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Even a Little Alcohol Can Harm Your Health

Recent research makes it clear that any amount of drinking can be detrimental. Here’s why you may want to cut down on your consumption beyond Dry January.

An illustration of a collection of alcohol bottles and drinks in a coupe glass, a high ball glass and a martini glass. The background is black and the bottles and glasses appear to be melting and slightly blurred, with streaks of burgundy and warm yellow and orange tones streaming into a puddle in the foreground.

By Dana G. Smith

Sorry to be a buzz-kill, but that nightly glass or two of wine is not improving your health.

After decades of confusing and sometimes contradictory research (too much alcohol is bad for you but a little bit is good; some types of alcohol are better for you than others; just kidding, it’s all bad), the picture is becoming clearer: Even small amounts of alcohol can have health consequences.

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, poisonings and homicides. But the majority were caused by chronic conditions attributed to alcohol, such as liver disease, cancer and heart disease.

When experts talk about the dire health consequences linked to excessive alcohol use, people often assume that it’s directed at individuals who have an alcohol use disorder. But the health risks from drinking can come from moderate consumption as well.

“Risk starts to go up well below levels where people would think, ‘Oh, that person has an alcohol problem,’” said Dr. Tim Naimi, director of the University of Victoria’s Canadian Institute for Substance Use Research. “Alcohol is harmful to the health starting at very low levels.”

If you’re wondering whether you should cut back on your drinking, here’s what to know about when and how alcohol impacts your health.

How do I know if I’m drinking too much?

“Excessive alcohol use” technically means anything above the U.S. Dietary Guidelines ’ recommended daily limits. That’s more than two drinks a day for men and more than one drink a day for women.

There is also emerging evidence “that there are risks even within these levels, especially for certain types of cancer and some forms of cardiovascular disease,” said Marissa Esser, who leads the alcohol program at the Centers for Disease Control and Prevention.

The recommended daily limits are not meant to be averaged over a week, either. In other words, if you abstain Monday through Thursday and have two or three drinks a night on the weekend, those weekend drinks count as excessive consumption. It’s both the cumulative drinks over time and the amount of alcohol in your system on any one occasion that can cause damage.

Why is alcohol so harmful?

Scientists think that the main way alcohol causes health problems is by damaging DNA. When you drink alcohol, your body metabolizes it into acetaldehyde, a chemical that is toxic to cells. Acetaldehyde both “damages your DNA and prevents your body from repairing the damage,” Dr. Esser explained. “Once your DNA is damaged, then a cell can grow out of control and create a cancer tumor.”

Alcohol also creates oxidative stress, another form of DNA damage that can be particularly harmful to the cells that line blood vessels. Oxidative stress can lead to stiffened arteries, resulting in higher blood pressure and coronary artery disease.

“It fundamentally affects DNA, and that’s why it affects so many organ systems,” Dr. Naimi said. Over the course of a lifetime, chronic consumption “damages tissues over time.”

Isn’t alcohol supposed to be good for your heart?

Alcohol’s effect on the heart is confusing because some studies have claimed that small amounts of alcohol, particularly red wine, can be beneficial. Past research suggested that alcohol raises HDL, the “good” cholesterol, and that resveratrol, an antioxidant found in grapes (and red wine), has heart-protective properties.

However, said Mariann Piano, a professor of nursing at Vanderbilt University, “There’s been a lot of recent evidence that has really challenged the notion of any kind of what we call a cardio-protective or healthy effect of alcohol.”

The idea that a low dose of alcohol was heart healthy likely arose from the fact that people who drink small amounts tend to have other healthy habits, such as exercising, eating plenty of fruits and vegetables and not smoking. In observational studies, the heart benefits of those behaviors might have been erroneously attributed to alcohol, Dr. Piano said.

More 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 dramatically for people who drink excessively. The good news is that when people stop drinking or just cut back, their blood pressure goes down . Alcohol is also linked to an abnormal heart rhythm, known as atrial fibrillation , which raises the risk of blood clots and stroke.

What types of cancer does alcohol increase the risk for?

Almost everyone knows about the link between cigarette smoking and cancer, but few people realize that alcohol is also a potent carcinogen. According to research by the American Cancer Society, alcohol contributes to more than 75,000 cases of cancer per year and nearly 19,000 cancer deaths.

Alcohol is known to be a direct cause of seven different cancers : head and neck cancers (oral cavity, pharynx and larynx), esophageal cancer, liver cancer, breast cancer and colorectal cancer. Research suggests there may be a link between alcohol and other cancers as well, including prostate and pancreatic cancer, although the evidence is less clear-cut.

For some cancers, such as liver and colorectal, the risk starts only when people drink excessively. But for breast and esophageal cancer, the risk increases, albeit slightly, with any alcohol consumption. The risks go up the more a person drinks.

“If somebody drinks less, they are at a lower risk compared to that person who is a heavy drinker,” said Dr. Farhad Islami, a senior scientific director at the American Cancer Society. “Even two drinks per day, one drink per day, may be associated with a small risk of cancer compared to non-drinkers.”

Which condition poses the greatest risk?

The most common individual cause of alcohol-related death in the United States is alcoholic liver disease, killing about 22,000 people a year . While the risk rises as people age and alcohol exposure accumulates, more than 5,000 Americans in their 20s, 30s and 40s die from alcoholic liver disease annually.

Alcoholic liver disease has three stages: alcoholic fatty liver, when fat accumulates in the organ; alcoholic hepatitis, when inflammation starts to occur; and alcoholic cirrhosis, or scarring of the tissue. The first two stages are reversible if you stop drinking entirely; the third stage is not.

Symptoms of alcoholic liver disease include nausea, vomiting, abdominal pain and jaundice — a yellow tinge to the eyes or skin. However, symptoms rarely emerge until the liver has been severely damaged.

The risk of developing alcoholic liver disease is greatest in heavy drinkers, but one report stated that five years of drinking just two alcoholic beverages a day can damage the liver. Ninety percent of people who have four drinks a day show signs of alcoholic fatty liver.

How do I gauge my personal risk for alcohol-related health issues?

Not everyone who drinks will develop these conditions. Lifestyle factors such as diet, exercise and smoking all combine to raise or lower your risk. Also, some of these conditions, such as esophageal cancer, are pretty rare, so increasing your risk slightly won’t have a huge impact.

“Every risk factor matters,” Dr. Esser said. “We know in public health that the number of risk factors that one has would go together into an increased risk for a condition.”

A pre-existing condition could also interact with alcohol to affect your health. For example, “people who have hypertension probably should not drink or definitely drink at very, very low levels ,” Dr. Piano said.

Genes play a role, too. For instance, two genetic variants, both of which are more common in people of Asian descent, affect how alcohol and acetaldehyde are metabolized. One gene variant causes alcohol to break down into acetaldehyde faster, flooding the body with the toxin. The other variant slows down acetaldehyde metabolism, meaning the chemical hangs around in the body longer, prolonging the damage.

So should I cut back — or stop drinking altogether?

You don’t need to go cold turkey to help your health. Even reducing a little bit can be beneficial, especially if you currently drink over the recommended limits. The risk “really accelerates once you’re over a couple of drinks a day,” Dr. Naimi said. “So people who are drinking five or six drinks a day, if they can cut back to three or four, they’re going to do themselves a lot of good.”

Light daily drinkers would likely benefit by cutting back a bit, too. Try going a few nights without alcohol: “If you feel better, your body is trying to tell you something,” said George Koob, director of the National Institute on Alcohol Abuse and Alcoholism.

Notably, none of the experts we spoke to called for abstaining completely, unless you have an alcohol use disorder or are pregnant. “I’m not going to advocate that people completely stop drinking,” Dr. Koob said. “We did prohibition, it didn’t work.”

Generally, though, their advice is, “Drink less, live longer,” Dr. Naimi said. “That’s basically what it boils down to.”

A More Mindful Approach to Drinking

If you consume alcohol, but are looking for a healthier approach to drinking, here are some tips..

  Consider the Dangers : Heart disease risk increases along with   our  alcohol consumption . Drinking can also lead to cancer and liver and kidney disease.

  ‘Go Dry’ for a Month: If you tend to overindulge, one month off from drinking can be an opportunity to examine your alcohol use .

 Cut Back:  You don’t need to abstain to rein in your alcohol consumption. Here are some tips to develop healthier drinking habits.

 Try Meditation: Mindfulness and strategies from cognitive behavioral therapy can also help you be more intentional about your relationship to drinking .

 Enjoy Your Drink: Learn to savor that glass of wine the way a connoisseur would — it starts with a shift in perspective  and a few best practices .

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Alcohol Consumption

Who consumes the most alcohol? How has consumption changed over time? And what are the health impacts?

By Hannah Ritchie and Max Roser

This article was first published in April 2018. It was revised in January 2024.

Alcohol has historically, and continues to, hold an important role in social engagement and bonding for many. Social drinking or moderate alcohol consumption for many is pleasurable.

However, alcohol consumption – especially in excess – is linked to a number of negative outcomes: as a risk factor for diseases and health impacts, crime, road incidents, and, for some, alcohol dependence.

This topic page looks at the data on global patterns of alcohol consumption, patterns of drinking, beverage types, the prevalence of alcoholism, and consequences, including crime, mortality, and road incidents.

Related topics:

Data on other drug use can be found on our full topic page here .

Drug use disorders are often classified within the same category as mental health disorders — research and data on mental health can be found on our topic page here .

Support for alcohol dependency

At the end of this topic page, you will find additional resources and guidance if you, or someone you know, needs support in dealing with alcohol dependency.

See all interactive charts on Alcohol Consumption ↓

Alcohol consumption across the world today

This interactive map shows the annual average alcohol consumption of alcohol, expressed per person aged 15 years or older. To account for the differences in alcohol content of different alcoholic drinks (e.g., beer, wine, spirits), this is reported in liters of pure alcohol per year.

To make this average more understandable, we can express it in bottles of wine. Wine contains around 12% pure alcohol per volume 1 so that one liter of wine contains 0.12 liters of pure alcohol. So, a value of 6 liters of pure alcohol per person per year is equivalent to 50 bottles of wine per year.

As the map shows, the average per capita alcohol consumption varies widely globally.

We see large geographical differences: Alcohol consumption across North Africa and the Middle East is particularly low — in many countries, close to zero. At the upper end of the scale, alcohol intake across Europe is higher.

Share of adults who drink alcohol

This interactive map shows the share of adults who drink alcohol. This is given as the share of adults aged 15 years and older who have drunk alcohol within the previous year.

In many countries, the majority of adults drink some alcohol. Across Europe, for example, more than two-thirds do in most countries.

Again, the prevalence of drinking across North Africa and the Middle East is notably lower than elsewhere. Typically, 5 to 10 percent of adults across these regions drank in the preceding year, and in a number of countries, this was below 5 percent.

Alcohol consumption by sex

When we look at gender differences, we see that in all countries, men are more likely to drink than women.

Data on the share who drink alcohol by gender and age group in the UK is available here .

Heavy drinking sessions

Alcohol consumption – whilst a risk factor for a number of health outcomes – typically has the greatest negative impacts when consumed within heavy sessions.

This pattern of drinking is often termed 'binging,' where individuals consume large amounts of alcohol within a single session versus small quantities more frequently.

Heavy episodic drinking is defined as the proportion of adult drinkers who have had at least 60 grams or more of pure alcohol on at least one occasion in the past 30 days. An intake of 60 grams of pure alcohol is approximately equal to 6 standard alcoholic drinks .

The map shows heavy drinkers – those who had an episode of heavy drinking in the previous 30 days – as a share of total drinkers (i.e., those who have drunk less than one alcoholic drink in the last 12 months are excluded).

The comparison of this map with the previous maps makes clear that heavy drinking is not necessarily most common in the same countries where alcohol consumption is most common.

Data on the prevalence of binge drinking by age and gender in the UK can be found here , and trends in heavy and binge drinking in the USA can be found here .

Share of adults who don't drink alcohol

Global trends on alcohol abstinence show a mirror image of drinking prevalence data. This is shown in the charts as the share of adults who had not drunk in the prior year and those who have never drunk alcohol.

Here, we see particularly high levels of alcohol abstinence across North Africa and the Middle East. In most countries in this region, the majority of adults have never drunk alcohol.

Data on the share who don't drink alcohol by gender and age group in the UK is available here .

Historical perspective on alcohol consumption

Total alcohol consumption over the long-run.

The chart shows alcohol consumption since 1890 in a number of countries.

A century ago, some countries had much higher levels of alcohol consumption. In France in the 1920s, the average was 22.1 liters of pure alcohol per person per year. This equals 184 one-liter wine bottles per person per year. 2 Note that in contrast to the modern statistics that are expressed in alcohol consumption per person older than 15 years, this includes children as well – the average alcohol consumption per adult was, therefore, even higher.

Alcohol consumption by type of alcoholic beverage

This chart shows the change in consumption of alcoholic beverages.

By default, the data for France is shown – in recent decades, here, the share of beer consumption increased to make up around a fifth of alcohol consumption in France.

With the change country feature, it is possible to view the same data for other countries. Sweden, for example, increased the share of wine consumption and, therefore, reduced the share of spirits.

Alcohol consumption in the United States since 1850

Long-run data on alcohol consumption from the United States gives us one perspective of drinking since 1850. In the chart, we see the average consumption (in liters of ethanol) of different beverage types per person in the USA since the mid-nineteenth century.

Over this long time period, we see that per capita drinking quantities have been relatively constant — typically averaging around 8 to 9 liters per year. Over the period 1920-1933, there was a ban on the production, importation, transportation, and sale of alcoholic beverages in the United States (known as the 'National Alcohol Prohibition'). Since the statistics here reflect reported sales and consumption statistics, they assume zero consumption of alcohol over this time. However, there is evidence that alcohol consumption continued through the black market and illegal sales, particularly in the sales of spirits. It's estimated that at the beginning of Prohibition, alcohol consumption decreased to approximately 30 percent of pre-prohibition levels but slowly increased to 60-70 percent by the end of the period. 3

As we see, following prohibition, levels of alcohol consumption returned to similar levels as in the pre-prohibition period.

Global beer consumption

The charts show global consumption of beer, first in terms of beer as a share of total alcohol consumption, and then the estimated average consumption per person.

Both are measured in terms of pure alcohol/ethanol intake rather than the total quantity of the beverage. Beer contains around 5% of pure alcohol per volume 1 so that one liter of beer contains 0.05 liters of pure alcohol. This means that 5 liters of pure alcohol equals 100 liters of beer.

Global wine consumption

The charts show global consumption of wine, first in terms of wine as a share of total alcohol consumption, and then the estimated average consumption per person.

Both are measured in terms of pure alcohol/ethanol intake rather than the total quantity of the beverage. Wine contains around 12% pure alcohol per volume, so that one liter of wine contains 0.12 liters of pure alcohol.

Global consumption of spirits

The charts show global consumption of spirits, which are distilled alcoholic drinks, including gin, rum, whisky, tequila, and vodka.

The first map shows this in terms of spirits as a share of total alcohol consumption. In many Asian countries, spirits account for most of total alcohol consumption.

The second map shows the estimated average consumption per person.

Both are measured in terms of pure alcohol/ethanol intake rather than the total quantity of the beverage.

Expenditures on alcohol and alcohol consumption by income

Alcohol consumption vs. income.

Does alcohol consumption increase as countries get richer?

In the chart, we see the relationship between average per capita alcohol consumption – in liters of pure alcohol per year – versus gross domestic product (GDP) per capita across countries.

When we look at national averages in this way, there is no distinct relationship between income and alcohol consumption. As shown by clusters of countries (for example, Middle Eastern countries with low alcohol intake but high GDP per capita), we tend to see strong cultural patterns that tend to alter the standard income-consumption relationship we may expect.

However, when we look at consumption data within given countries, we sometimes do see a clear income correlation. Taking 2016 data in the UK as an example, we see that people within higher income brackets tend to drink more frequently. This correlation is also likely to be influenced by other lifestyle determinants and habits; the UK ONS also reports that when grouped by education status, those with a university tend to drink more in total and more frequently than those of lower education status. There are also differences when grouped by profession: individuals in managerial or professional positions tend to drink more frequently than those in intermediate or manual labor roles. 4

We also find correlates in drinking  patterns when we look at groupings of income, education or work status. Although those in lower income or educational status groups often drink less overall, they are more likely to have lower-frequency, higher-intensity drinking patterns. Overall, these groups drink less, but a higher percentage will drink heavily when they do.

Alcohol expenditure

This interactive chart shows the average share of household expenditure that is spent on alcohol.

Data on alcohol expenditure is typically limited to North America, Europe, and Oceania.

Alcohol expenditure over the long-term

This shows the expenditure on alcohol in the United States, differentiated by where the alcohol has been purchased and consumed.

The health impact of alcohol

Alcohol is responsible for many premature deaths each year.

Alcohol is one of the world's largest risk factors for premature death.

The Institute for Health Metrics and Evaluation (IHME), in its Global Burden of Disease study, provides estimates of the number of deaths attributed to the range of risk factors. 5 In the visualization, we see the number of deaths per year attributed to each risk factor. This chart is shown for the global total but can be explored for any country or region using the "Change country or region" toggle.

Alcohol as a risk factor for mortality

Alcohol consumption is a known risk factor for a number of health conditions, and potential mortality cases. Alcohol consumption has a causal impact on more than 200 health conditions (diseases and injuries).

In the chart, we see estimates of the alcohol-attributable fraction (AAF), which is the proportion of deaths that are caused or exacerbated by alcohol (i.e., that proportion that would disappear if alcohol consumption was removed). We see that the proportion of deaths attributed to alcohol consumption is lower in North Africa and the Middle East and much higher in Eastern Europe.

Rate of premature deaths due to alcohol

Shown here is the rate of premature deaths caused by alcohol.

Globally, the age-standardized death rate has declined from approximately 40 deaths per 100,000 people in the early 1990s to 30 deaths per 100,000 in 2019.

Alcohol-related deaths by age

The chart shows the age distribution of those dying premature deaths due to alcohol.

It is possible to switch this data to any other country or region in the world.

Alcoholism and alcohol use disorders

Alcohol use disorder  (AUD) refers to the drinking of alcohol that causes mental and physical health problems.

Alcohol use disorder, which includes alcohol dependence, is defined in the WHO's International Classification of Diseases (available here ).

At the end of this topic page , we provide a number of potential sources of support and guidance for those concerned about uncontrolled drinking or alcohol dependency.

A definite diagnosis of dependence should usually be made only if three or more of the following have been present together at some time during the previous year:

  • (a) a strong desire or sense of compulsion to take the substance;
  • (b) difficulties in controlling substance-taking behaviour in terms of its onset, termination, or levels of use;
  • (c) a physiological withdrawal state when substance use has ceased or been reduced, as evidenced by: the characteristic withdrawal syndrome for the substance; or use of the same (or a closely related) substance with the intention of relieving or avoiding withdrawal symptoms;
  • (d) evidence of tolerance, such that increased doses of the psychoactive substance are required in order to achieve effects originally produced by lower doses (clear examples of this are found in alcohol- and opiate-dependent individuals who may take daily doses sufficient to incapacitate or kill nontolerant users);
  • (e) progressive neglect of alternative pleasures or interests because of psychoactive substance use, increased amount of time necessary to obtain or take the substance or to recover from its effects;
  • (f) persisting with substance use despite clear evidence of overtly harmful consequences, such as harm to the liver through excessive drinking, depressive mood states consequent to periods of heavy substance use, or drug-related impairment of cognitive functioning; efforts should be made to determine that the user was actually, or could be expected to be, aware of the nature and extent of the harm.

Prevalence of alcohol use disorders

It's estimated that globally, around 1 percent of the population has an alcohol use disorder. At the country level, as shown in the chart, this ranges from around 0.5 to 5 percent of the population.

When we look at the variance in prevalence across age groups , we see that globally, the prevalence is highest in those aged between 15 and 49 years old.

The breakdown of alcohol use disorders by gender for any country can be viewed here ; the majority of people with alcohol use disorders – around three-quarters – are male.

The scatter plot compares the prevalence of alcohol use disorders in males versus that of females. The prevalence of alcohol dependence in men is typically higher than in women across all countries.

Deaths from alcohol use disorders

Deaths from alcohol dependence can occur both directly or indirectly. Indirect deaths from alcohol use disorders can occur indirectly through suicide. Although clear attribution of suicide deaths is challenging, alcohol use disorders are a known and established risk factor. It's estimated that the relative risk of suicide in an individual with alcohol dependence is around ten times higher than in an individual without. 6

The chart shows direct death rates (not including suicide deaths) from alcohol use disorders across the world. The death rates are typically higher in Eastern Europe and lower in North Africa and the Middle East.

The total estimated number of deaths by country from 1990 to 2019 is found here .

Alcohol use disorder treatment

Global data on the prevalence and effectiveness of alcohol use disorder treatment is incomplete.

In the chart, we see data across some countries on the share of people with an alcohol use disorder who received treatment. This data is based on estimates of prevalence and treatment published by the World Health Organization (WHO).

Alcohol use disorder vs. average alcohol intake

Do countries with higher average alcohol consumption have a higher prevalence of alcohol use disorders?

In the chart, we see the prevalence of alcohol dependence versus the average per capita alcohol consumption. There is no clear evidence that high overall consumption (particularly in moderate quantities) is connected to the onset of alcohol dependency.

The disease burden from alcohol use disorders

Measuring the health impact by mortality alone fails to capture the impact that alcohol use disorders have on an individual's well-being. The ' disease burden ' – measured in Disability-Adjusted Life Years (DALYs) – considers mortality and years lived with disability or health burden. The map shows DALYs per 100,000 people, which result from alcohol use disorders.

DALY rates differentiated by age group can be found here .

Risk factors for alcohol use disorders

Many of the risk factors for alcohol dependency are similar to those of overall drug use disorders (including illicit drug disorders). Further discussion on these risk factors can be found on our topic page on drug use .

Mental health disorders as a risk factor for alcohol dependency

In the chart we show results from a study published by Swendsen et al. (2010). 7

In this study, the authors followed a cohort of more than 5,000 individuals with and without a mental health disorder (but without a drug use disorder) over a 10-year period. Following the ten-year period, they re-assessed such individuals for whether they had either nicotine, alcohol, or illicit drug dependency. 8

The results in the chart show the increased risk of developing alcohol dependency (we show results for illicit drug dependency in our topic page on drug use ) for someone with a given mental health disorder (relative to those without). For example, a value of 3.6 for bipolar disorder indicates that illicit drug dependency became more than three times more likely in individuals with bipolar disorder than those without. The risk of an alcohol use disorder is highest in individuals with intermittent explosive disorder, dysthymia, ODD, bipolar disorder, and social phobia.

Alcohol, crime, and road deaths

Alcohol-related road traffic deaths.

The map shows the share of all road traffic deaths attributed to alcohol consumption over the national legal limit for alcohol consumption.

In South Africa and Papua New Guinea, more than half of all traffic deaths are attributable to alcohol consumption.

In the US, Canada, Australia, New Zealand, Argentina, and many European countries, alcohol is responsible for around a third of all traffic deaths.

Definitions and Measurement

What is a standard drink measure.

Whilst the World Health Organization (WHO) and most national guidelines typically quantify one unit of alcohol as equal to 10 grams of pure alcohol, the metric used as a 'standard measure' can vary across countries. Most countries across Europe use this 10-gram metric. However, this can vary, with several adopting 12 or 14 grams per unit.

In North America, a unit is typically taken as 14 grams of pure alcohol. In Japan, this is as high as around 20 grams per unit.

Further Resources & Guidance

Alcohol rehab guide.

  • Information : Guidance on the signs of alcoholism, unhealthy drinking behaviors, and support on where to go for help
  • Geographical coverage: Universal guidance; support options for the United States
  • Available at: https://www.alcoholrehabguide.org/support/

Hello Sunday Morning

  • Information : A social movement with the aim to reduce stigma around alcohol and to encourages people to consider their relationship with alcohol.
  • Available at: HelloSundayMorning.org

Drink Aware

  • Information : List and contact details of a range of places for support on alcohol issues
  • Geographical coverage:  United Kingdom
  • Available at: https://www.drinkaware.co.uk/alcohol-support-services/

Rethinking Drinking

  • Information : Test to assess your drinking patterns relative to the US population
  • Geographical coverage:  Global; assesses relative to US drinking patterns
  • Available at: What's your drinking pattern?

Rehab 4 Addiction

  • Information : An advisory and referral service for people who suffer from alcohol, drug, and behavioral addiction.
  • Geographical coverage:   Universal guidance; support options for the United Kingdom
  • Available at: https://www.rehab4addiction.co.uk/

Interactive charts on alcohol consumption

Alcohol.org has this overview of the range of alcohol by volume of beer, wine, & liquor.

22.1 liters per person in France equals 22.1l / 0.12l = 184 bottles per year.

Miron & Zwiebel (1991). Alcohol Consumption During Prohibition.  The American Economic Review , Vol. 81, No. 2, pp. 242-247, (May 1991). Available online .

ONS (2018). Adult drinking habits in Great Britain. UK Office of National Statistics . Available at: https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/drugusealcoholandsmoking/datasets/adultdrinkinghabits

GBD 2019 Risk Factor Collaborators. "Global burden of 87 risk factors in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019" (2020). Link here

Ferrari et al. (2015). The Burden Attributable to Mental and Substance Use Disorders as Risk Factors for Suicide: Findings from the Global Burden of Disease Study 2010.  PLOS ONE . Available  online .

Swendsen, J., Conway, K. P., Degenhardt, L., Glantz, M., Jin, R., Merikangas, K. R., … & Kessler, R. C. (2010). Mental disorders as risk factors for substance use, abuse, and dependence: results from the 10‐year follow‐up of the National Comorbidity Survey.  Addiction ,  105 (6), 1117-1128. Available at: https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1360-0443.2010.02902.x

Full data with confidence intervals and statistical significance can be found in our table here .

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Alcohol use: Weighing risks and benefits

Drinking alcohol is a health risk regardless of the amount.

Research on alcohol suggests a sobering conclusion: Drinking alcohol in any amount carries a health risk. While the risk is low for moderate intake, the risk goes up as the amount you drink goes up.

Many people drink alcohol as a personal preference, during social activities, or as a part of cultural and religious practices. People who choose not to drink make that choice for the same reasons. Knowing your personal risk based on your habits can help you make the best decision for you.

The evidence for moderate alcohol use in healthy adults is still being studied. But good evidence shows that drinking high amounts of alcohol are clearly linked to health problems.

Here's a closer look at alcohol and health.

Defining moderate alcohol use

Moderate alcohol use may not mean the same thing in research studies or among health agencies.

