” for better part of 6 years now. The nights without kids sometimes are excruciating, anxiety, depression, boredom. So, I drink to cope sometimes. Not every day, weekends. But a 12 pack a week is probably more the average. My question is is which one is worse on health? Anxiety, depression, etc, or the extra alcohy?

Read Quran. Your depression will be gone

Sounds like excuses, we all have plenty for anything we choose to ignore. I have some anxiety now I wonder If i was expose to rabies i wake up and felt the anxiety of that. I know what I should do and you know what you should do. You are overvaluing your anxiety to make excuses to drink. The same way you use to give alcohol the netflix entrainment status, you can also use the same mind to reduce the status you give it to dismissed completely. At the end you are sitting think or mostly fear of thinking, so for once think, what I’m fear off? think of your fear and realize is just that.

OMG why is my picture on here?! Everyone else got a generic icon. FML

I wouldn’t believe the WHO for anything or any reason. That dummy with the glasses who is the chief or tribal leader was probably on a bus using a machete to kill rivals a few years back. Nope not believing any thing that comes from WHO as long as that Pygmy is running things – a Chinese agent!

Whatever. Give it a few months and it will be contradicted by another “study “

Whatever. Give it a few months and there will be another “study” that contradicts this.

No amount of alcohol is safe. Those who argue with that tend to be in denial.

Basically agree with posted comments. I’m 72, & not bent on living to be 100! Pretty healthy up to this point, so gonna have cocktail or two occasionally. Moderation is the key.

It’s clear. Why our creator has prohibited for consuming Alcohol. Allah the creator of everything has sent the message through the Prophet (pbuh) to stop consuming Alcohol 1443 years ago

Please read Quran. The only true message ftom the creator

I’ll tell you who just had “ HEART FAILURE “ The Cruise Ship 🚢 Industry 😎

Life’s a b!+€}{, then you die… Everybody has their poison, some worse than others. For me, I want to live life feeling better than what life presents, especially when times are bad because you can’t control what life throws your way & alcohol helps in those times, just can’t overdo it.

I have lived the last 40 years heavily drinking alcohol is brought a lot of health issues heartache and detrimental damage to my life! I would highly recommend anyone that doesn’t drink alcohol to not start and that does if you have to drink more than a couple of drinks a week you’re heading for trouble. It absolutely did damage to my heart I also had a brain bleed stroke and I still battle with alcohol but I am a recovering alcoholic! Horrible disease, that is not particular of its prisoners rather you’re rich or poor for the smartest guy in the world. To the contrary of most beliefs most of the alcoholic attics I’ve met or have super intelligent and started using as a medicine to cope with life in reality at a very young age and then cross the line as I did and there’s no return . Peter

Interesting that a study about consuming less alcohol (made mostly from grain/corn/agricultural sources) comes out at a time when we’re seeing news reports everywhere about grain crop shortages.

Funny comment about living at age 80 to 90 sucks. I’m 75 and healthy and more creative, skilled than ever before as a musician, who gets better with age, like wine. Only drink a little twice a week.

@justsomeone I’m a divorced father of one. A little alcohol to chill is probably ok, but that’s better for relaxing stress, not depression. First, forgive yourself for not being perfect and for your marriage “failing”. No one is perfect or even “good enough” all the time which actually means being flawed and trying your best IS good enough. Make sure your kids know you love them, listen to their feelings, and don’t put down their mother in front of them even if she deserves it (this mostly hurts them, not your ex). Next, no relationship is actually a failure if you learn from it. Make a list of what you could have done better at in your marriage…try not to make those same mistakes. Make a list of what your ex could have done better at…keep those handy as warning signs in new relationships. Now make a list of what you want from a relationship and from a partner. Instead of drinking when you don’t have your kids, try going to a strip club once or twice. If you enjoy it without missing an emotional connection, you probably aren’t ready or don’t want a relationship yet. Focus on hanging out with buddies instead to rebuild your sense of self. If you know you want to “sleep around” for a while, just be honest with the women that you’re still recovering from a bad marriage and looking for passion not love. If you KNOW that you want a partner and a close relationship, DON’T sleep around. If you’re honorable at all, once sex is involved, you’ll feel more obligated to stay with someone you care about, but know isn’t quite right for you. Doing this is a great way to trap yourself in another bad relationship. Use your list of what you want to try to objectively judge your connection. If the person doesn’t check most of the boxes after several good dates, you can more easily break it off or downgrade to friendship with her feeling used. If your new partner DOES check the boxes, still take it slow for a bit longer, but now for the fun of building up that passion and anticipation together.

43 years old and have been drinking heavily the past few years. As of 5 months ago, I haven’t had one drink. And as this study indicates, alcohol can cause cardiomyopathy, as I was diagnosed with it a couple of months ago. Now I’m on several medications and working to improve my overall health. With that and my faith, I pray that in a few months when I get another echo and mri, my ejection fraction has increased. Moral of the story, alcohol is poison and has no place in the human body.

I’ve been sober from alcohol for 13 years now I feel really good

My husband has drank for over 40 years and not just one can he drinks till he can’t and he his healthier than I . I never have drank and I am sick of my heart. So hard to believe your story

Alcohol is bad in the long run. Don’t let cops, lawyers, cities etc. make money off you with drunk driving arrests It’s A slow long detrimental addiction for too many

I, too, call TOTAL B.S. on this article AND this study! I enjoy several glasses of wine every day and I’m not about to stop, number one, number two, most of my family are what some would call “heavy drinkers,” and we ALL live to a ripe old age. Even if I DON’T, I’m going to enjoy my life while I’m on this planet, because our time here is fleeting, and I’m going to drink and relax with friends and family until I drop dead, so…to Hell with these new age temperance alarmists…here’s to you!

I’m 63 I’m a heavy beer drinker Imported only and And Enjoy Jameson Have a physical every 6 months my Doctor is on the Ball God Bless Her She takes Veterans Health insurance!! Blood work is Normal. Weight Normal. If You drink Eat heavy!

I am an alcoholic I am 48 years old I have congestive heart failure I am in poor health I still drink but not heavy I come from a long family of alcoholics everything in this world is going to kill you eventually we’re all going to die so whether or not we enjoy a few drinks so be it. I have now probably a beer or two a day after I get off work my point is if you enjoy it then do it I wouldn’t listen to anything that the who says because they’re a crock of s*** anyway

It does effect the heart in some way. I drank the day before yesterday, pretty heavy if I might add I had quit drinking for a good sixty days. And that’s how it would start, I’d get off work and just get a few. No big deal. After a few days of it. My anxiety and heart is always thumping out of my chest and I have no appetite. I’ll just stop and smoke my weeds. To hell with alcohol.

Some folks never learn. They NEED to drink. They don’t drink to feel good but to stop feeling BAD …for whatever reason. You can’t talk those folks out of it. And of course every drinker/ smoker I ever knew knows someone who drinks and/or smokes more and lived to be 80+. Long and large cohort studies be damned.. “Uncle Fred did 2/3 packs a day along with a 1/2 pint of whiskey washed with 2 pints of beer and lived until he was 90 and I’m in that 2% too.” Free country just don’t drive near me and pay for your own private health insurance please.

Nope I disagree why just had a ..one those test for sonic a embryos.atv6 week 8 week .but my heart pumping way it suppose to do.. I believe that weight like over weight your height. I drink a six pack..lol I weight 106. 5.5..and have heart examed

Alcohol is poison, it shouldn’t be surprising that it’s bad for you

We are all born naked wet and hungry and then things get worse, so enjoy life! We all know our limits…we are all grown and we should all act accordingly. Just saying….be responsible… And use common sense!

Justsomeone: First of all, I am sorry with what you are going through. The answer to your question would be the extra alcohol. (I’m in a bit of a unique position where in two years I will double boarded in addictionology and psychiatry, so I understand the effects of both alcohol as well as anxiety depression on the body.) I am a current US trained physician who uses the DSM5 and my answers are with this in mind.

In short, per the DSM5, anyone with a substance use disorder can’t be diagnosed with most other psychiatric disorders as the substance can mimic the symptoms of another illness making it hard to differentiate between the two. Alcohol, for example, can exacerbate depression and anxiety while you are intoxicated. These effects can also last for several days after the intoxication resolves. In your case, where there is likely an underlying depression and anxiety, the alcohol is likely making things worse, in addition to the other harmful effects that binge drinking can have on your body. (Not going to get into them here – internet should have all that info). I would recommend speaking to a psychiatrist and asking about medication options that might be a good fit for you for the depression (as you are self medicating already with alcohol) and speaking to a counselor about starting therapy. From my experience, I find a combination of meds and counseling to be more effective than either one alone. However, between the three (alcohol, depression, anxiety), alcohol will be the worse because that has the potential to exacerbate the other two and allow them to increase whatever damage they would normally cause – in addition to the damage alcohol would cause by itself.

Here are some specific definitions to see if you fall into the concerning category of drinking (there are different ones based on different organizations). Listing them for females as well if anyone is interested.

Binge Drinking: NIAAA defines binge drinking as a pattern of drinking alcohol that brings blood alcohol concentration (BAC) to 0.08 percent – or 0.08 grams of alcohol per deciliter – or higher. For a typical adult, this pattern corresponds to consuming 5 or more drinks (male), or 4 or more drinks (female), in about 2 hours. The Substance Abuse and Mental Health Services Administration (SAMHSA), which conducts the annual National Survey on Drug Use and Health (NSDUH), defines binge drinking as 5 or more alcoholic drinks for males or 4 or more alcoholic drinks for females on the same occasion (i.e., at the same time or within a couple of hours of each other) on at least 1 day in the past month.

Heavy Alcohol Use:

NIAAA defines heavy drinking as follows: For men, consuming more than 4 drinks on any day or more than 14 drinks per week

For women, consuming more than 3 drinks on any day or more than 7 drinks per week

SAMHSA defines heavy alcohol use as binge drinking on 5 or more days in the past month.

Yes, interesting study, at least someone is doing a study on the affect of alcohol to the body. More are needed! Keep up the great work! I have desired alcohol since the first time my mother allowed me a sip of her sweet cold icy wine cooler probably age 10. I never desired to become a drinker because I grew up around men that were called drunkerds and as a girl who would want to aspire to be a functional go to work never miss a day alcoholic/drunk! A majority of them lived into their 80’s, some died 50’s alcohol related heart/strokes! My point is, the United States government has given society the choice to abuse or not to abuse! I am now 55. 6 weeks ago had an excellent ekg, blood work all good, and have all my arteries ultrasound every year-excellent , and I drink in moderation, I could have easily been a predisposed excuse for being a drunk but if I can make the right choice anyone can! The study is about facts! The fact is Alcohol is just one more thing that will kill you! Period point blank… This one you can control!

Drink if u want to drink have fun live ur life . I’m a different kind of person I’m not judging you but I can tell u how u made me feel and did me wrong and what I think of u for doing it. U have said many times u have no regrets so I don’t even care to talk or read this stuff anymore

If you live where it legal go green

Tell that to the 113 year old man who says to drink everyday 🤣

My spouse if 27 years passed away from MVP heart failure. Its a horrible way to die. For over a decade she complained of not being able to breath low energy. MVP caused her legs to swell from registration. She couldn’t lie flat on her back because she would drown. She always quoted Dr. Oz drink wine it’s good for you. BS! Don’t drink. Don’t vote for Oz.

Whatever anyone says you just print It looks like you’re just filling some blank spots in news letter One day it’s good Other day it brings some brain failure Next day it’s helping a 100 year old woman in France live up to date Other day it’s the cause of heart failure What’s wrong with you people. Make up your mind and take side Don’t print anything, at least until you’re sure about it.

It’s not free speech, it’s bringing chaos to mind of readers.

That’s why alcohol is forbidden in islam

At 51 yrs I can’t tell you the countless times that I’ve heard of the legendary grandma who smoked unfiltered camels and drank scotches from 10 years of age and died at 95 whenever scientific studies come out on the topic.

What I’m hearing through all that noise is: “Science be damned, I’m gonna keep on doing me when it comes to alcohol”. Never mind that spirits are poison that our bodies and digest, that blocks key vitamin absorption for cellular function. I read a cancer study that that traced back a number of cancers to the alcohol consumption. I quit a year ago and I’m not looking back. But, continue doing you and keep enjoying those bottles as if they’re your last!

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Excessive drinking increased by 21 percent during the COVID-19 pandemic.

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Study holds warning on pandemic drinking

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Researchers model short- and long-term health toll amid rise in U.S. consumption

Scientists estimate that a one-year increase in alcohol consumption during the COVID-19 pandemic will result in 8,000 additional deaths from alcohol-related liver disease, 18,700 cases of liver failure, and 1,000 cases of liver cancer by 2040.

