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Sobering Perspectives on the Treatment of Alcohol Use Disorder

  • 1 Department of Medicine, University of Toronto, Toronto, Ontario, Canada
  • 2 Division of General Internal Medicine, University Health Network, Toronto, Ontario, Canada
  • 3 Division of Clinical Pharmacology & Toxicology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
  • 4 Sunnybrook Research Institute, Toronto, Ontario, Canada
  • Original Investigation Outcomes After Initiation of Medications for Alcohol Use Disorder at Hospital Discharge Eden Y. Bernstein, MD; Travis P. Baggett, MD, MPH; Shrunjal Trivedi, MPH; Shoshana J. Herzig, MD, MPH; Timothy S. Anderson, MD, MAS JAMA Network Open

Alcohol misuse is a leading cause of preventable suffering globally. Each year in the United States, alcohol misuse contributes to 140 000 deaths and nearly 3.6 million years of potential life lost. 1 , 2 Economic losses and health costs are staggering because alcohol can contribute to death and disability early in life. In 2010, the economic burden of alcohol misuse in the United States was estimated at a quarter of a trillion dollars, which is equivalent to $807 per person, or $2.05 per drink. 3

Treatment options for the 30 million individuals with alcohol use disorder (AUD) 4 in the US include behavioral interventions and pharmacotherapy. Naltrexone, acamprosate, and disulfiram are 3 approved drugs for treating AUD. Since disulfiram works only through aversive effects, with no impact on the desire to drink, it tends to work best in supervised settings and with highly motivated patients with strong social supports. 5 A recent systematic review suggested the number-needed-to-treat to prevent 1 person from returning to drinking was 11 for acamprosate and 18 for oral naltrexone. 1 Naltrexone use, in addition, was associated with a substantial decrease in heavy drinking. 1 Moreover, these drugs are well tolerated by patients with minimal side effects.

Despite these clear benefits, medications for AUD (MAUD) remain underused. In 2021, only 2% of Americans who reported AUD received pharmacotherapy. 4 Starting MAUD is especially infrequent during or after hospitalization. A study of nearly 30 000 Medicare beneficiaries with alcohol-related hospitalizations in 2016 showed that only approximately 1% received MAUD within a month of hospital discharge. 6 Hospitalization, therefore, represents an important missed opportunity for engaging patients in treatment.

In this population-based study, Bernstein et al 7 report on MAUD prescribing to Medicare patients with alcohol-related hospitalizations. 7 In a propensity score–matched analysis, receipt of a prescription for either naltrexone, acamprosate, or disulfiram was associated with a 42% lower risk of all-cause mortality or hospital readmission within the next month. 7 Roughly 6 patients would need to fill a prescription for MAUD to prevent 1 repeat emergency visit or hospital admission within a month. The substantial effect size was primarily driven by reductions in all-cause rehospitalization.

This study provides an estimate of the effect of prescribing MAUD to patients following an alcohol-related hospitalization. The results also reaffirm the underuse of MAUD: among the nearly 10 000 admitted patients eligible for study inclusion, only 1 in 50 filled a discharge prescription. 7 This low rate of use is consistent with past studies. 6 , 8 However, the infrequency of prescriptions raises questions about the external generalizability and the extent to which the dramatic reduction in subsequent use of acute care services reflects the effects of MAUD alone. Readers are left wondering in what ways the 2% of patients who filled a discharge prescription for MAUD are different from the 98% who did not.

Propensity score methods, such as those used in this study, are popular for addressing baseline differences between treatment groups in observational studies. This approach, whether by matching or inverse probability weighting, attempts to mimic the symmetry achieved in a randomized trial. However, an important distinction is that only measured factors are balanced when applying propensity score methods. In the study reported by Bernstein and colleagues, 7 we know little about potentially important patient characteristics, such as the severity of alcohol use and motivation for treatment. Such unmeasured confounding can lead to a misleading effect size or a difference in outcomes that is falsely attributed to treatment. 9

Prescribing medications in a thoughtful manner based on clinical indications can also contribute to confounding by indication. For instance, clinicians may have preferentially prescribed MAUD to patients whom they regarded as more likely to adhere following hospital discharge. In a sensitivity analysis restricted to patients who filled any drug prescription following discharge (reflecting some degree of health consciousness), Bernstein et al 7 showed an attenuation of the treatment effect size. Thus, the results may be partially confounded by a healthy adherer effect. 10

An important question is how the results of this study should influence clinical practice. Despite its methodological shortcomings, this study by Bernstein et al 7 highlights the benefits of prescribing MAUD at hospital discharge—benefits consistent with those seen in clinical trials. 1 In addition, the study provides a compelling argument for clinicians to offer MAUD to all hospitalized patients with AUD. 7 During a hospitalization, patients experience health vulnerability which may drive behavior change. Clinicians should take advantage of these opportunities to offer MAUD to patients who meet criteria to maximize treatment for those who might benefit. Greater engagement of inpatient addictions services might also help promote use of MAUD. 6 , 11

Addressing this treatment gap also requires an understanding of system-level barriers to MAUD prescribing. A recent mixed-methods study highlighted barriers to starting MAUD in inpatient settings. 12 Several themes emerged. First, prescribers reported limited knowledge and training with MAUD. 12 Despite the safety of these medications, prescribers overestimated the risks associated with their use. Second, there were concerns regarding discharge follow-up plan and a preference to initiate MAUD in the outpatient setting. 12 Third, alcohol-related stigma hindered clinicians from offering treatment to patients. 12 Clinicians expressed an expectation for a commitment to abstinence before starting MAUD.

Clinicians can also learn from prior successful quality improvement initiatives that have improved MAUD uptake. In 2013, clinical pharmacy specialists were sent to 2 western Department of Veterans Affairs networks to educate clinicians on the consequences of alcohol misuse and facilitate consideration of drug treatment for AUD. This comprehensive campaign was associated with increasing MAUD prescribing in a vulnerable patient population from 4.9% to 8.3%. 13 Moreover, structural changes, such as protocolizing MAUD prescribing at discharge, have also proven successful in other settings. Implementation of a discharge pathway (including a MAUD prescribing protocol) for patients with AUD on internal medicine wards was associated with substantially increased prescribing. 14

At present, most patients with AUD do not receive evidence-based treatment. An important first step might be reframing our mindset to considering AUD as a chronic disease. We should ask ourselves: would we accept the status quo if only 2% of our patients with diabetes were prescribed evidence-based therapy? Designing initiatives to address structural barriers and increase MAUD prescribing will improve the care of patients living with AUD. The insufficient use of MAUD is sobering and is also an enormous opportunity to do better for our patients.

Published: March 29, 2024. doi:10.1001/jamanetworkopen.2024.3340

Open Access: This is an open access article distributed under the terms of the CC-BY License . © 2024 Yaseen W et al. JAMA Network Open .

Corresponding Author: Jonathan Zipursky, MD, PhD, Division of Clinical Pharmacology & Toxicology, Sunnybrook Health Sciences Centre, 2075 Bayview Ave, V1 40, Toronto, ON M4N 3M5, Canada ( [email protected] ).