In the United States, moderate drinking for healthy adults is different for men and women. It means on days when a person does drink, women do not have more than one drink and men do not have more than two drinks.

Examples of one drink include:

  • 12 fluid ounces (355 milliliters) of regular beer
  • 5 fluid ounces (148 milliliters) of wine
  • 1.5 fluid ounces (44 milliliters) of hard liquor or distilled spirits

Health agencies outside the U.S. may define one drink differently.

The term "moderate" also may be used differently. For example, it may be used to define the risk of illness or injury based on the number of drinks a person has in a week.

Risks of moderate alcohol use

The bottom line is that alcohol is potentially addictive, can cause intoxication, and contributes to health problems and preventable deaths. If you already drink at low levels and continue to drink, risks for these issues appear to be low. But the risk is not zero.

For example, any amount of drinking increases the risk of breast cancer and colorectal cancer. As consumption goes up, the risk goes up for these cancers. It is a tiny, but real, increased risk.

Drinking also adds calories that can contribute to weight gain. And drinking raises the risk of problems in the digestive system.

In the past, moderate drinking was thought to be linked with a lower risk of dying from heart disease and possibly diabetes. After more analysis of the research, that doesn't seem to be the case. In general, a healthy diet and physical activity have much greater health benefits than alcohol and have been more extensively studied.

Risks of heavy alcohol use

Heavy drinking, including binge drinking, is a high-risk activity.

The definition of heavy drinking is based on a person's sex. For women, more than three drinks on any day or more than seven drinks a week is heavy drinking. For men, heavy drinking means more than four drinks on any day or more than 14 drinks a week.

Binge drinking is behavior that raises blood alcohol levels to 0.08%. That usually means four or more drinks within two hours for women and five or more drinks within two hours for men.

Heavy drinking can increase your risk of serious health problems, including:

  • Certain cancers, such as colorectal cancer, breast cancer and cancers of the mouth, throat, esophagus and liver.
  • Liver disease.
  • Cardiovascular disease, such as high blood pressure and stroke.

Heavy drinking also has been linked to intentional injuries, such as suicide, as well as accidental injury and death.

During pregnancy, drinking may cause the unborn baby to have brain damage and other problems. Heavy drinking also may result in alcohol withdrawal symptoms.

When to avoid alcohol

In some situations, the risk of drinking any amount of alcohol is high. Avoid all alcohol if you:

  • Are trying to get pregnant or are pregnant.
  • Take medicine that has side effects if you drink alcohol.
  • Have alcohol use disorder.
  • Have medical issues that alcohol can worsen.

In the United States, people younger than age 21 are not legally able to drink alcohol.

When taking care of children, avoid alcohol. And the same goes for driving or if you need to be alert and able to react to changing situations.

Deciding about drinking

Lots of activities affect your health. Some are riskier than others. When it comes to alcohol, if you don't drink, don't start for health reasons.

Drinking moderately if you're otherwise healthy may be a risk you're willing to take. But heavy drinking carries a much higher risk even for those without other health concerns. Be sure to ask your healthcare professional about what's right for your health and safety.

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  • Rethinking drinking: Alcohol and your health. National Institute on Alcohol Abuse and Alcoholism. https://www.rethinkingdrinking.niaaa.nih.gov/. Accessed Jan. 8, 2024.
  • 2020-2025 Dietary Guidelines for Americans. U.S. Department of Health and Human Services and U.S. Department of Agriculture. https://www.dietaryguidelines.gov. Accessed Jan. 8, 2024.
  • Scientific Report of the 2020 Dietary Guidelines Advisory Committee. Alcoholic beverages. U.S. Department of Health and Human Services and U.S. Department of Agriculture. https://www.dietaryguidelines.gov/2020-advisory-committee-report. Accessed Jan. 8, 2024.
  • Canada's guidance on alcohol and health. Canadian Centre on Substance Use and Addiction. https://www.ccsa.ca/canadas-guidance-alcohol-and-health. Accessed Jan. 9, 2024.
  • Science around moderate alcohol consumption. Centers for Disease Control and Prevention. https://www.cdc.gov/alcohol/fact-sheets/moderate-drinking.htm. Accessed Jan. 9, 2024.
  • Alcohol use and your health. Centers for Disease Control and Prevention. https://www.cdc.gov/alcohol/fact-sheets/alcohol-use.htm. Accessed Jan. 9, 2024.

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Alcohol: Balancing Risks and Benefits

research on alcohol consumption

Moderate drinking can be healthy—but not for everyone. You must weigh the risks and benefits.

– Introduction – What’s Moderate Alcohol Intake? What’s a Drink? – The Downside of Alcohol – Possible Health Benefits of Alcohol – Genes Play a Role – Shifting Benefits and Risks – The Bottom Line: Balancing Risks and Benefits

Introduction

Throughout the 10,000 or so years that humans have been drinking fermented beverages, they’ve also been arguing about their merits and demerits. The debate still simmers today, with a lively back-and-forth over whether alcohol is good for you or bad for you.

It’s safe to say that alcohol is both a tonic and a poison. The difference lies mostly in the dose. Moderate drinking seems to be good for the heart and circulatory system, and probably protects against type 2 diabetes and gallstones. Heavy drinking is a major cause of preventable death in most countries. In the U.S., alcohol is implicated in about half of fatal traffic accidents. [1] Heavy drinking can damage the liver and heart, harm an unborn child, increase the chances of developing breast and some other cancers, contribute to depression and violence, and interfere with relationships.

Alcohol’s two-faced nature shouldn’t come as a surprise. The active ingredient in alcoholic beverages, a simple molecule called ethanol, affects the body in many different ways. It directly influences the stomach, brain, heart, gallbladder, and liver. It affects levels of lipids (cholesterol and triglycerides) and insulin in the blood, as well as inflammation and coagulation. It also alters mood, concentration, and coordination.

What’s Moderate Alcohol Intake? What’s a Drink?

Loose use of the terms “moderate” and “a drink” has fueled some of the ongoing debate about alcohol’s impact on health.

In some studies, the term “moderate drinking” refers to less than 1 drink per day, while in others it means 3-4 drinks per day. Exactly what constitutes “a drink” is also fairly fluid. In fact, even among alcohol researchers, there’s no universally accepted standard drink definition. [2]

In the U.S., 1 drink is usually considered to be 12 ounces of beer, 5 ounces of wine, or 1½ ounces of spirits (hard liquor such as gin or whiskey). [3] Each delivers about 12 to 14 grams of alcohol on average, but there is a wider range now that microbrews and wine are being produced with higher alcohol content.

Is Red Wine Better?

The definition of moderate drinking is something of a balancing act. Moderate drinking sits at the point at which the health benefits of alcohol clearly outweigh the risks.

The latest consensus places this point at no more than 1-2 drinks a day for men, and no more than 1 drink a day for women. This is the definition used by the U.S. Department of Agriculture and the Dietary Guidelines for Americans 2020-2025, [3] and is widely used in the United States.

The Dark Side of Alcohol

Not everyone who likes to drink alcohol stops at just one. While many people drink in moderation, some don’t.

Red wine splashing out of glass

Problem drinking also touches drinkers’ families, friends, and communities. According to the National Institute on Alcohol Abuse and Alcoholism and others:

  • In 2014, about 61 million Americans were classified as binge alcohol users (5 or more drinks on the same occasion at least once a month) and 16 million as heavy alcohol users (5 or more drinks on the same occasion on 5 or more days in one month). [6]
  • Alcohol plays a role in one in three cases of violent crime. [7]
  • In 2015, more than 10,000 people died in automobile accidents in which alcohol was involved. [8]
  • Alcohol abuse costs about $249 billion a year. [9]

Even moderate drinking carries some risks. Alcohol can disrupt sleep and one’s better judgment. Alcohol interacts in potentially dangerous ways with a variety of medications, including acetaminophen, antidepressants, anticonvulsants, painkillers, and sedatives. It is also addictive, especially for people with a family history of alcoholism.

Alcohol Increases Risk of Developing Breast Cancer

There is convincing evidence that alcohol consumption increases the risk of breast cancer, and the more alcohol consumed, the greater the risk. [10-14]

  • A large prospective study following 88,084 women and 47,881 men for 30 years found that even 1 drink a day increased the risk of alcohol-related cancers (colorectum, female breast, oral cavity, pharynx, larynx, liver, esophagus) in women, but mainly breast cancer, among both smokers and nonsmokers. 1 to 2 drinks a day in men who did not smoke was not associated with an increased risk of alcohol-related cancers. [15]  
  • In a combined analysis of six large prospective studies involving more than 320,000 women, researchers found that having 2-5 drinks a day compared with no drinks increased the chances of developing breast cancer as high as 41%. It did not matter whether the form of alcohol was wine, beer, or hard liquor. [10] This doesn’t mean that 40% or so of women who have 2-5 drinks a day will get breast cancer. Instead, it is the difference between about 13 of every 100 women developing breast cancer during their lifetime—the current average risk in the U.S.—and 17 to 18 of every 100 women developing the disease. This modest increase would translate to significantly more women with breast cancer each year.

A lack of folate in the diet or folic acid, its supplement form, further increases the risk of breast cancer in women. [14] Folate is needed to produce new cells and to prevent changes in DNA. Folate deficiency, as can occur with heavy alcohol use, can cause changes in genes that may lead to cancer. Alcohol also increases estrogen levels, which fuel the growth of certain breast cancer cells. An adequate intake of folate, at least 400 micrograms a day, when taking at least 1 drink of alcohol daily appears to lessen this increased risk. [16, 17]

  • Researchers found a strong association among three factors—genetics, folate intake, and alcohol—in a cohort from the Nurses’ Health Study II of 2866 young women with an average age of 36 who were diagnosed with invasive breast cancer. Those with a family history of breast cancer who drank 10 grams or more of alcoholic beverages daily (equivalent to 1 or more drinks) and ate less than 400 micrograms of folate daily almost doubled their risk (1.8 times) of developing the cancer. Women who drank this amount of alcohol but did not have a family history of breast cancer and ate at least 400 micrograms of folate daily did not have an increased breast cancer risk. [14]

Folate , the B vitamin that helps guide the development of an embryo’s spinal cord, has equally important jobs later in life. One of the biggest is helping to build DNA, the molecule that carries the code of life. In this way, folate is essential for accurate cell division.

Alcohol blocks the absorption of folate and inactivates folate in the blood and tissues. It’s possible that this interaction may be how alcohol consumption increases the risk of breast, colon, and other cancers.

Getting extra folate may cancel out this alcohol-related increase. In the Nurses’ Health Study, for example, among women who consumed 1 or more alcoholic drinks a day, those who had the highest levels of this B vitamin in their blood were 90% less likely to develop breast cancer than those who had the lowest levels of the B vitamin. [18] An earlier study suggested that getting 600 micrograms a day of folate could counteract the effect of moderate alcohol consumption on breast cancer risk. [17] There was no association with folate and increased breast cancer risk among women who drank low or no alcohol daily.

Alcohol and Weight Gain

Sugary mixed alcoholic beverage

However, a prospective study following almost 15,000 men at four-year periods found only an increased risk of minor weight gain with higher intakes of alcohol. [19] Compared to those who did not change their alcohol intake, those who increased their intake by 2 or more drinks a day gained a little more than a half-pound. It was noted that calorie intake (not from alcohol) tended to increase along with alcohol intake.

Possible Health Benefits of Alcohol

What are some of the possible health benefits associated with moderate alcohol consumption?

Cardiovascular Disease

More than 100 prospective studies show an inverse association between light to moderate drinking and risk of heart attack, ischemic (clot-caused) stroke, peripheral vascular disease, sudden cardiac death, and death from all cardiovascular causes. [20] The effect is fairly consistent, corresponding to a 25-40% reduction in risk. However, increasing alcohol intake to more than 4 drinks a day can increase the risk of hypertension, abnormal heart rhythms, stroke, heart attack, and death. [5, 21-23]

Learn more about the results of some large prospective cohort studies of alcohol consumption and cardiovascular disease.

* compared with non-drinkers

The connection between moderate drinking and lower risk of cardiovascular disease has been observed in men and women. It applies to people who do not have heart disease, and also to those at high risk for having a heart attack or stroke or dying of cardiovascular disease, including those with type 2 diabetes, [32, 33] high blood pressure, [34, 35] and existing cardiovascular disease. [34, 35] The benefits also extend to older individuals. [36]

The idea that moderate drinking protects against cardiovascular disease makes sense biologically and scientifically. Moderate amounts of alcohol raise levels of high-density lipoprotein (HDL, or “good” cholesterol), [37] and higher HDL levels are associated with greater protection against heart disease. Moderate alcohol consumption has also been linked with beneficial changes ranging from better sensitivity to insulin to improvements in factors that influence blood clotting, such as tissue type plasminogen activator, fibrinogen, clotting factor VII, and von Willebrand factor. [37] Such changes would tend to prevent the formation of small blood clots that can block arteries in the heart, neck, and brain, the ultimate cause of many heart attacks and the most common kind of stroke.

Drinking Patterns Matter

Glass of beer on a table

A review of alcohol consumption in women from the Nurses’ Health Study I and II found that smaller amounts of alcohol (about 1 drink per day) spread out over four or more days per week had the lowest death rates from any cause, compared with women who drank the same amount of alcohol but in one or two days. [39]

The most definitive way to investigate the effect of alcohol on cardiovascular disease would be with a large trial in which some volunteers were randomly assigned to have 1 or more alcoholic drinks a day and others had drinks that looked, tasted, and smelled like alcohol but were actually alcohol free. Many of these trials have been conducted for weeks, and in a few cases months and even up to 2 years, to look at changes in the blood, but a long-term trial to test experimentally the effects of alcohol on cardiovascular disease has not been done.  A recent successful effort in the U.S. to launch an international study was funded by the National Institutes of Health.  Although the proposal was peer-reviewed and initial participants had been randomized to drink in moderation or to abstain, post hoc the NIH decided to stop the trial due to internal policy concerns .  Unfortunately, a future long trial of alcohol and clinical outcomes may never be attempted again, but nevertheless, the connection between moderate drinking and cardiovascular disease almost certainly represents a cause-and-effect relationship based on all of the available evidence to date.

Beyond the Heart

The benefits of moderate drinking aren’t limited to the heart. In the Nurses’ Health Study, the Health Professionals Follow-up Study, and other studies, gallstones [40, 41] and type 2 diabetes [32, 42, 43] were less likely to occur in moderate drinkers than in non-drinkers. The emphasis here, as elsewhere, is on moderate drinking.

In a meta-analysis of 15 original prospective cohort studies that followed 369,862 participants for an average of 12 years, a 30% reduced risk of type 2 diabetes was found with moderate drinking (0.5-4 drinks a day), but no protective effect was found in those drinking either less or more than that amount. [32]

The social and psychological benefits of alcohol can’t be ignored. A drink before a meal can improve digestion or offer a soothing respite at the end of a stressful day; the occasional drink with friends can be a social tonic. These physical and social effects may also contribute to health and well-being.

Genes Play a Role

Twin, family, and adoption studies have firmly established that genetics plays an important role in determining an individual’s preferences for alcohol and his or her likelihood for developing alcoholism. Alcoholism doesn’t follow the simple rules of inheritance set out by Gregor Mendel. Instead, it is influenced by several genes that interact with each other and with environmental factors. [1]

There is also some evidence that genes influence how alcohol affects the cardiovascular system. An enzyme called alcohol dehydrogenase helps metabolize alcohol. One variant of this enzyme, called alcohol dehydrogenase type 1C (ADH1C), comes in two “flavors.” One quickly breaks down alcohol, the other does it more slowly. Moderate drinkers who have two copies of the gene for the slow-acting enzyme are at much lower risk for cardiovascular disease than moderate drinkers who have two genes for the fast-acting enzyme. [44] Those with one gene for the slow-acting enzyme and one for the faster enzyme fall in between.

It’s possible that the fast-acting enzyme breaks down alcohol before it can have a beneficial effect on HDL and clotting factors. Interestingly, these differences in the ADH1C gene do not influence the risk of heart disease among people who don’t drink alcohol. This adds strong indirect evidence that alcohol itself reduces heart disease risk.

Shifting Benefits and Risks

White wine being poured into a glass from a bottle

  • For a pregnant woman and her unborn child, a recovering alcoholic, a person with liver disease, and people taking one or more medications that interact with alcohol, moderate drinking offers little benefit and substantial risks.
  • For a 30-year-old man, the increased risk of alcohol-related accidents outweighs the possible heart-related benefits of moderate alcohol consumption.
  • For a 60-year-old man, a drink a day may offer protection against heart disease that is likely to outweigh potential harm (assuming he isn’t prone to alcoholism).
  • For a 60-year-old woman, the benefit/risk calculations are trickier. Ten times more women die each year from heart disease (460,000) than from breast cancer (41,000). However, studies show that women are far more afraid of developing breast cancer than heart disease, something that must be factored into the equation.

The Bottom Line: Balancing Risks and Benefits

Given the complexity of alcohol’s effects on the body and the complexity of the people who drink it, blanket recommendations about alcohol are out of the question. Because each of us has unique personal and family histories, alcohol offers each person a different spectrum of benefits and risks. Whether or not to drink alcohol, especially for “medicinal purposes,” requires careful balancing of these benefits and risks.

  • Your healthcare provider should be able to help you do this. Your overall health and risks for alcohol-associated conditions should factor into the equation.
  • If you are thin, physically active, don’t smoke, eat a healthy diet, and have no family history of heart disease, drinking alcohol won’t add much to decreasing your risk of cardiovascular disease.
  • If you don’t drink, there’s no need to start. You can get similar benefits with exercise (beginning to exercise if you don’t already or boosting the intensity and duration of your activity) or healthier eating.
  • If you are a man with no history of alcoholism who is at moderate to high risk for heart disease, a daily alcoholic drink could reduce that risk. Moderate drinking might be especially beneficial if you have low HDL that just won’t budge upward with diet and exercise.
  • If you are a woman with no history of alcoholism who is at moderate to high risk for heart disease, the possible benefits of a daily drink must be balanced against the small increase in risk of breast cancer.
  • If you already drink alcohol or plan to begin, keep it moderate—no more than 2 drinks a day for men or 1 drink a day for women. And make sure you get adequate amounts of folate, at least 400 micrograms a day.
  • However, the study’s results contradict these headlines, as its findings mirrored those from previous cohort studies showing the lowest CVD risk among light/moderate drinkers (1-15 drinks a week), and risk sharply increasing in heavy/abusive drinkers (averaging >20 drinks a week). Yet the authors concluded that it wasn’t light/moderate drinking that protected the heart; rather, it was lifestyle factors associated with light/moderate drinking like exercising more and not smoking (as predicted by people possessing certain gene variants). Interestingly the study found that light/moderate drinkers had healthier habits than even the abstainers. When adjusting for these healthy habits, the protective effect from alcohol lessened slightly. Regardless, their overall conclusion still showed that light/moderate drinkers had the lowest risk of CVD and supported the additional benefit of healthy lifestyle behaviors. It may also be worth noting that the genetic variants studied were associated with alcohol use disorder (AUD) and not specific to general alcohol intake.
  • A 2018 analysis in The Lancet of the global impact of alcohol on injury and disease made headlines when it concluded that even moderate drinking is unsafe for health—and the risks outweigh any potential benefits. However, according to Dr. Walter Willett, professor of epidemiology and nutrition at Harvard T.H. Chan School of Public Health, it can be “misleading” to lump the entire world together when assessing alcohol’s risk. (For example, while tuberculosis is very rare in the U.S., it was the leading alcohol-related disease identified in the study.) In an interview with TIME , Willett said that while there is “no question” that heavy drinking is harmful, there are plenty of data supporting the benefits of moderate drinking, and it remains a decision that should be determined at the individual level: “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.
  • 10th Special Report to the U.S. Congress on Alcohol and Health.  National Institute on Alcohol Abuse and Alcoholism .
  • Kloner RA, Rezkalla SH. To drink or not to drink? That is the question.  Circulation .  2007 Sep 11;116(11):1306-17.
  • Dietary guidelines for Americans 2020-2025 . U.S. Department of Agriculture. https://www.dietaryguidelines.gov/sites/default/files/2020-12/Dietary_Guidelines_for_Americans_2020-2025.pdf
  • World Cancer Research Fund, American Institute for Cancer Research. Food, Nutrition, Physical Activity, and the Prevention of Cancer: A Global Perspective . Washington, D.C.: AICR, 2007.
  • Scoccianti C, Cecchini M, Anderson AS, Berrino F, Boutron-Ruault MC, Espina C, Key TJ, Leitzmann M, Norat T, Powers H, Wiseman M. European Code against Cancer 4th Edition: Alcohol drinking and cancer. Cancer epidemiology . 2015 Dec 1;39:S67-74.
  • Behavioral Health Trends in the United States: Results from the 2014 National Survey on Drug Use and Health . U.S. Substance Abuse and Mental Health Services Administration. https://www.samhsa.gov/data/sites/default/files/NSDUH-FRR1-2014/NSDUH-FRR1-2014.pdf . Accessed 4/23/2018.
  • Crime characteristics, 2006. U.S. Department of Justice.
  • Impaired driving: Get the Facts . Centers for Disease Control and Prevention. https://www.cdc.gov/motorvehiclesafety/impaired_driving/impaired-drv_factsheet.html . Accessed 4/23/2018.
  • Alcohol Facts and Statistics . National Institute on Alcohol Abuse and Alcoholism. June 2017. https://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/alcohol-facts-and-statistics . Accessed 4/23/2018.
  • Smith-Warner SA, Spiegelman D, Yaun SS, Van Den Brandt PA, Folsom AR, Goldbohm RA, Graham S, Holmberg L, Howe GR, Marshall JR, Miller AB. Alcohol and breast cancer in women: a pooled analysis of cohort studies. JAMA . 1998 Feb 18;279(7):535-40.
  • Collaborative Group on Hormonal Factors in Breast Cancer. Alcohol, tobacco and breast cancer–collaborative reanalysis of individual data from 53 epidemiological studies, including 58 515 women with breast cancer and 95 067 women without the disease. British journal of cancer . 2002 Nov 18;87(11):1234.
  • Scoccianti C, Lauby-Secretan B, Bello PY, Chajes V, Romieu I. Female breast cancer and alcohol consumption: a review of the literature. American journal of preventive medicine . 2014 Mar 1;46(3):S16-25.
  • Allen NE, Beral V, Casabonne D, Kan SW, Reeves GK, Brown A, Green J. Moderate alcohol intake and cancer incidence in women. Journal of the National Cancer Institute . 2009 Mar 4;101(5):296-305.
  • Kim HJ, Jung S, Eliassen AH, Chen WY, Willett WC, Cho E. Alcohol consumption and breast cancer risk in younger women according to family history of breast cancer and folate intake. American journal of epidemiology . 2017 Aug 10;186(5):524-31.
  • Cao Y, Willett WC, Rimm EB, Stampfer MJ, Giovannucci EL. Light to moderate intake of alcohol, drinking patterns, and risk of cancer: results from two prospective US cohort studies. BMJ . 2015 Aug 18;351:h4238.
  • Baglietto L, English DR, Gertig DM, Hopper JL, Giles GG. Does dietary folate intake modify effect of alcohol consumption on breast cancer risk? Prospective cohort study. BMJ . 2005 Oct 6;331(7520):807.
  • Zhang S, Hunter DJ, Hankinson SE, Giovannucci EL, Rosner BA, Colditz GA, Speizer FE, Willett WC. A prospective study of folate intake and the risk of breast cancer. JAMA . 1999 May 5;281(17):1632-7.
  • Zhang SM, Willett WC, Selhub J, Hunter DJ, Giovannucci EL, Holmes MD, Colditz GA, Hankinson SE. Plasma folate, vitamin B6, vitamin B12, homocysteine, and risk of breast cancer. Journal of the National Cancer Institute . 2003 Mar 5;95(5):373-80.
  • Downer MK, Bertoia ML, Mukamal KJ, Rimm EB, Stampfer MJ. Change in Alcohol Intake in Relation to Weight Change in a Cohort of US Men with 24 Years of Follow‐Up. Obesity . 2017 Nov;25(11):1988-96.
  • Goldberg IJ, Mosca L, Piano MR, Fisher EA. Wine and your heart: a science advisory for healthcare professionals from the Nutrition Committee, Council on Epidemiology and Prevention, and Council on Cardiovascular Nursing of the American Heart Association. Circulation . 2001 Jan 23;103(3):472-5.
  • O’Keefe JH, Bhatti SK, Bajwa A, DiNicolantonio JJ, Lavie CJ. Alcohol and cardiovascular health: the dose makes the poison… or the remedy. Mayo Clinic Proceedings 2014 Mar 1 (Vol. 89, No. 3, pp. 382-393). Elsevier.
  • Zhang C, Qin YY, Chen Q, Jiang H, Chen XZ, Xu CL, Mao PJ, He J, Zhou YH. Alcohol intake and risk of stroke: a dose–response meta-analysis of prospective studies. International journal of cardiology . 2014 Jul 1;174(3):669-77.
  • Bell S, Daskalopoulou M, Rapsomaniki E, George J, Britton A, Bobak M, Casas JP, Dale CE, Denaxas S, Shah AD, Hemingway H. Association between clinically recorded alcohol consumption and initial presentation of 12 cardiovascular diseases: population based cohort study using linked health records. BMJ . 2017 Mar 22;356:j909.
  • Lin Y, Kikuchi S, Tamakoshi A, Wakai K, Kawamura T, Iso H, Ogimoto I, Yagyu K, Obata Y, Ishibashi T, JACC Study Group. Alcohol consumption and mortality among middle-aged and elderly Japanese men and women. Annals of epidemiology . 2005 Sep 1;15(8):590-7.
  • Mukamal KJ, Conigrave KM, Mittleman MA, Camargo Jr CA, Stampfer MJ, Willett WC, Rimm EB. Roles of drinking pattern and type of alcohol consumed in coronary heart disease in men. New England Journal of Medicine . 2003 Jan 9;348(2):109-18.
  • Renaud SC, Guéguen R, Siest G, Salamon R. Wine, beer, and mortality in middle-aged men from eastern France. Archives of internal medicine . 1999 Sep 13;159(16):1865-70.
  • Thun MJ, Peto R, Lopez AD, Monaco JH, Henley SJ, Heath Jr CW, Doll R. Alcohol consumption and mortality among middle-aged and elderly US adults. New England Journal of Medicine . 1997 Dec 11;337(24):1705-14.
  • Camargo CA, Hennekens CH, Gaziano JM, Glynn RJ, Manson JE, Stampfer MJ. Prospective study of moderate alcohol consumption and mortality in US male physicians. Archives of Internal Medicine . 1997 Jan 13;157(1):79-85.
  • Camargo CA, Stampfer MJ, Glynn RJ, Gaziano JM, Manson JE, Goldhaber SZ, Hennekens CH. Prospective study of moderate alcohol consumption and risk of peripheral arterial disease in US male physicians. Circulation . 1997 Feb 4;95(3):577-80.
  • Klatsky AL, Armstrong MA, Friedman GD. Risk of cardiovascular mortality in alcohol drinkers, ex-drinkers and nondrinkers. American Journal of Cardiology . 1990 Nov 15;66(17):1237-42.
  • Stampfer MJ, Colditz GA, Willett WC, Speizer FE, Hennekens CH. A prospective study of moderate alcohol consumption and the risk of coronary disease and stroke in women. New England Journal of Medicine . 1988 Aug 4;319(5):267-73.
  • Koppes LL, Dekker JM, Hendriks HF, Bouter LM, Heine RJ. Moderate alcohol consumption lowers the risk of type 2 diabetes: a meta-analysis of prospective observational studies. Diabetes Care . 2005 Mar 1;28(3):719-25.
  • Solomon CG, Hu FB, Stampfer MJ, Colditz GA, Speizer FE, Rimm EB, Willett WC, Manson JE. Moderate alcohol consumption and risk of coronary heart disease among women with type 2 diabetes mellitus. Circulation . 2000 Aug 1;102(5):494-9.
  • Mukamal KJ, Maclure M, Muller JE, Sherwood JB, Mittleman MA. Prior alcohol consumption and mortality following acute myocardial infarction. JAMA . 2001 Apr 18;285(15):1965-70.
  • Muntwyler J, Hennekens CH, Buring JE, Gaziano JM. Mortality and light to moderate alcohol consumption after myocardial infarction. The Lancet . 1998 Dec 12;352(9144):1882-5.
  • Mukamal KJ, Chung H, Jenny NS, Kuller LH, Longstreth Jr WT, Mittleman MA, Burke GL, Cushman M, Psaty BM, Siscovick DS. Alcohol consumption and risk of coronary heart disease in older adults: the Cardiovascular Health Study. Journal of the American Geriatrics Society . 2006 Jan;54(1):30-7.
  • Booyse FM, Pan W, Grenett HE, Parks DA, Darley-Usmar VM, Bradley KM, Tabengwa EM. Mechanism by which alcohol and wine polyphenols affect coronary heart disease risk. Annals of epidemiology . 2007 May 1;17(5):S24-31.
  • Tolstrup J, Jensen MK, Anne T, Overvad K, Mukamal KJ, Grønbæk M. Prospective study of alcohol drinking patterns and coronary heart disease in women and men. BMJ . 2006 May 25;332(7552):1244.
  • Mostofsky E, Mukamal KJ, Giovannucci EL, Stampfer MJ, Rimm EB. Key findings on alcohol consumption and a variety of health outcomes from the Nurses’ Health Study. American journal of public health . 2016 Sep;106(9):1586-91.
  • Grodstein F, Colditz GA, Hunter DJ, Manson JE, Willett WC, Stampfer MJ. A prospective study of symptomatic gallstones in women: relation with oral contraceptives and other risk factors. Obstetrics and Gynecology . 1994 Aug;84(2):207-14.
  • Leitzmann MF, Giovannucci EL, Stampfer MJ, Spiegelman D, Colditz GA, Willett WC, Rimm EB. Prospective study of alcohol consumption patterns in relation to symptomatic gallstone disease in men. Alcoholism: Clinical and Experimental Research . 1999 May;23(5):835-41.
  • Conigrave KM, Hu BF, Camargo CA, Stampfer MJ, Willett WC, Rimm EB. A prospective study of drinking patterns in relation to risk of type 2 diabetes among men. Diabetes . 2001 Oct 1;50(10):2390-5.
  • Djoussé L, Biggs ML, Mukamal KJ, Siscovick DS. Alcohol consumption and type 2 diabetes among older adults: the Cardiovascular Health Study. Obesity . 2007 Jul;15(7):1758-65.
  • Hines LM, Stampfer MJ, Ma J, Gaziano JM, Ridker PM, Hankinson SE, Sacks F, Rimm EB, Hunter DJ. Genetic variation in alcohol dehydrogenase and the beneficial effect of moderate alcohol consumption on myocardial infarction. New England Journal of Medicine . 2001 Feb 22;344(8):549-55.
  • Biddinger KJ, Emdin CA, Haas ME, Wang M, Hindy G, Ellinor PT, Kathiresan S, Khera AV, Aragam KG. Association of Habitual Alcohol Intake With Risk of Cardiovascular Disease. JAMA Network Open . 2022 Mar 1;5(3):e223849-.  Author disclosures: Dr. Haas reported receiving personal fees and stock and stock options from Regeneron Pharmaceuticals outside the submitted work. Dr. Ellinor reported receiving grants from Bayer AG and IBM Health and personal fees from Bayer AG, MyoKardia, Quest Diagnostics, and Novartis during the conduct of the study. Dr. Kathiresan reported being an employee of Verve Therapeutics; owning equity in Verve Therapeutics, Maze Therapeutics, Color Health, and Medgenome; receiving personal fees from Medgenome and Color Health; serving on the advisory boards for Regeneron Genetics Center and Corvidia Therapeutics; and consulting for Acceleron, Eli Lilly and Co, Novartis, Merck, Novo Nordisk, Novo Ventures, Ionis, Alnylam, Aegerion, Haug Partners, Noble Insights, Leerink Partners, Bayer Healthcare, Illumina, Color Genomics, MedGenome, Quest Diagnostics, and Medscape outside the submitted work. Dr. Khera reported receiving personal fees from Merck, Amarin Pharmaceuticals, Amgen, Maze Therapeutics, Navitor Pharmaceuticals, Sarepta Therapeutics, Verve Therapeutics, Silence Therapeutics, Veritas International, Color Health, and Third Rock Ventures and receiving grants from IBM Research outside the submitted work. Dr. Aragam reported receiving speaking fees from the Novartis Institute for Biomedical Research.