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In the short term, alcohol consumption changes due to COVID-19 are expected to cause 100 additional deaths and 2,800 additional cases of liver failure by 2023.

The new research, published in  Hepatology , was led by investigators at Harvard-affiliated Massachusetts General Hospital.

Using data from a national survey of U.S. adults on their drinking habits that found that excessive drinking (such as binge drinking) increased by 21 percent during the COVID-19 pandemic, investigators simulated the drinking trajectories and liver disease trends in all U.S. adults. The researchers noted that a sustained increase in alcohol consumption for more than one year could result in 19 to 35 percent additional mortality.

“Our findings highlight the need for individuals and policymakers to make informed decisions to mitigate the impact of high-risk alcohol drinking during the COVID-19 pandemic in the U.S.,” says senior author Jagpreet Chhatwal, associate director of MGH’s Institute for Technology Assessment and an assistant professor of radiology at Harvard Medical School.

“While we have projected the expected impact of societal drinking changes associated with the COVID-19 pandemic without any interventions, we hope that our research can help jumpstart needed conversations at every level of society about how we can respond to the many behavioral changes, coping mechanisms, and choices that have short- and long-term implications for the health of individuals, families and communities in America,” adds lead author Jovan Julien, a data analyst at the MGH Institute for Technology Assessment.

“The COVID-19 pandemic has had many unintended consequences with unknown long-term impact. Our modeling study provides a framework for quantifying the long-term impact of increased alcohol consumption associated with COVID-19 and initiating conversations for potential interventions,” notes co-author Turgay Ayer, the George Family Foundation Early Career Professor of Systems Engineering at Georgia Institute of Technology.

Co-authors include Elliot B. Tapper, Carolina Barbosa, and William Dowd.

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Scientists give new insight into a molecular target of alcohol

Ethanol -- the compound found in alcoholic beverages -- interferes with the normal functioning of a long list of biological molecules, but how each of these interactions contributes to the behavioral effects of alcohol is not fully understood. A guiding, but elusive, goal of researchers is to identify the protein (or proteins) to which ethanol binds that makes some people vulnerable to excessive drinking. Solving this question would point the way to effective therapies for alcohol use disorder, which affects more than 10% of the U.S. adult population and is responsible for a myriad of health and societal issues.

Previous studies identified one such molecule, a protein widely expressed in the brain, called the BK channel. Ethanol can directly interact with a component of BK channels, known as the α subunit, to facilitate their opening. However, scientists at Scripps Research found that this interaction may not drive behaviors related to alcohol abuse as much as previously thought. Their study, appearing in the journal Molecular Psychiatry on December 22, 2023, demonstrates that preventing ethanol from interacting with the BK α subunit does not reduce or increase the motivation to consume alcohol in mice.

The relationship between the BK α subunit and ethanol had previously been explored in vitro , ex vivo and in live invertebrates. Previous studies suggested that the BK α subunit was involved in an animal's response to alcohol exposure, but there was a gap in understanding its role in mammals, particularly for the control of alcohol drinking.

"Knowing what a molecule does from in vitro experiments really doesn't tell you much about what the behavioral consequences of that action might be," says senior author Candice Contet, PhD, associate professor in the Department of Molecular Medicine at Scripps Research. "Things get complicated in vivo , because there are many layers of modulation that may occur in a cell-type specific manner. Moreover, the initial effect often changes with repeated or prolonged exposure to alcohol. We thus sought to determine whether the ability of ethanol to alter BK channel activity was in any way influencing the motivation to drink alcohol."

Tackling this question didn't lend itself well to conventional pharmacological testing: blocking BK channels with a drug causes tremors, which then interfere with drinking behavior. However, Contet's collaborator Alex Dopico, MD, PhD, of the University of Tennessee, had identified a residue in the mouse BK α subunit that is required for ethanol to activate BK channels but is dispensable for normal BK channel activity, as shown in frog eggs. In the new study, Contet and her colleagues leveraged this discovery to unlock the significance of ethanol's interaction with BK channels for alcohol drinking in mice.

Accordingly, the team tested mice that had a mutation in this particular BK α subunit residue. First, they found that the mutation prevented alcohol from altering the firing properties of neurons in the medial habenula, a brain region with high levels of BK channels, thereby demonstrating that it also confers resistance to ethanol in mouse brain cells, not just in frog eggs. At the behavioral level, the mice harboring the mutation did not display any anomalies when compared to control littermates. Notably, they exhibited the standard signs of intoxication upon alcohol injection, such as loss of balance and hypothermia, and they consumed the same amount of alcohol when tested under various conditions of moderate or excessive drinking.

"The lack of effect of the mutation was surprising, especially in light of our previous results showing that other BK channel subunits, β1 and β4, influence alcohol intake escalation in the same model of alcohol dependence," says Contet. "However, these negative results, which were replicated in multiple cohorts and both sexes, are just as important as positive ones, because they encourage the field to study other targets rather than focusing on the wrong culprit."

While the study does not point to a critical role of the BK α subunit in the motivation to drink alcohol or several physiological responses related to ethanol intoxication and withdrawal, the group will continue to explore whether the molecular target plays a role in other aspects of alcohol use disorder.

"Ethanol is highly pleiotropic. Beyond its reinforcing effects, it alters the functioning of multiple organs and cell types," Contet says. "It is likely that ethanol's interaction with BK channels contribute to some of these effects, but we've only explored the tip of the iceberg so far; the next challenge will be to find the right experimental readout."

This work was supported by funding from the National Institutes of Health (AA020913, AA006420, AA026685, AA027636, AA027372, AA020889, AA010422, AA021491, AA013498, AA011560, AA007456)

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Materials provided by Scripps Research Institute . Note: Content may be edited for style and length.

Journal Reference :

• Agbonlahor Okhuarobo, Max Kreifeldt, Pauravi J. Gandhi, Catherine Lopez, Briana Martinez, Kiera Fleck, Michal Bajo, Pushpita Bhattacharyya, Alex M. Dopico, Marisa Roberto, Amanda J. Roberts, Gregg E. Homanics, Candice Contet. Ethanol’s interaction with BK channel α subunit residue K361 does not mediate behavioral responses to alcohol in mice . Molecular Psychiatry , 2023; DOI: 10.1038/s41380-023-02346-y

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Canada’s New Guidelines for Alcohol Say ‘No Amount’ Is Healthy

The guidance builds on growing evidence, after decades of sometimes conflicting research, that even small amounts of alcohol can have serious health consequences.

By Michael Levenson

Canadian health officials have overhauled their guidelines for alcohol consumption, warning that no amount is healthy and recommending that people reduce drinking as much as possible.

The new guidelines, issued Tuesday, represent a major shift from the previous ones introduced in 2011, which recommended that women consume no more than 10 drinks per week and that men limit themselves to 15.

The experts who developed the guidelines said the new approach builds on growing evidence, after decades of sometimes conflicting research, that even small amounts of alcohol can have serious health consequences .

Instead of recommending that people limit themselves to a specific number of drinks per week, the guidelines outline a “continuum of risk” associated with drinking even a few glasses of wine or beer over a seven-day period.

The risk is “low” for people who consume two standard drinks or fewer per week; “moderate” for those who consume between three and six standard drinks per week; and “increasingly high” for those who consume seven or more standard drinks per week, according to the guidelines, which were issued in a report by the Canadian Centre on Substance Use and Addiction.

The report defines a standard drink as a 12-ounce bottle of beer that is 5 percent alcohol, a five-ounce glass of wine that is 12 percent alcohol or a 1.5-ounce shot glass of a spirit that is 40 percent alcohol.

“Research shows that no amount or kind of alcohol is good for your health,” the report states. “It doesn’t matter what kind of alcohol it is — wine, beer, cider or spirits. Drinking alcohol, even a small amount, is damaging to everyone, regardless of age, sex, gender, ethnicity, tolerance for alcohol or lifestyle. That’s why if you drink, it’s better to drink less.”

Recent research has found that even low levels of drinking slightly increase the risk of high blood pressure and heart disease, and the risk goes up significantly for people who drink excessively.

Research published in November revealed that between 2015 and 2019, excessive alcohol use resulted in roughly 140,000 deaths per year in the United States. About 40 percent of those deaths had acute causes, like car crashes. But a majority were caused by chronic conditions attributed to alcohol, such as liver disease, cancer and heart disease.

Dr. Catherine Paradis, interim associate director of research at the Canadian Centre on Substance Use and Addiction, said that consumption of even two drinks per week has been associated with an elevated risk of seven types of cancer, including breast and colon cancer, as well as cardiovascular disease.

Dr. Paradis, who was a co-chairwoman of the panel that developed the new guidelines, noted that the World Health Organization had recently declared that the harms associated with drinking alcohol had been “systematically evaluated over the years and are well documented” and that “when it comes to alcohol consumption, there is no safe amount that does not affect health.”

The good news, the report said, is that any reduction in alcohol consumption is beneficial. This is true even for those who do not cut their drinking to low or moderate levels. In fact, those consuming high levels of alcohol have much to gain by reducing their consumption by as much as possible, the report states.

“We have this line: Drink less, live more,” said Dr. Alexander Caudarella, chief executive of the Canadian Centre on Substance Use and Addiction. “The idea is that any reduction of alcohol will significantly reduce your risk.”

The new guidelines depart from the specific drink limits called for in other Western countries.

Although the measurements for standard drinks vary from country to country, Australia recommends no more than 10 drinks a week and no more than four drinks on any one day. Britain recommends drinking no more than six medium glasses of wine or six pints of beer per week. The guidelines in the United States call for two drinks or fewer a day for men and one drink or fewer per day for women.

Canadian health officials said they hoped their less prescriptive approach would encourage consumers to make healthier choices.

“The guidance is really a fundamentally different way of looking at alcohol and saying we need to be much more open and transparent about what are the risks associated with it and what the science has shown us,” Dr. Caudarella said. “It’s really putting it out there in a way that lets people assess their own risk target and work toward it.”

To encourage consumers to cut down on their drinking, the report recommended that all alcoholic beverages sold in Canada come with warning labels, similar to those on cigarettes. Evidence shows that adding health warnings to alcohol labels can increase public awareness of the link between alcohol consumption and cancer, the report states.

Beer Canada, a national trade group that represents more than 50 Canadian brewing companies, said that it continued to support the 2011 guidelines and that the process of updating those guidelines “lacked full transparency and, to date, has not included the essential rigor of an expert technical peer review.”

“Beer Canada and Canadian brewers have a long history promoting moderation and responsible consumption,” the group said in a statement. “Beer Canada believes the decision whether to drink, and if so how much, is a personal one. Responsible, moderate consumption can be part of a balanced lifestyle for most adults of legal drinking age.”

Dan Paszkowski, president and chief executive of Wine Growers Canada, which represents the country’s wineries, said the group had introduced a campaign, “ The Right Amount ,” in 2021 to promote “responsible consumption of wine.”

“It’s essential for Canadians to have confidence in public health institutions and the messaging must be informative, not persuasive, and based on sound science,” Mr. Paszkowski wrote in an opinion piece published this week in The Hill Times, a news outlet focused on Canadian politics and government. “From some to none, the right amount is different for every person.”

Michael Levenson joined The Times in December 2019. He was previously a reporter at The Boston Globe, where he covered local, state and national politics and news. More about Michael Levenson

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Advances in the science and treatment of alcohol use disorder

K. witkiewitz.

1 Department of Psychology and Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico, 2650 Yale Blvd. SE, Albuquerque, NM 87106, USA.

R. Z. Litten

2 Division of Medications Development and Division of Treatment and Recovery Research, National Institute on Alcohol Abuse and Alcoholism, 6700B Rockledge Drive, Bethesda, MD 20892-6902, USA.

3 Section on Clinical Psychoneuroendocrinology and Neuropsychopharmacology, National Institute on Alcohol Abuse and Alcoholism Division of Intramural Clinical and Biological Research, and National Institute on Drug Abuse Intramural Research Program, National Institutes of Health, 10 Center Drive (10CRC/15330), Bethesda, MD 21224, USA.

4 Medication Development Program, National Institute on Drug Abuse Intramural Research Program, 251 Bayview Blvd., Baltimore, MD 21224, USA.

5 Center for Alcohol and Addiction Studies, Brown University, Providence, RI 02912, USA.

Pharmacological and behavioral treatments exist for alcohol use disorder, but more are needed, and several are under development.