Conflict of Interest Disclosures: Dr Zipursky reported receiving personal fees from private law firms for medicolegal opinions regarding the safety and effectiveness of drugs outside the submitted work. No other disclosures were reported.

Additional Contributions: We thank Donald Redelmeier, MD, MSHSR, for helpful comments on earlier versions of this manuscript. He was not compensated for this work.

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Yaseen W , Mong J , Zipursky J. Sobering Perspectives on the Treatment of Alcohol Use Disorder. JAMA Netw Open. 2024;7(3):e243340. doi:10.1001/jamanetworkopen.2024.3340

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Key Takeaways

  • Alcohol is among the most used drugs, plays a large role in many societies and cultures around the world, 1  and greatly impacts public health. 2,3  More people over age 12 in the United States have used alcohol in the past year than any other drug or tobacco product, and alcohol use disorder is the most common type of substance use disorder in the United States. 4
  • NIDA works closely with the  National Institute on Alcohol Abuse and Alcoholism (NIAAA) , the lead NIH institute supporting and conducting research on the impact of alcohol use on human health and well-being. For information on  alcohol  and  alcohol use disorder , please visit  the NIAAA website .
  • Because many people use alcohol while using other drugs, 4  NIDA supports and conducts research on both the biological and social dynamics between alcohol use and the use of other substances.

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Use the  SAMHSA Treatment Locator  or call  1-800-662-HELP (4357) .

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  • Find treatment for alcohol use disorder and alcohol addiction (previously called alcoholism) using the NIAAA Alcohol Treatment Navigator .
  • Read more about the latest advances in alcohol addiction research on the NIAAA Director’s Blog .
  • Learn more about how NIH Institutes and Centers work together to better understand, treat and prevent addiction through the Collaborative Research on Addiction at NIH (CRAN) initiative.
  • Learn more about the scientific meeting “ Opioid Use in the Context of Polysubstance Use: Research Opportunities for Prevention, Treatment, and Sustained Recovery .”

NIDA Resources

  • See the latest statistics on alcohol use among young students from NIDA’s Monitoring the Future Survey.

More on this Topic

Addiction often goes hand-in-hand with other mental illnesses. both must be addressed., reported drug use among adolescents continued to hold below pre-pandemic levels in 2023, heart medication shows potential as treatment for alcohol use disorder, marijuana and hallucinogen use among young adults reached all time-high in 2021, additional resources.

  • Find basic health information on alcohol use disorder from MEDLINEplus , a service of NIH’s National Library of Medicine (NIH).
  • Read Alcohol Misuse information from the Substance Abuse and Mental Health Services Administration (SAMHSA).
  • Learn more about medical approaches to treating alcohol use disorder from the Substance Abuse and Mental Health Services Administration (SAMHSA) in Medication for the Treatment of Alcohol Use Disorder: A Brief Guide .
  • Read Alcohol Misuse Prevention: A Conversation for Everyone from the Substance Abuse and Mental Health Services Administration (SAMHSA).
  • Sudhinaraset M, Wigglesworth C, Takeuchi DT. Social and Cultural Contexts of Alcohol Use: Influences in a Social-Ecological Framework. Alcohol Res. 2016;38(1):35-45.
  • Witkiewitz K, Litten RZ, Leggio L. Advances in the science and treatment of alcohol use disorder. Sci Adv. 2019;5(9):eaax4043. Published 2019 Sep 25. doi:10.1126/sciadv.aax4043
  • GBD 2016 Alcohol Collaborators. Alcohol use and burden for 195 countries and territories, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016 [published correction appears in Lancet. 2018 Sep 29;392(10153):1116] [published correction appears in Lancet. 2019 Jun 22;393(10190):e44]. Lancet. 2018;392(10152):1015-1035. doi:10.1016/S0140-6736(18)31310-2
  • Substance Abuse Center for Behavioral Health Statistics and Quality. Results from the  2021 National Survey on Drug Use and Health: Detailed Tables, SAMHSA . Accessed January 2023.
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  • Important Events

Legislative Chronology

The mission of the National Institute on Alcohol Abuse and Alcoholism (NIAAA) is to generate and disseminate fundamental knowledge about the adverse effects of alcohol on health and well-being, and apply that knowledge to improve diagnosis, prevention, and treatment of alcohol-related problems, including alcohol use disorder (AUD), across the lifespan.

NIAAA provides leadership in the national effort to reduce alcohol-related problems by:

  • Conducting and supporting alcohol-related research in a wide range of scientific areas including neuroscience and behavior, epidemiology and prevention, treatment and recovery, and metabolism and health effects.
  • Coordinating and collaborating with other research institutes and federal programs on alcohol-related issues.
  • Collaborating with international, national, state, and local institutions, organizations, agencies, and programs engaged in alcohol-related work.
  • Translating and disseminating research findings to health care providers, researchers, policymakers, and the public. 

Important Events in NIAAA History

1970 —The Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment, and Rehabilitation Act was passed, establishing NIAAA as part of the National Institute of Mental Health (NIMH). Senator Harold E. Hughes of Iowa played a pivotal role in sponsoring the legislation, which recognized “alcohol abuse” and “alcoholism” as major public health problems.

1971 —The  First Special Report to the U.S. Congress on Alcohol and Health  was issued in December, part of a series of triennial reports established to chart the progress made by alcohol research toward understanding, preventing, and treating alcohol abuse and alcoholism.

1974 —NIAAA became an independent Institute within the Alcohol, Drug Abuse, and Mental Health Administration (ADAMHA), which also housed NIMH and the National Institute on Drug Abuse (NIDA).

1977 —NIAAA organized the first national research workshop on fetal alcohol syndrome (FAS), which reviewed the state of the research on FAS.

1980 —NIAAA science and staff were instrumental to the development of the  Report to the President and the Congress on Health Hazards Associated with Alcohol and Methods to Inform the General Public of these Hazards ; this report influenced the following year’s publication of the  U.S. Surgeon General’s Advisory on Alcohol and Pregnancy of 1981 .

1989 —NIAAA launched the Collaborative Studies on Genetics of Alcoholism with the goal of identifying the specific genes underlying vulnerability to alcoholism as well as collecting clinical, neuropsychological, electrophysiological, and biochemical data, and establishing a repository of immortalized cell lines.

1991 —NIAAA began the National Longitudinal Alcohol Epidemiologic Survey, designed to study drinking practices, behaviors, and related problems.

1994 —The medical success of disulfiram, a drug approved in 1951 by the U.S. Food and Drug Administration (FDA), spotlighted the effectiveness of pharmacological approaches for treating AUD. In 1994 and 2004, respectively, scientific evidence from NIAAA-supported studies helped achieve FDA approval of two new medications: naltrexone and acamprosate. NIAAA-supported studies also provided the foundation for the FDA’s more recent change in AUD clinical trial endpoints, opening the door for regulatory approval of a larger number of candidate AUD medications. In 2007, NIAAA established the NIAAA Clinical Investigations Group, a network of sites established to accelerate phase 2 clinical trials of promising compounds, and later expanded NCIG to include early human laboratory studies.

1995 —NIAAA celebrated its 25th anniversary.