Last reviewed April 2022

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Is alcohol good for your heart? It’s complicated, despite new insights

On nutrition.

We’re almost a month out from the end of Dry January, and I can’t help but wonder how February went for those who consciously abstained from alcohol for a month. How many people resumed their former drinking habits? How many resumed drinking at a lower level? How many decided to stay alcohol-free, at least for now?

Curious if there was any actual data on this, I went sleuthing and dug up a 2023 study that found 7% of “emerging adults” (ages 18-29) had participated in Dry January or another temporary alcohol abstinence challenge in the previous year, with half reporting drinking less after the challenge and 15% remaining abstinent. A British study published in 2016  found that six months after participating in Dry January, people drank alcohol one fewer day per week, on average, and consumed nearly one fewer drink less on each day they did drink, compared with their previous alcohol use.

Who’s more likely to participate in an alcohol abstinence challenge? Females with a higher education and income level, according to a 2022 review of six published studies and seven reports on one-month abstinence challenges. Temporary abstainers are also likely to be heavier drinkers and be more concerned about the effects of alcohol on health. Those concerns have merit.

It’s long been thought that moderate alcohol consumption — or at least red wine consumption — had benefits for heart health. After all, red wine is part of the Mediterranean diet. However, that belief was supported by research that observed associations between moderate intake and better heart health, and sometimes other aspects of health. But associations can’t prove cause-and-effect in the way that randomized control trials can, and the reality is it would be unethical to randomly assign people to drink moderately, heavily or not at all for months or years. It’s also important to ask the question: Who are moderate drinkers, and what other factors in their lives could promote heart health? Are they more likely to have higher socioeconomic status, to be physically active, to eat a lot of vegetables?

What was also missing was a real understanding of what mechanisms might connect alcohol intake to health or disease. Some recent research is helping to fill that in. For example, a study from Boston and Tufts universities published last fall found that alcohol consumption may either benefit or harm heart health, depending on what metabolites — small molecules produced by many cellular processes — are produced in response to drinking.

A number of previous studies had looked at associations between alcohol consumption in a single drinking episode and metabolites circulating in the blood. For this new study, to look at potential effects of habitual or long-term alcohol consumption, researchers used data from 2,428 participants to look for connections between cumulative average alcohol intake over 20 years with circulating metabolites. Then they looked at the connection between alcohol-associated metabolites and new cases of cardiovascular disease.

The average age of the group of participants was 56 at the time their metabolites were measured. The researchers found that among the 60 metabolites associated with alcohol consumption, some may reduce risk of cardiovascular disease, while others (such as certain triglycerides) may increase risk — and that the positive and negative effects seemed to cancel each other out. However, the authors noted that if other lifestyle or environmental factors disrupt the balance of metabolites, it’s possible that one effect may prevail, for better or for worse. Future research will hopefully find more conclusive answers.

More intriguing research came from researchers at Massachusetts General Hospital last year, suggesting that stress might be the link between moderate alcohol consumption and lower heart disease risk. Brain imaging showed lower levels of stress signaling in the amygdala — the region of the brain associated with stress responses such as increased blood pressure and heart rate — in light-to-moderate drinkers, compared with study participants who abstained or drank little. Importantly, these effects were longer term (not only right after having a drink) and appeared to account for much of the reduction in heart disease risk, including fewer heart attacks and strokes, observed in the light-to-moderate drinkers.

Now for a big “but.” The researchers aren’t advocating for drinking as a mode of stress relief, largely because of alcohol’s other potential negative health effects. For example, the study found that among people who consumed more than 14 alcoholic beverages per week, risk of heart attack increased and overall brain activity decreased. It also found that any amount of alcohol increased the risk of cancer.

According to the World Cancer Research Fund and the American Institute for Cancer Research , there is strong evidence that two or more drinks per day increases the risk of colon cancer, and three or more drinks per day increases the risk of stomach and liver cancer. There’s also strong evidence that drinking alcohol at all increases the risk of cancers of the mouth, throat and esophagus, as well as pre- and postmenopausal breast cancer — the evidence is even stronger for the latter.

The Global Burden of Disease Study 2016, coordinated by the University of Washington’s Institute for Health Metrics and Evaluation, used 694 sources of individual and population-level alcohol consumption, along with 592 studies on the risk of alcohol to estimate that nearly 3 million deaths globally in 2016 were attributed to alcohol use. The authors found that cancer risk rises with increasing levels of consumption, and the level of consumption that minimizes health risk is zero .

So what does this mean for you, if you happen to enjoy beer, wine, a cocktail or all of the above? It means reflecting and reconciling this against the weight of the evidence that consuming alcohol does carry risks — even if you’re careful to not drive under the influence . Use the facts to make a conscious decision about whether or how much to drink that aligns with the level of personal risk you are comfortable with.

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The opinions expressed in reader comments are those of the author only and do not reflect the opinions of The Seattle Times.

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Volume 38 Issue 1 1 January 2016

Alcohol Consumption in Demographic Subpopulations: An Epidemiologic Overview

Part of the Topic Series: Alcohol Use Among Special Populations

Erin Delker, M.P.H.; Qiana Brown, Ph.D., M.P.H., M.S.W.; and Deborah S. Hasin, Ph.D.

Erin Delker, M.P.H., is an assistant research scientist at the New York State Psychiatric Institute, New York, New York.

Qiana Brown, Ph.D., M.P.H., M.S.W., is a postdoctoral research fellow in the Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York.

Deborah S. Hasin, Ph.D., is professor of epidemiology at Columbia University Medical Center/New York State Psychiatric Institute, New York, New York.

Alcohol consumption is common across subpopulations in the United States. However, the health burden associated with alcohol consumption varies across groups, including those defined by demographic characteristics such as age, race/ethnicity, and gender. Large national surveys, such as the National Epidemiologic Survey on Alcohol and Related Conditions and the National Survey on Drug Use and Health, found that young adults ages 18–25 were at particularly high risk of alcohol use disorder and unintentional injury caused by drinking. These surveys furthermore identified significant variability in alcohol consumption and its consequences among racial/ethnic groups. White respondents reported the highest prevalence of current alcohol consumption, whereas alcohol abuse and dependence were most prevalent among Native Americans. Native Americans and Blacks also were most vulnerable to alcohol-related health consequences. Even within ethnic groups, there was variability between and among different subpopulations. With respect to gender, men reported more alcohol consumption and binge drinking than women, especially in older cohorts. Men also were at greater risk of alcohol abuse and dependence, liver cirrhosis, homicide after alcohol consumption, and drinking and driving. Systematic identification and measurement of the variability across demographics will guide prevention and intervention efforts, as well as future research.

Alcohol consumption is common across diverse populations in the United States; however, the level of consumption and its consequences vary considerably across major demographic subgroups. This review presents findings on the distribution and determinants of alcohol use and its aspects (i.e., age of onset, abstention vs. any drinking, binge drinking, and heavy drinking), alcohol abuse and dependence as defined in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM–IV) (American Psychiatric Association 1994), 1 and related health consequences . The health consequences considered include a selection of those often linked to alcohol consumption, such as unintentional and intentional injuries as well as liver disease (World Health Organization 2011). The article aims to summarize recent research and provide a comprehensive depiction of alcohol consumption and alcohol-related group differences across age, race/ethnicity, and gender. The growing emphasis on these group differences in alcohol epidemiologic research can expand our understanding of the etiology of alcohol use disorder (AUD), including the contribution of social contextual risk factors, and the receipt of prevention and treatment services.

1 Alcohol Research: Current Reviews generally uses the term alcoholuse disorder (AUD) to denote the full range of disorders, from abuse to dependence, associated with heavy drinking, as specified in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (American Psychiatric Association 2013). Exceptions to this policy may be made when referring to studies using other diagnostic criteria. For more detail on the specific criteria used to diagnose the disorders mentioned in this article, readers should consult the original studies cited in the text.

The information presented in this article is based primarily on self-reported alcohol use as ascertained in two large s urveys of the U.S. general population— the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) and the National Survey on Drug Use and Health (NSDUH). The NESARC, funded by the National Institute on Alcohol Abuse and Alcoholism, with supplemental funding from the National Institute on Drug Abuse, is a two-wave, longitudinal study of adults ages 18 and older that provides rich information on the epidemiology of alcohol and drug use disorders, psychiatric disorders, other health-related conditions and characteristics, and risk and protective factors (Grant et al. 2004). To ascertain these conditions, the survey used the interviewer-administered Alcohol Use Disorder and Associated Disabilities Interview Schedule—DSM–IV Version (AUDADIS–IV) (Grant 1997). Wave 1 was conducted in 2001–2002 and Wave 2 in 2004–2005. The NSDUH, funded by the Substance Abuse and Mental Health Services Administration (SAMHSA), is a national cross-sectional survey conducted annually of people ages 12 and older that is designed to track trends in substance use and other variables and collects data on substance use through self-administered computerized interviews (SAMHSA 2014) .

The estimates presented throughout this article were derived across both waves of the NESARC as well as across several years of the NSDUH. Use of both of these datasets gives readers a comprehensive overview of findings from large-scale U.S. surveys on the epidemiology of alcohol consumption. In addition, the NESARC and NSDUH complement one another in several ways:

  • Both surveys include adults age 18 and older. In addition, the NSDUH assesses alcohol and other drug use among adolescents (i.e., ages 12–17). Therefore, incorporating information from both surveys presents a picture of alcohol consumption across the life course.
  • Test–retest reliability coefficients for AUDADIS–IV alcohol consumption and AUD diagnoses have been shown to be good to excellent (kappa ≥ 0.60) in a wide range of studies in the United States (Canino et al. 1999; Grant et al. 1995, 2003; Hasin et al. 1997) and elsewhere (Chatterji et al. 1997; Vrasti et al. 1998). AUDADIS–IV alcohol dependence also demonstrated fair to very good concordance with a clinician-administered interview (Cottler et al. 1997) and psychiatrist re-interviews (Canino et al. 1999). The alcohol-dependence factor structure was significantly associated with external criterion variables (Grant et al. 2007), offering further support for the validity of the diagnosis. Less reliability and validity information is available on the NSDUH measure of AUD.
  • The NSDUH data have been collected annually on a cross-section of the population, thus supplying a different type of information (i.e., yearly trends) that is not captured in the two waves of the NESARC.
  • The two waves of interviews of the NESARC respondents 3 years apart constitute a longitudinal study following a large national cohort of people over time. This allows for causal inference, specifically regarding temporality, as well as for estimates of incidence, persistence, and offset when considering determinates of alcohol use and AUD. In contrast, discerning temporal ordering of variables is more difficult in cross-sectional designs, such as that of the NSDUH.

In addition to the NESARC and NSDUH, this article includes other recently published data from peer- reviewed journals to present the most current information and additional relevant research to supplement findings from these surveys.

Alcohol-Use Epidemiology

In the NESARC Wave 1 sample, approximately 65 percent of respondents reported any past-year con- sumption and 51 percent reported consuming at least 12 drinks in the past year (Dawson et al. 2004). Further, 17.8 percent and 4.7 percent, respectively, reported symptoms and criteria indicating a diagnosis of lifetime and past-year alcohol abuse, and 12.5 and 3.8 percent, respectively, reported symptoms and criteria indicating a diagnosis of lifetime and past-year alcohol dependence (Grant et al. 2004; Hasin et al. 2007). Similar results were obtained in secondary analyses with the 2002 NSDUH sample, the survey for which data are available that corresponds most closely to the NESARC Wave 1 sample. In the 2002 NSDUH, approximately 88 percent of respondents reported any alcohol consumption in their lifetime and around 70 percent reported past-year consumption (Grucza et al. 2007). Thus, the differences in estimates are slight.

The two-wave study design of the NESARC enabled researchers to make accurate estimates of the incidence and persistence of alcohol abuse and dependence over a 3-year period. Incident cases are those respondents who developed a disorder for the first time in their lives during the specified period (Grant et al. 2009). In the NESARC, 1-year incidence of alcohol abuse was 1.02 percent and 1-year incidence of alcohol dependence was 1.70 percent (Grant et al. 2009). Persistent cases are respondents who met the criteria for a current disorder at Wave 1 and continued to meet these criteria throughout the 3-year period. An analysis of the persistence of alcohol dependence between Waves 1 and 2 of the NESARC indicated that the disorder persisted in 30.1 percent of respondents with alcohol dependence at baseline (Hasin et al. 2011).

The following sections examine alcohol use and its consequences in specific subgroups of the general U.S. population based on age, race/ethnicity, and gender.

Alcohol Use and Its Consequences in Different Age Groups

In data analyses by age, the NESARC and NSDUH samples frequently have been collapsed into different age groups. NESARC results commonly are presented in four age groups: 18–29 years, 30–44 years, 45–64 years, and 65 years and older. NSDUH results commonly are divided into five age groups: 12–17 years, 18–25 years, 26–35 years, 36–49 years, and 50 years and older. For clarity, the specific age groups analyzed are clearly identified below when presenting published findings.

More generally, the population can be subdivided into adolescents, young adults, middle-aged adults, and older adults; accurate information on drink ing behaviors and related consequences is important for each of these groups. Among adolescents and young adults, alcohol consumption from an early age can have long-term effects on the trajectory of drinking and health consequences across the life course (Patrick et al. 2013); moreover, these two age groups represent the peak age of onset for AUD (Hasin et al. 2007). Middle-aged adults are important to study because many people whose AUD began in young adulthood “mature out” of such a disorder in this age group (Dawson et al. 2005, 2006; Lee et al. 2013; Watson and Sher 1998); further, the mean age of individuals with AUD is 42.2 years (Cohen et al. 2007). Finally, it is essential to examine alcohol use in older adults, because alcohol consumption in this age group can exacerbate many pre-existing vulnerabilities to physical and mental health problems (Sacco et al. 2009).

Abstention Versus Drinking and Binge Drinking

Despite the fact that alcohol sales to individuals under age 21 are illegal in the United States, many initiate drinking between the ages of 12 and 14, and the prevalence of alcohol use and binge alcohol use increases sharply as adolescents transition into early adulthood (i.e., ages 18–21) (Faden 2006). Consistent with previous studies (Grant 1997; Grant et al. 2001), early drinking initiation in NESARC participants predicted frequency of binge drinking between Waves 1 and 2 (Hingson and Zha 2009). In the NESARC Wave 2 sample, the risk for binge drinking in the 12 months before Wave 2 was approximately twice as high among respondents with drinking onset at age 16 or younger compared with respondents whose drinking began at age 21 or older (Hingson and Zha 2009). In fact, drinking onset across all adoles cent age groups (i.e., age 14 or younger , age 15–16, age 17–18, and age 19–20) was associated with significantly higher odds of binge drinking compared with drinking onset at age 21 (i.e., the minimum legal drinking age) (Grant et al. 2001).

The prevalence of any alcohol consumption peaks among young adults. Thus, 73.1 percent of NESARC Wave 1 respondents ages 18–29 reported drinking in the past year. Further, 21.1 percent of young adults reported drinking heavily (5 or more drinks for men or 4 or more drinks for women) more than once a month, and 11 percent reported drinking heavily more than once a week (Dawson et al. 2004). Among young adults, those enrolled in college drink heavily more frequently than their nonstudent counterparts (Dawson et al. 2004).

After age 30, the incidence and prevalence of alcohol consumption generally decreases gradually with age, particularly after age 65 (Chan et al. 2007). In the 2002 NESARC, respondents ages 30–44 had a 25 percent lower prevalence of any past-year drinking compared with respondents ages 18–29. Respondents ages 45–64 and age 65 and older had a 50 percent and 68 percent, respectively, lower prevalence of any past-year drinking compared with the youngest group (Dawson et al. 2004). In the 2002 NSDUH, lifetime and past-year alcohol-use prevalence among adults age 65 and older was 78 percent and 50 percent, respectively (Moore et al. 2009). In the NESARC Wave 1 sample, the odds of past-year alcohol use were particularly low among respondents age 85 or older (odds ratio [OR] = 0.64) and ages 75–84 (OR = 0.64), compared with a reference group of 65- to 74-year-olds (Moore et al. 2009). More recently, in the 2007 NSDUH sample, 43 percent of adults age 65 and older reported past-year alcohol use (Blazer and Wu 2011). The mean number of drinks per drinking occasion also declines with age. Thus, adults ages 18–34 on average consume more than 2 drinks per drinking occasion, adults ages 35–64 between 1 and 2 drinks per occasion, and adults age 65 and older less than 1 drink per occasion (Chan et al. 2007).

DSM-IV–Defined Alcohol Dependence and Abuse

In the NESARC, prevalence of current and lifetime alcohol abuse and dependence generally decreased with age (Hasin et al. 2007). A similar pattern was evident for incident AUD (Grant et al. 2009). Age of drinking onset also was a predictor of alcohol dependence and abuse in both the NSDUH and NESARC. Among NSDUH respondents age 21 or older at the time of the interview who had started drinking before age 14, about 15 percent reported an AUD after age 21. Among those who had begun to drink at ages 15–17, ages 18–20, or age 21 and older, in contrast, only 9 percent, 5 percent, and 2 percent, respectively, reported an AUD after age 21 (SAMHSA 2014). In the NESARC, respondents with drinking onset before age 16 had approximately twice the odds of developing alcohol dependence/abuse between Waves 1 and 2 compared with respondents whose drinking began at age 21 or later (Hingson and Zha 2009).

In addition, compared with the oldest age group (i.e., age 50 and older), the odds of incident alcohol abuse and dependence after controlling for NESARC Wave 1 demographic and clinical characteristics were significantly higher among people ages 20–29, with ORs of 11.6 for alcohol abuse and 8.7 for alcohol dependence. The risk also was higher among respondents ages 30–54 compared with people age 55 and older (OR = 4.3 for alcohol abuse and OR = 3.5 for alcohol dependence) (Grant et al. 2009). Overall, in the NESARC, 1.2 percent of women and 4.8 percent of men age 50 and older were classified as having either current alcohol dependence or current alcohol abuse (Balsa et al. 2008). Similarly, in the 2005–2007 NSDUH, 1.9 percent and 2.3 percent of adults ages 50–64 endorsed dependence and abuse, respectively, as did 0.6 percent and 0.9 percent, respectively, of adults ages 65 and older (Blazer and Wu 2011).

People in older age groups not only have lower prevalence of alcohol abuse or dependence but also have fewer alcohol-related role-function problems (e.g., problems at work or school). Thus, in the NSDUH, adults ages 26–34 had higher odds of such problems compared with adults ages 65 and older, followed by young adults ages 18–25 and adults ages 35–49, respectively (Alameida et al. 2010).

The finding that younger cohorts were at a higher risk of AUD in both surveys could indicate a true age effect or could be the result of underrepresentation among older cohorts as a result of differential mortality or poor recall of remote events. Birth cohort effects, or historical effects, also may contribute to the observed findings, but prospective population-based investigation is required to adequately address this issue.

Alcohol-Related Health Consequences

The health burden associated with alcohol use stretches across the lifespan, beginning in utero, with prenatal alcohol exposure resulting in a variety of adverse birth effects, including fetal alcohol syndrome as the most severe consequence (Warren et al. 2011). Over the life course, alcohol use contributes to a variety of health conditions and risk behaviors. Among adolescents, heavy alcohol use is correlated with other risky health behaviors, including tobacco use, violence, suicide, and driving under the influence (Windle 2003). In the NESARC Wave 1 sample, young adults ages 20–29 were most likely to engage in risk behavior after drinking (age 20–24 versus 50 or older, OR = 6.5; age 25–29 versus 50 or older, OR = 4.2) compared with older adults (age 50 or older). The oldest age group (age 50 or older) in the sample was the least likely to drive under the influence of alcohol (Hingson and Zha 2009). Overall, the proportion of alcohol-related deaths was highest among young adults ages 18–24 and decreased with age (Rehm et al. 2014).

Alcohol Use and Its Consequences in Different Racial/Ethnic Groups

In analyses of NESARC data, alcohol consumption and AUD most commonly have been investigated in five U.S. Census–defined racial/ethnic groups: Whites, Blacks, Native Americans, Asians, and Hispanics. The NSDUH uses the same racial/ethnic categories, with the addition of respondents reporting two or more races, because over time, individuals are increasingly endorsing more than one race, indicating a growing population of people identifying as biracial or multiracial (Hirschman et al. 2000; Jones and Bullock 2012).

In the 2007 NSDUH, current (i.e., past 30 days) alcohol consumption was most prevalent among Whites (59.8 percent) and least prevalent among Asian Americans (38.0 percent). Native Americans/Alaskan Natives (47.8 percent), Hispanics (46.3 percent), and Blacks (43.8 percent) reported similar prevalence of any alcohol consumption (Chartier and Caetano 2010). In the NESARC Wave 1, the prevalence of current alcohol consumption was highest among Whites (63.5 percent), followed by Hispanics (60.3 percent) and Blacks (52.5 percent) (Caetano et al. 2010). However, the prevalence of weekly drinking (i.e., once per week or more) was higher among Hispanics (14.1 percent) than among Whites (13.6 percent) and Blacks (11.4 percent) in the same sample (Caetano et al. 2010).