Alcohol is a major contributor to global disease and a leading cause of preventable death, causing approximately 88,000 deaths annually in the United States alone. Alcohol use disorder is one of the most common psychiatric disorders, with nearly one-third of U.S. adults experiencing alcohol use disorder at some point during their lives. Alcohol use disorder also has economic consequences, costing the United States at least $249 billion annually. Current pharmaceutical and behavioral treatments may assist patients in reducing alcohol use or facilitating alcohol abstinence. Although recent research has expanded understanding of alcohol use disorder, more research is needed to identify the neurobiological, genetic and epigenetic, psychological, social, and environmental factors most critical in the etiology and treatment of this disease. Implementation of this knowledge in clinical practice and training of health care providers is also needed to ensure appropriate diagnosis and treatment of individuals suffering from alcohol use disorder.

INTRODUCTION

In most regions of the world, most adults consume alcohol at least occasionally ( 1 ). Alcohol is among the leading causes of preventable death worldwide, with 3 million deaths per year attributable to alcohol. In the United States, more than 55% of those aged 26 and older consumed alcohol in a given month, and one in four adults in this age group engaged in binge drinking (defined as more than four drinks for women and five drinks for men on a single drinking occasion) ( 2 ). Excessive alcohol use costs U.S. society more than $249 billion annually and is the fifth leading risk factor for premature death and disability ( 3 ).

The morbidity and mortality associated with alcohol are largely due to the high rates of alcohol use disorder in the population. Alcohol use disorder is defined in the Diagnostic and Statistical Manual for Mental Disorders , 5th edition (DSM-5) ( 4 ) as a pattern of alcohol consumption, leading to problems associated with 2 or more of 11 potential symptoms of alcohol use disorder (see Table 1 for criteria). In the United States, approximately one-third of all adults will meet criteria for alcohol use disorder at some point during their lives ( 5 ), and approximately 15.1 million of U.S. adults meet criteria for alcohol use disorder in the previous 12 months ( 6 ). The public health impacts of alcohol use extend far beyond those individuals who drink alcohol, engage in heavy alcohol use, and/or meet criteria for an alcohol use disorder. Alcohol use is associated with increased risk of accidents, workplace productivity losses, increased medical and mental health costs, and greater rates of crime and violence ( 1 ). Analyses that take into account the overall harm due to drugs (harm to both users and others) show that alcohol is the most harmful drug ( 7 ).

Only a small percent of individuals with alcohol use disorder contribute to the greatest societal and economic costs ( 8 ). For example, in the 2015 National Survey on Drug Use and Health survey (total n = 43,561), a household survey conducted across the United States, 11.8% met criteria for an alcohol use disorder ( n = 5124) ( 6 ). Of these 5124 individuals, 67.4% ( n = 3455) met criteria for a mild disorder (two or three symptoms, based on DSM-5), 18.8% ( n = 964) met criteria for a moderate disorder (four or five symptoms, based on DSM-5), and only 13.8% ( n = 705) met criteria for a severe disorder (six or more symptoms) ( 6 ). There is a large treatment gap for alcohol use disorder, arising from the fact that many individuals with alcohol use disorder do not seek treatment. Those with a mild or moderate alcohol use disorder may be able to reduce their drinking in the absence of treatment ( 9 ) and have a favorable course; but it is those with more severe alcohol use disorder who most often seek treatment and who may experience a chronic relapsing course ( 10 ).

HISTORY OF TREATMENT FOR ALCOHOL USE DISORDER

Near the end of the 18th century, the Pennsylvania physician Benjamin Rush described the loss of control of alcohol and its potential treatments ( 11 ). His recommendations for remedies and case examples included practicing the Christian religion, experiencing guilt and shame, pairing alcohol with aversive stimuli, developing other passions in life, following a vegetarian diet, taking an oath to not drink alcohol, and sudden and absolute abstinence from alcohol. Through the 1800s and early 1900s, the temperance movement laid the groundwork for mutual help organizations, and the notion of excessive alcohol use as a moral failing. During the same period, inebriate asylums emerged as a residential treatment option for excessive alcohol use, although the only treatment offered was forced abstinence from alcohol ( 12 ). The founding of Alcoholics Anonymous (A.A.) in the 1930s ( 13 ) and the introduction of the modern disease concept of alcohol use disorder (previously called “alcoholism”) in the 1940s ( 14 ) laid the groundwork for many of the existing treatment programs that remain widely available today. Over the past 80 years, empirical studies have provided support for both mutual support [A.A. and other support groups, such as SMART (Self-Management and Recovery Training)] and medical models of treatment for alcohol use disorder, as well as the development of new pharmacological and behavioral treatment options. In addition, there are several public health policy initiatives (e.g., taxation, restrictions on advertising, and outlet density) and brief intervention programs (e.g., social norms interventions) that can be effective in reducing prevalence of alcohol use disorder and alcohol-related harms ( 1 ).

NEUROBIOLOGY OF ALCOHOL USE DISORDER

Alcohol use disorder is characterized by loss of control over alcohol drinking that is accompanied by changes in brain regions related to the execution of motivated behaviors and to the control of stress and emotionality (e.g., the midbrain, the limbic system, the prefrontal cortex, and the amygdala). Mechanisms of positive and negative reinforcement both play important roles with individual drinking behavior being maintained by positive reinforcement (rewarding and desirable effects of alcohol) and/or negative reinforcement mechanisms (negative affective and physiological states that are relieved by alcohol consumption) ( 15 , 16 ). At the neurotransmitter level, the positive reinforcing effects of alcohol are primarily mediated by dopamine, opioid peptides, serotonin, γ-aminobutyric acid (GABA), and endocannabinoids, while negative reinforcement involves increased recruitment of corticotropin-releasing factor and glutamatergic systems and down-regulation of GABA transmission ( 16 ). Long-term exposure to alcohol causes adaptive changes in several neurotransmitters, including GABA, glutamate, and norepinephrine, among many others. Discontinuation of alcohol ingestion results in the nervous system hyperactivity and dysfunction that characterizes alcohol withdrawal ( 15 , 16 ). Acting on several types of brain receptors, glutamate represents one of the most common excitatory neurotransmitters. As one of the major inhibitory neurotransmitters, GABA plays a key role in the neurochemical mechanisms involved in intoxication, tolerance, and withdrawal. This brief review can offer only a very simplified overview of the complex neurobiological basis of alcohol use disorder. For deeper, more detailed analysis of this specific topic, the reader is encouraged to consult other reviews ( 15 , 16 ).

CLINICAL MANAGEMENT OF ALCOHOL WITHDRAWAL SYNDROME

Alcohol withdrawal symptoms may include anxiety, tremors, nausea, insomnia, and, in severe cases, seizures and delirium tremens. Although up to 50% of individuals with alcohol use disorder present with some withdrawal symptoms after stopping drinking, only a small percentage requires medical treatment for detoxification, and some individuals may be able to reduce their drinking spontaneously. Medical treatment may take place either in an outpatient or, when clinically indicated, inpatient setting. In some cases, clinical monitoring may suffice, typically accompanied by supportive care for hydration and electrolytes and thiamine supplementation. For those patients in need of pharmacological treatment, benzodiazepines (e.g., diazepam, chlordiazepoxide, lorazepam, oxazepam, and midazolam) are the most commonly used medications to treat alcohol withdrawal syndrome. Benzodiazepines work by enhancing the effect of the GABA neurotransmitter at the GABA A receptor. Notably, benzodiazepines represent the gold standard treatment, as they are the only class of medications that not only reduces the severity of the alcohol withdrawal syndrome but also reduces the risk of withdrawal seizures and/or delirium tremens. Because of the potential for benzodiazepine abuse and the risk of overdose, if benzodiazepine treatment for alcohol withdrawal syndrome is managed in an outpatient setting, careful monitoring is required, particularly when combined with alcohol and/or opioid medications ( 17 ).

a-2 agonists (e.g., clonidine) and β-blockers (atenolol) are sometimes used as an adjunct treatment to benzodiazepines to control neuro-autonomic manifestations of alcohol withdrawal not fully controlled by benzodiazepine administration ( 18 ). However, because of the lack of efficacy of a-2 agonists and β-blockers in preventing severe alcohol withdrawal syndrome and the risk of masking withdrawal symptoms, these drugs are recommended not as monotherapy, but only as a possible adjunctive treatment.

Of critical importance to a successful outcome is the fact that alcohol withdrawal treatment provides an opportunity for the patient and the health care provider to engage the patient in a treatment program aimed at achieving and maintaining long-term abstinence from alcohol or reductions in drinking. Such a treatment may include pharmacological and/or psychosocial tools, as summarized in the next sections.

PHARMACOLOGICAL APPROACHES TO THE TREATMENT OF ALCOHOL USE DISORDER

U.s. food and drug administration–approved pharmacological treatments.

Development of novel pharmaceutical reagents is a lengthy, costly, and expensive process. Once a new compound is ready to be tested for human research use, it is typically tested for safety first via phase 0 and phase 1 clinical studies in a very limited number of individuals. Efficacy and side effects may then be further tested in larger phase 2 clinical studies, which may be followed by larger phase 3 clinical studies, typically conducted in several centers and are focused on efficacy, effectiveness, and safety. If approved for use in clinical practice, this medication is still monitored from a safety standpoint, via phase 4 postmarketing surveillance.

Only three drugs are currently approved by the U.S. Food and Drug Administration (FDA) for use in alcohol use disorder. The acetaldehyde dehydrogenase inhibitor disulfiram was the first medication approved for the treatment of alcohol use disorder by the FDA, in 1951. The most common pathway in alcohol metabolism is the oxidation of alcohol via alcohol dehydrogenase, which metabolizes alcohol to acetaldehyde, and aldehyde dehydrogenase, which converts acetaldehyde into acetate. Disulfiram leads to an irreversible inhibition of aldehyde dehydrogenase and accumulation of acetaldehyde, a highly toxic substance. Although additional mechanisms (e.g., inhibition of dopamine β-hydroxylase) may also play a role in disulfiram’s actions, the blockade of aldehyde dehydrogenase activity represents its main mechanism of action. Therefore, alcohol ingestion in the presence of disulfiram leads to the accumulation of acetaldehyde, resulting in numerous related unpleasant symptoms, including tachycardia, headache, nausea, and vomiting. In this way, disulfiram administration paired with alcohol causes the aversive reaction, initially proposed as a remedy for alcohol use disorder by Rush ( 11 ) in 1784. One challenge in conducting a double-blind, placebo-controlled alcohol trial of disulfiram is that it is easy to break the blind unless the “placebo” medication also creates an aversive reaction when consumed with alcohol, which would then provide the same mechanism of action as the medication (e.g., the placebo and disulfiram would both have the threat of an aversive reaction). Open-label studies of disulfiram do provide support for its efficacy, as compared to controls, with a medium effect size ( 19 ), as defined by Cohen’s d effect size ranges of small d = 0.2, medium d = 0.5, and large d = 0.8 ( 20 ). The efficacy of disulfiram largely depends on patient motivation to take the medication and/or supervised administration, given that the medication is primarily effective by the potential threat of an aversive reaction when paired with alcohol ( 21 ).

The next drug approved for treatment of alcohol use disorder was acamprosate; first approved as a treatment for alcohol dependence in Europe in 1989, acamprosate has subsequently been approved for use in the United States, Canada, and Japan. Although the exact mechanisms of acamprosate action are still not fully understood, there is evidence that it targets the glutamate system by modulating hyperactive glutamatergic states, possibly acting as an N -methyl- d -aspartate receptor agonist ( 22 ). The efficacy of acamprosate has been evaluated in numerous double-blind, randomized controlled trials and meta-analyses, with somewhat mixed conclusions ( 23 – 26 ). Although a meta-analysis conducted in 2013 ( 25 ) indicated small to medium effect sizes in favor of acamprosate over placebo in supporting abstinence, recent large-scale trials conducted in the United States ( 27 ) and Germany ( 28 ) failed to find effects of acamprosate distinguishable from those of a placebo. Overall, there is evidence that acamprosate may be more effective in promoting abstinence and preventing relapse in already detoxified patients than in helping individuals reduce drinking ( 25 ), therefore suggesting its use as an important pharmacological aid in treatment of abstinent patients with alcohol use disorder. The most common side effect with acamprosate is diarrhea. Other less common side effects may include nausea, vomiting, stomachache, headache, and dizziness, although the causal role of acamprosate in giving these side effects is unclear.