1996 —NIAAA established the Mark Keller Honorary Lecture Series. The series pays tribute to Mark Keller, a pioneer in the field of alcohol research, and features a lecture each year by an outstanding alcohol researcher who has made significant and long-term contributions to our understanding of alcohol's effects on the body and mind. 

1999 —NIAAA organized the first National Alcohol Screening Day, created to provide public education, screening, and referral for treatment when indicated. The program was held at 1,717 sites across the United States, including 499 college sites.

NIAAA co-sponsored the launch of The Leadership to Keep Children Alcohol Free, a unique coalition of state governors' spouses, federal agencies, and public and private organizations that targets prevention of drinking in young people ages 9–15.

2001 —NIAAA launched the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions, a representative sample of the U.S. population with data on alcohol and drug use; alcohol and drug abuse and dependence; and associated psychiatric and other co-occurring disorders.

2002 —NIAAA published  A Call to Action: Changing the Culture of Drinking at U.S. Colleges , which was developed by the Task Force of the National Advisory Council on Alcohol Abuse and Alcoholism as a comprehensive review of research on college drinking and the effectiveness of prevention programs.

2004 —NIAAA established the Underage Drinking Research Initiative by convening a steering committee of experts in adolescent development, child health, brain imaging, genetics, neuroscience, prevention research, and other research fields, with the goal of working towards a more complete and integrated scientific understanding of the environmental, biobehavioral, and genetic factors that promote initiation, maintenance, and acceleration of alcohol use among youth, framed within the context of human development.

2005 —NIAAA published  Helping Patients Who Drink Too Much: A Clinician's Guide  to help primary care and mental health clinicians incorporate alcohol screening and intervention into their practices. The 2005 edition introduced a simple one-question screening tool that streamlined recommendations published in earlier NIAAA guides.

The Surgeon General released the  Surgeon General's Advisory on Alcohol Use in Pregnancy , updated from the original advisory released in 1981. As with the 1981 report, NIAAA science contributed significantly to the development of this document, and NIAAA staff were instrumental in its crafting.

2007 —NIAAA partnered with NIDA, the Robert Wood Johnson Foundation, and HBO to produce Addiction, an Emmy-award winning documentary exploring alcohol and drug addiction, treatment, and recovery, and featuring interviews with medical researchers working to better understand and treat addictive disorders.

2008 —The Acting Surgeon General of the United States issued  The Surgeon General's Call to Action to Prevent and Reduce Underage Drinking . NIAAA’s Underage Drinking Research Initiative provided much of the scientific foundation for that document.

NIAAA published a special supplemental issue of the journal  Pediatrics , presenting a developmental framework for understanding and addressing underage drinking as a guide to future research, prevention, and treatment efforts. The research reflected in these articles contributed to the development of  The Surgeon General’s Call to Action To Prevent and Reduce Underage Drinking .

2009 —NIAAA established the Jack Mendelson, M.D., Honorary Lecture Series. The series pays tribute to Dr. Mendelson’s contributions to the field of clinical alcohol research, and features a lecture each year by an outstanding alcohol researcher whose clinical research has made significant and long-term contributions to our understanding of susceptibility to alcohol use disorder (AUD), alcohol's effects on the brain and other organs, and the prevention and treatment of AUD.

NIAAA launched Rethinking Drinking , a website and booklet, following extensive audience usability testing. These resources offer valuable, research-based information enabling people to take a look at their drinking patterns and how these patterns may be affecting their health. 

2010 —To celebrate NIAAA’s 40th anniversary, the Institute published a special double issue of its peer-reviewed journal,  Alcohol Research & Health that describes the Institute’s public health impact and multidisciplinary contributions to alcohol research. Additionally, on October 4, 2010, the Institute hosted a special symposium recognizing the 40th anniversary, where, leaders in the field discussed the ways in which alcohol research has evolved over the past 40 years, as well as NIAAA's role in this progress.

2011 —NIAAA released  Alcohol Screening and Brief Intervention for Youth: A Practitioner's Guide , Developed in collaboration with the American Academy of Pediatrics, clinical researchers, and health practitioners, the guide introduced a two-question screening tool and an innovative youth alcohol risk estimator to help clinicians overcome time constraints and other common barriers to youth alcohol screening.

2012 —NIH announced the Trans-NIH Substance Use, Abuse, and Addiction Functional Integration to enhance the NIH Institute and Center (IC) collaborations around this important scientific and public health topic. The Functional Integration is a collaborative framework that draws on the collaboration among the NIH ICs on substance use, abuse, and addiction-related research. NIAAA and NIDA have made significant progress toward integrating their intramural research programs in substance use, abuse, and addiction, including the appointment of a single Clinical Director for both Institutes and the establishment of a joint genetics intramural research program and a common optogenetics lab. By pooling resources and expertise, the Functional Integration will identify cross-cutting areas of research and confront challenges faced by multiple Institutes and Centers.

2013 —NIAAA helped establish and participated in the NIH partnership, Collaborative Research on Addiction at NIH (CRAN). CRAN’s mission is to provide a strong collaborative framework to enable NIAAA, NIDA, and the National Cancer Institute (NCI), to integrate resources and expertise to advance substance use, abuse, and addiction research and public health outcomes. NIAAA helped launch  a website to share funding opportunities and research resources readily with the public.

In addition, NIAAA developed and launched an online course for health care professionals to learn more about screening youth for alcohol problems. Doctors, nurses, psychologists, and others can take the online training to earn continuing medical education credits. The course, produced jointly with Medscape, shows providers how to conduct fast, evidence-based alcohol screening and brief intervention for patients ages 9–18. Since its launch in August, more than 5,000 health care professionals have earned credit for the course.

2015 —NIAAA launched CollegeAIM — the College Alcohol Intervention Matrix , a new resource to help schools address harmful and underage student drinking. In 2020, NIAAA published significant updates to the CollegeAIM website, updating resources and scientific evidence. NIAAA also added a clinician’s portal to the Alcohol Treatment Navigator website, helping clinicians to feel more confident making patient referrals for AUD.

2016 —NIAAA science and staff were instrumental to the development of  Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health . HBO Documentary Films premiered Risky Drinking, which follows the stories of four people whose drinking dramatically affects their relationships and their lives. This 85-minute film features commentary by experts including NIAAA Director George F. Koob, Ph.D., and NIAAA Medical Project Officer Deidra Roach, M.D.

2017 —NIAAA issued the  NIAAA Strategic Plan, 2017-2021.

NIAAA also launched the Alcohol Treatment Navigator website to help adults find alcohol treatment for themselves or an adult loved one.

2018 —CRAN, based on the need to understand how substance use and other experiences during adolescence influence development, established the Adolescent Behavioral and Cognitive (ABCD) Study , a large scale, long-term, longitudinal study. In 2018, the ABCD study successfully completed its baseline enrollment of 11,874 participants ages 9 to 10 and began follow-up assessments which will continue into adulthood.

2020 —NIAAA celebrated its 50th anniversary with a range of events and promotional activities. These efforts culminated with a virtual 50th anniversary science symposium on November 30 and December 1, “Alcohol Across the Lifespan: 50 Years of Evidence-Based Diagnosis, Prevention, and Treatment Research.” Presentations spotlighted scientific milestones, the current state of the science, and future opportunities for alcohol research.