An analysis of Asian-American adults from the NESARC Wave 2 sample showed that Asians reported the least amount of drinking compared with other groups. However, hetero geneity in alcohol consumption existed within this group, with Korean, Japanese, Taiwanese, and Chinese subpopulations reporting the highest per-capita annual alcohol consumption and Vietnamese, Malaysian, Indian/Afghan/Pakistani, and Indonesian groups reporting the lowest consumption (Cook et al. 2012). The level of acculturation, measured by the use of the subject’s native Asian language, also influenced patterns of alcohol consumption. Among Asian Americans from countries of origin with low per-capita annual alcohol consumption, the probability of being a current drinker was highest among those who reported low use of Asian languages. Among Asian Americans from countries of origin with higher per-capita annual alcohol consumption, the probability of being a current drinker was similar regardless of Asian-language use (Cook et al. 2012).

Hispanic subgroups also display heterogeneity in alcohol consumption. In the 2003–2005 NSDUH, the prevalence of current alcohol use was highest among Cubans, followed by Puerto Ricans, Mexicans, and people of Central/South American descent (Lipsky and Caetano 2009). These patterns differed for binge and heavy drinking, which had the highest prevalence among Puerto Ricans, followed by Mexicans, Cubans, and Central/South Americans. Varying degrees of acculturation may help to explain these subgroup differences among Hispanics; however, the impact of acculturation on drinking also may vary by gender and age (Lipsky and Caetano 2009).

Racial/ethnic differences also exist with respect to binge drinking and heavy drinking during pregnancy. Pregnant White women reported more binge drinking during pregnancy than other racial/ethnic groups (Caetano et al. 2006). However, another study using the Pregnancy Risk Assessment Monitoring System (2001–2005) found that among those who binge drank in the last month, Black, Hispanic, and Asian women were less likely to reduce heavy drinking during pregnancy compared with White women (Tenkku et al. 2009). More research on alcohol consumption patterns among pregnant women by ethnic group is needed to better elucidate racial disparities in the risk for fetal alcohol syndrome (Tenkku et al. 2009).

Both alcohol abuse and alcohol dependence are most prevalent among Native Americans and least prevalent among Blacks and Asians. For example, among Native Americans in the NESARC Wave 1 sample, 5.8 percent met criteria for past-year alcohol abuse and 6.4 percent met criteria for past-year alcohol dependence, whereas among Asians, 2.1 percent met criteria for past-year alcohol abuse and 2.4 percent met criteria for past-year alcohol dependence (Hasin et al. 2007). Amon g Blacks, the prevalence for past-year alcohol abuse and dependence was 3.3 percent and 3.6 percent, respectively, and among Hispanics it was 4.0 percent for both past-year abuse and dependence (Hasin et al. 2007). Among drinkers, Blacks and Hispanics reported more symptoms of past-year alcohol dependence than did Whites (Mulia et al. 2009).

One-year incident rates of alcohol abuse and dependence in the NESARC Wave 2 sample varied little by race (Grant et al. 2009). However, this analysis did not include Native Americans or Asians because of small sample sizes. The only significant difference by race was that Blacks had significantly lower odds than Whites to report incident alcohol abuse (OR = 0.6) at Wave 2 of the NESARC, controlling for Wave 1 demographic characteristics and psychiatric disorders. No significant differences existed between Hispanics and Whites (OR = 0.8) (Grant et al. 2009).

A more recent analysis of Asians within the NESARC Wave 1 sample demonstrated some variations in the lifetime prevalence of AUD among Asian-American ethnic subgroups. For example, 5.4 percent of East Asians (i.e., whose countries of origin were the People’s Republic of China, Japan, Korea, or the Republic of China [Taiwan]), 4.3 percent of Southeast Asians (i.e., whose countries of origin were Indonesia, Malaysia, Vietnam, Thailand, Laos, Cambodia, Myanmar, or a Pacific Island nation), and 3.6 percent of South Asians (i.e., whose countries of origin were India, Afghanistan, Pakistan, or Iran) met criteria for a DSM–IV AUD (Lee et al. 2015).

Among Hispanic subgroups, the prevalence of alcohol abuse and dependence was highest in Mexicans, followed by Puerto Ricans, and was lowest among Cubans (Lipsky and Caetano 2009). Some Hispanic subgroups exhibited a protective effect of foreign-born nativity on risk for alcohol abuse or dependence. For example, in NESARC Wave 1, 4.8 percent of foreign-born Cuban Americans reported a lifetime DSM–IV AUD, compared with 28.1 percent of U.S.-born Cuban Americans. A similar, albeit less extreme, pattern was found among Puerto Ricans, with 14.5 percent of island-born Puerto Ricans but 21.4 percent of U.S.-born Puerto Ricans reporting a lifetime AUD (Alegria et al. 2006).

The burden of alcohol consumption and AUD on physical health varies by racial/ethnic group. Hispanic White males have higher age-adjusted death rates from liver cirrhosis than non-Hispanic White males, Hispanic Black males, non-Hispanic Black males, and females (i.e., Hispanic White females, non-Hispanic White females, Hispanic Black females, and non-Hispanic Black females) (Yoon and Yi 2012). Within the Hispanic subgroup, Puerto Ricans and Mexicans have the highest mortality rates attributable to liver cirrhosis. Conversely, Asians had the lowest death rates attributable to alcoholic liver disease of all racial/ethnic groups (Hoyert and Xu 2012).

Genetic factors may contribute to racial/ethnic differences in alcohol-related health consequences. For example, in Asian populations, including Asian Americans (Cook et al. 2005; Duranceaux et al. 2008), the prevalence of certain genetic variants encoding the alcohol-metabolizing enzymes alcohol dehydrogenase (ADH) and acetaldehyde dehydrogenase 2 (ALDH2) is higher than in other U.S. racial/ethnic groups. One genetic variant encoding an inactive ALDH2 enzyme that is found primarily in Asian populations is associated with an elevated risk of cancer and d igestive disease from alcohol consumption (Oze et al. 2011). This association may apply to Asian Americans as well, a topic warranting further research.

The prevalence of accidents and injuries associated with alcohol consumption, especially with heavy drinking and AUD, also often varies across racial/ethnic groups. For example, the National Violent Death Reporting System provides toxicological information on suicide victims based on coroner/medical examiner reports, death certificates, and toxicological laboratory findings. Analyses of these data have shown that fewer non- Hispanic Blacks (25.6 percent) had positive blood alcohol concentrations at the time of suicide compared with Hispanics (40.3 percent) and non-Hispanic Whites (34.3 percent) (Karch et al. 2006).

Alcohol consumption also is associated with violent crimes. In one study, the offender was under the influence of alcohol in 42 percent of violent crimes studied. However, this percentage differed substantially among racial/ethnic groups and was greatest among Native Americans (62 percent), followed by Whites (43 percent), Blacks (35 percent), and Asians (33 percent) (Chartier et al. 2013). Furthermore, although Blacks in the United States have lower prevalence of alcohol consumption, binge drinking, and AUD compared with non-Hispanic Whites, they still had higher prevalence of alcohol-related homicide (Stahre and Simon 2010). Likewise, Blacks reported drinking during an episode of interpersonal violence more often (i.e., in 41.4 percent of cases) compared with Whites (29.4 percent) and Hispanics (29.1 percent) (Chartier et al. 2013).

Racial/ethnic differences also exist in the prevalence of alcohol use in traffic crashes. According to the National Highway Traffic Safety Administration, the prevalence of intoxication among drivers who are fatally injured in car crashes is highest among Native Americans and Hispanics, followed by Whites, Blacks, and Asians (Chartier et al. 2013). Moreover, Native Americans (4.1 percent) and Whites (3.3 percent) report drinking and driving significantly more often than do Asians (1.4 percent), Hispanics (2.1 percent), and Blacks (1.5 percent) (Chou et al. 2006). However, significant heterogeneity regarding alcohol use and traffic crashes exists within Asians subgroups, with Pacific Islanders and Native Hawaiians reporting prevalence of alcohol-related motor vehicle crashes similar to that of Hispanics (Chartier et al. 2013).

In summary, ethnic minorities make up more than one-fifth of the U.S. population (U.S. Census Bureau 2013). Their risk for drinking, AUD, and other alcohol-related consequences differs markedly. Studies consistently find that Native Americans are at particularly high risk for alcohol-related health consequences. However, despite these negative consequences for Native Americans, their impact on alcohol- related health consequences in the U.S. population overall is less pronounced because Native Americans are a relatively small racial group compared with others. Future research is needed on various ethnic and racial groups to better inform the allocation of prevention and intervention efforts.

Gender-Differences in Alcohol Use and Its Consequences

Among NESARC Wave I participants, 40 percent of women were abstinent in the past year, compared with 32 percent of men. In addition, men reported more drinks per drinking occasion than women (Chan et al. 2007). Likewise, in the 2011 NSDUH, 57.4 percent of men were past-month drinkers compared with only 46.5 percent of women (Wilsnack et al. 2013). Although epidemiologic findings consistently support that men are at increased risk for alcohol consumption, current drinking, and heavy drinking compared with women, this gap is closing in younger cohorts (Keyes et al. 2008, 2010; SAMHSA 2014). As Western social norms continue to shift away from “traditional” gender roles that see women only as homemakers and mothers, women report greater lifetime largest number of drinks consumed in one sitting and greater frequency of binge drinking than they did in earlier surveys, leading to a closing of the gender gap not only in consumption but also in alcohol-related consequences (Keyes et al. 2008, 2010).

Of particular concern regarding drinking among women is alcohol consumption during pregnancy. Any alcohol drinking during pregnancy can be unsafe (Vall et al. 2015). In particular, binge drinking and heavy drinking during pregnancy are harmful to the fetus and have been related to increased risk for fetal alcohol syndrome (Caetano et al. 2006; Vall et al. 2015). In the NESARC Wave 1 sample, about one-third of pregnant women reported drinking during the last year (Caetano et al. 2006). In the combined NSDUH data from 2012 and 2013, the percentage of pregnant women who reported binge drinking and heavy drinking was 2.3 percent and 0.4 percent, respectively (SAMHSA 2014).

In the NESARC Wave 1, the prevalence of current (i.e., in the last 12 months) alcohol abuse and alcohol dependence was 6.9 percent and 5.4 percent, respectively, among men and 2.6 percent and 2.3 percent, respectively, among women (Hasin et al. 2007). Also, between NESARC Wave 1 and Wave 2, men had significantly higher odds than women to develop incidents of alcohol abuse (OR = 2.3) and dependence (OR = 2.4), controlling for Wave 1 demographic characteris tics and psychiatric disorders (Grant et al. 2009).

Clinicians often consider AUD among women as “telescoped,” with a later onset of alcohol use but shorter times from initiation to dependence and treatment (Keyes et al. 2008). However, in a recent analysis, Keyes and colleagues (2008) found little evidence for a telescoping effect among women in the general population. Further, sex differences in the prevalence of AUD seem to have decreased over time. As a result, younger women may require more targeted prevention and intervention efforts (Keyes et al. 2008, 2011). Current (Brown et al. 2012) and lifetime (Cavanaugh and Latimer 2010) alcohol abuse or dependence were prevalent among pregnant women (Vesga-Lopez et al. 2008), emphasizing the need for targeted interventions among this population (Mitchell et al. 2008). Women who had been pregnant in the past year also were 1.7 times more likely than non-pregnant women to seek treatment for alcohol abuse or dependence in the previous year (Vesga-Lopez et al. 2008).

Mortality associated with AUD is higher among men than among women (Rehm et al. 2014). For example , with the exception of Native Americans, mortality rates from alcoholic liver disease were at least twice as high among men compared with women (Hoyert and Xu 2012). Gender differences also existed with respect to alcohol-related morbidity. Thus, although alcohol overall contributed to 32 percent of liver cirrhosis cases, the rates differed significantly between men (39 percent of cases) and women (18 percent of cases) (Room et al. 2005).

With regard to alcohol-related accidents and injuries, males were more likely than females to drive after drinking too much in most age and racial/ethnic groups (Chou et al. 2006). Alcohol also contributed to 7 percent of falls, 10 percent of drowning incidents, and 18 percent of poisonings each year, mostly among men, as well as to a greater proportion of self-inflicted injuries among males (15 percent) than among females (5 percent) (Room et al. 2005). Moreover, male gender was a significant risk factor for alcohol- related suicide in all racial/ethnic groups except Native Americans, where alcohol was involved in similar propor tions of male and female suicides (Chartier et al. 2013). Overall, the groups reporting the highest rates of alcohol use among suicide victims were Native Americans ages 30–39, Native Americans and Hispanics ages 20–29, and Asians ages 10–19 (Chartier et al. 2013). Finally, alcohol contributed to 24 percent of homicides, with the proportion of alcohol-related homicides higher among males (26 percent) than among females (16 percent) (Room et al. 2005).

Methodological Issues

Despite the usefulness of using data from two nationally representative surveys to obtain an accurate picture of alcohol use and its consequences in the U.S. population, methodological differences between the two surveys may have contributed to some differences in population estimates (Grucza et al. 2007). For example, the private, self-administered questions in the NSDUH may have elicited some higher prevalence estimates of use than the face-to-face interviews used in the NESARC. However, the NESARC indicates a higher prevalence of AUD, perhaps resulting from the greater number of items that allowed for more in-depth probing of DSM–IV abuse and dependence criteria. Other factors, including response rates, questionnaire structures, and question text also could contribute to different estimates. Although any of these factors may have contributed to differences between the two surveys (Grucza et al. 2007), the largely common findings across the surveys attest to the robustness of the findings to methodological variation.

Conclusions

In the United States, AUD accounts for a high and potentially preventable proportion of overall disability and mortality. However, the burden of disease related to alcohol use and its consequences differs significantly between population subgroups. The myriad of genetic, social, and environmental risk factors for AUD and their impact in various subpopulations remain to be elucidated. Future epidemiologic studies will include information necessary to prevent and treat alcohol and drug use disorders by identifying factors that increase the risk of these disorders and their persistence in the general population as well as in specific subgroups.

Population-level surveys, such as the NSDUH and the NESARC, are valu able tools to describe the epidemiology of alcohol consumption and AUD in the United States. Although varying methodology may limit comparability and interpretation of estimates between these epidemiologic studies, both surveys were conducted in nationally representative samples with methodological rigor. Consequently, both surveys present a valid depiction of alcohol consumption and related disorders and can offer important information needed to develop evidence-based measures to prevent the onset of AUD and comorbidity, as well as to identify factors that increase the risk of alcohol problems.

A better understanding of the age, race/ethnicity, and gender-based differences in the various alcohol variables discussed in this review would be gained by considering the social, political, and economic context of alcohol use in various populations. These factors are discussed further in other articles in this issue.

Acknowledgments

This research was supported by grants from the National Institutes of Health (U01–AA–018111; to Hasin), T32–DA–031099; to Brown [PI] and Hasin, and the New York State Psychiatric Institute (to Hasin).

Disclosures

The authors declare that they have no competing financial interests.

Alameida, M.D.; Harrington, C.; LaPlante, M.; and Kang, T. Factors associated with alcohol use and its consequences. Journal of Addictions Nursing 21(4):194–206, 2010.

Alegria, M.; Canino, G.; Stinson, F.S.; and Grant, B.F. Nativity and DSM–IV psychiatric disorders among Puerto Ricans, Cuban Americans, and non-Latino Whites in the United States: Results from the National Epidemiologic Survey on Alcohol and Related Conditions. Journal of Clinical Psychiatry 67(1):56–65, 2006. PMID: 16426089

American Psychiatric Association (APA). Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Washington, DC: APA, 1994.

APA. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Washington, DC: APA, 2013.

Balsa, A.I.; Homer, J.F.; Fleming, M.F.; and French, M.T. Alcohol consumption and health among elders. Gerontologist 48(5):622–636, 2008. PMID: 18981279

Blazer, D.G., and Wu, L.T. The epidemiology of alcohol use disorders and subthreshold dependence in a middle-aged and elderly community sample. American Journal of Geriatric Psychiatry 19(8):685–694, 2011. PMID: 21785289

Brown, Q.L.; Cavanaugh, C.E.; Penniman, T.V.; and Latimer, W.W. The impact of homelessness on recent sex trade among pregnant women in drug treatment. Journal of Substance Use 17(3):287–293, 2012. PMID: 22754382

Caetano, R.; Baruah, J.; Ramisetty-Mikler, S.; and Ebama, M.S. Sociodemographic predictors of pattern and volume of alcohol consumption across Hispanics, Blacks, and Whites: 10-year trend (1992–2002). Alcoholism: Clinical and Experimental Research 34(10):1782–1792, 2010. PMID: 20645935

Caetano, R.; Ramisetty-Mikler, S.; Floyd, L.R.; and McGrath, C. The epidemiology of drinking among women of child-bearing age. Alcoholism: Clinical and Experimental Research 30(6):1023–1030, 2006. PMID: 16737461

Canino, G.; Bravo, M.; Ramirez, R.; Febo, V.E.; et al. The Spanish Alcohol Use Disorder and Associated Disabilities Interview Schedule (AUDADIS): Reliability and concordance with clinical diagnoses in a Hispanic population. Journal of Studies on Alcohol 60(6):790–799, 1999. PMID: 10606491

Cavanaugh, C.E., and Latimer, W.W. Recent sex trade and injection drug use among pregnant opiate and cocaine dependent women in treatment: The significance of psychiatric comorbidity. Addictive Disorders & Their Treatment 9(1):32–40, 2010. PMID: 20672018

Chan, K.K.; Neighbors, C.; Gilson, M.; et al. Epidemiological trends in drinking by age and gender: Providing normative feedback to adults. Addictive Behaviors 32(5):967–976, 2007. PMID: 16938410

Chartier, K., and Caetano, R. Ethnicity and health disparities in alcohol research. Alcohol Research & Health 33(1–2):152–160, 2010. PMID: 21209793

Chartier, K.G.; Vaeth, P.A.; and Caetano, R. Focus on: Ethnicity and the social and health harms from drinking. Alcohol Research: Current Reviews 35(2):229–237, 2013. PMID: 24881331

Chatterji, S.; Saunders, J.B.; Vrasti, R.; et al. Reliability of the alcohol and drug modules of the Alcohol Use Disorder and Associated Disabilities Interview Schedule— Alcohol/Drug-Revised (AUDADIS-ADR): An international comparison. Drug and Alcohol Dependence 47(3):171–185,1997. PMID: 9306043

Chou, S.P.; Dawson, D.A.; Stinson, F.S.; et al. The prevalence of drinking and driving in the United States, 2001-2002: Results from the National Epidemiologic Survey on Alcohol and Related Conditions. Drug and Alcohol Dependence 83(2):137–146, 2006. PMID: 16364565

Cohen, E.; Feinn, R.; Arias, A.; and Kranzler, H.R. Alcohol treatment utilization: Findings from the National Epidemiologic Survey on Alcohol and Related Conditions . Drug and Alcohol Dependence 86(2–3):214–221, 2007. PMID: 16919401

Cook, T.A.; Luczak, S.E.; Shea, S.H.; et al. Associations of ALDH2 and ADH1B genotypes with response to alcohol in Asian Americans. Journal of Studies on Alcohol 66(2):196–204, 2005. PMID: 15957670

Cook, W.K.; Mulia, N.; and Karriker-Jaffe, K. Ethnic drinking cultures and alcohol use among Asian American adults: Findings from a national survey. Alcohol and Alcoholism 47(3):340–348, 2012. PMID: 22378829

Cottler, L.B.; Grant, B.F.; Blaine, J.; et al. Concordance of DSM–IV alcohol and drug use disorder criteria and diagnoses as measured by AUDADIS–ADR, CIDI and SCAN. Drug and Alcohol Dependence 47(3):195–205, 1997. PMID: 9306045

Dawson, D.; Grant, B.F.; Stinson, F.S.; and Chou, S.P. Toward the attainment of low risk drinking goals: A 10-year progress report. Alcoholism: Clinical and Experimental Research 28(9):1371–1378, 2004. PMID: 15365308

Dawson, D.; Grant, B.F.; Stinson, F.S.; et al. Recovery from DSM–IV alcohol dependence: United States, 2001–2002. Addiction 100(3):281–292, 2005. PMID: 15733237

Dawson, D.; Grant, B.F.; Stinson, F.S.; and Chou, S.P. Maturing out of alcohol dependence: The impact of transitional life events. Journal of Studies on Alcohol 67(2):195–203, 2006. PMID: 16568565

Duranceaux, N.C.; Schuckit, M.A.; Luczak, S.E.; et al. Ethnic differences in level of response to alcohol between Chinese Americans and Korean Americans. Journal of Studies on Alcohol and Drugs 69(2):227–234, 2008. PMID: 18299763

Faden, V.B. Trends in initiation of alcohol use in the United States 1975 to 2003. Alcoholism: Clinical and Experimental Research 30(6):1011–1022, 2006. PMID: 16737460

Grant, B.F. Prevalence and correlates of alcohol use and DSM–IV alcohol dependence in the United States: Results of the National Longitudinal Alcohol Epidemiologic Survey. Journal of Studies on Alcohol 58(5):464–473, 1997. PMID: 9273910

Grant, B.F.; Dawson, D.A.; Stinson, F.S.; et al. The Alcohol Use Disorder and Associated Disabilities Interview Schedule-IV (AUDADIS-IV): Reliability of alcohol consumption, tobacco use, family history of depression and psychiatric diagnostic modules in a general population sample. Drug and Alcohol Dependence 71(1):7–16, 2003. PMID: 12821201

Grant, B.F.; Goldstein, R.B.; Chou, S.P.; et al. Sociodemographic and psychopathologic predictors of first incidence of DSM–IV substance use, mood and anxiety disorders: Results from the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions. Molecular Psychiatry 14(11):1051–1066, 2009. PMID: 18427559

Grant, B.F.; Harford, T.C.; Dawson, D.A.; et al. The Alcohol Use Disorder and Associated Disabilities Interview Schedule (AUDADIS): Reliability of alcohol and drug modules in a general population sample. Drug and Alcohol Dependence 39(1):37–44, 1995. PMID: 7587973

Grant, B.F.; Harford, T.C.; Muthen, B.O.; et al. DSM–IV alcohol dependence and abuse: Further evidence of validity in the general population. Drug and Alcohol Dependence 86(2–3):154–166, 2007. PMID: 16814489

Grant, B.F.; Stinson, F.S.; and Harford, T.C. Age at onset of alcohol use and DSM–IV alcohol abuse and dependence: A 12-year follow-up. Journal of Substance Abuse 13(4):493–504, 2001. PMID: 11775078

Grant, B.F.; Stinson, F.S.; Dawson, D.A.; et al. Co-occurrence of 12-month alcohol and drug use disorders and personality disorders in the United States: Results from the National Epidemiologic Survey on Alcohol and Related Conditions. Archives of General Psychiatry 61(4):361–368, 2004. PMID: 15066894

Grucza, R.A.; Abbacchi, A.M.; Przybeck, T.R.; and Gfroerer, J.C. Discrepancies in estimates of prevalence and correlates of substance use and disorders between two national surveys. Addiction 102(4):623–629, 2007. PMID: 17309538

Hasin, D.; Carpenter, K.M.; McCloud, S.; et al. The Alcohol Use Disorder and Associated Disabilities Interview Schedule (AUDADIS): Reliability of alcohol and drug modules in a clinical sample. Drug and Alcohol Dependence 44(2–3):133–141, 1997. PMID: 9088785

Hasin, D.; Fenton, M.C.; Skodol, A.; et al. Personality disorders and the 3-year course of alcohol, drug, and nicotine use disorders. Archives of General Psychiatry 68(11):1158–1167, 2011. PMID: 22065531

Hasin, D.S.; Stinson, F.S.; Ogburn, E.; and Grant, B.F. Prevalence, correlates, disability, and comorbidity of DSM–IV alcohol abuse and dependence in the United States: Results from the National Epidemiologic Survey on Alcohol and Related Conditions. Archives of General Psychiatry 64(7):830–842, 2007. PMID: 17606817

Hingson, R.W., and Zha, W. Age of drinking onset, alcohol use disorders, frequent heavy drinking, and unintentionally injuring oneself and others after drinking. Pediatrics 123(6):1477–1484, 2009. PMID: 19482757

Hirschman, C.; Alba, R.; and Farley, R. The meaning and measurement of race in the U.S. census: Glimpses into the future. Demography 37(3):381–393, 2000. PMID: 10953811

Hoyert, D.L., and Xu, J. Deaths: Preliminary data for 2011. National Vital Statistics Reports 61(6):1–51, 2012. PMID: 24984457

Jones, N.A., and Bullock, J. The Two or More Races Population: 2010 . (2010 Census Briefs. Publication C201BR-13.) Washington, DC: U.S. Census Bureau, 2012 .

