Alcohol Use In The United States

"Alcohol remains the most widely used psychoactive substance in the United States. In 2024, 134.3 million individuals age 12 and older, 46.6% of the population, reported past-month drinking, and 57.9 million adults reported binge drinking (≥5 drinks within 2 hours for males, ≥4 for females; National Institute on Alcohol Abuse and Alcoholism [NIAAA], 2025a). The overall prevalence of past-year drinking has remained relatively stable in recent years, with binge drinking showing a 1.6% decrease between 2021 and 2024 (Substance Abuse and Mental Health Services Administration [SAMHSA], 2025). Alcohol consumption, even at what is perceived as “moderate” levels, is causally linked to more than 200 health conditions (measured by three-digit ICD-10 codes), underscoring its role in preventable disease, death, and economic loss (Rehm et al., 2017). As a result of alcohol consumption, the annual number of alcohol-attributable deaths in 2020–2021 was estimated to be 178,000, making alcohol a leading preventable cause of death and accounting for 12.9% of all deaths among working-age adults (Esser et al., 2022; Slater & Alpert, 2021).

"Despite alcohol’s substantial health burden, national estimates of lifetime-attributable mortality remain limited. All-cause mortality studies (i.e., studies relating alcohol consumption levels to deaths from any cause) include deaths from many conditions that are not causally related to alcohol. Furthermore, these studies combine studies that are often nonrepresentative (e.g., underrepresent marginalized groups, are outdated, and are conducted in locations whose mortality patterns do not reflect those in the United States; Shield et al., 2025a). These challenges limit the generalizability and relevance of the studies to U.S. public health. Rather, to effectively inform prevention strategies and drinking guidelines, it is important to estimate alcohol-attributable mortality using a cause-specific approach that includes conditions that have evidence of being causally related to alcohol use (including both harmful and protective risk estimates), as we do in the present study. The cumulative net risk from alcohol in a population can then be estimated by combining risk functions for all conditions causally related to alcohol consumption, weighting each risk function by its contribution to mortality in the population being studied."