During the COVID-19 pandemic, NIAAA developed a list of web-based resources for the research community, healthcare professionals, and the general public regarding the potential for alcohol misuse, including information about telehealth for alcohol treatment. NIAAA also supported research on trends in alcohol use during the pandemic, and served as the lead institute for the NIH RADx-rad request for applications on “Automatic Detection and Tracing of SARs-CoV-2” to support proof-of-concept research on automatic, real-time detection and tracing of SARS-COV-2.

2022 —NIAAA released The Healthcare Professional's Core Resource on Alcohol  help healthcare professionals provide evidence-based care for people who drink alcohol. Created with busy clinicians in mind, the HPCR provides concise, thorough information designed to help them integrate alcohol care into their practice.

2023 —As part of its efforts to raise awareness of and combat underage drinking, NIAAA launched the web resources NIAAA for Middle School and NIAAA for Teens , as well as a virtual reality and video experience,  Alcohol and Your Brain .

December 31, 1970 —NIAAA was established under authority of the Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment, and Rehabilitation Act of 1970 (Public Law 91-616) with authority to develop and conduct comprehensive health, education, training, research, and planning programs for the prevention and treatment of alcohol abuse and alcoholism.

May 14, 1974 —P.L. 93-282 was passed, establishing NIAAA, NIMH, and NIDA as coequal institutes within the Alcohol, Drug Abuse, and Mental Health Administration (ADAMHA).

July 26, 1976 —NIAAA's research authority was expanded to include behavioral and biomedical etiology of the social and economic consequences of alcohol abuse and alcoholism under authority of the Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment, and Rehabilitation Act amendments of 1976 (P.L. 94-371).

August 1981 —The Omnibus Budget Reconciliation Act of 1981 (P.L. 97-35) was passed, transferring responsibility and funding for alcoholism treatment services to the states through the creation of an Alcohol, Drug Abuse, and Mental Health Services block grant administered by ADAMHA and strengthening NIAAA's research mission.

October 27, 1986 —A new Office for Substance Abuse Prevention in ADAMHA was created through the Anti-Drug Abuse Act of 1986 (P.L. 99-570), which consolidated the remainder of NIAAA's non-research prevention activities with those of NIDA and permitted NIAAA's total commitment to provide national stewardship to alcohol research.

July 10, 1992 —NIAAA became a new NIH research institute under the ADAMHA Reorganization Act of 1992 (P.L. 102-321).

December 20, 2006 —The Sober Truth on Preventing Underage Drinking Act (P.L. 109-422) was passed, requiring the Secretary of Health and Human Services to formally establish and enhance the efforts of the Interagency Coordinating Committee on the Prevention of Underage Drinking that began operating in 2004.

December 13, 2016 —The 21 st  Century Cures Act (P.L. 114-255) was passed, requiring the Directors of NIAAA, the National Institute of Mental Health (NIMH), and the National Institute on Drug Abuse (NIDA) to serve as ex officio members of the Substance Abuse and Mental Health Services Administration (SAMHSA) Advisory Councils. It also called for increased collaboration between SAMHSA and NIAAA, NIDA, and the States to promote the study of substance abuse prevention and the dissemination and implementation of research findings that will improve the delivery and effectiveness of substance abuse prevention activities. Finally, it reauthorized the Sober Truth on Preventing Underage Drinking Act from 2018 through 2022.

Biographical Sketch of NIAAA Director George F. Koob, Ph.D.

George F. Koob, Ph.D., Director of the National Institute on Alcohol Abuse and Alcoholism

George F. Koob, Ph.D. , is an internationally recognized expert on alcohol and stress, and the neurobiology of alcohol and drug addiction. As the Director of the NIAAA, he provides leadership in the national effort to reduce the public health burden associated with alcohol misuse. He oversees a broad portfolio of alcohol research ranging from basic science to epidemiology, diagnostics, prevention, and treatment.

Dr. Koob earned his doctorate in Behavioral Physiology from Johns Hopkins University in 1972. Prior to taking the helm at NIAAA, he served as Professor and Chair of the Scripps’ Committee on the Neurobiology of Addictive Disorders and Director of the Alcohol Research Center at the Scripps Research Institute. Early in his career, Dr. Koob conducted research in the Department of Neurophysiology at the Walter Reed Army Institute of Research and in the Arthur Vining Davis Center for Behavioral Neurobiology at the Salk Institute for Biological Studies. He was a post-doctoral fellow in the Department of Experimental Psychology and the MRC Neuropharmacology Unit at the University of Cambridge.

Dr. Koob began his career investigating the neurobiology of emotion, particularly how the brain processes reward and stress. He subsequently applied basic research on emotions, including on the anatomical and neurochemical underpinnings of emotional function, to alcohol and drug addiction, significantly broadening knowledge of the adaptations within reward and stress neurocircuits that lead to addiction. This work has advanced our understanding of the physiological effects of alcohol and other substance use and why some people transition from use to misuse to addiction, while others do not. Dr. Koob has authored more than 650 peer-reviewed scientific papers and is a co-author of  The Neurobiology of Addiction , a comprehensive textbook reviewing the most critical neurobiology of addiction research conducted over the past 50 years.

Dr. Koob is the recipient of many prestigious honors and awards for his research, mentorship, and international scientific collaboration. In 2018, Dr. Koob received the E.M. Jellinek Memorial Award for his outstanding contributions to understanding the behavioral course of addiction, In 2017, Dr. Koob was  elected to the National Academy of Medicine  (NAM). In 2016, the government of France awarded Dr. Koob with the insignia of  Chevalier de la Légion d’honneur (Knight of the Legion of Honor)  for developing scientific collaborations between France and the United States. [View the video:  World-class scientist Dr Koob receives the Legion of Honor .]

In addition, Dr. Koob previously received the Research Society on Alcoholism (RSA) Seixas Award for extraordinary service in advancing alcohol research; the RSA Distinguished Investigator Award; the RSA Marlatt Mentorship Award; the Daniel Efron Award for excellence in basic research and the Axelrod Mentorship Award, both from the American College of Neuropsychopharmacology; the NIAAA Mark Keller Award for his lifetime contributions to our understanding of the neurobiology of alcohol use disorder; and an international prize in the field of neuronal plasticity awarded by La Fondation Ipsen.

NIAAA Directors

NIAAA’s organizational chart is available  here .

NIAAA Offices manage administrative, policy and communications activities across the institute.

Office of the Director, Director:   Dr. George F. Koob The Office of the Director leads the Institute by setting research and programmatic priorities and coordinating cross-cutting initiatives. The Office includes:

Office of Extramural Activities, Director: Dr. Philippe Marmillot (Acting) The Office of Extramural Activities is responsible for extramural grant and contract review, the management of chartered initial review groups and special emphasis panels, and all grants management activities. OEA also manages the Committee Management Office—responsible for advisory council activities and nominations to advisory and review panels—and provides advice to the Institute's senior leadership on matters that concern FACA (Federal Advisory Committee Act) and non-FACA meetings.