Karch, D.L.; Barker, L.; and Strine, T.W. Race/ethnicity, substance abuse, and mental illness among suicide victims in 13 US states: 2004 data from the National Violent Death Reporting System. Injury Prevention 12(Suppl. 2):ii22–ii27, 2006. PMID: 17170166

Keyes, K.M.; Grant, B.F.; and Hasin, D.S. Evidence for a closing gender gap in alcohol use, abuse, and dependence in the United States population. Drug and Alcohol Dependence 93(1–2):21–29, 2008. PMID: 17980512

Keyes, K.M.; Li, G.; and Hasin, D.S. Birth cohort effects and gender differences in alcohol epidemiology: A review and synthesis. Alcoholism: Clinical and Experimental Research 35(12):2101–2112, 2011. PMID: 21919918

Keyes, K.M.; Martins, S.S.; Blanco, C.; and Hasin, D.S. Telescoping and gender differences in alcohol dependence: New evidence from two national surveys. American Journal of Psychiatry 167(8):969–976, 2010. PMID: 20439391

Lee, M.R.; Chassin, L.; and Villalta, I.K. Maturing out of alcohol involvement: Transitions in latent drinking statuses from late adolescence to adulthood. Development and Psychopathology 25(4 Pt. 1):1137–1153, 2013. PMID: 24229554

Lee, S.Y.; Martins S.S.; and Lee, H.B. Mental disorders and mental health service use across Asian American subethnic groups in the United States. Community Mental Health Journal 51(2):153–160, 2015. PMID: 24957253

Lipsky, S., and Caetano, R. Epidemiology of substance abuse among Latinos. Journal of Ethnicity in Substance Abuse 8(3):242–260, 2009. PMID: 25985069

Mitchell, M.M.; Severtson, S.G.; and Latimer, W.W. Pregnancy and race/ethnicity as predictors of motivation for drug treatment. American Journal of Drug and Alcohol Abuse 34(4):397–404, 2008. PMID: 18584569

Moore, A.A.; Karno, M.P.; Grella, C.E.; et al. Alcohol, tobacco, and nonmedical drug use in older U.S. adults: Data from the 2001/02 National Epidemiologic Survey of Alcohol and Related Conditions. Journal of the American Geriatrics Society 57(12):2275–2281, 2009. PMID: 19874409

Mulia, N.; Ye, Y.; Greenfield, T.K.; and Zemore, S.E. Disparities in alcohol-related problems among White, Black, and Hispanic Americans. Alcoholism: Clinical and Experimental Research 33(4):654–662, 2009. PMID: 19183131

Oze, I.; Matsuo, K.; Wakai, K.; et al. Alcohol drinking and esophageal cancer risk: An evaluation based on a systematic review of epidemiologic evidence among the Japanese population. Japanese Journal of Clinical Oncology 41(5):677–692, 2011. PMID: 21430021

Patrick, M.E.; Schulenberg, J.E.; Martz, M.E.; et al. Extreme binge drinking among 12th-grade students in the United States: Prevalence and predictors. JAMA Pediatrics 167(11):1019–1025, 2013. PMID: 24042318

Rehm, J.; Dawson, D.; Frick, U.; et al. Burden of disease associated with alcohol use disorders in the United States. Alcoholism: Clinical and Experimental Research 38(4):1068–1077, 2014. PMID: 24428196

Room, R.; Babor, T.; and Rehm, J. Alcohol and public health. Lancet 365(9458):519–530, 2005. PMID: 15705462

Sacco, P.; Bucholz, K.K.; and Spitznagel, E.L. Alcohol use among older adults in the National Epidemiologic Survey on Alcohol and Related Conditions: A latent class analysis. Journal of Studies on Alcohol and Drugs 70(6):829–838, 2009. PMID: 19895759

Stahre, M., and Simon, M. Alcohol-related deaths and hospitalizations by race, gender, and age in California. Open Epidemiology Journal 3:3–15, 2010.

Substance Abuse and Mental Health Services Administration (SAMHSA). Results from the 2013 National Survey on Drug Use and Health: National Findings. Rockville, MD: SAMHSA, 2014.

Tenkku, L.E.; Morris, D.S.; Salas, J.; and Xaverius, P.K. Racial disparities in pregnancy-related drinking reduction. Maternal and Child Health Journal 13(5):604–613, 2009. PMID: 18780169

U.S. Census Bureau. Annual Estimates of the Resident Population by Sex, Race, and Hispanic Origin for the United States, States, and Counties: April 1, 2010 to July 1, 2012. Washington, DC: U.S. Census Bureau, 2013.

Vall, O.; Salat-Batlle, J.; and Garcia-Algar, O. Alcohol consumption during pregnancy and adverse neurodevelopmental outcomes. Journal of Epidemiology and Community Health 69:927–929, 2015. PMID: 25903753

Vesga-Lopez, O.; Blanco, C.; Keyes, K.; et al. Psychiatric disorders in pregnant and postpartum women in the United States. Archives of General Psychiatry 65(7):805–815, 2008. PMID: 18606953

Vrasti, R.; Grant, B.F.; Chatterji, S.; et al. Reliability of the Romanian version of the alcohol module of the WHO Alcohol Use Disorder and Associated Disabilities Interview Schedule–Alcohol/Drug-Revised . European Addiction Research 4(4):144–149, 1998. PMID: 9852366

Warren, K.R.; Hewitt, B.G.; and Thomas, J.D. Fetal alcoho l spectrum disorders: Research challenges and opportunities. Alcohol Research & Health 34(1):4–14, 2011. PMID: 23580035

Watson, A.L., and Sher, K.J. Resolution of alcohol problems without treatment: Methodological issues and future directions of natural recovery research. Clinical Psychology: Science and Practice 5(1):1–18, 1998.

Wilsnack, S.C.; Wilsnack, R.W.; and Kantor, L.W. Focus on: Women and the costs of alcohol use. Alcohol Research: Current Reviews 35(2):219–228, 2013. PMID: 24881330

Windle, M. Alcohol use among adolescents and young adults . Alcohol Research & Health 27(1):79–85, 2003. PMID: 15301402

World Health Organization (WHO). The Global Status Report on Alcohol and Health. Geneva: WHO, 2011.

Yoon, Y.H., and Yi, H.Y. Surveillance Report #83: Liver Cirrhosis Mortality in the United States, 1970–2005. Bethesda, MD: National Institute on Alcohol Abuse and Alcoholism, Division of Epidemiology and Prevention Research, Alcohol Epidemiologic Data System, 2012.

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The Palgrave Handbook of Psychological Perspectives on Alcohol Consumption pp 1–22 Cite as

Psychological Perspectives on Alcohol Consumption

  • Richard Cooke 8 , 9 ,
  • Dominic Conroy 10 ,
  • Emma Louise Davies 11 ,
  • Martin S. Hagger 12 , 13 &
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This chapter provides an introduction to the Handbook, setting the scene for the subsequent chapters by covering several key topics in psychological research on alcohol consumption, such as why do people drink alcohol, how drinking patterns are defined (e.g., heavy episodic drinking, low-risk drinking), and how do governments and health agencies encourage performance of low-risk drinking. The chapter goes on to discuss issues of definition and measurement of alcohol consumption in psychological research studies, beginning with a focus on limitations with self-report measures used in most studies, before a brief discussion of alternative (biological measures, observation) methods to measure consumption. The chapter ends by introducing the five sections that comprise the book.

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A UK unit equals 8 g or 10 ml of pure alcohol and is the same as a single (25 ml) shot of spirits, approximately half a 175 ml glass of wine and approximately half a pint (568 ml) of beer, 1 cider, or lager.

Anderson, P., Chisholm, D., & Fuhr, D. C. (2009). Effectiveness and cost-effectiveness of policies and programmes to reduce the harm caused by alcohol. Lancet (London, England), 373 (9682), 2234–2246. https://doi.org/10.1016/S0140-6736(09)60744-3

Article   PubMed   Google Scholar  

Babor, T. (Ed.). (2010). Alcohol: No ordinary commodity: Research and public policy . Oxford, UK: Oxford University Press.

Google Scholar  

Barratt, M. J., Ferris, J. A., Zahnow, R., Palamar, J. J., Maier, L. J., & Winstock, A. R. (2017). Moving on from representativeness: Testing the utility of the global drug survey. Substance Abuse: Research and Treatment, 11 , 117822181771639. https://doi.org/10.1177/1178221817716391

Article   Google Scholar  

Beccaria, F., Petrilli, E., & Rolando, S. (2015). Binge drinking vs. drunkenness. The questionable threshold of excess for young Italians. Journal of Youth Studies, 18 (7), 823–838. https://doi.org/10.1080/13676261.2014.992321

Bowring, A. L., Gold, J., Dietze, P., Gouillou, M., Van Gemert, C., & Hellard, M. E. (2012). Know your limits: Awareness of the 2009 Australian alcohol guidelines among young people: Alcohol guidelines: Awareness and risk. Drug and Alcohol Review, 31 (2), 213–223. https://doi.org/10.1111/j.1465-3362.2011.00409.x

Burgess, M., Cooke, R., & Davies, E. L. (2019). My own personal hell : Approaching and exceeding thresholds of too much alcohol. Psychology & Health , 34 , 1451–1469. https://doi.org/10.1080/08870446.2019.1616087

Ceballos, N., & Babor, T. F. (2017). Editor’s corner: Binge drinking and the evolving language of alcohol research. Journal of Studies on Alcohol and Drugs, 78 (4), 488–490. https://doi.org/10.15288/jsad.2017.78.488

Centers for Disease Control and Prevention. (2011). Fact sheets: Binge drinking . http://www.cdc.gov/alcohol/fact-sheets/bingedrinking.htm

Clapp, J. D., Holmes, M. R., Reed, M. B., Shillington, A. M., Freisthler, B., & Lange, J. E. (2007). Measuring college students’ alcohol consumption in natural drinking environments: Field methodologies for bars and parties. Evaluation Review, 31 (5), 469–489. https://doi.org/10.1177/0193841X07303582

Conroy, D., & Measham, F. (2020). Young adult drinking styles: Current perspectives on research, policy and practice . Palgrave Macmillan US: https://public.ebookcentral.proquest.com/choice/publicfullrecord.aspx?p=5987650

Cooke, R., French, D. P., & Sniehotta, F. F. (2010). Wide variation in understanding about what constitutes ‘binge-drinking’. Drugs: Education, Prevention and Policy, 17 (6), 762–775. https://doi.org/10.3109/09687630903246457

Cooper, M. L., Kuntsche, E., Levitt, A., Barber, L. L., & Wolf, S. (2015). Motivational models of substance use: A review of theory and research on motives for using alcohol, marijuana, and tobacco. In K. J. Sher (Ed.), The Oxford handbook of substance use disorders (Vol. 1). Oxford, UK: Oxford University Press. https://doi.org/10.1093/oxfordhb/9780199381678.013.017

Chapter   Google Scholar  

Cox, W. M., & Klinger, E. (1988). A motivational model of alcohol use. Journal of Abnormal Psychology, 97 (2), 168–180.

Crawford, J., Jones, A., Rose, A., & Cooke, R. (2020). ‘You see the pictures the morning after and you’re like I wish I was in them’: an interpretative phenomenological analysis of university student’s alcohol-related regrets. Psychology & Health . https://doi.org/10.1080/08870446.2020.1867728

Davies, E. L., Cooke, R., Maier, L. J., Winstock, A. R., & Ferris, J. A. (2020). Drinking to excess and the tipping point: An international study of alcohol intoxication in 61,000 people. International Journal of Drug Policy, 83 , 102867. https://doi.org/10.1016/j.drugpo.2020.102867

Davies, E. L., Puljevic, C., Connolly, D., Zhuparris, A., Ferris, J. A., & Winstock, A. R. (2020). The world’s favourite drug: What we have Learned about alcohol from over 500,000 respondents to the global drug survey. In D. Frings & I. P. Albery (Eds.), Alcohol handbook: From synapse to society . Cambridge, MA: Academic Press.

Davis, P., Patton, R., & Jackson, S. (Eds.). (2017). Addiction: Psychology and treatment . Hoboken, NJ: John Wiley & Sons.

de Beukelaar, M. F., Janse, M. L., Sierksma, A., Feskens, E. J., & de Vries, J. H. (2019). How full is your glass? Portion sizes of wine, fortified wine and straight spirits at home in the Netherlands. Public Health Nutrition, 22 (10), 1727–1734. https://doi.org/10.1017/S1368980019000442

de Visser, R., Brown, C., Cooke, R., Cooper, G., & Memon, A. (2017). Using alcohol unit-marked glasses enhances capacity to monitor intake: Evidence from a mixed-method intervention trial. Alcohol and Alcoholism, 52 , 206–212. https://doi.org/10.1093/alcalc/agw084

de Visser, R. O., & Birch, J. D. (2012). My cup runneth over: Young people’s lack of knowledge of low-risk drinking guidelines: Young people’s knowledge of alcohol guidelines. Drug and Alcohol Review, 31 (2), 206–212. https://doi.org/10.1111/j.1465-3362.2011.00371.x

de Visser, R. O., Hart, A., Abraham, C., Memon, A., Graber, R., & Scanlon, T. (2014). Which alcohol control strategies do young people think are effective?: Alcohol policies. Drug and Alcohol Review, 33 (2), 144–151. https://doi.org/10.1111/dar.12109

de Visser, R. O., & Nicholls, J. (2020). Temporary abstinence during Dry January: Predictors of success; impact on well-being and self-efficacy. Psychology & Health , 35 , 1293–1305. https://doi.org/10.1080/08870446.2020.1743840

Department of Health. (2016). UK chief medical officers’ alcohol guidelines review summary of the proposed new guidelines. https://www.gov.uk/government/uploads/sys-tem/uploads/attachment_data/file/489795/summary.pdf

Furtwaengler, N. A. F. F., & de Visser, R. O. (2013). Lack of international consensus in low-risk drinking guidelines. Drug and Alcohol Review, 32 (1), 11–18. https://doi.org/10.1111/j.1465-3362.2012.00475.x

Graber, R., de Visser, R., Abraham, C., Memon, A., Hart, A., & Hunt, K. (2016). Staying in the ‘sweet spot’: A resilience-based analysis of the lived experience of low-risk drinking and abstention among British youth. Psychology & Health, 31 (1), 79–99. https://doi.org/10.1080/08870446.2015.1070852

Heather, N., Partington, S., Partington, E., Longstaff, F., Allsop, S., Jankowski, M., … St Clair Gibson, A. (2011). Alcohol use disorders and hazardous drinking among undergraduates at English universities. Alcohol and Alcoholism (Oxford, Oxfordshire), 46 (3), 270–277. https://doi.org/10.1093/alcalc/agr024

Holmes, J., Brown, J., Meier, P., Beard, E., Michie, S., & Buykx, P. (2016). Short-term effects of announcing revised lower risk national drinking guidelines on related awareness and knowledge: A trend analysis of monthly survey data in England. BMJ Open, 6 (12), e013804. https://doi.org/10.1136/bmjopen-2016-013804

Article   PubMed   PubMed Central   Google Scholar  

Jones, L., Bellis, M. A., Dedman, D., Sumnall, H., & Tocque, K. (2008). Alcohol attributable fractions for England: Alcohol attributable mortality and hospital admissions . North West Public Health Observatory and Department of Health.

Kuntsche, E., Kuntsche, S., Thrul, J., & Gmel, G. (2017). Bing drinking: Health impact, prevalence, correlates and interventions. Psychology & Health, 32 , 976–1017. https://doi.org/10.1080/08870446.2017.1325889

Kuntsche, E., Stewart, S. H., & Cooper, M. L. (2008). How stable is the motive–alcohol use link? A cross-national validation of the drinking motives questionnaire revised among adolescents from Switzerland, Canada, and the United States. Journal of Studies on Alcohol and Drugs, 69 (3), 388–396. https://doi.org/10.15288/jsad.2008.69.388

Livingston, M. (2012). Perceptions of low-risk drinking levels among Australians during a period of change in the official drinking guidelines: Perceptions of low-risk drinking. Drug and Alcohol Review, 31 (2), 224–230. https://doi.org/10.1111/j.1465-3362.2011.00414.x

Lovatt, M., Eadie, D., Meier, P. S., Li, J., Bauld, L., Hastings, G., & Holmes, J. (2015). Lay epidemiology and the interpretation of low-risk drinking guidelines by adults in the United Kingdom: Lay epidemiology and the interpretation of low-risk drinking guidelines. Addiction, 110 (12), 1912–1919. https://doi.org/10.1111/add.13072

McCambridge, J., & Day, M. (2008). Randomized controlled trial of the effects of completing the Alcohol Use Disorders Identification Test questionnaire on self-reported hazardous drinking. Addiction, 103 (2), 241–248. https://doi.org/10.1111/j.1360-0443.2007.02080.x

McKenna, H., Treanor, C., O’Reilly, D., & Donnelly, M. (2018). Evaluation of the psychometric properties of self-reported measures of alcohol consumption: A COSMIN systematic review. Substance Abuse Treatment, Prevention, and Policy, 13 (1), 6. https://doi.org/10.1186/s13011-018-0143-8

Moss, A. C., & Dyer, K. R. (2010). Psychology of addictive behaviour . Basingstoke, UK: Palgrave Macmillan.

Book   Google Scholar  

National Institute on Alcohol Abuse and Alcoholism (NIAAA). (2004). NIAAA approves definition of binge drinking. NIAAA Newsletter, 3 (Winter) https://pubs.niaaa.nih.gov/publications/Newsletter/winter2004/Newsletter_Number3.pdf

Piano, M. R., Mazzuco, A., Kang, M., & Phillips, S. A. (2017). Binge drinking episodes in young adults: How should we measure them in a research setting? Journal of Studies on Alcohol and Drugs, 78 (4), 502–511. https://doi.org/10.15288/jsad.2017.78.502

Radaev, V. (2019). Making sense of alcohol consumption among Russian young adults in the context of post-2009 policy initiatives. In D. Conroy & F. Measham (Eds.), Young adult drinking styles (pp. 313–332). Cham, Switzerland: Palgrave Macmillan.

Riordan, B. C., Flett, J. A. M., Cody, L. M., Conner, T. S., & Scarf, D. (2019). The Fear of Missing Out (FoMO) and event-specific drinking: The relationship between FoMO and alcohol use, harm and breath alcohol concentration during orientation week. Current Psychology . https://doi.org/10.1007/s12144-019-00318-6

Saunders, J. B., Aasland, O. G., Babor, T. F., de la Fuente, J. R., & Grant, M. (1993). Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO collaborative project on early detection of persons with harmful alcohol consumption--II. Addiction (Abingdon, England), 88 (6), 791–804.

Sobell, L. C., & Sobell, M. B. (1992). Timeline follow-back: A technique for assessing self-reported alcohol consumption. In R. Z. Litten & J. P. Allen (Eds.), Measuring alcohol consumption (pp. 41–72). Totowa, NJ: Humana Press.

Svanberg, J. (2018). The psychology of addiction . London/Washington, DC: Routledge/Taylor & Francis Group.

van der Sar, R., Storvoll, E. E., Brouwers, E. P. M., van de Goor, L. A. M., Rise, J., & Garretsen, H. F. L. (2012). Dutch and Norwegian support of alcohol policy measures to prevent young people from problematic drinking: A cross-national comparison. Alcohol and Alcoholism, 47 (4), 479–485. https://doi.org/10.1093/alcalc/ags032

van Egmond, K., J.C Wright, Livingston, M., & Kuntsche, E. (2020). Wearable transdermal alcohol monitors: A systematic review of detection validity, relationship between transdermal and breath alcohol concentration and influencing factors. Alcoholism: Clinical and Experimental Research , acer.14432. doi: https://doi.org/10.1111/acer.14432

World Health Organization. (2018). Global status report on alcohol and health 2018 . Geneva, Switzerland: World Health Organization.

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Cooke, R., Conroy, D., Davies, E.L., Hagger, M.S., de Visser, R.O. (2021). Psychological Perspectives on Alcohol Consumption. In: Cooke, R., Conroy, D., Davies, E.L., Hagger, M.S., de Visser, R.O. (eds) The Palgrave Handbook of Psychological Perspectives on Alcohol Consumption. Palgrave Macmillan, Cham. https://doi.org/10.1007/978-3-030-66941-6_1

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Harmful and underage college drinking.

Photo of student asleep in class

Harmful and underage college drinking are significant public health problems, and they exact an enormous toll on the lives of students on campuses across the United States.

Drinking at college has become a ritual that students often see as an integral part of their higher education experience. Some students come to college with established drinking habits, and the college environment can lead to a problem. According to the 2022 National Survey on Drug Use and Health (NSDUH), of full-time college students ages 18 to 22, 49.0% drank alcohol and 28.9% engaged in binge drinking in the past month. 1  For the purposes of this survey, binge drinking was defined as consuming 5 drinks or more on one occasion for males and 4 drinks or more for females. However, some college students drink at least twice that amount, a behavior that is often called high-intensity drinking. 2

What Is Binge Drinking?

Many college alcohol problems are related to binge drinking. NIAAA defines binge drinking as a pattern of drinking alcohol that brings blood alcohol concentration (BAC) to 0.08%—or 0.08 grams of alcohol per deciliter—or more. For a typical adult, this pattern corresponds to consuming 5 or more drinks (male), or 4 or more drinks (female), in about 2 hours. 11

Drinking this way can pose serious health and safety risks, including car crashes, drunk-driving arrests, sexual assaults, and injuries. Over the long term, frequent binge drinking can damage the liver and other organs.

Note: BAC of 0.08% corresponds to 0.08 grams per 100 milliliters.

Consequences of Harmful and Underage College Drinking

Drinking affects college students, their families, and college communities. 

The most recent statistics from the National Institute on Alcohol Abuse and Alcoholism (NIAAA) estimate that about 1,519 college students ages 18 to 24 die from alcohol-related unintentional injuries, including motor vehicle crashes. 3

The most recent NIAAA statistics estimate that about 696,000 students ages 18 to 24 are assaulted by another student who has been drinking. 4

Sexual Assault

Although estimating the number of alcohol-related sexual assaults is exceptionally challenging—since sexual assault is typically underreported—researchers have confirmed a long-standing finding that 1 in 5 college women experience sexual assault during their time in college. 5 A majority of sexual assaults in college involve alcohol or other substances. 6,7 Research continues in order to better understand the relationships between alcohol and sexual assault among college students. Additional national survey data are needed to better estimate the number of alcohol-related assaults.

Photo of four students sitting outside talking

Academic Problems

About 1 in 4 college students report experiencing academic difficulties from drinking, such as missing class or getting behind in schoolwork. 8

In a national survey, college students who binge drank alcohol at least three times per week were roughly six times more likely to perform poorly on a test or project as a result of drinking (40% vs. 7%) than students who drank but never binged. The students who binge drank were also five times more likely to have missed a class (64% vs. 12%). 9

Alcohol Use Disorder 

Around 15% of full-time college students ages 18 to 22 meet the criteria for past-year alcohol use disorder (AUD), according to the 2022 NSDUH. 10

Other Consequences

Other consequences include suicide attempts, health problems, injuries, unsafe sexual behavior, and driving under the influence of alcohol, as well as vandalism, damage, and involvement with the police.

How Much Is a Drink?

To avoid binge drinking and its consequences, college students (and all people who drink) are advised to track the number of drinks they consume over a given period of time. That is why it is important to know exactly what counts as a drink.

In the United States, a standard drink (or one alcoholic drink-equivalent) is one that contains 0.6 fl oz or 14 grams of pure alcohol (also known as an alcoholic drink-equivalent), which is found in the following:

  • 12.0 oz of beer with about 5% alcohol content
  • 5.0 oz of wine with about 12% alcohol content
  • 1.5 oz of distilled spirits (e.g., gin, rum, tequila, vodka, and whiskey) with about 40% alcohol content

Unfortunately, although the standard drink (or alcoholic drink-equivalent) amounts are helpful for following health guidelines, they may not reflect customary serving sizes. A large cup of beer, an overpoured glass of wine, or a single mixed drink could contain much more alcohol than a standard drink. In addition, the percentage of pure alcohol varies within and across beverage types (e.g., beer, wine, and distilled spirits).

Factors Affecting Student Drinking

Photo of young woman studying

Although some students come to college already having some experience with alcohol, certain aspects of college life—such as unstructured time, widespread availability of alcohol, inconsistent enforcement of underage drinking laws, and limited interactions with parents and other adults—can lead to a problem. In fact, college students have higher binge-drinking rates and a higher incidence of driving under the influence of alcohol than their noncollege peers.

The first 6 weeks of freshman year are a vulnerable time for heavy drinking and alcohol-related consequences because of student expectations and social pressures at the start of the academic year.

Factors related to specific college environments also are significant. Students attending schools with strong Greek systems or prominent athletic programs tend to drink more than students at other types of schools. In terms of living arrangements, alcohol consumption is highest among students living in fraternities and sororities and lowest among commuting students who live with their families.

An often-overlooked preventive factor involves the continuing influence of parents. Research shows that students who choose not to drink often do so because their parents discussed alcohol use and its adverse consequences with them.

Addressing College Drinking

Ongoing research continues to improve our understanding of how to address the persistent and costly problem of harmful and underage student drinking. Successful efforts typically involve a mix of strategies that target individual students, the student body as a whole, and the broader college community.

Strategies Targeting Individual Students

Individual-level interventions target students, including those in higher risk groups such as first-year students, student athletes, members of Greek organizations, and mandated students. The interventions are designed to change student knowledge, attitudes, and behaviors related to alcohol so they drink less, take fewer risks, and experience fewer harmful consequences.

Categories of individual-level interventions include the following:

  • Education and awareness programs
  • Cognitive-behavioral skills-based approaches
  • Motivation and feedback-related approaches
  • Behavioral interventions by health professionals

Strategies Targeting the Campus and Surrounding Community

Environmental-level strategies target the campus community and student body as a whole. They are designed to change the campus and community environments where student drinking occurs. Often, a major goal is to reduce the availability of alcohol because research shows that reducing alcohol availability cuts consumption and harmful consequences on campuses as well as in the general population.

Alcohol Overdose and College Students

Thousands of college students are transported to the emergency room each year for alcohol overdose, which occurs when there is so much alcohol in the bloodstream that areas of the brain controlling basic life-support functions—such as breathing, heart rate, and temperature control—begin to shut down. Signs of this dangerous condition can include the following:

  • Mental confusion, stupor
  • Difficulty remaining conscious or inability to wake up
  • Slow breathing (fewer than eight breaths per minute)
  • Irregular breathing (10 seconds or more between breaths)
  • Slow heart rate
  • Clammy skin
  • Dulled responses, such as no gag reflex (which prevents choking)
  • Extremely low body temperature, bluish skin color, or paleness

Alcohol overdose can lead to permanent brain damage or death, so a person showing any of these signs requires immediate medical attention. Do not wait for the person to have all the symptoms, and be aware that a person who has passed out can die. Call 911 if you suspect alcohol overdose.

A Mix of Strategies Is Best

Photo of five students sitting, chatting, and studying

For more information on individual- and environmental-level strategies, visit NIAAA's CollegeAIM (which stands for College Alcohol Intervention Matrix) guide and interactive website. Revised and updated in 2020, CollegeAIM rates more than 60 alcohol interventions for effectiveness, cost, and other factors—and presents the information in a user-friendly and accessible way.

In general, the most effective interventions in CollegeAIM represent a range of counseling options and policies related to sales and access. After analyzing alcohol problems at their own schools, officials can use the CollegeAIM   ratings to find the best combination of interventions for their students and unique circumstances.

Research suggests that creating a safer campus and reducing harmful and underage student drinking will likely come from a combination of individual- and environmental-level interventions that work together to maximize positive effects. Strong leadership from a concerned college president in combination with engaged parents, an involved campus community, and a comprehensive program of evidence-based strategies can help address harmful student drinking.