A third drug, the opioid receptor antagonist naltrexone, was approved for the treatment of alcohol dependence by the FDA in 1994. Later, a monthly extended-release injectable formulation of naltrexone, developed with the goal of improving patient adherence, was also approved by the FDA in 2006. Naltrexone reduces craving for alcohol and has been found to be most effective in reducing heavy drinking ( 25 ). The efficacy of naltrexone in reducing relapse to heavy drinking, in comparison to placebo, has been supported in numerous meta-analyses ( 23 – 25 ), although there is less evidence for its efficacy in supporting abstinence ( 25 ). Fewer studies have been conducted with the extended-release formulation, but its effects on heavy drinking, craving, and quality of life are promising ( 29 , 30 ). Common side effects of naltrexone may include nausea, headache, dizziness, and sleep problems. Historically, naltrexone’s package insert has been accompanied by a risk of hepatotoxicity, a precaution primarily due to observed liver toxicity in an early clinical trial with administrating a naltrexone dosage of 300 mg per day to obese men ( 31 ). However, there is no published evidence of severe liver toxicity at the lower FDA-approved dosage of naltrexone for alcohol use disorder (50 mg per day). Nonetheless, transient, asymptomatic hepatic transaminase elevations have also been observed in some clinical trials and in the postmarketing period; therefore, naltrexone should be used with caution in patients with active liver disease and should not be used in patients with acute hepatitis or liver failure.

Additional pharmacological treatments approved for alcohol use disorder in Europe

Disulfiram, acamprosate, and naltrexone have been approved for use in Europe and in the United States. Pharmacologically similar to naltrexone, nalmefene was also approved for the treatment of alcohol dependence in Europe in 2013. Nalmefene is a m- and d-opioid receptor antagonist and a partial agonist of the k-opioid receptor ( 32 ). Side effects of nalmefene are similar to naltrexone; compared to naltrexone, nalmefene has a longer half-life. Meta-analyses have indicated that nalmefene is effective in reducing heavy drinking days ( 32 ). An indirect meta-analysis of these two drugs concluded that nalmefene may be more effective than naltrexone ( 33 ), although whether a clinically relevant difference between the two medications really exists is still an open question ( 34 ). Network meta-analysis and microsimulation studies suggest that nalmefene may have some benefits over placebo for reducing total alcohol consumption ( 35 , 36 ). The approval of nalmefene in Europe was accompanied by some controversy ( 37 ); a prospective head-to-head trial of nalmefene and naltrexone could help clarify whether nalmefene has added benefits to the existing medications available for alcohol use disorder. Last, nalmefene was approved in Europe as a medication that can be taken “as needed” (i.e., on days when drinking was going to occur). Prior work has also demonstrated the efficacy of taking naltrexone only on days that drinking was potentially going to occur ( 38 ).

In addition to these drugs, a GABA B receptor agonist used to treat muscle spasms, baclofen, was approved for treatment of alcohol use disorder in France in 2018 and has been used off label for alcohol use disorder for over a decade in other countries, especially in other European countries and in Australia ( 39 , 40 ). Recent human laboratory work suggests that baclofen may disrupt the effects of an initial priming dose of alcohol on subsequent craving and heavy drinking ( 41 ). Meta-analyses and systematic reviews examining the efficacy of baclofen have yielded mixed results ( 35 , 39 , 42 ); however, there is some evidence that baclofen might be useful in treatment of alcohol use disorder among individuals with liver disease ( 43 , 44 ). Evidence of substantial heterogeneity in baclofen pharmacokinetics among different individuals with alcohol use disorder ( 41 ) could explain the variability in the efficacy of baclofen across studies. The appropriate dose of baclofen for use in treatment of alcohol use disorder remains a controversial topic, and a recent international consensus statement highlighted the importance of tailoring doses based on safety, tolerability, and efficacy ( 40 ).

Promising pharmacological treatments

Numerous other medications have been used off label in the treatment of alcohol use disorder, and many of these have been shown to be modestly effective in meta-analyses and systematic reviews ( 23 , 24 , 26 , 35 ). Systematic studies of these medications suggest promising findings for topiramate, ondansetron, gabapentin, and varenicline. The anticonvulsant drug topiramate represents one of the most promising medications in terms of efficacy, based on its medium effect size from several clinical trials [for a review, see ( 45 )], including a multisite clinical study ( 46 ). One strength of topiramate is the possibility of starting treatment while people are still drinking alcohol, therefore serving as a potentially effective treatment to initiate abstinence (or to reduce harm) rather than to prevent relapse in already detoxified patients ( 45 ). Although not approved by the FDA, it is worth noticing that topiramate is a recommended treatment for alcohol use disorder in the U.S. Department of Veterans Affairs ( 47 ). A concern with topiramate is the potential for significant side effects, especially those affecting cognition and memory, warranting a slow titration of its dose and monitoring for side effects. Furthermore, recent attention has been paid on zonisamide, another anticonvulsant medication, whose pharmacological mechanisms of actions are similar to topiramate but with a better tolerability and safety profile ( 48 ). Recently published and ongoing research focuses on a potential pharmacogenetic approach to treatment in the use of topiramate to treat alcohol use disorder, based on the possibility that both efficacy and tolerability and safety of topiramate may be moderated by a functional single-nucleotide polymorphism (rs2832407) in GRIK1, encoding the kainate GluK1 receptor subunit ( 49 ). Human laboratory studies ( 50 ) and treatment clinical trials ( 51 ) have also used a primarily pharmacogenetic approach to testing the efficacy of the antinausea drug ondansetron, a 5HT 3 antagonist, in alcohol use disorder. Overall, these studies suggest a potential role for ondansetron in alcohol use disorder, but only in those individuals with certain variants of the genes encoding the serotonin transporter 5-HTT and the 5-HT 3 receptor. The anticonvulsant gabapentin has shown promising results in human laboratory studies and clinical trials ( 52 – 54 ), although a more recent multisite trial with an extended-release formulation of the medication did not have an effect of gabapentin superior to that of a placebo ( 55 ). Although the latter findings might be related to potential pharmacokinetic issues secondary to the specific formulation used, it is nonetheless possible that gabapentin may be more effective in patients with more clinically relevant alcohol withdrawal symptoms ( 52 ). Several human laboratory studies support a role for varenicline, a nicotinic acetylcholine receptor partial agonist approved for smoking cessation, in alcohol use disorder [for a review, see ( 56 )], and two of three clinical trials also support its efficacy on alcohol outcomes ( 57 – 59 ), especially in heavy drinkers who are males ( 59 ) and in male and female alcohol-dependent individuals who are also smokers ( 60 ). Additional details on the FDA-approved medications and other medications tested in clinical research settings for the treatment of alcohol use disorder are summarized in Table 2 .

FDA, U.S. Food and Drug Administration; AMPA, α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid; NMDA, N -methyl- d -aspartate; PO, per os (oral); IM, intramuscular; HT, serotonin.

The medications and targets described above have shown promising results in phase 2 or phase 3 medication trials. However, owing to the development of novel neuroscience techniques, a growing and exciting body of data is expanding the armamentarium of targets currently under investigation in animal models and/or in early-phase clinical studies. Pharmacological approaches with particular promise for future drug development include, but are not limited to the following [for recent reviews, see, e.g., ( 56 , 61 – 68 )]: the antipsychotic drug aripiprazole, which has multiple pharmacological actions (mainly on dopamine and serotonin receptors), the antihypertensive alpha-1 blocker drugs prazosin and doxazosin, neurokinin-1 antagonism, the glucocorticoid receptor blocker mifepristone, vasopressin receptor 1b antagonism, oxytocin, ghrelin receptor antagonism, glucagon-like peptide-1 agonism, and pharmacological manipulations of the nociception receptor (We are intentionally using a general pharmacological terminology for the nociceptin receptor, given that it is unclear whether agonism, antagonism, or both may represent the best approach.). New medications development is particularly important for the treatment of comorbid disorders that commonly co-occur among individuals with alcohol use disorder, particularly affective disorders, anxiety disorders, suicidality, and other substance use disorders. This aspect of alcohol use disorder is relevant to the fact that addictive disorders often present with significantly more severe symptoms when they coexist with other mental health disorders ( 69 ). Likewise, there is evidence that pharmacotherapy is most effective when implemented in conjunction with behavioral interventions ( 70 ), and all phase 2 and phase 3 medication trials, mentioned above, have included a brief psychosocial behavioral treatment in combination with medication.

BEHAVIORAL/PSYCHOLOGICAL TREATMENTS FOR ALCOHOL USE DISORDER

Evidence-based treatments.

A wide range of behavioral and psychological treatments are available for alcohol use disorder, and many treatments are equally effective in supporting abstinence or drinking reduction goals ( 71 – 74 ). Treatments with the greatest evidence of efficacy range from brief interventions, including motivational interviewing approaches, to operant conditioning approaches, including contingency management and the community reinforcement approach, to cognitive behavioral treatments, including coping skills training and relapse prevention, and to acceptance- and mindfulness-based approaches. Twelve-step facilitation, which was designed specifically to connect individuals with mutual support groups, has also been shown to be effective ( 75 ). In addition, harm reduction treatments, including guided self-control training and controlled drinking interventions, have been successful in supporting drinking reduction goals ( 70 ).

Meta-analyses and systematic reviews have found that brief interventions, especially those based on the principles of motivational interviewing, are effective in the treatment of alcohol use disorder. These interventions can include self-monitoring of alcohol use, increasing awareness of high-risk situations, and training in cognitive and behavioral techniques to help clients cope with potential drinking situations, as well as life skills training, communication training, and coping skills training. Cognitive behavioral treatments can be delivered in individual or group settings and can also be extended to the treatment of families and couples ( 72 , 73 ).

Acceptance- and mindfulness-based interventions are increasingly being used to target alcohol use disorder and show evidence of efficacy in a variety of settings and formats, including brief intervention formats ( 76 ). Active ingredients include raising present moment awareness, developing a nonjudgmental approach to self and others, and increasing acceptance of present moment experiences. Acceptance- and mindfulness-based interventions are commonly delivered in group settings and can also be delivered in individual therapy contexts.

Computerized, web-based, and mobile interventions have also been developed, incorporating the principles of brief interventions, behavioral and cognitive behavioral approaches, as well as mindfulness and mutual support group engagement; many of these approaches have demonstrated efficacy in initial trials ( 77 – 79 ). For example, the National Institute on Alcohol Abuse and Alcoholism (NIAAA) has developed the Take Control computerized intervention that includes aspects of motivational interviewing and coping skills training and was designed to provide psychosocial support (particularly among those assigned to the placebo medication) and also to increase adherence and retention among individuals enrolled in pharmacotherapy trials ( 80 ).

Mutual support group (e.g., A.A. and SMART) attendance and engagement have been shown to be associated with recovery from alcohol use disorder, even in the absence of formal treatment ( 81 ). However, selection biases (e.g., people selecting to attend these groups) raise difficulties in assessing whether other factors that are associated with treatment effectiveness may be the active ingredients for improving outcomes among those who attend mutual support groups. For example, individuals who are highly motivated to change might be more likely to attend mutual support groups. Likewise, mutual support groups often provide individuals with increased social network support for abstinence ( 82 ). Motivation to change and having a social network that supports abstinence (or reductions in drinking) are both factors that are associated with greater treatment effectiveness ( 83 ).

As noted above, most behavioral and psychological treatments are equally effective with small effect size differences [Cohen’s d = 2.0 to 0.3 ( 20 )] between active treatments ( 84 – 88 ). Behavioral interventions have also been shown to be as effective as pharmacotherapy options, with a 16-week cognitive behavioral intervention shown to be statistically equivalent to naltrexone in reducing heavy drinking days in a large randomized trial ( 27 ). One of the challenges of examining behavioral interventions in randomized trials is that intervention blinding and placebo controls cannot be implemented in most contexts, other than in computerized interventions. Furthermore, the general therapeutic factors common to most behavioral interventions (e.g., therapist empathy and supportive therapeutic relationship) in treatment of alcohol use disorder are as powerful as the specific therapeutic targets of specific behavioral interventions (e.g., teaching skills in a cognitive behavioral treatment) in facilitating behavioral change ( 89 ).

Promising future behavioral treatments and neuromodulation treatments

With respect to behavioral treatments, there are numerous opportunities for the development of novel mobile interventions that could provide treatment and recovery support in near real time. This mobile technology may also extend the reach of treatments to individuals with alcohol use disorder, particularly in rural areas. On the basis of a contextual self-regulation model of alcohol use ( 90 ), it is critical to address the immediate situational context alongside the broader social, environmental, and familial context in which an individual experiences the world and engages in momentary decision-making. Ambulatory assessment, particularly tools that require only passive monitoring (e.g., GPS, heart rate, and skin conductance) and real-time support via mobile health, could provide immediate environmental supports and could extend the reach of medications and behavioral treatments for alcohol use disorder. For example, a mobile device could potentially signal a high-risk situation by indicating the geographic location (near a favorite drinking establishment) and the heart rate (increased heart rate when approaching the establishment). The device could provide a warning either to the individual under treatment and/or to a person supporting that individual’s recovery. In addition, developments in alcohol sensing technology (e.g., transdermal alcohol sensors) could greatly increase rigor of research on alcohol use disorder and also provide real-time feedback on alcohol consumption levels to individuals who are attempting to moderate and/or reduce their alcohol use.