Office of Science Policy and Communications , Director: Dr. Bridget Williams-Simmons The goal of the Office of Science Policy and Communications (OSPC) is to give visibility to NIAAA-supported research and initiatives and to establish NIAAA as an authoritative source of evidence-based information on alcohol and health in support of the NIAAA mission. OSPC serves a broad range of stakeholders including NIH and NIAAA leadership, the Department of Health and Human Services, the Office of National Drug Control Policy, Congress, the research community, health professionals, advocacy organizations, the media, and patients and the public at large. 

Office of Resource Management, Director: Ms. Vicki Buckley The Office of Resource Management provides administrative management support to the Institute in the areas of financial management, grants and contracts management, administrative services, and personnel operations; (2) develops administrative management policies, procedures, guidelines, and operations; (3) maintains liaison with the management staff of the Office of the Director and implements within the Institute general management policies prescribed by NIH and higher authorities.  

NIAAA’s Divisions manage the Institute’s intramural and extramural basic, translational, and clinical research.

Division of Intramural Clinical and Biological Research , Scientific Director: Dr. David Lovinger; Clinical Director: Dr. David Goldman The Division of Intramural Clinical and Biological Research seeks to understand the mechanisms by which alcohol produces intoxication, dependence, and damage to vital body organs, and to develop tools to prevent and treat those biochemical and behavioral processes.

Division of Epidemiology and Prevention Research , Director: Dr. Ralph Hingson The Division of Epidemiology and Prevention Research promotes and supports applied, translational, and methodological research on the epidemiology and prevention of hazardous alcohol consumption and related behaviors, alcohol use disorder, alcohol-related mortality and morbidity, and other alcohol-related problems and consequences.

Division of Metabolism and Health Effects , Director: Dr. Kathy Jung The Division of Metabolism and Health Effects develops scientific initiatives and supports basic and translational research on the health consequences of alcohol consumption and metabolism.

Division of Neuroscience and Behavior , Director: Dr. Antonio Noronha The Division of Neuroscience and Behavior promotes research on ways in which neuronal and behavioral systems are influenced by genetic, developmental, and environmental factors in conjunction with alcohol exposure to engender alcohol use disorder.

Division of Treatment and Recovery , Director: Dr. Raye Z. Litten The Division of Treatment and Recovery stimulates and supports research to identify and improve pharmacological and behavioral treatment for alcohol use disorder, enhance methods for sustaining recovery, and increase the use of evidence-based treatments in real-world practice.

For more information about NIAAA research programs, visit the NIAAA Research webpage .

Communications and Outreach Activities

NIAAA has several major web resources to disseminate unbiased science and health information to a range of audiences and stakeholders, which include:

  • NIAAA primary website
  • Rethinking Drinking
  • Alcohol Treatment Navigator
  • NIAAA for Middle School
  • NIAAA for Teens
  • College Drinking Prevention
  • College Alcohol Intervention Matrix (CollegeAIM )
  • The Healthcare Professional's Core Resource on Alcohol
  • Alcohol Research: Current Reviews  
  • Collaborative Research on Addiction at NIH

NIAAA also uses social media outlets to share health information, the latest science discoveries, funding and training opportunities, events, and initiatives with broader, more diverse audiences.

  • Twitter: @NIAAAnews
  • Facebook: @NIAAAgov
  • Instagram: @NIAAAnews
  • YouTube: @NIAAANIH

NIAAA also plans events and other activities with a network of liaison organizations. These organizations include research and professional societies, advocacy groups, and other interested stakeholders.

This page last reviewed on March 28, 2024

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Why alcohol-use research is more important than ever

Nih's george koob talks about how addiction changes the brain and the rise in alcohol-related deaths.

Alcohol use disorder is a common but serious condition that affects how the brain functions.

Alcohol use disorder is a common but serious condition that affects how the brain functions.

George Koob, Ph.D.

  George Koob, Ph.D.

Alcohol use disorder (AUD) affects roughly 15 million people in the U.S. People with the condition may drink in ways that are compulsive and uncontrollable, leading to serious health issues.

"It's the addiction that everyone knows about, but no one wants to talk about," says George Koob, Ph.D., the director of the National Institute on Alcohol Abuse and Alcoholism (NIAAA).

As NIAAA celebrates an important milestone this year—its 50th anniversary—the institute's research is more important than ever. Like NIAAA reported earlier this year, alcohol-related health complications and deaths as a result of short-term and long-term alcohol misuse are rising in the U.S.

"Alcohol-related harms are increasing at multiple levels—from emergency department visits and hospitalizations to deaths," Dr. Koob says. He spoke about NIAAA efforts that are working to address this and how people can get help.

What has your own research focused on?

I started my career researching the science of emotion: how the brain processes things like reward and stress. Later, I translated this to alcohol and drug addiction and investigating why some people go from use to misuse to addiction, while others do not.

What are some major breakthroughs NIAAA has made in this area?

We now understand how alcohol affects the brain and why it causes symptoms of AUD . This has far-reaching implications for everything from prevention to treatment. We also understand today that AUD physically changes the brain. This has been critical in treating it as a mental disorder, like you would treat major depressive disorder.

Other breakthroughs have been made in screening and intervention, and in the medications available for treatment. All of this has led to a better understanding of how the body changes when one misuses alcohol and the proactive actions we can take to prevent alcohol misuse.

What is a misconception that people have about AUD?

Many people don't realize how common AUD is. There are seven times more people affected by AUD than opioid use disorder, for example. It doesn't discriminate against who it affects. People also don't realize that AUD is a brain disorder that actually changes how the brain functions. Severe AUD is associated with widespread injury to the brain, though some of the effects might be partially reversible.

What's next for NIAAA?

For five decades, the institute has studied how alcohol affects our health, bringing greater awareness to alcohol-related health issues and providing better options for diagnosis and treatment. Recent research has focused on areas such as the genetics of addiction, links between excessive alcohol use and mental health and other disorders, harm to long-term brain health that can be caused by adolescent alcohol use, and the effects of prenatal alcohol exposure, among others.

"We want everyone from pharmacists and nurses to addiction medicine specialists to know more about alcohol and addiction." - George Koob, Ph.D.

Currently, we are working on a number of initiatives. One is education. We want everyone from pharmacists and nurses to addiction medicine specialists to know more about alcohol and addiction. We're also working on prevention resources for middle school-aged adolescents. Other goals include understanding recovery and what treatments work best for people and why. We're also learning more about alcohol's effects on sleep and pain, and we have ongoing efforts in medication development.

Finally, we're learning more about the impact of alcohol on women and older adults. Women have begun to catch up to men in alcohol consumption and alcohol-related harms. Women are more susceptible to some of the negative effects that alcohol has on the body, from liver disease to certain cancers. Further, more older adults are binge drinking and this places them at greater risk of alcohol-medication interactions, falls, and health problems related to alcohol misuse.

How can someone get help?

If alcohol is negatively affecting you or someone you know, seek help from someone you respect. For example, a primary care doctor or clergy member. There are a number of online resources from NIAAA, like the NIAAA Alcohol Treatment Navigator® , an online resource to help people understand AUD treatment options and search for professionally led, evidence-based alcohol treatment nearby. There's also Rethinking Drinking SM , an interactive website to help individuals assess and change their drinking habits. Also, know that there is hope. Many people recover from AUD and lead vibrant lives.