For more information, please visit:  collegedrinkingprevention.gov/CollegeAIM

1  Past-month alcohol use: consuming a drink of a beverage containing alcohol (a can or bottle of beer, a glass of wine or a wine cooler, a shot of distilled spirits, or a mixed drink with distilled spirits in it), not counting a sip or two from a drink in the past 30 days. Population prevalence estimates (5) are weighted by the person-level analysis weight and derived from the Center for Behavioral Health Statistics and Quality 2022 National Survey on Drug Use and Health (NSDUH-2022-DS0001) public-use file. [cited 2024 Jan 12]. Available from: https://www.datafiles.samhsa.gov/dataset/national-survey-drug-use-and-health-2022-nsduh-2022-ds0001

2  Hingson RW, Zha W, White AM. Drinking beyond the binge threshold: predictors, consequences, and changes in the U.S. Am J Prev Med, 2017;52(6):717–27. PubMed PMID: 28526355

3  Methodology for arriving at estimates described in Hingson R, Zha W, and Smyth D. Magnitude and trends in heavy episodic drinking, alcohol-impaired driving, and alcohol-related mortality and overdose hospitalizations among emerging adults of college ages 18–24 in the United States, 1998–2014. J Stud Alcohol Drugs. 2017;78(4):540–48. PubMed PMID: 28728636  

4  Methodology for arriving at estimates described in Hingson R, Heeren T, Winter M, Wechsler H. Magnitude of alcohol-related mortality and morbidity among U.S. college students ages 18–24: changes from 1998 to 2001. Annu Rev Public Health. 2005;26:259–79. PubMed PMID: 15760289

5  Muehlenhard C, Peterson Z, Humphreys T, Jozkowski K. Evaluating the one-in-five statistic: women's risk of sexual assault while in college. J Sex Res . 2017;54(4-5):549–76. PubMed PMID: 28375675

6  Carey KB, Durney SE, Shepardson RL, Carey MP. Incapacitated and forcible rape of college women: prevalence across the first year. J Adolesc Health. 2015;56(6):678–80. PubMed PMID: 26003585

7  Lawyer S, Resnick H, Bakanic V, Burkett T, Kilpatrick D. Forcible, drug-facilitated, and incapacitated rape and sexual assault among undergraduate women. J Am Coll Health. 2010;58(5):453–60. PubMed PMID: 20304757

8 Wechsler H, Lee JE, Kuo M, Seibring M, Nelson TF, Lee H. Trends in college binge drinking during a period of increased prevention efforts. Findings from 4 Harvard School of Public Health College Alcohol Study Surveys: 1993-2001. J Am Coll Health. 2002;50(5):203–17. PubMed PMID: 11990979

9 Presley CA, Pimentel ER. The introduction of the heavy and frequent drinker: a proposed classification to increase accuracy of alcohol assessments in postsecondary educational settings. J Stud Alcohol. 2006;67(2):324–31. PubMed PMID: 16562416

10  SAMHSA, Center for Behavioral Statistics and Quality. 2022 National Survey on Drug Use and Health. Table 8.33B—Alcohol use disorder in past year: among people aged 18 to 22, by college enrollment status and demographic characteristics: percentages, 2021 and 2022 [cited Jan 27]. Available from:  https://www.samhsa.gov/data/sites/default/files/reports/rpt42728/NSDUHDetailedTabs2022/NSDUHDetailedTabs2022/NSDUHDetTabsSect8pe2022.htm#tab8.33b

11 National Institute on Alcohol Abuse and Alcoholism [Internet]. Defining binge drinking. In: What Colleges Need to Know Now: An Update on College Drinking Research. Bethesda (MD): National Institutes of Health; 2007 [cited 2021 Oct 22]. Available from:  https://www.collegedrinkingprevention.gov/media/1College_Bulleting-508_361C4E.pdf

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  • Published: 15 November 2022

Alcohol consumption and its associated factors among adolescents in a rural community in central Thailand: a mixed-methods study

  • Pichak Pramaunururut 1 ,
  • Pijak Anuntakulnathee 1 ,
  • Piti Wangroongsarb 1 ,
  • Thanapat Vongchansathapat 1 ,
  • Kullanith Romsaithong 1 ,
  • Jareewan Rangwanich 1 ,
  • Nuttamon Nukaeow 1 ,
  • Poonyawee Chansaenwilai 1 ,
  • Ploynaphat Greeviroj 1 ,
  • Pimchanok Worawitrattanakul 1 ,
  • Pamornwat Rojanaprapai 1 ,
  • Veerapatra Tantisirirux 1 ,
  • Pongpisut Thakhampaeng 2 ,
  • Wanida Rattanasumawong 3 ,
  • Ram Rangsin 2 ,
  • Mathirut Mungthin 4 &
  • Boonsub Sakboonyarat 2  

Scientific Reports volume  12 , Article number:  19605 ( 2022 ) Cite this article

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  • Epidemiology
  • Public health
  • Risk factors

Early onset of alcohol use was associated with alcohol dependence and other health problems. We aimed to identify the prevalence and factors associated with alcohol consumption among adolescents in a rural community in Thailand. A mixed-methods study was carried out in 2021 using an explanatory sequential design. The study enrolled a total of 413 adolescents. On average, young adolescents initiated alcohol consumption at age 13. The lifetime drinking prevalence among adolescents was 60.5%, while the 1-year drinking prevalence was 53.0%. The prevalence of hazardous drinking among current drinkers was 42.0%. Alcohol consumption was associated with females (adjusted prevalence ratio (APR): 1.19; 95% CI 1.01–1.41), age ≥ 16 years (APR: 1.28; 95% CI 1.09–1.50), having close friends consuming alcohol (APR: 1.75; 95% CI 1.43–2.14), night out (APR: 1.93; 95% CI 1.53–2.45), being a current smoker (APR: 1.39; 95% CI 1.15–1.69), and having relationship (with boyfriend/girlfriend) problems (APR: 1.18; 95% CI 1.01–1.38). Qualitative data demonstrated that individual and environmental factors, including friends, family, social media use, and alcohol accessibility, affect alcohol use in this population. Therefore, effective strategies should be implemented across multiple levels of the socio-ecological model simultaneously to alleviate alcohol consumption and attenuate its complications.

Introduction

Alcohol consumption is associated with various health issues, such as maternal and child health, infectious diseases, noncommunicable diseases, mental health, and injuries 1 .

The National Statistical Office (NSO) in Thailand reported that, during 2003–2015, the prevalence of current alcohol consumption among adults aged at least 15 years consistently ranged from 32.7 to 34.0% and then reduced slightly to 28.4% in 2017 2 . Current alcohol consumption among Thai males (47.5%) is more likely to be higher than that among females (10.6%). As regards the residential area, the prevalence of current alcohol consumption was 29.3% and 27.4% outside and within the municipal area, respectively 2 .

Early onset of alcohol consumption was associated with a higher risk of heavy alcohol drinking 3 , substance use 4 , and poorer performance in psychomotor speed and visual attention 5 . In Thailand, national policies and interventions to solve this issue have been implemented, including the national legal minimum age for on-/off-premises sales of alcoholic beverages, restrictions for on-/off-premises sales of alcoholic beverages (hours, days/places, and density), and national level government support for community action 1 . Unfortunately, a continuous increase in the incidence of early alcohol consumption (before the age of 20 years) has been observed, which ranged from 8.9% in 2007 to 10.9% in 2017 6 , 7 .

The Global School-Based Student Health survey illustrated that the prevalence of current alcohol use among Thai adolescents aged 13–17 years increased from 14.8% in 2008 to 22.2% in 2015 8 . Furthermore, the Global Status Report on Alcohol and Health 2018 presented that alcohol consumption among Thai adolescents was top-ranking in Southeast Asia 1 . Recent studies revealed several factors associated with current alcohol consumption among adolescents, such as family problems, direct observation of friends’ drinking, having parents store alcohol at home, and exposure to alcohol advertising. In addition, risky sexual and suicidal behaviors were associated with alcohol use 9 , 10 .

Although national data include information about alcohol consumption in Thailand 2 , sufficient information about the socio-ecological context associated with alcohol consumption among adolescents in a particular community is still limited. A few studies investigating alcohol consumption among adolescents were conducted in urban and suburban areas, presenting an estimated prevalence of current alcohol consumption ranging from 10.4 to 18.6% 9 , 10 , 11 . Nowadays, one-half of the Thai population still resides in rural areas where healthcare provider characteristics, health literacy, and socioeconomic contexts may differ from those in urban areas 12 . Recently, a related quantitative study about the substance abuse situation in a remote rural community, Chachoengsao Province, detected that 36.8% of adolescents reported being a current alcohol drinker and indicated that alcohol drinking was associated with substance abuse in the rural community 4 , which was considered a major health issue in the Thai rural community. Unfortunately, information regarding risk factors for alcohol consumption among adolescents in this remote rural area was not uncovered.

The present study aimed to identify the prevalence and factors associated with alcohol consumption among adolescents in a remote rural area using quantitative methods. Moreover, a qualitative study will explore the socio-ecological factors affecting alcohol consumption, including family members and friends, store and accessibility, and social and environmental factors. If factors associated with alcohol consumption among adolescents are explored, appropriate strategies and practical interventions may be implemented in this population to resolve this issue in the future.

Study design and subjects

The current study was performed in a remote rural area in Thakradan Subdistrict, Sanam Chai Khet District, at the border area of Chachoengsao Province, central Thailand, 160 km east of Bangkok. Due to their location in the border area of the province, a total of five villages (from 23 villages) in the Thakradan Subdistrict were selected to conduct the study. Furthermore, since 2002, these five villages have been known as the Na-Yao community, where Phramongkutklao College of Medicine established the teaching community for undertaking community-based research. In 2018, a related study in this community revealed that alcohol use among adolescents in this rural area is relatively high (36.8%) and also related to substance use. Nevertheless, information on factors associated with alcohol use was unavailable. Therefore, we aimed to employ a mixed-methods study using explanatory sequential design in this area to explore the magnitude of alcohol use and also determine socio-ecological factors affecting alcohol use among adolescents in this rural context. Regarding the explanatory sequential mixed method, we collected quantitative data about adolescents and then collected qualitative data through the use of in-depth interviews and focus group discussions among adolescents, teachers, parents, and adults in the community to help explain the quantitative results.

Quantitative part

We conducted a cross-sectional quantitative study to identify the prevalence and factors associated with alcohol consumption among adolescents in March 2021. The minimal calculated sample size of 341 was determined according to the 2018 Global Status Report on Alcohol and Health of Thai adolescents 1 , 13 . We expected that 25% of available adolescents would be unable to participate. Thus, 427 were finally estimated to mitigate the effect of possible losses. We carried out a quantitative method at school A , which is a government high school providing education for adolescents aged 13 to 18 years residing in this community. The exclusion criteria included individuals who did not provide informed consent or could not answer the questionnaire. Four hundred twenty-five adolescents in school A were invited to participate in the study, and 413 individuals agreed to participate.

Qualitative part

We also performed a qualitative study to investigate the socio-ecological factors that affect alcohol consumption among adolescents. At high school A , the investigator invited adolescents, teachers, parents, and adults in the community to participate in the qualitative study. Moreover, advertising posters were provided at school to encourage target participants to participate in the study. Purposive sampling was also utilized for selecting six adolescents, three teachers, six parents, and adults in this community for in-depth interviews. Forty-nine adolescents, seven teachers, and five parents and adults in the community were purposively selected for focus group discussions. Nine focus groups (FGs) included adolescents, teachers, parents, and adults in the community. The first FG to seventh FG (n = 7/group) consisted of adolescents. The eighth FG (n = 7) comprised teachers from high school, whereas the ninth FG (n = 5) comprised parents of adolescents and adults. Forty-nine adolescents who participated in the quantitative study also participated in the FGs.

Data collection

After permission was received from the director of school A , the investigators invited adolescents in school A to participate in the quantitative part of the study. Additionally, an advertising poster of the present study was provided in front of the classroom to encourage them to participate in the study. Furthermore, information sheets, objectives, and study methods were provided to the subjects. Informed consent was obtained prior to the research. During the study, self-reported questionnaires were utilized to obtain essential information from participants within 20 min. The questionnaires were self-administered and delivered in an envelope. To de-identify, a unique identification number was used instead of the names and identities of the volunteers. An adolescent could decide not to participate in the study. This decision does not affect any dimensions of adolescents, such as education and health care.

Standardized questionnaires developed by the investigators for the current study were divided into three parts as follows: demographic characteristics, associated factors, and history of alcohol consumption. They included information regarding demographics, including sex, age, parental status, religion, educational level, and grade point average (GPA). The characteristics of alcohol consumption were collected through the use of standardized questionnaires asking about lifetime prevalence and the last 12-month prevalence of alcohol consumption, age at initial alcohol consumption, and categories of alcoholic beverages including beer, whiskey, white liquor, and wort. Lifetime alcohol consumption and the last 12-month prevalence of alcohol consumption were defined based on the data obtained from the responses to the following questions: (1) “Have you ever consumed any alcohol such as beer, wine, spirits, and wort?” and (2) “Have you consumed any alcohol within the past 12 months?”, respectively 14 . Among the participants consuming alcohol in the last 12 months, hazardous drinking was assessed using the Alcohol Use Disorders Identification Test (AUDIT) (score ≥ 8) 15 .

The investigators (BS, TV, PT, and VT), who were the interviewers, were trained at the Phramongkutklao College of Medicine before conducting the qualitative study. The interviews were done in the meeting room of high school A in the community. Informed consent was obtained before the research. Two researchers (BS and TV) conducted in-depth interviews and took notes on non-verbal communication. Interviews of the nine FGs were facilitated by two investigators (BS and TV). In addition, notes on non-verbal communication and other notable items were taken by two researchers (PT and VT). All investigators wrote additional notes after the interviews of the FGs. The interviews were carried out with questions and probes for further questioning, covering questions on the factors influencing alcohol consumption among adolescents, how adolescents access alcohol, and existing interventions in the community (Supplementary File 1 ). The data were collected continuously until the contents were saturated. The conversations were taped using a voice recorder and transcribed into text. Two investigators (BS and TV) reviewed the transcription to check the errors before performing an analysis.

Statistical analysis

Data were analyzed using StataCorp, 2021, Stata Statistical Software: Release 17 , College Station, TX, USA, StataCorp LLC. Demographic characteristics were determined through the use of descriptive statistics. The age of participants was categorized into two groups (< 16 and \(\ge\) 16 years) regarding median age. According to the NSO report in Thailand, the age at initiation of alcohol consumption was categorized into two groups: < 15 and \(\ge\) 15 years. The frequency distribution of categorical variables by strata was compared using the Chi -square test, while continuous data were compared using Student’s t -test. Through descriptive statistics, lifetime prevalence and last 12-month prevalence of alcohol consumption were reported as a percentage with a 95% confidence interval (CI). The univariable analysis was utilized to identify the associated factors of the last 12 months of alcohol consumption. Multivariable analysis was performed. After running a logit model, the adjrr (margin) command was used to calculate the adjusted prevalence ratio (APR), which was presented with a corresponding 95% CI. A two-sided  p -value less than 0.05 was considered statistically significant.

The qualitative study employed a thematic analysis. Analytic rigor in the qualitative analysis was ensured through investigator triangulation 16 . Transcripts were compared to the investigators' notes taken during the in-depth interviews and focus groups (BS and TV). The text-based data transcribed from the conversation were sorted and coded. Inductive and deductive coding were used, and analytic categories and themes were then developed. Initial coding and themes (by BS and TV) were checked by the other investigators (PP and VT) 17 . The quotations below best represent the range of ideas voiced around key themes.

Ethics consideration

The current study was reviewed and approved by the Institutional Review Board, Royal Thai Army Medical Department according to international guidelines including the Declaration of Helsinki, the Belmont Report, CIOMS Guidelines, and the International Conference on Harmonization of Technical Requirements for Registration of Pharmaceuticals for Human Use-Good Clinical Practice (ICH-GCP) (approval number R190q/63). Written informed consent was obtained from the participants according to the WMA Declaration of Helsinki Ethics Principles for medical research involving human subjects.

Quantitative study

Demographic characteristics of participants.

In a rural community, a total of 425 adolescents were invited to the present study, among which 413 (97.2%) responded to participate in the study. The demographic data of these participants are shown in Table 1 . Among them, 250 (60.5%) were females. The average age of the participants was 15.5 ± 1.6 years (ranging from 13 to 18). The adolescents were in grades 7 to 12 and vocational training. One-half of the participants (49.9%) lived with both a father and a mother.

Prevalence of alcohol consumption among adolescents in a Thai rural community

The characteristics of alcohol consumption among adolescents are presented in Table 2 . The average age at initial alcohol consumption was 13.9 ± 1.8 years (ranging from 10 to 18); 59.6% of drinkers started drinking at age less than 15. The lifetime drinking prevalence among adolescents was 60.5% (95% CI 55.6–65.3%). The overall one-year drinking prevalence was 53.0% (95% CI 48.1–57.9%) and was comparable between 52.1% (95% CI 44.2–60.0%) among males and 53.6% (95% CI 47.2–59.9%) among females ( p -value = 0.772). Hazardous drinking determined by AUDIT score among current drinkers was 42.0, 41.2, and 42.5% among total, male, and female participants ( p -value = 0.842), respectively. Beer and whiskey were the most prevalent beverages among adolescents accounting for 59.3 and 20.0%, respectively.

Associated factors of alcohol consumption among adolescents in a Thai rural community

Univariable and multivariable analyses were carried out to identify the associated factors of alcohol consumption within 12 months (Tables 3 , 4 ). After adjusting for potential confounders, the independent factors associated with alcohol consumption within 12 months included females (APR: 1.19; 95% CI 1.01–1.41), age ≥ 16 years (APR: 1.28; 95% CI 1.09–1.50), having close friends consuming alcohol (APR: 1.75; 95% CI 1.43–2.14), night out (APR: 1.93; 95% CI 1.53–2.45), being a current smoker (APR: 1.39; 95% CI 1.15–1.69), and having relationship (with boyfriend/girlfriend) problems (APR: 1.18; 95% CI 1.01–1.38).

Qualitative study

For in-depth interviews, data were collected from a total of 15 participants, including 6 adolescents, 6 parents and adults in the community, and 3 teachers. For focus group discussions, data were gathered from a total of 61 participants, including 49 adolescents (aged 13 to 18 years), 5 parents and adults in the community (aged 19 to 63 years), and 7 teachers (aged 44 to 48 years). The information from in-depth interviews and focus group discussions can be grouped into more factors and interventions.

Knowledge of disadvantages of alcohol consumption among adolescents

Adolescents were aware of the short-term negative effects of alcohol consumption on mental and physical health, for instance, encouraging aggression, decreasing the level of consciousness, and facilitating road traffic accidents. However, they did not realize the long-term health risks of excessive alcohol use, including chronic liver disease and gastrointestinal hemorrhage. A 21-year-old man, working freelance, said, “If you know the disadvantage, you will drink less. It can be reduced anyway”. A 13-year-old talked about the disadvantages of consuming alcohol, “create a bad mood, more aggressive and threatening behaviors to other people. Some people even hurt family members. I have seen people whose motorcycles collide because they drove drunk”. From the inquiries of the participants, regarding the pros and cons of consuming alcohol, many commented that they did not have knowledge regarding the effects of alcohol on the body, like health aspects including liver disease and mental health.

Personal factors affecting alcohol consumption among adolescents

Curiosity and ignorance of individuals provoke the urge for trial and entertainment, especially during important festivals such as the Songkran water festival and New Year’s Eve. An adolescent stated, “I wanted to try drinking so I asked my dad”. However, the parents believed that adolescents with good judgment tended to drink lightly. As they disclosed, “If the adolescent can think for himself/herself, then abstinence may be possible, but if he/she drinks and goes partying at night and has a group of friends who do the same, then the chances of quitting are quite low”. “Teens drink according to their judgment and will regarding their knowledge of the pros and cons of alcohol”.

Friends affecting alcohol consumption among adolescents

Most adolescents thought that their initial alcohol consumption was due to an invitation from their friends or seniors. A 19-year-old maintained, “I was in grade 7 in a boarding school and often visited my senior’s flat to hang out with my friends”. Another 13-year-old girl commented, “a friend tricked her into drinking by putting alcohol in the bottle and affirmed that it was punch. Friends often hang out in groups to drink in private areas”. “Her friends invite her on weekends to a friend’s house or a restaurant that sells alcohol”.

Teachers pointed out that adolescents without sufficient care in the family would be persuaded by their friends to consume alcohol. A 48-year-old teacher stated, “He saw an 18-year-old teen drink after work with his/her friend during a festival because his/her friend invited him. Some kids do not reside with their parents and live with their grandparents who may lack sufficient care”. Parents believed that friends were a major facilitator of alcohol consumption among adolescents. One parent group mentioned, “Friends are the main contributors to consuming alcohol. In the curiosity of the adolescents, they thought that everyone who drinks seems to enjoy themselves and a person who gets drunk will be seen as a funny person, which was inaccurate”.

Family factors affecting alcohol consumption among adolescents

Some adolescents faced family disharmony including the separation of their parents, while others had grandparents and relatives as their main guardians. Therefore, adolescents were not taken care of and expressed inappropriate behaviors including alcohol consumption. A 60-year-old uncle reported, “Most of the parents did not know that the children drank because the children drank outside of the home”. The parents commented, “the influence of family members consuming alcohol facilitates the children to drink. Another contributing factor is problems in the family institution, such as separation”.

Furthermore, one teacher believed that smoking may initiate alcohol consumption. Alcohol consumption among adolescents resulted from imitating family members who smoke, which could lead them to consume alcohol later. A 44-year-old teacher revealed, “When children begin to show up to be at risk, the first thing you can find is that the cigarette may not be a real cigarette. Sometimes a paper substitute can be a simulated behavior. Cigarettes are easier to find than alcohol because parents and other older members had them at home. Children could pick them up easily. Then they may arrange an appointment with friends to buy liquor and drink as the next step”. On the other hand, adolescents believed that alcohol use in the family would not influence teenagers to drink alcohol accordingly.

Social and environmental factors affecting alcohol consumption among adolescents

Children gain various experiences in the society and environment in which they grow up. Thus, these factors will greatly affect their behaviors when they become adolescents. A 44-year-old teacher indicated, “Environment and society have a great effect on teenager experience. The new generation is growing by changing their lifestyle to create their own identity. After an adolescent receives information, they cannot distinguish right or wrong, and the bad things are easier than the good”. Another teacher suggested, “I think children are used to behaving well, but they have changed over time and by their friends; however, this group can repent and be guided correctly. On the other hand, if the family did not help from the beginning, for example, some children are born unwilling or do not feel what the word “love” is, this group will be a little tricky. It means that it is his/her way of life which is very difficult to change”.

Advertising and cyber society factors affecting alcohol consumption among adolescents

Teachers and parents thought that adolescents easily access advertising and cyber society, in which the evolution of technology is present. Therefore, adolescents could watch any story including alcohol-drinking behavior on social media which may influence their behavior in the future. A 44-year-old teacher explained, “Lacking media literacy and using too much technology on the mobile phone, celebrity, games, or anything easy to access and fast, these things are shaping and creating the new generation without an appropriate evaluation”. A group of parents responded, “Some children watch the drinking behavior from the media and think it is normal”.

Financial factors affecting alcohol consumption among adolescents

Many people thought that drinking alcohol could solve financial problems, for example, and that stress problems and anxiety would be eliminated by drinking. Unfortunately, it placed additional financial burden on them because they had to find more money to buy alcohol. A 21-year-old man expressed, “I started smoking and drinking for the first time in grade 6 because of stress from the fact that people had more money to go to school than me. He added that money to buy alcohol comes in various ways, saying there are many ways to get money—from parents, stealing, and doing illegal things. Having voiced that, what can be converted into money, for example, to steal a phone”.

Access to alcohol in the rural community

Young people could easily buy alcohol in the shops. Sellers did not have restrictions about selling liquor to children under 20 years, so teenagers could buy and drink by themselves. They did not ask about the age of the children when buying alcohol. If there were children to buy alcohol, they tended to understand that their parents asked them to buy. In addition, alcohol could be bought in the area around the school. A 13-year-old boy alleged, “easy access to the shops nearby school. In some stores, children can buy by themselves”. A 14-year-old girl acknowledged, “You can buy liquor from a store without any limited age. The merchant thinks they buy it for adults”. A 53-year-old woman replied, “The liquor store sells to even children under 18, not strict. Sometimes the child claims to buy it for his parents, and the shop sells it”. A 44-year-old teacher said, “Access to alcohol, I think, is not difficult. Teenagers can find all these things everywhere. The word shame should never exist in the minds of these teenagers”.

Alcohol consumption intervention in a Thai rural community

The existing intervention included education from schools, health services, or policies for controlling alcohol access within the school-based program. A 15-year-old boy asserted, “The school has a rule that bringing alcohol to school is not allowed by random examination”. A 13-year-old girl insisted, “Public health service used to give information, but it is not effective”, A 15-year-old boy also said, “There is teaching about drinking alcohol too. Nevertheless, I think this class is not interesting”. The expected intervention is that volunteers come up with an idea. A 16-year-old declared, “I would like the community to teach more about the disadvantages of drinking alcohol. If they know that drinking has drawbacks, they can reduce drinking”. A parent suggested, “If there is a control measure for being stricter to selling alcohol, for example, not selling it to children under 18 years old”. A group of teachers maintained, “We want the government to get involved in providing knowledge and assistance community by supporting the budget and staff”.

The current study illustrated the extreme lifetime prevalence and the last 12-month prevalence of alcohol consumption among adolescents in a Thai rural community. In comparison with the 2018 Global Status Report on Alcohol and Health indicating that the prevalence of current alcohol consumption among young Thai adults accounted for 27.3% 1 , the present study demonstrated that the prevalence was substantially high (53.0%). Furthermore, a 2018 study in this rural area revealed that the last 12-month prevalence of alcohol consumption among adolescents was 36.8% 4 . Thus, the prevalence of alcohol consumption has risen dramatically over three years. Most related reports demonstrated that young males tended to consume alcohol more than females 1 , 6 . Unexpectedly, the last 12-month prevalence of alcohol consumption among males (52.1%) was comparable to that among females (53.6%) in the present study. Additionally, after adjusting for potential confounders, we found that alcohol use within 12 months among females was relatively high. Hazardous and harmful alcohol use were assessed by AUDIT score, revealing that two-fifths of current drinkers were classified into hazardous and harmful alcohol consumption which was higher than those in the data from the Thai National Household Survey for Substance and Alcohol Use 18 .