Recent advances in neuromodulation techniques may also hold promise for the development of novel treatments for alcohol use disorder. Deep brain stimulation, transcranial magnetic stimulation, transcranial electrical stimulation (including transcranial direct current stimulation and transcranial alternating current stimulation), and real-time neurofeedback have recently been tested as potential treatments for addiction, although evidence in favor of these treatments is currently uncertain and focused mostly on intermediate targets (e.g., alcohol craving) ( 91 ). These techniques attempt to directly target specific brain regions and addiction-related cognitive processes via surgically implanted electrodes (deep brain stimulation), electrical currents or magnetic fields applied to the scalp (transcranial electrical and magnetic stimulation, respectively), or individual self-generated modulation via feedback (neurofeedback). Although robust large scale trials with double-blind, sham controls, and long-term follow-ups of alcohol behavior change and relapse have not been conducted ( 91 ), the heterogeneity of alcohol use disorder suggests that targeting one specific neural region may be insufficient to treat such a complex disorder, with its multiple etiologies and diverse clinical courses ( 92 ).

Factors contributing to the effectiveness of treatments

Numerous models have examined factors that predict treatment readiness, treatment engagement, and treatment outcomes for alcohol use disorder. The transtheoretical model of change proposes that an individual’s own readiness to change his or her drinking behavior may have an impact on treatment engagement and effectiveness ( 93 ). The dynamic model of relapse proposes the involvement of multiple interacting biological, psychological, cognitive, emotional, social, and situational risk factors that are static and dynamic in their association with treatment outcomes ( 83 ). Neurobiological models of addiction focus on the brain reward and stress system dysfunction that contributes to the development and maintenance of alcohol use disorder, that is, the “addiction cycle” ( 15 , 16 ). The alcohol and addiction research domain criteria (AARDoC) ( 92 ), which have been operationalized in the addictions neuroclinical assessment ( 94 ), focus on the following three domains that correspond to particular phases in the addiction cycle: incentive salience in the binge/intoxication phase, negative emotionality in the withdrawal/negative affect phase, and executive function in the preoccupation/anticipation phase. Within each domain of the AARDoC, the addictions neuroclinical assessment proposes constructs that can be measured at multiple levels of analysis, such as craving in the incentive salience domain, negative affect and emotion dysregulation in the negative emotionality domain, and cognitive impairment and impulsivity in the executive function domain. The AARDoC acknowledge that environmental and contextual factors play a role in alcohol use disorder and treatment outcomes. Moreover, because of the heterogeneity of alcohol use disorder, the significance of these domains in causing alcohol use disorder and alcohol-related problems will vary among individuals.

Each of the abovementioned theoretical models proposes factors that may affect treatment effectiveness; however, many of the constructs proposed in each of these models are overlapping and likely contribute to the effectiveness of alcohol use disorder treatment across a range of populations and settings. A heuristic model combining components from each of these models is shown in Fig. 1 . Specifically, this model highlights the precipitants of alcohol use that are influenced by the neurobiological adaptations proposed in the addiction cycle (indicated by bold font) and additional contextual factors (regular font) that decrease or increase the likelihood of drinking in context, depending on whether an individual uses effective coping regulation in the moment. The domains supporting alcohol use/coping regulation (negative emotionality, executive function, incentive salience, and social environment) may interact to predict alcohol use or coping regulation in the moment. For example, network support for abstinence could improve decision-making and decrease likelihood of drinking. Conversely, experiences of physical pain are associated with increases in negative affect and poorer executive function, which could both increase likelihood of drinking. Both of these examples require environmental access to alcohol and a desire to drink alcohol. Treatment effectiveness will depend on the extent to which a particular treatment targets those risk factors that are most likely to increase or decrease the likelihood of drinking for each individual, as well as the personal resources that each individual brings to treatment and/or that could be enhanced in treatment. A functional analysis of contextual risk and protective factors can be critically important in guiding treatment.

Risk factors proposed in the AARDoC, including incentive salience, negative emotionality, executive function, and social environmental factors, are shown in black bold font encircling alcohol use. Contextual risk factors, including decision-making, self-efficacy, pain, craving, etc., are shown in black font in colored boxes. Risk and protective factors overlap with alcohol use and interact in predicting coping regulation and alcohol use among individual patients.

For example, there is considerable heterogeneity in treatment response to naltrexone, which may vary in efficacy in some individuals. Recent studies conducted to determine whether certain patients may benefit more from naltrexone have yielded mixed findings ( 95 ). Promising evidence suggests that individuals with the OPRM1 A118G G (Asp40) allele may have a better response to naltrexone ( 96 – 98 ); however, a prospective study of medication response among individuals stratified by presence of the Asp40 allele did not provide support for the genotype by treatment interaction ( 99 ), and recent human laboratory studies have not confirmed the hypothesized mechanisms underlying the pharmacogenomic effect ( 100 ). Initial evidence suggests that naltrexone may be more effective in reducing heavy drinking among smokers ( 101 ) and among those with a larger number of heavy drinkers in their social networks ( 102 ). With respect to reinforcement typologies, recent work has found that naltrexone may be more effective among those who tend to drink alcohol for rewarding effects ( 103 ), and acamprosate may also be more effective for individuals who drink to relieve negative affect ( 104 ).

GAPS IN SCIENTIFIC KNOWLEDGE AND NEW RESEARCH DIRECTIONS

Heterogeneity of individuals with alcohol use disorder.

This review has briefly summarized the treatments currently available for alcohol use disorder that are relatively effective, at least in some patients. Many new treatments are also being developed, and some of them seem promising. Nevertheless, numerous gaps in scientific knowledge remain. Notably, most people who drink alcohol do not develop an alcohol use disorder, most people with alcohol use disorder do not seek treatment, and most of those who do not seek treatment “recover” from alcohol use disorder without treatment ( 2 ). Very little is known about factors, particularly neurobiological, genetic, and epigenetic factors, that predict the transition from alcohol use to alcohol use disorder, although basic science models suggest that a cycle of neuroadaptations could be at play ( 15 , 16 ). We also lack a basic understanding of how individuals recover from alcohol use disorder in the absence of treatment and what neurobiological, psychological, social, and environmental factors are most important for supporting recovery from alcohol use disorder. Gaining a better understanding of recovery in the absence of treatment, particularly modifiable psychological, neurobiological, and epigenetic factors, could provide novel insights for medications and behavioral treatment development. Among many other factors, special attention is needed in future studies to shed light on the role of sex and gender in the development and maintenance of alcohol use disorder and on the response to pharmacological, behavioral, and other treatments.

The heterogeneity of alcohol use disorder presents a major challenge to scientific understanding and to the development of effective treatments for prevention and intervention ( 92 ). For example, a DSM-5 diagnosis of alcohol use disorder requires 2 or more symptoms, out of 11, over the past year. That requirement equates to exactly 2048 potential symptom combinations that would meet the criteria of alcohol use disorder. An individual who only meets criteria for tolerance and withdrawal (i.e., physiological dependence) likely requires a very different course of treatment from an individual who only meets the criteria for failure to fulfill role obligations and use of alcohol in hazardous situations. Gaining a better understanding of the etiology and course of alcohol use disorder, as well as identifying whether different subtypes of drinkers may respond better to certain treatments ( 103 , 104 ), is critical for advancing the science of alcohol use disorder prevention and treatment. Alternative conceptualizations of alcohol use disorder may also aid in improving our understanding of the disorder and reducing heterogeneity. For example, the pending International Classification of Diseases , 11th edition, will simplify the diagnosis of alcohol dependence to requiring only two of three criteria in the past 12 months: (i) impaired control over alcohol use; (ii) alcohol use that dominates over other life activities; and (iii) persistence of alcohol use despite consequences. The diagnosis will be made with or without physiological dependence, as characterized by tolerance, withdrawal, or repeated use to prevent or alleviate withdrawal ( 105 ). It remains to be seen whether simplification of the criteria set will narrow our conceptualization or potentially increase heterogeneity of this disorder among those diagnosed with alcohol dependence.

Placebo effect

An additional challenge to development of pharmacological treatments for alcohol use disorder is the high placebo response rates seen in drug trials ( 106 ). The tendency for individuals to have a good treatment response when assigned to placebo medication reflects both the high probability of recovery without treatment and the heterogeneity in the disorder itself. Many people who enter treatment are already motivated to change behavior, and receiving a placebo medication can help these individuals continue the process of change. Gaining a better understanding of which kinds of individuals respond to placebo and of the overall physiological and behavioral complexities in the placebo response is critical to identifying those individuals who will benefit the most from active medication. More generally, very little is understood about how motivation to change drinking behavior may influence the efficacy of active medications, particularly via adherence mechanisms. Additional research on targeted (i.e., as needed) dosing of medications, such as nalmefene and naltrexone ( 32 , 38 ), would be promising from the perspective of increasing adherence to medications and also raising awareness of potentially heavy drinking occasions.

Recent developments in pharmacological and behavioral approaches

In addition to gaining a better understanding of the disorder and who benefits from existing treatments, the examination of molecular targets for alcohol use disorder could open up multiple innovative directions for future translational research on the treatment of alcohol use disorder. Recent research has identified many targets that might be important for future medication trials ( 67 ). For example, most of the medication development efforts in past decades have focused on pathways and targets typically related to reward processing and positive reinforcement. While important, this approach ignores the important role of stress-related pathways (e.g., corticotropin release factor and other related pathways) in negative reinforcement and in the later stages of alcohol use disorder, which is often characterized by physical dependence, anxiety, and relief drinking [for reviews, see ( 15 , 16 )]. Furthermore, it is also becoming more and more apparent that other promising targets may be identified by looking at the brain not as an isolated system but rather as an organ with bidirectional interactions with peripheral systems. Examples of the latter approach include the growing evidence suggesting a potential role of inflammation and neuroinflammation and of the gut-liver-brain axis in the neurobiological mechanisms that regulate the development and/or maintenance of alcohol use disorder ( 107 – 109 ). Moving medications development from phase 1 to phase 2 and 3 trials has also been a difficulty in the field. Future directions that might improve translation of basic science into clinical practice include the broader use of human laboratory models and pilot clinical trials ( 110 ), as well as expanding the outcomes that might be targeted in phase 2 and phase 3 trials to include drinking reduction outcomes ( 111 , 112 ).

New directions for behavioral treatment development include a greater focus on identifying effective elements of behavioral treatments and on the components of treatment that are most critical for successful behavior change ( 89 , 113 ). Studies investigating the effects of specific treatment components are critical for refining treatment protocols to more efficiently target the symptoms of alcohol use disorder. Continued development of mobile health interventions will also help with disseminating treatment to a wider range of individuals struggling with alcohol use disorder.

Translation of addiction science to clinical practice

Last, but not the least, there is also a critical need for more research on dissemination and implementation, given the fact that many treatment programs still do not incorporate evidence-based practices, such as cognitive behavioral skills training, mindfulness-based interventions, and medications. Both pharmacological and behavioral treatments for alcohol use disorder are markedly underused; the recent Surgeon General’s report Facing Addiction in America ( 114 ) highlights the fact that only about 1 in 10 people with a substance use disorder receives any type of specialty treatment. Therefore, basic science and human research efforts will need to be accompanied by translational approaches, where effective novel medications and precision medicine strategies are effectively translated from research settings to clinical practice. Greater integration of alcohol screening and medication in primary care and other clinical settings, as well as research on best methods for implementation, has great potential for expanding access to effective treatment options ( 115 ). Because the heterogeneity of alcohol use disorder makes it highly unlikely that one single treatment will work for all individuals, it is important to provide a menu of options for pharmacological and behavioral therapies to both clinicians and patients. Reducing the stigma of alcohol use disorder and moving toward a public health approach to addressing this problem may further increase the range of acceptable treatment options.

Acknowledgment

Funding: This research was supported by a grant from NIAAA (R01 AA022328) awarded to K.W. (principal investigator). R.Z.L. is funded by NIAAA. L.L. is jointly funded by NIAAA and the National Institute on Drug Abuse (NIDA) (ZIA-AA000218). The content of this review does not necessarily represent the official views of the funders. Author contributions: K.W. wrote the first draft of the manuscript. K.W., R.Z.L., and L.L. provided additional text and edits. All authors approved the final draft. Competing interests: The authors declare that they have no competing interests. Data and materials availability: All data needed to evaluate the conclusions in the paper are present in the paper and/or in the materials cited herein. Additional data related to this paper may be requested from the authors.