July 16, 2020

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Alcohol Abuse Is on the Rise, but Doctors Too Often Fail to Treat It

People with alcohol use disorder are often seen in clinics and hospitals, but medical professionals too often ignore the condition.

research about alcohol misuse

By Anahad O’Connor

Like many people who struggle to control their drinking, Andy Mathisen tried a lot of ways to cut back.

He went through an alcohol detox program, attended Alcoholics Anonymous meetings, and tried using willpower to stop himself from binge drinking. But this past winter, with the stress of the pandemic increasingly weighing on him, he found himself craving beer every morning, drinking in his car and polishing off two liters of Scotch a week.

Frustrated, and feeling that his health and future were in a downward spiral, Mr. Mathisen turned to the internet and discovered Ria Health, a telehealth program that uses online coaching and medication to help people rein in their drinking without necessarily giving up alcohol entirely.

After signing up for the service in March, he received coaching and was given a prescription for naltrexone, a medication that diminishes cravings and blunts the buzz from alcohol. The program accepts some insurance and charges $350 a month for a one-year commitment for people who pay out of pocket. Since he started using it, Mr. Mathisen has reduced his drinking substantially, limiting himself to just one or two drinks a couple days a week.

“My alcohol consumption has dropped tremendously,” said Mr. Mathisen, 70, a retired telecommunications manager who lives in central New Jersey. “It’s no longer controlling my life.”

Mr. Mathisen is one of the roughly 17 million Americans who grapple with alcoholism, the colloquial term for alcohol use disorder, a problem that was exacerbated this past year as the pandemic pushed many anxious and isolated people to drink to excess. The National Institutes of Health defines the disorder as “a medical condition characterized by an impaired ability to stop or control alcohol use despite adverse social, occupational or health consequences.” Yet despite how prevalent it is, most people who have the disorder do not receive treatment for it, even when they disclose their drinking problem to their primary care doctor or another health care professional.

Last month, a nationwide study by researchers at the Washington University School of Medicine in St. Louis found that about 80 percent of people who met the criteria for alcohol use disorder had visited a doctor, hospital or medical clinic for a variety of reasons in the previous year. Roughly 70 percent of those people were asked about their alcohol intake. Yet just one in 10 were encouraged to cut back on their drinking by a health professional, and only 6 percent received any form of treatment.

Alcohol abuse can be driven by a complex array of factors, including stress, depression and anxiety, as well as a person’s genetics, family history and socioeconomic circumstances. Many people kick their heavy drinking habit on their own or through self-help programs like Alcoholics Anonymous or SMART Recovery . But relapse rates are notoriously high. Research suggests that among all the people with alcohol use disorder who try to quit drinking every year, just 25 percent are able to successfully reduce their alcohol intake long-term.

While there is no silver bullet for alcohol use disorder, several medications have been approved to treat it, including pills like acamprosate and disulfiram, as well as oral and injectable forms of naltrexone. These medications can blunt cravings and reduce the urge to drink, making it easier for people to quit or cut back when combined with behavioral interventions like therapy.

Yet despite their effectiveness, physicians rarely prescribe the drugs, even for people who are most likely to benefit from them, in part because many doctors are not trained to deal with addiction or educated on the medications approved to treat it. In a study published last month , scientists at the N.I.H. found that just 1.6 percent of the millions of Americans with alcohol use disorder had been prescribed a medication to help them control their drinking. “These are potentially life saving medications, and what we found is that even among people with a diagnosable alcohol use disorder the rate at which they are used is extremely low,” said Dr. Wilson Compton, an author of the study and deputy director of the National Institute on Drug Abuse.

The implications of this are substantial. Alcohol is one of the most common forms of substance abuse and a leading cause of preventable deaths and disease, killing almost 100,000 Americans annually and contributing to millions of cancers, car accidents, heart attacks and other ailments. It is also a significant cause of workplace accidents and lost work productivity, as well as a driver of frayed family and personal relationships. Yet for a variety of reasons, people who need treatment rarely get it from their physicians.

Some doctors buy into a stereotype that people who struggle with alcohol are difficult patients with an intractable condition. Many patients who sign up for services like Ria Health do so after having been turned away by doctors, said Dr. John Mendelson, a professor of clinical medicine at the University of California, San Francisco, and Ria Health’s chief medical officer. “We have patients who come to us because they’ve been fired by their doctors,” he added.

In other cases, doctors without a background in addiction may worry that they don’t have the expertise to treat alcoholism. Or they may feel uncomfortable prescribing medications for it, even though doing so does not require special training, said Dr. Carrie Mintz, an assistant professor of psychiatry at Washington University and a co-author of the study last month that looked at nationwide treatment rates.

The result is that a lot of patients end up getting referred to mental health experts or sent to rehab centers and 12-step programs like A.A.

“There’s a stigma associated with substance use disorders, and the treatment for them has historically been outside of the health care system,” Dr. Mintz said. “We think these extra steps of having to refer people out for treatment is a hindrance. We argue that treatment should take place right there at point of care when people are in the hospital or clinic.”

But another reason for the low rates of treatment is that problem drinkers are often in denial, said Dr. Compton at the National Institute on Drug Abuse. Studies show that most people who meet the criteria for alcohol use disorder do not feel that they need treatment for it, even when they acknowledge having all the hallmarks of the condition , like trying to cut back on alcohol to no avail, experiencing strong cravings, and continuing to drink despite it causing health and relationship problems.

“People are perfectly willing to tell you about their symptoms and the difficulties they face,” Dr. Compton said. “But then if you say, ‘Do you think you need treatment?’ they will say they do not. There’s a blind spot when it comes to putting those pieces together.”

Studies suggest that a major barrier to people seeking treatment is that they believe that abstinence is their only option. That perception is driven by the ubiquity and long history of 12-step programs like A.A. that preach abstinence as the only solution to alcoholism. For some people with severe drinking problems, that may be necessary. But studies show that people who have milder forms of alcohol use disorder can improve their mental health and quality of life, as well as their blood pressure, liver health and other aspects of their physical health, by lowering their alcohol intake without quitting alcohol entirely. Yet the idea that the only option is to quit cold turkey can prevent people from seeking treatment.

“People believe that abstinence is the only way — and in fact it’s not the only way,” said Katie Witkiewitz, the director of the Addictive Behaviors and Quantitative Research Lab at the University of New Mexico and a former president of the Society of Addiction Psychology. “We find robust improvements in health and functioning when people reduce their drinking, even if they’re not reducing to abstinence.”

For people who are concerned about their alcohol intake, Dr. Witkiewitz recommends tracking exactly how much you drink and then setting goals according to how much you want to lower your intake. If you typically consume 21 drinks a week, for example, then cutting out just five to 10 drinks — on your own or with the help of a therapist or medication — can make a big difference, Dr. Witkiewitz said. “Even that level of reduction is going to be associated with improvements in cardiovascular functioning, blood pressure, liver function, sleep quality and mental health generally,” she added.

Here are some tools that can help.