The current study demonstrated that adolescents aged ≥ 16 years tended to consume alcohol within 12 months in comparison to those who are younger. However, the average age at initiation of alcohol consumption was 13.9 years. Moreover, approximately 60% of drinkers started alcohol use at the age of less than 15 years. These initiation ages were low compared to the NSO in Thailand, which demonstrated that the average age to start drinking among Thai people outside the municipal area was 20.5 years, and 12.5% of drinkers started consuming alcohol at the age of < 15 years 2 . This phenomenon may be explained by our qualitative data as follows: although the national legal minimum age for on-/off-premises sales of alcoholic beverages was implemented, adolescents in this remote rural area could still easily access alcohol. Retailers did not enforce the policy or recognize the age of adolescents when they purchased alcohol. Moreover, they tended to understand that parents had asked their children to buy alcohol for them. Additionally, we found that adolescents did not know the long-term risks of alcohol consumption; they only recognized short-term effects such as being drunk and decreased level of consciousness. The study conducted by Hingson et al. illustrated that people who initiate drinking before age 14 were more likely to experience alcohol dependence than those who began drinking at age 21 (adjusted hazard ratio of 1.78) 19 . In addition, the early onset of alcohol consumption was associated with substance use 4 , family violence, injuries, suicide, and sexual behaviors 5 . Our study suggested that these issues should be solved promptly. Primary prevention programs should be implemented in the community. Regarding hazardous drinkers, effective therapy may be initiated and delivered by nurses working at primary care units in this rural area 20 .

Current drinker status among adolescents in this community was associated with individual and environmental factors. A significant association was found between current smokers and alcohol consumption. This finding was in compliance with related reports in the US 21 , 22 and the UK 23 that people who decided to try smoking tended to try alcohol and vice versa 22 . From the qualitative information, the teachers believed that smoking may initiate alcohol consumption which resulted from imitating the behaviors of family members.

Both quantitative and qualitative findings indicated that adolescents having friends consuming alcohol tended to be current drinkers. Adolescents, parents, and teachers affirmed that adolescents were provided an opportunity to consume alcohol by their friends. For instance, when adolescents have a party, they themselves claim that their friends do not influence their choice of action, and when a friend allows alcohol, their decision to try alcohol lies in their own hands. This finding is also in accordance with a related study in eastern Thailand, indicating that adolescents who directly observe their friends’ drinking were more likely to be drinkers 9 . On the other hand, support from friends can help the drinkers have a chance to alleviate alcohol use 24 .

Social media use may be a potential factor affecting alcohol consumption among adolescents. Although social media use was no longer associated with current drinker status, information from the qualitative study demonstrated that adolescents could access any content via social media platforms, such as peer alcohol behavior and alcohol advertising, because of unregulated marketing on social media 25 , 26 . Therefore, adolescents could perceive inappropriate behaviors such as alcohol consumption as usual. Social media also facilitate pro-alcohol environments and encourage drinking 25 , 27 . This may be explained by social learning theory 28 , 29 , suggesting that adolescents realize alcohol use by observing and imitating the behavior of others. For instance, adolescents repeatedly exposed to alcohol content shared by their friends could motivate the initiation of alcohol use or increase drinking 30 , 31 .

The present study indicated that alcohol consumption may contribute to further problems including love relationships between adolescents and their boyfriends/girlfriends. Related studies supporting this finding demonstrated that alcohol consumption negatively affects relationships 32 . In addition, a meta‐analysis of a longitudinal study illustrated that becoming single was associated with increased consumption at follow-up 33 . Furthermore, qualitative data revealed that alcohol consumption among adolescents may be associated with financial problems and, consequently, illegal behaviors such as thievery. This finding may be explained by adolescents excessively spending money on buying alcohol to consume, resulting in financial issues. Some evidence supported that higher debt and financial strain were positively associated with alcohol use 34 , 35 . Other related evidence also indicated that illegal acts, including theft and acts against persons, were more likely to be higher under the influence of alcohol. Furthermore, the acute use of alcohol, alone or in combination with other drugs, was involved with the illegal acts 36 .

To date, the existing intervention that helps in solving alcohol-related problems among adolescents in this rural area is the conventional health education provided in the school. However, the qualitative study indicated that adolescents were not interested in that program. Although the national legal minimum age for on-/off-premises sales of alcoholic beverages and restrictions for on-/off-premises sales of alcoholic beverages have been established (hours, days/places, and density), adolescents aged less than 18 years are still able to purchase alcohol at stores in this community.

It is observed that alcohol consumption among adolescents in this remote rural area is still a substantial issue related to not only personal factors but also socio-ecological context, including family members, peers, and community members, as well as social and cultural norms. Our results suggest that the primary prevention programs to attenuate alcohol-related problems among adolescents in this community must be implemented across multiple levels of the socio-ecological model simultaneously 37 . A specific approach should promote attitudes, beliefs, and behaviors preventing alcohol use at the individual level 38 . Generally, knowledge about the disadvantages of alcohol use should be provided, both short- and long-term consequences on physical and mental health, such as cognitive impairment, family violence, suicide, and sexual behaviors 39 .

Another level is the relationship with family and peers. The related evidence demonstrated that parental monitoring and supervision effectively prevent the onset of alcohol consumption and misuse. For instance, parents monitor their adolescents during free time and time with friends and provide active supervision by being present during youth activities 40 , 41 . Effective strategies such as school strategies should be also implemented in the community 38 . The related evidence established that a routine interactive educational program encouraged adolescents to be actively engaged in forming social norms to reduce alcohol use 42 , 43 . Furthermore, school-based prevention can focus on self-esteem and self-efficacy, concentrating on interpersonal interactions and educating about alcohol and its harmful effects 44 , 45 . Besides, our findings suggested that local authorities should seriously force alcohol sellers in the community to follow the minimum age regulations for on-/off-premises sales of alcoholic beverages. The strategies at the societal level, such as establishing norms that support nonuse, are crucial for preventing alcohol use and misuse. Moreover, other social institutions, such as Buddhist temples, may play an essential role through religious beliefs that can potentially assist in preventing alcohol use 46 . Additionally, the active participation of people and community engagement will serve as potential facilitators to alleviate underage drinking 47 .

In terms of limitations, firstly, the study utilized a cross-sectional survey, which made it difficult to determine a cause-and-effect relationship between associated factors and alcohol consumption. Secondly, we carried out a quantitative study at a school in the community; therefore, a few adolescents who were outside school were not included in the present study. Thirdly, there were missing data in some variables regarding the questions in the case report form that may comprise sensitive issues; the participants may not voluntarily answer those questions. Therefore, some variables, such as GPA (missing data for 57.3%), would not be included in the multivariable analysis. Fourthly, some variables, such as personal media literacy, were not collected; therefore, unmeasured confounders may not be included in the final model. Another limitation of this study was that only adolescents in this rural area were included; thus, the study may not be generalized to the whole country but may reflect the real experience of adolescents residing in rural communities in Thailand.

To sum up, we presented the situation of alcohol consumption among adolescents in a remote rural community in Thailand. The current study revealed that the prevalence of alcohol consumption was extremely high among males and females. On average, young adolescents initiate alcohol consumption at age 13. The factors affecting alcohol use included individual and environmental factors. Therefore, effective strategies should be implemented across multiple levels of the socio-ecological model simultaneously to alleviate alcohol consumption among adolescents and attenuate its complications.

Data availability

The datasets generated during and/or analyzed during the current study are not publicly available because the data set contains sensitive identifying information. Because ethical restrictions have been placed, the data sets are available from the corresponding author on reasonable request (contact Boonsub Sakboonyarat via [email protected]).

Abbreviations

National Statistic Office

Alcohol use disorders identification test

Adjusted prevalence ratio

Confidence interval

Standard deviation

WHO. Global Status Report on Alcohol and Health 2018 (World Health Organization, 2018).

Google Scholar  

Ministry of Information and Communication Technology. The Smoking and Drinking Behaviour Survey 2017 (National Statistical Office, Ministry of Information and Communication Technology, 2018).

Liang, W. & Chikritzhs, T. Age at first use of alcohol predicts the risk of heavy alcohol use in early adulthood: A longitudinal study in the United States. In. J. Drug Policy 26 , 131 (2015).

Article   Google Scholar  

Yaimai, W. et al. Prevalence and associated risk factors of substance abuse among adolescents in rural communities, central Thailand: A cross-sectional study. J. Southeast Asian Med. Res. 3 , 73–81 (2019).

Jiang, H. et al. Measuring and preventing alcohol use and related harm among young people in Asian countries: A thematic review. Glob. Health Res Policy 3 , 1–14 (2018).

Assanangkornchai, S. & Vichitkunakorn, P. Does drinking initiation of young Thai drinkers vary over time and generation? Results of the national surveys on tobacco and alcohol consumption of the Thai populations 2007 to 2017. Alcohol Clin. Exp. Res. 44 , 2239–2246 (2020).

Article   PubMed   Google Scholar  

World Health Organization. Global Status Report on Alcohol and Health 2018: Executive Summary (World Health Organization, 2018).

World Health Organization. Thailand 2015 Global School-Based Student Health Survey 2018 (World Health Organization, 2018).

Luecha, T., Peremans, L., Junprsert, S. & van Rompaey, B. Factors associated with alcohol consumption among early adolescents in a province in Eastern region of Thailand: A cross-sectional analysis. J. Ethn Subst. Abuse 21 , 325 (2022).

Boonchooduang, N., Louthrenoo, O., Charnsil, C. & Narkpongphun, A. Alcohol use and associated risk behaviors among adolescents in Northern Thailand. ASEAN J. Psychiatry 18 , 1 (2017).

Luecha, T., Peremans, L., Dilles, T. & van Rompaey, B. The prevalence of alcohol consumption during early adolescence: A cross-sectional study in an eastern province, Thailand. Int. J. Adolesc. Youth 24 , 160 (2019).

The Population Division of the Department of Economic and Social Affairs of the United Nations. World Urbanization Prospects 20 18. https://population.un.org/wup/ . Accessed 21 December 2021. (2018).

Cochran, W. G. Sampling Techniques (Wiley, 2007).

MATH   Google Scholar  

World Health Organization. WHO STEPS Surveillance Manual: The WHO STEPwise Approach to Chronic Disease Risk Factor Surveillance (World Health Organization, 2005).

Babor, T. F., Higgins-Biddle, J. C., Saunders, J. B. & Monteiro, M. G. The Alcohol Use Disorders Identification Test (World Health Organization, 2001).

Carter, N. The use of triangulation in qualitative research. Number 5/September 2014 41 , 545–547 (1969).

Machado-da-Silva, C. L. Qualitative research & evaluation methods. Rev. de Admin. Contemp. 7 , 219 (2003).

Assanangkornchai, S., Sam-Angsri, N., Rerngpongpan, S. & Lertnakorn, A. Patterns of alcohol consumption in the Thai population: Results of the National Household Survey of 2007. Alcohol Alcohol. 45 , 278 (2010).

Hingson, R. W., Heeren, T. & Winter, M. R. Age at drinking onset and alcohol dependence: Age at onset, duration, and severity. Arch. Pediatr. Adolesc. Med. 160 , 739 (2006).

Noknoy, S., Rangsin, R., Saengcharnchai, P., Tantibhaedhyangkul, U. & McCambridge, J. RCT of effectiveness of motivational enhancement therapy delivered by nurses for hazardous drinkers in primary care units in Thailand. Alcohol Alcohol. 45 , 263 (2010).

Jiang, N., Lee, Y. O. & Ling, P. M. Association between tobacco and alcohol use among young adult bar patrons: A cross-sectional study in three cities. BMC Public Health 14 , 1 (2014).

de Leon, J. et al. Association between smoking and alcohol use in the general population: Stable and unstable odds ratios across two years in two different countries. Alcohol Alcohol. 42 , 252 (2007).

Beard, E., West, R., Michie, S. & Brown, J. Association between smoking and alcohol-related behaviours: A time-series analysis of population trends in England. Addiction 112 , 1832 (2017).

Article   PubMed   PubMed Central   Google Scholar  

Groh, D. R., Jason, L. A., Davis, M. I., Olson, B. D. & Ferrari, J. R. Friends, family, and alcohol abuse: An examination of general and alcohol-specific social support. Am. J. Addict. 16 , 49 (2007).

Moreno, M. A. & Whitehill, J. M. Influence of social media on alcohol use in adolescents and young adults. Alcohol Res. 36 , 91 (2014).

PubMed   PubMed Central   Google Scholar  

Jernigan, D. H. & Rushman, A. E. Measuring youth exposure to alcohol marketing on social networking sites: Challenges and prospects. J. Public Health Policy 35 , 91–104 (2014).

McCreanor, T. et al. Youth drinking cultures, social networking and alcohol marketing: Implications for public health. Crit. Public Health 23 , 110 (2013).

Bandura, A. & Walters, R. H. Social Learning Theory Vol. 1 (Englewood Cliffs Prentice Hall, 1977).

Strickland, D. E. ‘Social learning and deviant behavior: A specific test of a general theory’: A comment and critique. Am. Sociol. Rev. 47 , 162–167 (1982).

Brunborg, G. S., Skogen, J. C. & Burdzovic Andreas, J. Time spent on social media and alcohol use among adolescents: A longitudinal study. Addict. Behav. 130 , 107294 (2022).

Moreno, M. A., D’Angelo, J. & Whitehill, J. Social media and alcohol: Summary of research, intervention ideas and future study directions. Media Commun. 4 , 50–59 (2016).

Kelly, A. B., Halford, W. K. & Young, R. M. D. Expectations of the effects of drinking on couple relationship functioning: An assessment of women in distressed relationships who consume alcohol at harmful levels. Addict. Behav. 27 , 451 (2002).

Temple, M. T. et al. A meta-analysis of change in marital and employment status as predictors of alcohol consumption on a typical occasion. Br. J. Addict. 86 , 1269 (1991).

Article   CAS   PubMed   Google Scholar  

Jenkins, R. et al. Debt, income and mental disorder in the general population. Psychol. Med. 38 , 1485 (2008).

Shaw, B. A., Agahi, N. & Krause, N. Are changes in financial strain associated with changes in alcohol use and smoking among older adults? J. Stud. Alcohol Drugs 72 , 917 (2011).

White, H. R., Tice, P. C., Loeber, R. & Stouthamer-Loeber, M. Illegal acts committed by adolescents under the influence of alcohol and drugs. J. Res. Crime Delinq. 39 , 131 (2002).

Centers for Disease Control and Prevention. The Social-Ecological Model: A Framework for Prevention. 2015 . https://www.cdc.gov/violenceprevention/about/social-ecologicalmodel.html (Accessed 22 April 2021) (2016).

National Research Council (US) and Institute of Medicine (US) Committee on Developing a Strategy to Reduce and Prevent Underage Drinking. Reducing underage drinking: A collective responsibility. Choice Rev. Online 42 , 1601 (2004).

Nguyen-Louie, T. T. et al. Earlier alcohol use onset predicts poorer neuropsychological functioning in young adults. Alcohol Clin. Exp. Res. 41 , 2082 (2017).

Vicary, R., Snyder, R. & Henry, L. The effects of family variables and personal competencies on the initiation of alcohol use by rural seventh grade students. Adoles. Fam. Health 1 , 21 (2000).

Dusenbury, L. Family-based drug abuse prevention programs: A review. J. Prim. Prev. 20 , 337–352 (2000).

Gottfredson, D. C. & Wilson, D. B. Characteristics of effective school-based substance abuse prevention. Prev. Sci. 4 , 27 (2003).

Tobler, N. S. et al. School-based adolescent drug prevention programs: 1998 meta-analysis. J. Prim. Prev. 20 , 275–336 (2000).

Friedman, H. S. Encyclopedia of Mental Health (Academic Press, 2015).

Stigler, M. H., Neusel, E. & Perry, C. L. School-based programs to prevent and reduce alcohol use among youth. Alcohol Res. Health 34 , 157 (2011).

Assanangkornchai, S., Conigrave, K. M. & Saunders, J. B. Religious beliefs and practice, and alcohol use in Thai men. Alcohol Alcohol. 37 , 193 (2002).

Fagan, A. A., Hawkins, J. D. & Catalano, R. F. Engaging communities to prevent underage drinking. Alcohol Res. Health 34 , 167 (2011).

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Acknowledgements

The authors express their grateful thanks to the director, teachers, healthcare workers and village health volunteers of Baan-Na-Yao Health Promoting Hospital, Chachoengsao Province. The authors thank all the staff of the Department of Military and Community Medicine, Phramongkutklao College of Medicine, for their support in completing this study.

This research was supported by the Phramongkutklao College of Medicine, Bangkok, Thailand.

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Pichak Pramaunururut, Pijak Anuntakulnathee, Piti Wangroongsarb, Thanapat Vongchansathapat, Kullanith Romsaithong, Jareewan Rangwanich, Nuttamon Nukaeow, Poonyawee Chansaenwilai, Ploynaphat Greeviroj, Pimchanok Worawitrattanakul, Pamornwat Rojanaprapai & Veerapatra Tantisirirux

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The concept for the study was developed by P.P., P.A., P.W., T.V., K.R., J.R., N.N., P.C., P.G., P.W., P.R., V.T., P.T., M.M., W.R., R.R. and B.S. P.P., P.A., P.W., T.V., K.R., J.R., N.N., P.C., P.G., P.W., P.R., V.T. and B.S. collected the data. P.P., P.A., and B.S. analyzed the data. P.P., P.A., T.V., M.M. and B.S. wrote the first draft, and all authors contributed and approved the final version.

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Pramaunururut, P., Anuntakulnathee, P., Wangroongsarb, P. et al. Alcohol consumption and its associated factors among adolescents in a rural community in central Thailand: a mixed-methods study. Sci Rep 12 , 19605 (2022). https://doi.org/10.1038/s41598-022-24243-0

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Effects of Alcohol Consumption on Various Systems of the Human Body: A Systematic Review

Jerin varghese.

1 Medical School, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Wardha, IND

Sarika Dakhode

2 Community Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Wardha, IND

Prolonged alcohol intake for many years has been known to cause serious ailments in human beings since time memorial. Even after knowing that this dangerous addiction paves the way to one’s own grave, there isn’t much difference in the way the community sees this deadly habit. Time and again history has proven that this fatal addiction could make the life of those who consume it terrible. Also, the lives of the dear ones of alcoholic people are affected as alcohol not only affects those who consume them but also kin and friends. Various research studies conducted over many years clearly show the association of prolonged alcohol intake in the causation, aggravation, worsening, and deterioration of the health of its consumers. Moreover, chronic alcohol intake single-handedly is one of the major etiological factors in various serious diseases.

Introduction and background

Through the ages, alcoholism has been undisputedly maintaining its position in the list of risk factors for preventable diseases in the world. According to a WHO report, 5.3% of all deaths that occurred worldwide in the year 2016 were because of harmful alcohol use [ 1 ]. It is the main culprit behind the advancing nature of many chronic diseases. It drastically increases the severity of diseases and also makes the treatments less effective. Alcohol not only affects the person physiologically, but it has many adverse effects psychologically and socially too. Also, the habit of alcoholism leads to huge expenses [ 2 ]. Apart from systemic involvement, which causes various clinical manifestations, there are certain signs and symptoms that are most of the times non-specific and that as such don’t point out or say lead to a particular diagnosis, such as nausea, agitation, vomiting, anxiety, diaphoresis, tremors, headache, visual hallucinations, tachycardia, seizures, delirium, temperature elevation, etc. It is not always necessary that these mentioned signs and symptoms are compulsorily linked with disease conditions.

Alcohol clearly plays a very important role in making many other diseases progress to their advanced stages. It has been also noted that alcohol intake and its related disorders are often associated with many other manifestations; for example, patients with alcoholic neuropathy often have associated nutritional deficiencies. Recent studies have clearly proved that alcoholism is associated with many types of cancers too and this understanding of alcoholism has spurred research minds all over the globe to find out the exact pathophysiology behind the same. Alcohol is a very easily available source of addiction, which is one of the main reasons why it remains a serious threat to the community. There is a huge variety that is available as far as alcoholic drinks are concerned. Alcohol is also one of the cheaply accessible means of addiction; this explains why alcoholism is so prevalent. A person may initially start consuming alcohol in very low amounts most probably with just a desire to try it, but once he or she gets addicted, then getting rid of the habit becomes extremely difficult. Even if a person is mentally resolute enough to quit alcoholism, his or her body, which has been modified because of the chronic use of alcohol, won’t be up to the challenge anytime soon; he or she has to overcome many hurdles put forward by the body, which could in an umbrella term be referred to as alcohol withdrawal syndrome.

There are many social stigmas associated with alcohol intake. Most people get into this addiction by getting inspired by the people whom they admire, like actors, celebrities, role models, etc. Also, exposure to the sight of family members, relatives and friends drinking alcohol has a huge impact on one’s mindset as he or she may take it to be something that is normal. In the long run, most of the time, even without their realization, people get pathetically trapped in this dangerous fatal habit of alcoholism, which eventually makes their lives pitiful in almost all aspects. Studies have shown that alcohol is also a key player in many other domains too like accidents, suicide, depression, hallucinations, violence, memory disturbances, etc.

The main purpose of this review article is to enable any person reading this article to get a comprehensive insight into the effects of alcohol on the various systems of the human body, and for the same, many recognized research articles published in numerous well-acknowledged journals across the globe are reviewed. The article is written using very basic and simple terminologies so that even a layperson who reads it would be able to understand it. For the easy acceptability and understanding of the reader, the discussion is written in such a way that almost every major system is reviewed one by one and the effect of alcohol on these systems put forward in very simple language. The strategies used for the establishment of this review article are summarised in Figure ​ Figure1; 1 ; these include considering research articles that have been published in journals with are indexed in reputed platforms, segregating articles according to the different systems, framing the review like a discussion section of an article where details are explained in simple and straight forward sentences, etc.

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Impact of alcohol on the central nervous system (CNS)

Alcohol exerts various effects on our CNS in various ways, the common ones being depression of the CNS, destruction of the brain cells, contraction of the tissues of the brain, suppression of the excitatory nerve pathway activity, neuronal injury, etc [ 3 ]. Alcohol’s impact on the functioning of the brain ranges from mild and anxiolytic disinhibitory effects, motor incoordination, sedation, emesis, amnesia, hypnosis and ultimately unconsciousness [ 4 ]. The synaptic transmission is heavily disturbed and altered by ethanol, and the intrinsic excitability in various areas of the brain is also compromised. The effects of ethanol may be pre-synaptic, post-synaptic, and at times, non-synaptic too. Alcohol being a psychotropic depressant of the CNS exerts a deeply profound impact on the neurons, which alters the biological and behavioural well-being of the one who consumes it by the promotion of interference in various neuronal pathways [ 5 ]. The treatments of many disorders of the CNS are shown to be affected by the consumption of alcohol, and thus, it is generally advised to keep oneself away from alcohol if one is undergoing treatment for any CNS manifestations, like anxiety or mood disorders [ 6 ].

Alcohol use disorder (AUD) is chronic in nature and is characterized by uncontrolled drinking and also a preoccupation with alcohol. The severity of AUD is a crucial factor in how it is going to affect the human body. AUD can be mild, moderate, or severe according to the symptoms a person experiences. The clinical manifestations of AUD include signs and symptoms such as inability to control the amount of alcohol intake, spending a lot of time drinking, feeling an uncontrollable craving for alcohol, loss of interest in social activities, failure to fulfil tasks within the time provided, etc. Most of the time, along with the person who consumes alcohol, several other factors are also to be taken care of in order to effectively manage alcohol-related health conditions. These factors can be social, environmental, genetic, psychological, etc, which make a considerable impact on how alcohol affects the behaviour and body of those consuming it. Binge drinking, i.e., drinking to such an extent on a single occasion that the blood alcohol concentration level becomes 0.08% or more, is a very relevant aspect of alcohol intake, which has to be dealt with, with utmost urgency. Certain research studies suggest that mild to moderate alcohol intake provides a certain sort of protection against a few CNS disorders like dementia, ischemia of neurons, etc, but this in no way should encourage the community in promoting alcohol intake as in reality, it is very difficult to remain within the limits of mild to moderate alcohol intake, and thus, eventually, people do end up as full-time severe alcohol abusers. Epilepsy, a seizure disorder caused by disturbed nerve cell activity in the brain, aggravates on excessive alcohol intake as alcohol increases the frequency of seizures in patients of epilepsy [ 7 ]. The issue becomes more severe in those epileptic patients who have refractory forms of epilepsy. As far as comorbidities are concerned, a valid history of abuse of substances or alcohol dependence is believed to be strongly associated with a high risk of sudden unexpected death in epilepsy (SUDEP) [ 8 ]. Heavy alcohol drinking over a long period of time has been found to have an intensely negative undesirable effect on the autonomic nervous system too.

Impact of alcohol on the cardiovascular system (CVS)

Chronic alcohol intake is undoubtedly a very important risk factor as far as cardiovascular diseases are concerned and several clinical trials do point out this fact. The results of several research studies conducted in various settings clearly indicate that increased intake of alcohol has increased adverse effects on our heart and its vasculature. Alcohol exerts its action on the cardiovascular system both directly and indirectly. Blood pressure, a very vital player in the domain of cardiovascular diseases, is in turn itself affected by increased alcohol consumption. Blood pressure gets increased on regular consumption of alcohol in a manner which is dose-dependent, which in turn increases the risk of hypertension and eventually leads to various cardiovascular complications. How exactly alcohol causes hypertension is still unclear with many pathophysiological theories out there. Atrial fibrillation, one of the most common causes of arrhythmia, is associated with the high-volume chronic intake of alcohol and above 14 g alcohol/day, the relative risk dramatically increases by 10% for each extra standard drink (14 g ethanol) [ 9 ].

Cerebrovascular accidents are increased to a great extent at almost all levels of alcohol intake [ 10 ]. Alcohol intake leads to both acute (depresses the cardiac function and also alters the blood flow of the involved region) and chronic cardiovascular manifestations [ 11 ]. Alcohol abuse along with other associated factors is one of the leading causes of secondary cardiomyopathy [ 12 ]. Cardiac arrhythmias get precipitated by alcohol consumption, be it acute or chronic. Heavy alcohol drinking is shown to impact the cardiovascular system in many ways, one of the most important among them being rebound hypertension [ 13 ]. Apart from congenital disorders of the cardiovascular system, it indeed is a very well-evident fact, which could be understood from the history of most of the patients diagnosed with cardiovascular disorders, that they used to consume a lot of alcohol for many years.