REFERENCES AND NOTES

• Diet & Nutrition

A New Study Says Any Amount of Drinking Is Bad for You. Here’s What Experts Say

A new study concludes there’s no amount of alcohol consumption that’s safe for overall health — a finding that’s likely to surprise moderate drinkers, and that has left some experts unconvinced.

For years, public health officials have said that, while no one should pick up drinking in search of better health, moderate drinking (defined as up to a drink per day for women and up to two per day for men) probably won’t hurt anyone who already imbibes, and may even confer some benefits . This standard is written into the Dietary Guidelines for Americans and is supported by organizations including the American Heart Association and the American Cancer Society .

But the new paper, published Thursday in The Lancet , calls that long-held conclusion into question.

“The evidence is adding up that no amount of drinking is safe,” says study co-author Emmanuela Gakidou, a professor of global health and health metrics sciences at the University of Washington. “I don’t think we’re going out on a limb to say anything that the data do not support.”

The new research was based on a review of nearly 700 existing studies on global drinking prevalence and nearly 600 studies on alcohol and health, and found that alcohol was the seventh leading risk factor for premature death in 2016, contributing to 2.8 million deaths worldwide. That number is equivalent to 2.2% of all female deaths and 6.8% of all male deaths that year, according to the study.

The health risks likely only increase the more you drink, the study found. Compared to non-drinkers, people who had one alcoholic beverage per day had a 0.5% higher risk of developing one of 23 alcohol-related health problems, including cancer , road injuries and tuberculosis, in a given year, the study says. At that level, the absolute increase is small, equaling only four additional deaths per 100,000 people per year, according to the study. But those who had two drinks per day had a risk 7% higher than non-drinkers. At five drinks per day, the risk was 37% higher, the study says.

Gakidou’s paper did show some modest cardiovascular benefits associated with moderate drinking, particularly among women, but she says that effect is overshadowed by the numerous ways alcohol can threaten health. When you consider risks like breast cancer and road traffic injuries, she says, “the protective effect goes away, even at low doses.”

Other experts have recently come to similar conclusions. In May, for example, the World Cancer Research Fund released a report saying that, at least in terms of cancer prevention, “it’s best not to drink alcohol.” The U.K. government made a similar recommendation in 2016.

Meanwhile, some studies have questioned the long-standing idea that moderate drinking is good for heart health . That’s in part because some older studies didn’t account for the fact that many people who don’t drink abstain either because they had addiction issues in the past, or have other health problems that force them to stay away from alcohol. Including these individuals in the general non-drinking population may have skewed research results to make teetotalers as a whole group look unhealthier than they actually are, some studies have suggested .

Walter Willett, a professor of nutrition and epidemiology at the Harvard T.H. Chan School of Public Health, questions the conclusion that the cons of drinking always outweigh the pros. While there’s “no question” that heavy drinking is harmful , he says that plenty of data supports links between moderate drinking and lower total mortality and a decreased risk of heart disease — which, he says, are far more relevant concerns for most Americans than something like tuberculosis, which the Lancet paper identifies as a leading alcohol-related disease worldwide. Tuberculosis is very rare in the U.S.

“Our decisions about drinking in the United States shouldn’t be influenced by what alcohol does to tuberculosis,” Willett says. “When you throw together everything in one big pot and draw conclusions for the whole world, it’s just misleading.”

Willett does acknowledge that even moderate drinking comes with tradeoffs. A drink a day may decrease a woman’s risk of heart disease but increase her risk of breast cancer . For a young, healthy woman who is unlikely to die of heart disease, those risks might outweigh the benefits. But that’s a decision that woman would have to make with her doctor, Willett says — and it’s unlikely the entire population would or should come to the same conclusion.

“I think they went too far in this paper,” Willett says. “There are risks and benefits, and I think it’s important to have the best information about all of those and come to some personal decisions, and engage one’s health care provider in that process as well.”

Gakidou, on the other hand, says her paper’s recommendation is valid precisely because individual health decisions are so variable.

“We don’t have the information for specific individuals…we’re making overall recommendations at the population level,” she says. “If you’re running a health system in a country, it’s better overall for the population of your country to not drink at all than to drink a little bit.”

Dariush Mozaffarian, dean of the Friedman School of Nutrition Science and Policy at Tufts University, agrees with that assessment. It’s clear, he says, that drinking comes with health risks, and far less clear that it comes with any benefits. So while some moderate drinkers might never experience health problems from drinking, “if you look at all the risks and all the benefits of alcohol, it’s probably net harmful, on average, for the whole population,” he says.

While that conclusion may seem stark to people who have come to feel virtuous about their nightly glass of wine, Mozaffarian says it’s actually not so different from current medical advice.

“I think this is actually consistent with every organization’s recommendation that, overall, no one should start drinking to prevent heart disease or diabetes,” Mozaffarian says. “No organization has ever recommended to drink alcohol. The recommendation has been that if you drink — and that’s the key caveat — don’t drink more than moderately.”

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Write to Jamie Ducharme at [email protected]

$4.7 million award to help researchers prevent adolescent alcohol use

IU School of Medicine Apr 18, 2024

Tamika Zapolski, PhD, MS, and Zachary Adams, PhD

INDIANAPOLIS – Indiana University School of Medicine researchers recently were awarded $4.7 million from the Patient-Centered Outcomes Research Institute (PCORI) to further the study of caregiver intervention in reducing adolescent alcohol use and other substance use disorders (SUDs).

PCORI is an independent, nonprofit organization authorized by the U.S. Congress with a mission to fund patient-centered comparative clinical effectiveness research that provides patients, their caregivers and clinicians with the evidence-based information they need to make better informed health and healthcare decisions.

The funding will support a new research project to compare the effectiveness of brief interventions in the primary care setting to reduce alcohol and other substance use in adolescents. This five-year project, commencing in March 2024, is being led by co-principal investigators Zachary Adams, PhD , and Tamika Zapolski, PhD, MS , both associate professors of psychiatry at the IU School of Medicine.

“Alcohol is the most-used substance among adolescents and can lead to several negative outcomes if it isn’t identified and addressed early,” Adams said. “This funding will allow us to find the most effective and efficient treatment plan to get adolescents the help they need before it becomes a larger issue.”

More than 90% of U.S. adolescents receive care in primary care clinics, and primary care providers are among the most familiar and accessible health care professionals in both local and national communities.

IU Health and Riley Children’s Health, in partnership with the State of Indiana, are currently supporting the Pediatric Integrated Behavioral Health Initiative, led by IU School of Medicine’s Leslie Hulvershorn, MD , and Matthew Aalsma, PhD, MA , and managed by Practice Administrator Cara Jones. The initiative aims to add more behavioral health support into IU Health primary care settings, which will increase access to high-quality behavioral health care to Indiana pediatric patients. These practices will serve as the study sites for the PCORI study.

The project will study the efficacy of brief interventions with varying types of caregiver involvement and support. All enrolled adolescents will be offered “Teen Intervene,” a brief intervention that includes motivational interviewing, education, personalized feedback, goal setting, and skills for avoiding alcohol and other substance use problems. Teen Intervene can be recommended to adolescents from a standardized substance use screener completed in the primary care setting.

Zapolski said caregiver involvement is key to a successful intervention process.

“Parents and other types of caregivers can play a vital role in supporting their adolescents, but the logistics of involvement can be challenging,” she said.

To address this potential hurdle, the study will compare three approaches to caregiver involvement: no caregiver involvement, a dedicated caregiver session, and a self-paced online parenting program called “Family Check-Up Online.”

The research team aims to enroll 585 adolescents aged 12-17 from diverse sociodemographic backgrounds across 18 or more primary care clinics in rural, urban, and suburban communities in Indiana. The participants will be asked to complete online surveys and brief interviews at multiple timepoints to provide valuable insights into the effectiveness of interventions over time on outcomes including alcohol and other substance use frequency and amount, mental health, service utilization, and overall wellbeing.

To ensure the project's relevance and success, the research team will collaborate closely with a patient and provider advisory board comprising community stakeholders, youth, caregivers, and primary care clinicians. A stakeholder advisory panel of national and state-level leaders in adolescent healthcare will also provide guidance from start to finish.

“Findings from this study can be disseminated and implemented quickly in other primary care settings, helping to reduce adolescent alcohol and other substance use problems nationally,” Zapolski said.

“This study was selected for PCORI funding for its potential to answer the need for real-world evidence to enable optimal use of brief interventions to reduce and prevent alcohol use among adolescents,” said PCORI Executive Director Nakela L. Cook, MD, MPH. “We look forward to following the study’s progress and working with IU School of Medicine to share the results.”

The IU School of Medicine's commitment to the wellbeing of youth takes a significant stride forward with this innovative and comprehensive approach to addressing adolescent substance use disorders.

“These interventions could help redefine the way pediatricians and other primary care providers prevent adolescent alcohol and other substance use in Indiana and across the country,” Adams said.

Other IU investigators involved in the project include IU School of Medicine’s Brigid Marriott, PhD , and Wei Wu, PhD , and the IU School of Public Health-Bloomington’s Jon Agley, PhD, MPH .

About IU School of Medicine

The IU School of Medicine  is the largest medical school in the U.S. and is annually ranked among the top medical schools in the nation by U.S. News & World Report. The school offers high-quality medical education, access to leading medical research and rich campus life in nine Indiana cities, including rural and urban locations consistently recognized for livability. According to the Blue Ridge Institute for Medical Research, the IU School of Medicine ranks No. 13 in 2023 National Institutes of Health funding among all public medical schools in the country.

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• Open access
• Published: 19 April 2024

Brief interventions 2.0: a new agenda for alcohol policy, practice and research

• Duncan Stewart   ORCID: orcid.org/0000-0001-7355-4280 1 ,
• Mary Madden 2 &
• Jim McCambridge 2  

Globalization and Health volume  20 , Article number:  34 ( 2024 ) Cite this article

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Alcohol problems are increasing across the world and becoming more complex. Limitations to international evidence and practice mean that the screening and brief intervention paradigm forged in the 1980s is no longer fit for the purpose of informing how conversations about alcohol should take place in healthcare and other services. A new paradigm for brief interventions has been called for.

Brief interventions 2.0

We must start with a re-appraisal of the roles of alcohol in society now and the damage it does to individual and population health. Industry marketing and older unresolved ideas about alcohol continue to impede honest and thoughtful conversations and perpetuate stigma, stereotypes, and outright fictions. This makes it harder to think about and talk about how alcohol affects health, well-being, and other aspects of life, and how we as a society should respond. To progress, brief interventions should not be restricted only to the self-regulation of one’s own drinking. Content can be orientated to the properties of the drug itself and the overlooked problems it causes, the policy issues and the politics of a powerful globalised industry. This entails challenging and reframing stigmatising notions of alcohol problems, and incorporating wider alcohol policy measures and issues that are relevant to how people think about their own and others' drinking. We draw on recent empirical work to examine the implications of this agenda for practitioners and for changing the public conversation on alcohol.

Against a backdrop of continued financial pressures on health service delivery, this analysis provokes debate and invites new thinking on alcohol. We suggest that the case for advancing brief interventions version 2.0 is both compelling and urgent.

In an era of restrictions on health budgets and ageing populations, alcohol problems are increasing across the world [ 1 ], generating new treatment demand and need for interventions. This is particularly so in low- and middle-income countries (LMICs) where alcohol markets are expanding and harm per litre consumed is greatest [ 2 ], whilst within high income countries, alcohol makes health inequalities worse [ 3 ]. Substantial mental health comorbidities are increasingly the norm in treatment systems [ 4 ], and physical health comorbidities are becoming more visible in older populations [ 5 ].

The obvious response to this situation is to make a better case to win more resources, resist cuts and defend what exists. We suggest, however, that this is not enough, and that new thinking is now needed. Health systems struggle to embrace prevention across the board [ 6 ]. “Brief interventions” originated in the public health understanding of alcohol. The nature of the challenge has changed in fundamental ways in recent decades, and their limitations are better understood. This makes timely a re-appraisal, reconnecting to contemporary public health ideas and evidence.

We propose that we should now reimagine the contents and aims of brief interventions, and how they might act in synergy with other efforts to address the avoidable damage done by alcohol.

The brief intervention concept

A little under half a century ago, the rise of the new public health movement made health promotion and disease prevention central to improving population health. Alcohol was highly relevant to this development. The World Health Organisation brought together alcohol researchers in a major programme that developed the AUDIT screening tool [ 7 ] and undertook a randomised trial that demonstrated that it was possible to have conversations with people in primary care that led them to reduce drinking [ 8 ]. This represented a new way of responding to alcohol problems; avoiding waiting until treatment for well-established problems was sought.