Ria Health is a telehealth program that offers treatment for people with alcohol use disorder. It provides medical consultations, online coaching, medication and other tools to help people lower their alcohol intake or abstain if they prefer. It costs $350 a month for the annual program, cheaper than most rehab programs, and accepts some forms of health insurance.

The National Institute on Alcohol Abuse and Alcoholism has a free website called Rethinking Drinking that can help you find doctors, therapists, support groups and other ways to get treatment for a drinking problem.

Cutback Coach is a popular app that helps people track their alcohol intake and set goals and reminders so they can develop healthier drinking habits. The service allows people to track their progress and sends out daily reminders for motivation. The cost is $79 if you pay annually, $23 per quarter or $9 a month.

Moderation Management is an online forum for people who want to reduce their drinking but not necessarily abstain. The group offers meetings, both online and in person, where members can share stories, advice and coping strategies. It also maintains an international directory of “moderation-friendly” therapists.

CheckUp & Choices is a web-based program that screens people for alcohol use disorder. It provides feedback on your drinking habits and options for cutting back. The service charges $79 for three months or $149 per year.

Anahad O’Connor is a staff reporter covering health, science, nutrition and other topics. He is also a bestselling author of consumer health books such as “Never Shower in a Thunderstorm” and “The 10 Things You Need to Eat.” More about Anahad O’Connor

Late singer Amy Winehouse, whose name is displayed in lights, performs on a stage with musical instruments and a guitar player behind her.

Binge drinking is a growing public health crisis − a neurobiologist explains how research on alcohol use disorder has shifted

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Assistant Professor of Biology, Biomedical Engineering and Pharmacology, Penn State

Disclosure statement

Nikki Crowley receives funding from The National Institutes of Health, The Brain and Behavior Research Foundation, and the Penn State Huck Institutes of the Life Sciences endowment funds.

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With the new Amy Winehouse biopic “Back to Black ” in U.S. theaters as of May 17, 2024, the late singer’s relationship with alcohol and drugs is under scrutiny again. In July 2011, Winehouse was found dead in her flat in north London from “death by misadventure” at the age of 27. That’s the official British term used for accidental death caused by a voluntary risk.

Her blood alcohol concentration was 0.416%, more than five times the legal intoxication limit in the U.S. – leading her cause of death to be later adjusted to include “alcohol toxicity” following a second coroner’s inquest.

Nearly 13 years later, alcohol consumption and binge drinking remain a major public health crisis , not just in the U.K. but also in the U.S.

Roughly 1 in 5 U.S. adults report binge drinking at least once a week, with an average of seven drinks per binge episode . This is well over the amount of alcohol thought to produce legal intoxication, commonly defined as a blood alcohol concentration over 0.08% – on average, four drinks in two hours for women, five drinks in two hours for men.

Among women, days of “heavy drinking” increased 41% during the COVID-19 pandemic compared with pre-pandemic levels , and adult women in their 30s and 40s are rapidly increasing their rates of binge drinking , with no evidence of these trends slowing down. Despite efforts to comprehend the overall biology of substance use disorders, scientists’ and physicians’ understanding of the relationship between women’s health and binge drinking has lagged behind.

I am a neurobiologist focused on understanding the chemicals and brain regions that underlie addiction to alcohol . I study how neuropeptides – unique signaling molecules in the prefrontal cortex , one of the key brain regions in decision-making, risk-taking and reward – are altered by repeated exposure to binge alcohol consumption in animal models.

My lab focuses on understanding how things like alcohol alter these brain systems before diagnosable addiction, so that we can better inform efforts toward both prevention and treatment.

Full color cross-section side view of a child's brain with labels.

The biology of addiction

While problematic alcohol consumption has likely occurred as long as alcohol has existed, it wasn’t until 2011 that the American Society of Addiction Medicine recognized substance addiction as a brain disorder – the same year as Winehouse’s death. A diagnosis of an alcohol use disorder is now used over outdated terms such as labeling an individual as an alcoholic or having alcoholism.

Researchers and clinicians have made great strides in understanding how and why drugs – including alcohol, a drug – alter the brain. Often, people consume a drug like alcohol because of the rewarding and positive feelings it creates, such as enjoying drinks with friends or celebrating a milestone with a loved one. But what starts off as manageable consumption of alcohol can quickly devolve into cycles of excessive alcohol consumption followed by drug withdrawal.

While all forms of alcohol consumption come with health risks, binge drinking appears to be particularly dangerous due to how repeated cycling between a high state and a withdrawal state affect the brain. For example, for some people, alcohol use can lead to “ hangxiety ,” the feeling of anxiety that can accompany a hangover.

Repeated episodes of drinking and drunkenness, coupled with withdrawal, can spiral, leading to relapse and reuse of alcohol. In other words, alcohol use shifts from being rewarding to just trying to prevent feeling bad.

It makes sense. With repeated alcohol use over time, the areas of the brain engaged by alcohol can shift away from those traditionally associated with drug use and reward or pleasure to brain regions more typically engaged during stress and anxiety .

All of these stages of drinking, from the enjoyment of alcohol to withdrawal to the cycles of craving, continuously alter the brain and its communication pathways . Alcohol can affect several dozen neurotransmitters and receptors , making understanding its mechanism of action in the brain complicated.

Work in my lab focuses on understanding how alcohol consumption changes the way neurons within the prefrontal cortex communicate with each other. Neurons are the brain’s key communicator, sending both electrical and chemical signals within the brain and to the rest of your body.

What we’ve found in animal models of binge drinking is that certain subtypes of neurons lose the ability to talk to each other appropriately. In some cases, binge drinking can permanently remodel the brain. Even after a prolonged period of abstinence, conversations between the neurons don’t return to normal .

These changes in the brain can appear even before there are noticeable changes in behavior . This could mean that the neurobiological underpinnings of addiction may take root well before an individual or their loved ones suspect a problem with alcohol.

Researchers like us don’t yet fully understand why some people may be more susceptible to this shift, but it likely has to do with genetic and biological factors, as well as the patterns and circumstances under which alcohol is consumed.

Image of hormone receptors in the prefrontal cortex of the brain, lit up in varying colors.

Women are forgotten

While researchers are increasingly understanding the medley of biological factors that underlie addiction, there’s one population that’s been largely overlooked until now: women.

Women may be more likely than men to have some of the most catastrophic health effects caused by alcohol use, such as liver issues, cardiovascular disease and cancer . Middle-aged women are now at the highest risk for binge drinking compared with other populations.

When women consume even moderate levels of alcohol, their risk for various cancers goes up, including digestive, breast and pancreatic cancer , among other health problems – and even death. So the worsening rates of alcohol use disorder in women prompt the need for a greater focus on women in the research and the search for treatments.

Yet, women have long been underrepresented in biomedical research.

It wasn’t until 1993 that clinical research funded by the National Institutes of Health was required to include women as research subjects. In fact, the NIH did not even require sex as a biological variable to be considered by federally funded researchers until 2016. When women are excluded from biomedical research, it leaves doctors and researchers with an incomplete understanding of health and disease, including alcohol addiction.

There is also increasing evidence that addictive substances can interact with cycling sex hormones such as estrogen and progesterone . For instance, research has shown that when estrogen levels are high, like before ovulation, alcohol might feel more rewarding , which could drive higher levels of binge drinking. Currently, researchers don’t know the full extent of the interaction between these natural biological rhythms or other unique biological factors involved in women’s health and propensity for alcohol addiction.