Impact of alcohol on the digestive system

Chronic alcoholism is found to have a very strong relationship with both acute pancreatitis and chronic pancreatitis. Chronic alcohol intake impairs the repair ability of the structures of the exocrine pancreas, thereby leading to pancreatic dysfunctioning [ 14 ]. Most of the patients diagnosed with pancreatitis have a strong history of chronic intake of alcohol. Liver diseases related to alcohol intake are known to humankind from the very beginning and probably are one of the oldest known forms of injury to the liver [ 15 ]. In liver diseases linked with alcohol, liver cirrhosis is a major concern. Statistics show that liver cirrhosis is one of the top 10 causes of death worldwide and this in itself indicates the severity of the same [ 16 ]. The changing lifestyle and also many people turning to prolonged alcohol intake for many years are contributing to the increased number of liver cirrhosis patients in the modern world. In liver cirrhosis patients, there occurs an increased severity of fibrosis due to the loss of parenchyma and fibrous scar proliferation [ 17 ]. Alcoholic liver disease (ALD) is an umbrella term which incorporates a wide range of injuries of the liver, spanning from simple steatosis to cirrhosis, and this also includes alcohol-related fatty liver disease (AFLD) and also alcoholic hepatitis [ 18 ]. Advancements in the diagnostic modalities have helped to diagnose ALD at an early phase and there is no doubt that newer and better investigations that have helped to detect more cases have led to a surge in the number of ALD patients on whole. Alcohol intake has a prominently bigger impact on the mortality of liver cirrhosis when compared with the morbidity [ 19 ]. A systemic review and meta-analysis suggests that women might be at a higher risk as far as developing liver cirrhosis is concerned even with little consumption of alcohol, as compared to men [ 20 ].

Impact of alcohol on the causation of cancer

Alcohol has much to do with cancers too and continuous research studies are conducted in order to find out the relationship between the two in detail. In a meta-analysis, it was found that women consuming alcohol had a later menopause onset, which is found to be associated with reduced cardiovascular disease risk and also all-cause mortality, but unfortunately, the happiness of this advantage gets compromised by the ironic fact that it has an increased risk of cancer (including ovarian and breast cancers) [ 21 , 22 ]. Large cohort studies, many meta-analyses, experimental research studies, etc are suggestive of the fact that the chronic intake of alcohol clearly increases colon and gastric cancer risk [ 23 ]. A causal association is also found between alcohol intake and cancers of the rectum, colon, liver, oesophagus, larynx, pharynx and oral cavity [ 24 ]. There are various theories put forward so as to understand the role of the consumption of alcohol in the development of cancer; there is suspicion that the rise in the number of alcohol users worldwide may be one of the reasons why the number of cancer patients is increasing at a global level. Chronic intake of alcohol may promote the genesis of cancer in many ways, some of the most notable ones being acetaldehyde (weak mutagen and carcinogen) production, cytochrome P450 2E1 induction associated oxidative stress, S-adenosylmethionine depletion/ which leads to global DNA hypomethylation induction, iron induction associated oxidative stress, retinoic acid metabolism impairment, etc [ 25 ].

Impact of alcohol on other systems

Apart from the systemic manifestations which do affect a particular system of the body, there are various disorders in which alcohol indirectly provides its crucial contribution. It is a common finding that one could perceive that alcohol is most of the time in the list of risk factors for various diseases. Alcohol has been found to adversely affect our immune system and the matter of concern as far as this issue is concerned is that immune responses are influenced by even moderate amounts of alcohol intake [ 26 ]. Alcohol affects innate immunity and also interferes with almost all the various aspects of the adaptive immune response. Alcohol is a key player in impairing anti-inflammatory cytokines and also promotes proinflammatory immune responses. The gastrointestinal biome is severely manipulated by the use of alcohol over a long period of time, which in turn is found to have a link with the establishment of various complications [ 27 ]. Alcohol and its metabolites are found to promote inflammation in the intestines and they do so through varied pathways [ 28 ]. Alcohol being a teratogen is documented to cause abnormalities of the brain, limbs, etc [ 29 ]. Multiple studies have been conducted across the globe to understand the effect of alcohol on humans; implications from certain such studies are put forth in Table ​ Table1 1 . 

Conclusions

Alcohol seldom leaves any system untouched as far as leaving its impression is concerned, spanning from single tissue involvement to complex organ system manifestations. Almost all the major organs that make up a human’s physiological being are dramatically affected by the overconsumption of alcohol. There is an enormous overall economic cost that is paid for alcohol abuse all over the world.

The content published in Cureus is the result of clinical experience and/or research by independent individuals or organizations. Cureus is not responsible for the scientific accuracy or reliability of data or conclusions published herein. All content published within Cureus is intended only for educational, research and reference purposes. Additionally, articles published within Cureus should not be deemed a suitable substitute for the advice of a qualified health care professional. Do not disregard or avoid professional medical advice due to content published within Cureus.

The authors have declared that no competing interests exist.

Characteristics of Alcohol, Marijuana, and Other Drug Use Among Persons Aged 13–18 Years Being Assessed for Substance Use Disorder Treatment — United States, 2014–2022

Weekly / February 8, 2024 / 73(5);93–98

Sarah Connolly, PhD 1 ,2 ; Taryn Dailey Govoni, MPH 3 ; Xinyi Jiang, PhD 2 ; Andrew Terranella, MD 2 ; Gery P. Guy Jr., PhD 2 ; Jody L. Green, PhD 3 ; Christina Mikosz, MD 2 ( View author affiliations )

What is already known about this topic?

Substance use, including drugs and alcohol, often begins during adolescence.

What is added by this report?

Among adolescents being assessed for substance use disorder treatment, the most commonly reported reasons for substance use included seeking to feel mellow or calm, experimentation, and other stress-related motivations. Most reported using substances with friends; however, approximately one half of respondents who reported past–30-day prescription drug misuse reported using alone.

What are the implications for public health practice?

Reducing stress and promoting mental health among adolescents might lessen motivations for substance use. Educating adolescents on harm reduction practices, including the risks of using drugs alone and ensuring they are able to recognize and respond to overdose (e.g., administering naloxone), could prevent fatal overdoses.

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The figure is a graphic with text about how clinicians can help address teen substance use with illustrations of teens doing healthy activities.

Substance use often begins during adolescence, placing youths at risk for fatal overdose and substance use disorders (SUD) in adulthood. Understanding the motivations reported by adolescents for using alcohol, marijuana, and other drugs and the persons with whom they use these substances could guide strategies to prevent or reduce substance use and its related consequences among adolescents. A cross-sectional study was conducted among adolescents being assessed for SUD treatment in the United States during 2014–2022, to examine self-reported motivations for using substances and the persons with whom substances were used. The most commonly reported motivation for substance use was “to feel mellow, calm, or relaxed” (73%), with other stress-related motivations among the top reasons, including “to stop worrying about a problem or to forget bad memories” (44%) and “to help with depression or anxiety” (40%); one half (50%) reported using substances “to have fun or experiment.” The majority of adolescents reported using substances with friends (81%) or using alone (50%). These findings suggest that interventions related to reducing stress and addressing mental health concerns might reduce these leading motivations for substance use among adolescents. Education for adolescents about harm reduction strategies, including the danger of using drugs while alone and how to recognize and respond to an overdose, can reduce the risk for fatal overdose.

Introduction

Initiation of substance use often occurs during adolescence ( 1 ), and adolescents commonly report using substances to feel good or get high and to relieve pain or aid with sleep problems ( 2 , 3 ). Adverse consequences of adolescent substance use include overdose, risk for development of substance use disorder (SUD), negative impact on brain development, and death. Prescription opioid misuse during adolescence is associated with SUD in adulthood ( 4 ). In the event of an overdose, immediate medical attention is necessary; bystanders can respond by calling emergency medical personnel and administering naloxone, which reverses overdoses caused by opioids. To guide the development and implementation of prevention strategies and help reduce substance use and fatal overdoses among youths, the motivations for substance use and the persons with whom adolescents report using substances were studied.

Data Source

Data were obtained from the National Addictions Vigilance Intervention and Prevention Program’s Comprehensive Health Assessment for Teens (CHAT) ( 5 ). CHAT is a self-reported, online assessment for persons aged 13–18 years who are being evaluated for SUD treatment. Assessments conducted during January 1, 2014–September 28, 2022, were analyzed. Because the assessment may be completed more than once, assessments completed by the same person within 60 days of a previous assessment were removed. The data set was restricted to assessments reporting past–30-day use of alcohol, marijuana, or other drugs* and with at least one option selected for motivation or persons with whom substances were used.

Respondents were asked to report specific substances used within six categories: 1) alcohol, 2) marijuana, hashish, or tetrahydrocannabinol (THC), 3) drugs other than alcohol or marijuana, † and misuse § of 4) prescription pain medications, ¶ 5) prescription stimulants,** or 6) prescription sedatives or tranquilizers. †† Motivation for use was asked for each of the six categories; each motivation question had 15 response options §§ and respondents were asked to select all options that applied. Respondents were also asked to select the persons with whom they used substances from four categories of substances: 1) alcohol, 2) marijuana, hashish, or THC, 3) drugs other than alcohol or marijuana, and 4) prescription drugs (which included prescription pain medications, prescription stimulants, and prescription sedatives or tranquilizers). Ten options describing the persons with whom substances were used were presented, ¶¶ and respondents were asked to select all that applied.

Data Analysis

The percentages of each motivation and the persons with whom substances were used were calculated.*** Responses were not mutually exclusive: a respondent could report more than one motivation or person with whom substances were used; therefore, the percentages sum to >100. R software (version 4.2.2; R Foundation) was used to conduct all analyses. This activity was reviewed by CDC, deemed not research, and was conducted consistent with applicable federal law and CDC policy. †††

Substance Use

Among 15,963 CHAT assessments conducted during the study period, 9,557 (60%) indicated past–30-day use of alcohol, marijuana, or other drugs. Of those, 9,543 reported at least one motivation or person with whom substances were used and were included in further analyses. Marijuana was most commonly reported (84% of assessments), followed by alcohol (49%) ( Figure ) ( Table ). Nonprescription drug use was indicated on 2,032 (21%) assessments; those most commonly reported were methamphetamine (8%), cough syrup (7%), and hallucinogens (6%). Prescription drug misuse was indicated on 1,812 (19%) assessments, with prescription pain medication reported most commonly (13%), followed by prescription sedatives or tranquilizers (11%), and prescription stimulants (9%).

Reasons Reported for Using Substances

Overall, the most common reasons adolescents reported for using substances were to feel mellow, calm, or relaxed (73%), to have fun or experiment (50%), to sleep better or to fall asleep (44%), to stop worrying about a problem or to forget bad memories (44%), to make something less boring (41%), and to help with depression or anxiety (40%). By category, the most frequently reported motivation for alcohol use and nonprescription drug misuse was to have fun or experiment (51% and 55%, respectively), whereas use to feel mellow, calm, or relaxed was the most reported motivation for use of marijuana (76%), and misuse of prescription pain medications (61%) and prescription sedatives or tranquilizers (55%). The most common motivation for prescription stimulant misuse was to stay awake (31%).

Persons with Whom Substances Were Used

Adolescents most commonly used substances with friends (81%), a boyfriend or girlfriend (24%), anyone who has drugs (23%), and someone else (17%); however, one half (50%) reported using alone. Although using with friends and using alone were reported most often for all substances, the prevalence varied by substance type. Approximately 80% of adolescents who reported using alcohol, marijuana, or nonprescription drugs reported using these substances with friends; however, 64% of those who reported misusing prescription drugs used them with friends. Among adolescents reporting prescription drug misuse, more than one half (51%) reported using these drugs alone, whereas using alone was reported by 44% of those who used marijuana, 39% of those who used nonprescription drugs, and 26% of those who used alcohol.

This analysis summarizing self-reported motivations for use of various substances among adolescents being assessed for SUD treatment who used alcohol, marijuana, or other drugs during the previous 30 days, and the persons with whom adolescents used these substances, found that many adolescents use substances to have fun or experiment or to seek relief mentally, emotionally, or physically. These findings are consistent with those reported in a 2020 study that examined motivations for the nonmedical use of prescription drugs in a sample of young adults, which identified recreational and self-treatment motivations among young adults over time and across drug classes ( 2 ). Anxiety and experiencing traumatic life events have been associated with substance use in adolescents ( 6 ). Specific reporting of motivations, including “to stop worrying about a problem or to forget bad memories” and “to help with depression or anxiety,” underscores the potential direct impact that improving mental health could have on substance use.

One half of adolescents reported using substances while alone. Of particular concern, more than one half of respondents who reported past–30-day prescription drug misuse reported using the drugs alone. Prescription drug misuse while alone presents a significant risk for fatal overdose, especially given the proliferation of counterfeit pills resembling prescription drugs and containing illegal drugs (e.g., illegally manufactured fentanyl) ( 7 ). Education about harm reduction behaviors, such as using in the presence of others and expanding access to naloxone to all persons who use drugs, could reduce this risk.

Adolescents most commonly reported using substances with friends, which presents the opportunity for bystander intervention in the event of an overdose. Nearly 70% of fatal adolescent overdoses occurred with a potential bystander present, yet in most cases no bystander response was documented ( 8 ). Overdose deaths can be prevented through education tailored to adolescents to improve recognition of signs of overdose and teach bystanders how to respond, including the administration of naloxone ( 9 ) and increasing awareness of local Good Samaritan laws, which protect persons against liability when they provide emergency care to others ( 10 ). In addition, ensuring access to effective, evidence-based treatment for SUD and mental health conditions might decrease overdose risk.

Limitations

The findings in this report are subject to at least three limitations. First, the population represents a convenience sample of adolescents being assessed for SUD treatment and is not generalizable to all adolescents in the United States. Second, the assessment is self-reported and subject to potential reporting and recall biases as well as social desirability bias. Finally, several questions on motivations and persons with whom respondents use substances refer to categories of substances; thus, it was not possible to ascertain to which specific drug a person might be referring in their response if use of more than one substance within a drug category was reported.

Implications for Public Health Practice

Harm reduction education specifically tailored to adolescents has the potential to discourage using substances while alone and teach how to recognize and respond to an overdose in others, which could thereby prevent overdoses that occur when adolescents use drugs with friends from becoming fatal. Public health action ensuring that youths have access to treatment and support for mental health concerns and stress could reduce some of the reported motivations for substance use. These interventions could be implemented on a broad or local scale to improve adolescent well-being and reduce harms related to substance use.

Acknowledgment

Akadia Kacha-Ochana, CDC.

Corresponding author: Sarah Connolly, [email protected] .

1 Epidemic Intelligence Service, CDC; 2 Division of Overdose Prevention, National Center for Injury Prevention and Control, CDC; 3 Inflexxion, Irvine, California.

All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. No potential conflicts of interest were disclosed.

* Two assessments that reported using only methadone were excluded.

† The category “drugs, other than alcohol or marijuana” included the following nonprescription drugs: inhalants, cocaine, methamphetamines, hallucinogens, phenylcyclidine or ketamine, heroin, ecstasy or 3,4-methylenedioxy-methamphetamine, gamma hydroxybutyrate or rohypnol, cough syrup, illegally made fentanyl (added to assessment in 2017), and xylazine (added to assessment in 2022), methadone, “other drug,” and “any drug.”

§ Misuse is described as prescription medication use “not as prescribed,” “without a prescription from a doctor,” “to get high,” or “to change how you feel.”

¶ A description of prescription pain medications provided in the assessment states, “Examples of painkillers include Oxycontin, Vicodin, and Percocet. Pain medications help people feel less pain after surgery, and help manage intense chronic pain.”

** A description of prescription stimulants provided in the assessment states, “Examples of stimulants include Ritalin, Adderall, and Dexedrine. Stimulants help people concentrate or focus better.”

†† A description of prescription sedatives or tranquilizers provided in the assessment states, “Examples of sedatives include Valium, Xanax, and Klonopin. Sedatives or tranquilizers help people sleep or feel less anxious.”

§§ 1) To feel mellow, calm, or relaxed, 2) to sleep better or fall asleep, 3) to stay awake, 4) to feel less shy or more social, 5) to stop worrying about a problem or forget bad memories, 6) to have fun or experiment, 7) to be sexier or make sex more fun, 8) to lose weight, 9) to make something less boring, 10) to improve or get rid of the effects of other drugs, 11) to concentrate better, 12) to deal with chronic pain, 13) to help with depression or anxiety, 14) to fit in, or 15) other reasons.

¶¶ 1) Friend or friends, 2) brother or sister, 3) parent or parents, 4) adult relative or other adult, 5) relative near adolescent’s own age, 6) boyfriend or girlfriend, 7) coworker, 8) someone else, 9) anyone who has drugs, or 10) used alone.

*** The number of assessments for which an option was selected was divided by the total number of assessments in that substance type category.

††† 45 C.F.R. part 46.102(l)(2), 21 C.F.R. part 56; 42 U.S.C. Sect. 241(d); 5 U.S.C. Sect. 552a; 44 U.S.C. Sect. 3501 et seq.

  • Meich RA, Johnston LD, Patrick ME, O’Malley PM, Bachman JG. Monitoring the future: national survey results on drug use, 1975–2022: secondary school students. Ann Arbor, MI: Institute for Social Research, University of Michigan; 2023. https://monitoringthefuture.org/wp-content/uploads/2023/12/mtf2023.pdf
  • Drazdowski TK, Kelly LM, Kliewer WL. Motivations for the nonmedical use of prescription drugs in a longitudinal national sample of young adults. J Subst Abuse Treat 2020;114:108013. https://doi.org/10.1016/j.jsat.2020.108013 PMID:32527515
  • Groenewald CB, Patel KV, Rabbitts JA, Palermo TM. Correlates and motivations of prescription opioid use among adolescents 12 to 17 years of age in the United States. Pain 2020;161:742–8. https://doi.org/10.1097/j.pain.0000000000001775 PMID:31815917
  • McCabe SE, Veliz PT, Boyd CJ, Schepis TS, McCabe VV, Schulenberg JE. A prospective study of nonmedical use of prescription opioids during adolescence and subsequent substance use disorder symptoms in early midlife. Drug Alcohol Depend 2019;194:377–85. https://doi.org/10.1016/j.drugalcdep.2018.10.027 PMID:30481692
  • Lord SE, Trudeau KJ, Black RA, et al. CHAT: development and validation of a computer-delivered, self-report, substance use assessment for adolescents. Subst Use Misuse 2011;46:781–94. https://doi.org/10.3109/10826084.2010.538119 PMID:21174498
  • Richert T, Anderberg M, Dahlberg M. Mental health problems among young people in substance abuse treatment in Sweden. Subst Abuse Treat Prev Policy 2020;15:43. https://doi.org/10.1186/s13011-020-00282-6 PMID:32580732
  • O’Donnell J, Tanz LJ, Miller KD, et al. Drug overdose deaths with evidence of counterfeit pill use—United States, July 2019–December 2021. MMWR Morb Mortal Wkly Rep 2023;72:949–56. https://doi.org/10.15585/mmwr.mm7235a3 PMID:37651284
  • Tanz LJ, Dinwiddie AT, Mattson CL, O’Donnell J, Davis NL. Drug overdose deaths among persons aged 10–19 years—United States, July 2019–December 2021. MMWR Morb Mortal Wkly Rep 2022;71:1576–82. https://doi.org/10.15585/mmwr.mm7150a2 PMID:36520659
  • Walley AY, Xuan Z, Hackman HH, et al. Opioid overdose rates and implementation of overdose education and nasal naloxone distribution in Massachusetts: interrupted time series analysis. BMJ 2013;346:f174. https://doi.org/10.1136/bmj.f174 PMID:23372174
  • Hamilton L, Davis CS, Kravitz-Wirtz N, Ponicki W, Cerdá M. Good Samaritan laws and overdose mortality in the United States in the fentanyl era. Int J Drug Policy 2021;97:103294. https://doi.org/10.1016/j.drugpo.2021.103294 PMID:34091394

FIGURE . Percentage of persons aged 13–18 years being assessed for substance use disorder treatment reporting specific substances used during the previous 30 days* — National Addictions Vigilance Intervention and Prevention Program Comprehensive Health Assessment for Teens, United States, 2014–2022

Abbreviations: GHB = gamma hydroxybutyrate; MDMA = 3,4-methylenedioxy-methamphetamine; PCP = phenylcyclidine.

* Among those reporting previous 30-day use of any alcohol, marijuana, or other drugs, and at least one motivation or person with whom substances were used.

Abbreviation: THC = tetrahydrocannabinol. * Includes motivations or persons with whom adolescents used substances reported for any of the following: alcohol, marijuana, nonprescription drugs, prescription drug misuse, methadone, “other drug,” and “any drug.” † The alcohol motivation question is phrased, “People use alcohol for many reasons. Why have you used alcohol? Select all that apply.” The question asking with whom alcohol is used is phrased, “When you drink, who do you drink with? Select all that apply.” § The marijuana motivation question is phrased, “People use marijuana, hashish, or THC for many reasons. Why have you used marijuana, hashish, or THC? Select all that apply.” The question asking with whom marijuana is used is phrased, “When you use marijuana, hashish, or THC, who do you use it with? Select all that apply.” ¶ Inhalants, cocaine, methamphetamines, hallucinogens, phenylcyclidine or ketamine, heroin, ecstasy or 3,4-methylenedioxy-methamphetamine, gamma hydroxybutyrate or rohypnol, cough syrup, illegally made fentanyl (added to assessment in 2017), and xylazine (added to assessment in 2022). The motivation question is phrased, “People use drugs for many reasons. Why have you used drugs, other than alcohol or marijuana? Select all that apply.” The question asking with whom these substances are used is phrased, “When you use drugs, other than alcohol or marijuana, who do you use them with? Select all that apply.” This assessment section also included methadone, “other drug,” and “any drug,” which are captured by the same motivation question and the question asking with whom persons use. If a person reported methadone, “other drug,” or “any drug” in addition to one or more nonprescription drugs, the motivations and with whom they use (for methadone, “other drug,” or “any drug”) cannot be differentiated and are counted in this table. ** Includes persons who responded affirmatively to assessment questions asking about prescription pain medication use “not as prescribed,” “without a prescription from a doctor,” “to get high,” or “to change how you feel.” The motivation question is phrased, “People use drugs for many reasons. Why have you used prescription pain medications on your own? Select all that apply.” †† Includes persons who responded affirmatively to assessment questions asking about prescription stimulant use “not as prescribed,” “without a prescription from a doctor,” “to get high,” or “to change how you feel.” The motivation question is phrased, “People use drugs for many reasons. Why have you used prescription stimulants on your own? Select all that apply.” §§ Includes persons who responded affirmatively to assessment questions asking about prescription sedative and tranquilizer use “not as prescribed,” “without a prescription from a doctor,” “to get high,” or “to change how you feel.” The motivation question is phrased, “People use drugs for many reasons. Why have you used prescription sedatives or tranquilizers on your own? Select all that apply.” ¶¶ The question asking with whom substances are used is asked once for all prescription drugs and is phrased, “When you use prescription drugs, who do you use them with? Select all that apply.” The denominator for the number of assessments indicating past–30-day misuse of at least one prescription drug is 1,812. *** Motivation and persons with whom substances are used questions are in a “select all that apply” format; therefore, percentages sum to >100. Median and IQR summarize the number of motivations and the number of persons with whom they use substances that respondents selected for each question.

Suggested citation for this article: Connolly S, Govoni TD, Jiang X, et al. Characteristics of Alcohol, Marijuana, and Other Drug Use Among Persons Aged 13–18 Years Being Assessed for Substance Use Disorder Treatment — United States, 2014–2022. MMWR Morb Mortal Wkly Rep 2024;73:93–98. DOI: http://dx.doi.org/10.15585/mmwr.mm7305a1 .

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Prevalence and Correlates of Post-Diagnosis Alcohol Use among Cancer Survivors

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Jaimee L. Heffner , Mimi Ton , Salene M.W. Jones , Rachel C. Malen , Stacey A. Cohen , Polly A. Newcomb; Prevalence and Correlates of Post-Diagnosis Alcohol Use among Cancer Survivors. Cancer Epidemiol Biomarkers Prev 2024; https://doi.org/10.1158/1055-9965.EPI-23-1155

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Alcohol is a risk factor for cancer and may pose unique risks for cancer survivors. Population-based studies of confirmed cancer cases are needed to estimate the extent of drinking among cancer survivors and to understand which survivors are most at risk of alcohol-related health problems.

Cancer survivors who resided in the Puget Sound Surveillance, Epidemiology, and End Results (SEER) region, were ages 21 to 74 years at diagnosis, and were 6 to 17 months post-diagnosis at the start of the recruitment period (April 2020–December 2020) were sent a survey that included demographics, substance use, mental health, and cancer-related items. Data from returned surveys ( n = 1,488) were weighted to represent the characteristics of the Puget Sound SEER region. We estimated the prevalence of post-diagnosis alcohol use as well as demographic, behavioral, and clinical correlates of three levels of drinking: any drinking, drinking exceeding cancer prevention guidelines, and hazardous drinking.

The weighted prevalence of any drinking, drinking exceeding cancer prevention guidelines, and hazardous drinking was 71%, 46.2%, and 31.6%, respectively. Higher income and cannabis use were associated with increased odds of all three drinking levels. Lower physical health quality of life, having non-colorectal gastrointestinal cancer, and receiving chemotherapy within the last month were associated with decreased odds of all three drinking levels.

The prevalence of any drinking and at-risk drinking was higher than in previous studies and differed based on sociodemographic, substance use, and cancer-related factors.

Findings highlight the importance of identifying and addressing risky alcohol use in cancer care settings.

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KGAN Cedar Rapids

Iowa's growing cancer rates linked to high alcohol consumption, study finds

N ew research from the Iowa Cancer Registry found that Iowa has the second highest and fastest growing rate of new cancers in the nation. 

One of the risk factors of developing cancer, alcohol, is a main focus of the study released Tuesday.

The University of Iowa College of Public Health said the state has the 4th highest incidence of alcohol-related cancers in the U.S., and it also has the 4th highest rate of binge drinking. 

Binge drinking is when men have five or more alcoholic beverages, or when women have four or more drinks in one sitting.

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John Stokes of Iowa City is now cancer-free after fighting neck and head cancer twice.

He said he used to drink heavily decades ago, in combination with using tobacco. 

"Never during that time did I realize that those choices could cause cancer later in life," said Stokes.

Dr. Marisa Buchakjian still has check-ups with Stokes two years after she performed his cancer removal surgery.

"As a healthcare provider, I'm concerned about the role that alcohol is playing in our cancer patients in Iowa," said Dr. Buchakjian.

Director of the Iowa Cancer Registry Dr. Mary Charlton said there isn't one main cause of cancer, but alcohol can play a factor in the development of the disease, especially when used excessively or in combination with tobacco. 

"What are the things that we can do at a population level, whether it's policy, legislation, programming, things like that, that make it easier to make the healthy choices and harder to make the less healthy choices," said Dr. Charlton.

For now, the panelists at the press conference Tuesday encourage individuals to reduce their intake of any type of alcohol.

"It's never too late to reduce your risk of alcohol related cancer, and if you're thinking about making the move to drink less, reducing your cancer risk is a great motivation to do so," said Stokes.

Iowa's growing cancer rates linked to high alcohol consumption, study finds

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