Many of the key research questions identified in a “golden age” of research advances in the late 1980s and early 1990s remain unanswered today [ 9 ]. There were theoretical weaknesses in the advice and counselling interventions developed and practitioners did not implement them in routine practice [ 10 ]. Much of the available evidence is from high-income countries, with relatively few trials conducted in LMICs [ 11 ]. Conflicting findings and the limitations of the large body of international literature have received too little attention [ 12 ]. It is perhaps most appropriately interpreted as demonstrating efficacy; recent large trials in naturalistic conditions demonstrate that confident claims of effectiveness are misplaced [ 12 ]. As a result, programmes may attain reach, which is itself challenging, but cannot be expected alone to deliver health impacts in populations where they are implemented [ 13 ]. The digital alcohol intervention literature has evolved in similar ways, with much promise in early studies, but with near exclusive reliance on self-reported outcomes not routinely included within risk of bias assessments, large trials with different findings than smaller trials, and substantial unexplained heterogeneity in meta-analyses [ 10 ].

Over the last 10 years a consensus has taken hold in the field that a change in direction is needed; a chronic disease paradigm is one possibility [ 14 , 15 ], and more extensive development of digital interventions another [ 16 ]. Our thinking centres on the unhelpful dislocation of brief interventions from wider alcohol policy measures everywhere. We note the very different contexts for the audience for this paper. These include readers in LMICs where there are no brief intervention programmes or alcohol policy measures. And also, readers in high income countries where such programmes provide important care services (such as screening, brief intervention and referral to treatment (SBIRT) in the U.S.) with or without otherwise well-developed alcohol policies.

The alcohol challenge for health systems

Adults, and children, are exposed to alcohol marketing in competition with relatively impotent health promotion messages [ 17 ]. Norms are shaped early in life, and drinking and heavy drinking is normalized in many countries. With the aid of new technologies, marketing is getting ever more sophisticated [ 18 ]. The environment is also one in which the persistence of stereotypical ideas of the so called ‘alcoholic’ and stigmatized images of alcohol problems obstruct broader thinking about the nature and impacts of alcohol harms [ 19 ]. Public understanding has not been informed by the developing science: there remains no consensus in the research community on what is an alcohol problem [ 20 ].

Locating an alcohol problem within the individual, consonant with neoliberal ideas that people are responsible for everything in their own lives, invisibilises government and business roles and responsibilities in causing alcohol problems [ 21 ]. Large corporations typically make a potentially dangerous drug widely available, encourage people to use it, shape government policy to place few restrictions on its use, and then blame those who end up having problems with it [ 22 ]. The ethical issues here warrant attention, especially as problems for drinkers cause families and communities to have alcohol problems too [ 23 ].

The structure of the alcohol industry increasingly resembles tobacco, especially in beer and spirits [ 24 ]. The largest companies are now highly profitable and operate globally, whereas only 30 years ago they were national operators. They are connected to tobacco companies in various ways [ 22 , 25 ] and use the same approaches; selling themselves as part of the solution not part of the problem, with the resources needed to do that effectively [ 26 ]. Alcohol policy interference is unrestricted, whereas tobacco has been curbed [ 27 ].

The power of alcohol industry marketing needs to be restricted if we are to help people to manage their alcohol consumption in ways which limit damage to health and well-being. Brief interventions have sought to help people avoid or manage problems with alcohol, but that is harder to do now in the contexts of lifetime exposure to industry and other social influences, deepening inequalities and weakened capacity or willingness to manage unhealthy commodity industries [ 28 ]. It is perhaps unsurprising that the original ambitions for brief interventions have yet to be realised convincingly when prices are low, availability easy and norms encourage more drinking [ 29 ]. To progress, we need to recognise that, for many reasons, alcohol and the problems it causes may be challenging to identify and discuss with individuals. Invidiously, this is especially so when drinking is heavier. We need to find new ways of talking about all of this.

Ways forward for brief interventions 2.0

Brief interventions are simply conversations about alcohol, so how might brief interventions 2.0 (BI 2.0) make them more powerful?

Firstly, we should not continue to think of brief interventions as only to do with self-regulation of one’s own consumption, in isolation from personal health and social contextual factors. This means re-orientating brief interventions to the damage done, directly and indirectly, by a toxic and carcinogenic drug and the enormous burden it places on health services and society. There is no entirely safe dose [ 30 , 31 ] and people with existing health problems are particularly vulnerable to additional harms from interference with the effects of medications designed to benefit health, including on adherence [ 5 ]. These impacts should be integral to routine discussions about treatments, conditions and wider well-being, rather than the current practice of regarding alcohol as a separate, “lifestyle” issue. Such constructs inhibit patients and practitioners in approaching alcohol and its harms meaningfully.

Brief intervention content has also failed to keep pace with and take account of contemporary evidence on the wider determinants of health [ 32 , 33 , 34 ], the continued challenges they present for policy and practice [ 35 ], and the particular vulnerability of the most disadvantaged to alcohol harms [ 36 ]. Stigmatising attitudes, cultural norms, price, availability, and industry marketing are important influences on drinking behaviour [ 37 ], so we need brief interventions to address these issues too. Having a wider content repertoire may help people to think differently about the place of alcohol in their lives, and in wider society. This may be particularly apposite where there is media attention or concurrent policy debates and developments; brief intervention programmes could be designed to incorporate attention to them. In the absence of policy innovations, in all countries where alcohol consumption is widespread, there is mass media content on alcohol; alcohol harm hides in plain sight. Such influences should not only be more fully recognised as the context in which conversations about one’s own drinking takes place but can also be a part of that conversation. We should be talking about whatever is interesting about alcohol to the people we have the time and opportunity to talk with.

A further proposition follows on from this. Where new policy measures are being considered, adopted, or implemented, or where there are public health campaigns, brief intervention programmes could form a key part of more integrated comprehensive alcohol strategies. Innovative resources, in diverse media, can be produced that support conversations taking place that reinforce the effects of other interventions. Such materials may be designed to prompt thinking, enhance readiness and willingness to discuss alcohol, with health and other services being able to take further the implications for the needs they serve. Adjusting programme aims in this way may seem obvious, and is very much in line with the original aspirations for brief interventions as instruments of public health improvement, so it is disappointing that possible synergies of this kind have been so little studied. Opportunities for so doing should be grasped when they arise.

Progressing BI 2.0 is contingent on overcoming the prevalent idea that labelling people as ‘alcoholics’ or ‘problem drinkers’ provides the most helpful way of thinking about this subject [ 38 ]. It does not. In fact, it gets in the way [ 39 ]. People can have many problems, and the more one drinks the more likely it is that alcohol will complicate things, often in ways that are difficult to appreciate [ 40 ]. Perhaps, focusing on what may seem the less serious initially may help problem recognition, such as having a hangover, missing a day’s work, or an “accident”. There is something to consider in these examples that it might be helpful to discuss rather than disregard.

At the population-level, it is for all of us and our policy makers to consider how far and in which ways we have an alcohol problem [ 41 ]. This does not mean denying that alcohol also brings pleasure and other benefits. Decision-making around use of this drug needs to be more rational, because currently it is too pressured by pro-consumption influence and relics of past ways of thinking. Ultimately, development of BI 2.0 requires a candid public conversation about how alcohol and alcohol problems interfere with the lives that people want to live.

Putting BI 2.0 ideas into practice

In busy and over-burdened health services, it may at first seem far-fetched to expect that BI 2.0 will appeal to practitioners or their managers, especially so if presented as a new or additional task. A better approach is to present it as a way of responding to what patients already bring with them. We have been working with clinical pharmacists in primary care to help them briefly explore whether there are any alcohol connections to why patients are presenting or have been asked to attend [ 42 ]. To be a conscientious professional, many health care practitioners need to be able to discuss alcohol for medication safety, adherence, and effectiveness reasons, as well as the implications of alcohol for many conditions. Seeing alcohol as a drug makes it not just legitimate but important to raise and integrate clinically into consultations for both professionals and patients [ 43 ]. Most importantly for the patient, alcohol is discussed in the context of their health and what matters to them, using their own language and terminology, where the relevance is clear.

If people make connections between alcohol, medicines regimes, other daily activities and their health, then this invites broader social contexts into discussions. Too often, conversations in health and care settings about alcohol are too brief, too crude, heavily moralised, paternalistic and all too easy to ignore, when they are not avoided altogether [ 43 , 44 ]. Confident, skilled practitioners can offer support that helps people make their own decisions about alcohol use, navigating the cultural influences that make talking about alcohol more challenging than it needs to be. For professionals as well as patients. Much existing information and other tools for discussion look dry and dull, especially in comparison to industry investment in engaging marketing materials. So too our digital resources. We need content that is appealing, lively, and engaging to capture and keep hold of attention. We should design material that people will want to share with others in their social networks. Intimacy also matters; content that resonates personally is to be prized because that is tapping into what’s important to the person.

For all these reasons, and more, these conversations need to be skilfully handled or the deleterious effects of alcogenic cultural baggage will continue to hinder us. That is why we think that working with practitioners and opening up practice development issues is a promising place to move forward with BI 2.0 (Table  1 ).

Conclusions

There is global recognition that tackling alcohol harms requires a multifaceted approach, incorporating restrictions on availability, advertising, and pricing policies as well as facilitating access to brief interventions [ 34 , 45 ]. We have presented ideas for progressing BI 2.0, which orientates intervention content and aims to these other elements and the larger contexts, and puts prevention at the heart of policy and practice. This requires a system-wide approach that avoids the pitfalls of focusing on stereotyped notions of problem drinking, highlights the need to strengthen the wider public conversation on alcohol and promotes synergies with developing alcohol policies. Our intention is to provoke discussion, debate, study and action, and we suggest this must proceed with urgency.

Availability of data and materials

Not applicable.

Abbreviations

• Brief interventions

Low- and middle-income countries

Screening, brief intervention and referral to treatment

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Acknowledgements

This research was funded by the National Institute for Health Research [NIHR] Programme Grants for Applied Research (reference: RP-PG-0216–20002). The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. No funding bodies had any role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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Stewart, D., Madden, M. & McCambridge, J. Brief interventions 2.0: a new agenda for alcohol policy, practice and research. Global Health 20 , 34 (2024). https://doi.org/10.1186/s12992-024-01031-1

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10 facts about Americans and alcohol as ‘Dry January’ begins

As Americans hang fresh calendars and debut New Year’s resolutions, some will swear off alcohol, whether as part of a “Dry January” challenge or a longer-term goal . Here are 10 key facts about Americans’ behaviors and attitudes when it comes to drinking alcohol and how these have changed over time, drawn from surveys and sales data.

Pew Research Center conducted this analysis to understand Americans’ experiences with alcohol and how they have changed over time. Survey data comes from Gallup and the University of Michigan’s Monitoring the Future Survey . Data on Americans’ drinking habits comes from the National Institute on Alcoholism and Alcohol Abuse (NIAAA) , and alcohol sales data is from the U.S. Census Bureau’s monthly retail sales survey .

Overall, 62% of U.S. adults say they ever drink alcohol, while 38% abstain completely, according to a July 2023 Gallup survey . Gallup has asked Americans for more than eight decades whether they have “had occasion to use alcoholic beverages such as liquor, wine or beer.” During that span, majorities have consistently said they consume alcohol. This share peaked in the late 1970s, when 71% of adults said they drank alcohol.

Adults ages 35 to 54, those with a college degree, those with household incomes of $100,000 or more, and those who attend church less than once a week are all more likely than other Americans to drink alcohol.

Most adults who consume alcohol have done so recently, according to the July Gallup survey. Among adults who drink, 69% say they last had a drink within the past week. This includes 32% whose most recent drink was in the last 24 hours, and 37% who most recently had one within the last two to seven days. Another 32% say they last consumed alcohol more than a week ago. 

About one-in-five adults who drink alcohol (19%) say they sometimes drink more than they think they should, the Gallup survey shows. Some demographic groups are more likely than others to say this:

• Men: Men are more likely than women to say they sometimes overindulge (21% vs. 16%).
• Younger adults: About two-in-ten adults younger than 35 (22%) and ages 35 to 54 (20%) say this, compared with 14% of those 55 and older.
• Upper-income adults: 24% of adults with annual household incomes of at least $100,000 say they occasionally drink too much, compared with 10% of those with household incomes of less than $40,000.

Among adults who don’t drink, the most common reason given is that they just don’t want to, the Gallup survey found. About a quarter of nondrinkers (24%) say in an open-ended question that they have no desire to drink or do not want to.

Other common answers include that they do not like drinking (16%); it is unhealthy (14%); they are afraid of the consequences (13%); and they had a bad past experience with alcohol (13%).

