More U.S. adults are drinking, and more heavily

The United States has a serious drinking problem. Since 2001, heavy drinking and alcohol use disorder have risen dramatically, according to a new study that surveyed tens of thousands of adults. The numbers reveal “a public health crisis,” the authors say.

The increases were especially large among those 65 years and older, minorities and women, researchers report online August 9 in JAMA Psychiatry. Alcohol is a risk factor for many potentially life-threatening injuries and health problems, including cardiovascular diseases, type 2 diabetes and liver cirrhosis.

In 2012‒2013, an estimated 29.6 million American adults reported high-risk drinking, up from 20.2 million in 2001‒2002. This heavy drinking is defined as consuming more than the daily guidelines — five or more drinks per occasion for men, four or more for women — at least once a week. The number of adults who suffered from an alcohol abuse or dependence grew from 17.6 million to 29.9 million over that decade. Some high-risk drinkers could also fall into this alcohol use disorder category.  

“Once you get into the more heavy drinking ranges, the probability is you’re cutting five to 10 years off people’s lives,” says Marc Schuckit, a psychiatrist at the University of California, San Diego School of Medicine, who wrote an editorial accompanying the study.

The study presents data from two national surveys conducted by the National Institute on Alcohol Abuse and Alcoholism in 2001‒2002 and 2012‒2013. These face-to-face interviews queried adults 18 years and older on their drinking habits in the past 12 months.

In the first survey, 65.4 percent of Americans reported that they drink alcohol; in the second survey, that number climbed to 72.7 percent. High-risk drinking grew from 9.7 percent to 12.6 percent. The increases were especially steep for women, minorities and those over 65 (see graph).

During the same time period, the incidence of alcohol use disorder rose from 8.5 percent to 12.7 percent. Unlike high-risk drinking, which is defined by an amount of alcohol consumed, alcohol use disorder is classified according to psychological criteria. These include, for instance, whether drinking interferes with family or professional life and if drinkers experience withdrawal symptoms such as nausea or shakiness. The jump for adults 65 and older was 106.7 percent, 83.7 percent for women, 51.9 percent for Hispanics and 92.8 percent for blacks.

Heavy drinking and alcohol use disorder contribute to diseases that are also on the rise, says study coauthor Bridget Grant, an epidemiologist at NIAAA in Bethesda, Md. Death rates from cirrhosis increased between 2009 and 2013, which hasn’t happened since the early 1970s, she says. Heavy alcohol use may also be contributing to a slowdown in the decline of death rates from cardiovascular diseases.

This study wasn’t designed to determine why people are drinking more. But a 2013 study found that alcoholic beverages are more affordable in the United States now than at any time since 1950. “If something’s cheaper, we buy more,” says Jürgen Rehm, an epidemiologist at the Centre for Addiction and Mental Health in Toronto. Alcohol is widely available and advertisements send the message that “you cannot imagine that anybody can exist without alcohol,” he says.

To stop the rise in heavy drinking, he suggests “you need to counteract exactly those factors: make [alcohol] more expensive, make it less available and ban advertisements.” In Canada, there is a minimum price for alcohol, and when that price has gone up, health problems and hospitalizations related to alcohol have gone down, he says.

There “is and always has been” a lack of awareness regarding the health dangers of drinking excessively, Schuckit says. The stigma associated with heavy drinking and alcohol use disorder is also an issue, deterring people from getting help. “Clearly, alcohol does not get the necessary attention given the problems it causes,” says Rehm.