On average, Americans have been consuming more alcohol in recent years, according to the National Institute on Alcohol Abuse and Alcoholism (NIAAA) , which has data going back to 1970. In 2021, the most recent year with data, the average American age 21 or older consumed 2.83 gallons of pure alcohol – the equivalent of about 603 “standard drinks.” (A standard drink, per the NIAAA , contains 0.6 ounces of alcohol.)

Per-capita alcohol consumption peaked in the early 1980s at 3.28 gallons, or almost 700 drinks. It bottomed out in the late 1990s at 2.45 gallons per person, or about 523 drinks.

Americans drink less beer and more wine than they used to, according to the NIAAA. Since 1970, the peak year for beer consumption was 1981, when the typical American age 21 or older drank 36.7 gallons. By 2021, beer consumption had fallen to 26.5 gallons per person. Over those four decades, the amount of wine the average American drank annually rose from 3.2 gallons to 3.8 gallons. Meanwhile, consumption of distilled spirits dropped slightly, from 3.0 to 2.8 gallons. Looked at another way, 17.4% of all alcohol consumed by Americans in 2021 came from wine, up from 12.0% in 1971. The share coming from beer fell from 44.6% to 42.3% during the same period, while the share coming from spirits fell from 43.5% to 40.3%.

Per-capita alcohol consumption appears to be highest in the West and lowest in the South, based on the NIAAA data. On the state level, it appears to be highest in New Hampshire and Delaware, and lowest in Utah. However, state-level consumption estimates can be affected by such factors as sales to people from neighboring states (especially when there are significant differences in alcohol tax rates) and alcohol consumption by tourists (think Nevada, Florida, and Washington, D.C.).

Young adults today are less likely to drink than young adults two decades ago – but older adults are more likely to do so, according to Gallup . The share of adults ages 18 to 34 who say they  ever drink dropped from 72% in 2001-03 to 62% in 2021-23. (Gallup looked at the data in three-year time periods to allow for reliable age-group analysis.)

Young adults who drink, meanwhile, are less likely than those two decades ago to have had a drink recently : 61% say they had a drink in the week before the survey, compared with 67% in the early 2000s. And the share who say they sometimes drink more than they think they should has declined from 28% in the early 2000s to 22% now.

Americans 55 and older, on the other hand, are more likely than their counterparts two decades ago to say they do all of these things. Among those ages 35 to 54, the shares who do these things have remained relatively stable over time.

Underage drinking among U.S. teens has declined over the last 20 years, according to the University of Michigan’s Monitoring the Future survey . In 2023, 46% of 12th graders said they had consumed alcohol in the 12 months prior to the survey, as did 31% of 10th graders and 15% of eighth graders. These shares are down from 2001, when 73% of 12th graders, 64% of 10th graders and 42% of eighth graders said they had drunk alcohol in the previous year.

Across all three grade levels, the shares who said they had drunk alcohol in the 30 days prior to the survey and who reported binge drinking – having five or more drinks in a row during the last two weeks – also declined between 2001 and 2023.

Annual sales at beer, wine and liquor stores have been on the rise, typically peaking each year in December. Even after adjusting for inflation, sales at beer, wine and liquor stores rose gradually throughout the 2000s and 2010s, until spiking in the early months of the COVID-19 pandemic . Since midsummer 2020, sales volume has gradually fallen, though it remains above pre-pandemic levels. (Not all alcoholic beverages are bought at beer, wine and liquor stores, but these figures provide insight into broader trends.)

In a typical year, sales are highest in December. In 2022, according to the U.S. Census Bureau’s monthly retail sales survey , December sales at such retailers were 37% above the average for the other 11 months of the year. Conversely, January and February are typically the slowest months for those sellers.

Among Black adults, those with higher incomes are most likely to say they are happy

New year’s resolutions: who makes them and why, about 1 in 10 restaurants in the u.s. serve mexican food, americans who have worked for tips themselves are usually more likely to leave one, tipping culture in america: public sees a changed landscape, most popular.

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• View all journals

Alcoholic liver disease articles from across Nature Portfolio

Alcoholic liver disease is liver damage that results from alcohol misuse. The least severe stage of alcoholic liver disease is alcoholic fatty liver disease, followed by alcoholic hepatitis and then alcoholic cirrhosis; some overlap exists between these stages. Symptoms generally occur only once the liver has been severely damaged.

Latest Research and Reviews

Screening for liver fibrosis: lessons from colorectal and lung cancer screening

In this Perspective, Ginès and colleagues discuss liver fibrosis screening programmes using insights from colorectal and lung cancer screening.

• Maja Thiele
• Patrick S. Kamath

Binge-pattern alcohol consumption and genetic risk as determinants of alcohol-related liver disease

Deaths from alcohol-related liver disease have sharply increased following the Covid-19 pandemic. Here, the authors show that binge-pattern alcohol consumption, genetic factors and the presence of diabetes mellitus confer the greatest risk, allowing targeted interventions for high-risk individuals.

• Chengyi Ding
• Linda Ng Fat
• Gautam Mehta

Waist-hip ratio is superior to BMI in predicting liver-related outcomes and synergizes with harmful alcohol use

Åberg et al. assess the predictive performance of obesity measures, including waist-hip ratio, waist circumference, and BMI, for liver-related outcomes in participants of Finnish health surveys. They find that the waist-hip ratio is a better predictor for liver-related outcomes than other measures and synergizes with harmful alcohol use.

• Fredrik Åberg
• Martti Färkkilä
• Ville Männistö

The intersection between alcohol-related liver disease and nonalcoholic fatty liver disease

In this Review, Arrese and colleagues discuss the intersection of nonalcoholic fatty liver disease and alcohol-related liver disease, including their pathophysiology, clinical management and suggestions for future research.

• Luis Antonio Díaz
• Juan Pablo Arab
• Marco Arrese

The Elk-3 target Abhd10 ameliorates hepatotoxic injury and fibrosis in alcoholic liver disease

Analyses of human samples and murine models of alcoholic liver disease (ALD) reveal that the Elk-3 target Abhd10 ameliorates hepatotoxic injury and fibrosis in ALD by downregulating PRDX5 S-palmitoylation.

• Tian-Zhu Li
• Chun-Ying Bai

Enhanced Ca 2+ -channeling complex formation at the ER-mitochondria interface underlies the pathogenesis of alcohol-associated liver disease

Ca2+ overload-induced mitochondrial dysfunction is considered a contributing factor alcohol-associated liver disease pathogenesis. Here the authors report that PDK4 promotes Ca2 + -channelling complex formation at the endoplasmic reticulum-mitochondria contact sites, which contributes to the pathogenesis of alcohol-associated liver disease in studies with male mouse and hepatocyte models.

• Themis Thoudam
• Dipanjan Chanda

News and Comment

Novel interventions against alcohol-related liver disease

In 2023, there were significant advancements in trials of interventions to reduce mortality and morbidity from alcohol-related liver disease, spanning the entire spectrum of disease: primary prevention to reduce overall alcohol-related harm, secondary prevention to attenuate fibrosis progression and tertiary prevention using antibiotics for severe alcohol-associated hepatitis.

• Christophe Moreno

Hepatocyte-derived biomarkers in alcohol-related cirrhosis

• Eleni Kotsiliti

Rifaximin-α for ALD: phase II results

• Jordan Hindson

Advancing alcohol-related liver disease: from novel biomarkers to refining selection for liver transplantation

In 2022, we witnessed advances in the field of alcohol-related liver disease. Key developments included the discovery of novel proteomics-based biomarkers and potential therapeutic targets that regulate the recognition of molecules derived from gut microbiota to modulate liver injury. Additionally, there have been significant advances in refining selection for liver transplantation in severe alcohol-associated hepatitis.

• Ramon Bataller

Enteric neurons and gut homeostasis

Proteomics and machine-learning models for alcohol-related liver disease biomarkers, quick links.

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Study shows people check their phones 144 times a day. Here's how to detach from your device.

*Checks phone*

The common practice can be deemed as an addiction that has captured many Americans. With a 4-to-5-inch screen many smartphone devices hold most of our daily life activities. From apps like Facebook, Instagram and TikTok to help us stay connected, to work-related apps like Slack, Google, Microsoft and Zoom that keep us tethered.

As a society we have ditched alarm clocks to wake us up or a notebook to write things down. When we get a new smartphone, those apps are already embedded within its interface. The dependence we have on a smartphone has grown exponentially over the past decade, too.

In 2023, research showed that Americans checked their phones 144 times a day.

• Nearly 90% of those respondents check their phone within the first 10 minutes of waking up.
• About 75% of the population said that they checked their phone when they're in the restroom.
• At least 60% of the people in the study admitted that they sleep with their phone at night.
• About 57% of the respondents acknowledged they were addicted to the devices, according to results from Reviews.org.

Can you relate?

If so, here are some ways you can break up with your cell phone.

Advice from an expert: Eye strain in a digital age

USA TODAY Tech columnist Kim Komando shares ways to detach from your devices

Kim Komando wrote in a column for USA TODAY that people who are attached to their smartphones need to cut the screen time in half.

Here are some of her suggestions:

Notifications

Instead of running to pick up your phone every time it pings, Komando suggests that smartphone users should put their phone on "Do Not Disturb" on weekends, vacations and holidays in order to spend time with the people you care about.

Limit your screen times for Android and iPhone users

If Do Not Disturb doesn't help, you can have your phone monitor your usage for you.

With the Screen Time function in the iPhone settings and the Digital Well-Being app in Android, smartphone users can set time limits for apps they use often to lower the amount of time spent on it per day. These features will create a lock-out function that will prohibit you from using the app until the following day.

Ahjané Forbes is a reporter on the National Trending Team at USA TODAY. Ahjané covers breaking news, car recalls, crime, health, lottery and public policy stories. Email her at  [email protected] . Follow her on  Instagram ,  Threads  and  X @forbesfineest.

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National Institute on Alcohol Abuse and Alcoholism (NIAAA)

Data science tools for alcohol research.

Elizabeth Powell, Ph.D.

September 07, 2023

The goal is to promote data science concepts and tools in alcohol research, integrating data across disciplines and clinical and basic sciences realms.

Data science has been a major focus of NIH, including the establishment of the Office for Data Science Strategy. Data science approaches have been used to make key findings in other research areas such as cancer and Parkinson’s disease research. The flood of data generated by NIAAA supported studies in genomics, imaging, electrophysiology and optogenetics, electronic health records, and personal wearable devices presents new challenges in analyses and interpretations and opportunities for discovery. Since 2019, NIAAA has required that human research data be stored in the NIAAA Data Archive ( NOT-AA-23-002  for most recent notice).

Statement of Work/Project Objectives

The large databases of biological and behavioral and imaging studies supported by NIAAA provide ample information for data science approaches. However, the investigators lack the tools to participate in the data ecosystem and take advantage of current statistical and computational approaches. The state of the data science field in alcohol research has advanced only slightly since this concept was introduced in 2018. While the scope of the data is broad, many of the tools needed to answer questions in alcohol research require specific applications, algorithms or toolkits that are not currently available. This initiative is expected to:

• Generate intellectual property, analytical tools and methods for alcohol research that interface within modern data ecosystems for use by entire scientific community.
• Promote harmonization of data sets within specific disciplines of alcohol research to improve scientific reproducibility and increase sharing of data across multiple scientific teams.
• Transform fragmented sets of individual data components into a coordinated ecosystem.
• Enable multiscale analysis of clinical and basic science datasets, employ modern data science techniques of artificial intelligence, machine learning and deep learning.
• Promote interdisciplinary collaborations between neuroscientists and data scientists.
• Adapt NIH data science tools and tactics for use in alcohol research.

Justification

The volumes of data produced by NIAAA-supported research, along with publicly available databases and future results, can be analyzed using data science approaches to find new therapeutic targets and approaches for diagnosis and treatment of alcohol use disorder. Data science includes and extends beyond bioinformatics and computational neuroscience to discover new relationships and pathways for complex systems of normal human function and during adaptations due to disorders or disease. Data science is not widespread alcohol research, and thus the field is missing opportunities for discovery and treatment.

The Final NIH Policy for Data Management and Sharing ( NOT-OD-21-013 ) requires data sharing, yet there are limited tools and resources for combining and analyzing data from alcohol research. Since the concept was introduced in 2018, NIAAA has funded two SBIR projects for new algorithms and automated data harmonization and imputation tools. These projects are currently in Phase II. Additional tools and strategies are needed to analyze data from NIAAA research, and tools are needed to make best use of the investment in the NIAAA Data Archive.

niaaa.nih.gov

An official website of the National Institutes of Health and the National Institute on Alcohol Abuse and Alcoholism