Adult woman faces away from the camera, holding a glass of white wine in one hand and pressing her left hand against her neck.

Looking ahead

Researchers and lawmakers are recognizing the vital need for increased research on women’s health. Major federal investments into women’s health research are a vital step toward developing better prevention and treatment options for women.

While women like Amy Winehouse may have been forced to struggle both privately and publicly with substance use disorders and alcohol, the increasing focus of research on addiction to alcohol and other substances as a brain disorder will open new treatment avenues for those suffering from the consequences.

For more information on alcohol use disorder, causes, prevention and treatments, visit the National Institute on Alcohol Abuse and Alcoholism .

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Rethinking drinking Alcohol and your health

How much is too much?

What is alcohol misuse.

Alcohol misuse, which includes binge drinking and heavy drinking, increases your risk of harmful consequences, including AUD. The more drinks on any day and the more alcohol misuse over time, the greater the risk.

The National Institute on Alcohol Abuse and Alcoholism (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. This typically happens if a woman has four or more drinks, or a man has five or more drinks, within about two hours.

NIAAA defines heavy drinking as follows:

  • For women —four or more drinks on any day or eight or more per week
  • For men —five or more drinks on any day or 15 or more per week

Previous Why do Women Face Higher Risks for Alcohol-Related Consequences?

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Associations of common mental disorder with alcohol use in the adult general population: a systematic review and meta‐analysis

Jo‐anne puddephatt.

1 Department of Psychology, University of Liverpool, Liverpool UK

Patricia Irizar

Andrew jones, suzanne h. gage, laura goodwin, associated data.

Table S2: Full Search Terms

Table S3: Associations of Moderate/Severe AUD Among Those With an Anxiety or Mood Disorder Compared to Those Without ( N  = 210 121)

Table S4: Associations of Any AUD Among Those With Any Anxiety Disorder (excluding PTSD and OCD) and Among Those with PTSD ( N  = 137 916)

Table S5: Associations of Any AUD Among Those With a CMD Compared to Those Without Stratified by Continent ( N  = 365 331)

Table S6: Associations of Any AUD Among Those With a CMD Compared to Those Without Stratified by the Decade Data was Collected ( N  = 224 835)

Figure S1: A funnel plot illustrating the heterogeneity of having any alcohol use disorder (AUD) among those with any common mental disorder (CMD) ( N  = 382 201)

Figure S2: A funnel plot illustrating the heterogeneity of having any alcohol use disorder (AUD) among those with any common mental disorder (CMD) stratified by the decade in which the study was conducted ( N  = 224 835)

Figure S3: A funnel plot illustrating the heterogeneity of having any alcohol use disorder (AUD) among those with any common mental disorder (CMD) stratified by the continent in which the study was conducted in ( N  = 382 201)

Figure S4: A funnel plot illustrating the heterogeneity of having any alcohol use disorder (AUD) among those with any common mental disorder (CMD) stratified by each study's bias score ( N  = 382 201)

Figure S5: 12‐month and life‐time associations of alcohol use disorder (AUD) among those with a common mental disorder (CMD), compared to those without, after removing Kinley et al . 2009 study ( N  = 353 660)

Figure S6: 12‐month and life‐time associations of any alcohol use disorder (AUD) stratified by type of common mental disorder (CMD), compared to those without, after removing Patel et al . 2002 study ( N  = 373 637)

Figure S7: Figure S7: Funnel plot to explore publication bias

Background and Aims

Research has shown that alcohol use and common mental disorders (CMDs) co‐occur; however, little is known about how the global prevalence of alcohol use compares across different CMDs. We aimed to (i) report global associations of alcohol use (alcohol use disorder (AUD), binge drinking and consumption) comparing those with and without a CMD, (ii) examine how this differed among those with and without specific types of CMDs and (iii) examine how results may differ by study characteristics.

We used a systematic review and meta‐analysis. Cross‐sectional, cohort, prospective, longitudinal and case–control studies reporting the prevalence of alcohol use among those with and without a CMD in the general population were identified using PsycINFO, MEDLINE, PsyARTICLES, PubMed, Scopus and Web of Science until March 2020. Depression, anxiety and phobia were included as a CMD. Studies were included if they used a standardized measure of alcohol use. A random‐effects meta‐analysis was conducted to generate pooled prevalence and associations of AUD with CMD with 95% confidence intervals (CI). A narrative review is provided for binge drinking and alcohol consumption

A total of 512 full‐texts were reviewed, 51 included in our final review and 17 in our meta‐analyses ( n  = 382 201). Individuals with a CMD had a twofold increase in the odds of reporting an AUD [odds ratio (OR) = 2.02, 95% CI = 1.72–2.36]. The odds of having an AUD were similar when stratified by the type of CMD (mood disorder: OR = 2.00, 95% CI = 1.62–2.47; anxiety/phobic disorder: OR = 1.94, 95% CI = 1.35–2.78). An analysis of study characteristics did not reveal any clear explanations for between‐study heterogeneity ( I 2  > 80%). There were no clear patterns for associations between having a CMD and binge drinking or alcohol consumption, respectively.

Conclusions

People with common mental disorders (depression, anxiety, phobia) are twice as likely to report an alcohol use disorder than people without common mental disorders.

INTRODUCTION

It is estimated that 32.5% of the global population consume alcohol [ 1 ]. While there are differences between countries [ 2 ], approximately 18.4% of adults report binge drinking [ 3 ] and 5.1% have an alcohol use disorder (AUD) [ 2 ], including harmful and dependent drinking. Despite differences between countries, alcohol use was ranked the seventh leading risk factor for premature death and disability. Alcohol use has also led to 1.6 and 6% of disability‐adjusted life‐years for females and males, respectively [ 1 ]. Meanwhile, depressive and anxiety disorders (known as common mental disorders; CMD) are also prevalent in the general population globally, with 4.4 and 3.6% reporting a depressive or anxiety disorder, respectively [ 4 ].

Drinking alcohol can be harmful to an individual's mental health, particularly if they meet criteria for an AUD (symptoms include an impaired ability to control alcohol use [ 5 ]), binge drinking (generally consuming more than 5 units of alcohol in a certain period [ 6 ]) or drinking excessively (drinking excessive amounts of alcohol on most days or weeks [ 7 ]). Among the general population, research has found associations between CMD with binge drinking [ 8 , 9 , 10 ] and AUD [ 11 ]. Research has also shown that those with co‐occurring panic disorder and AUD or depression and AUD are at an increased risk of mortality compared to those without such disorders [ 12 , 13 ]. Elsewhere, a narrative review found evidence to suggest that anxiety and depressive episodes are related to binge drinking which can subsequently lead to injury [ 14 ]. Other research also found that college students with co‐occurring anxiety and depressive symptoms reported increased weekly alcohol use, more hazardous use and negative alcohol consequences compared to those without symptoms [ 15 ]. Nineteen per cent of all alcohol‐related hospital admissions have been attributed to mental health problems that resulted from alcohol use [ 16 ], and those with co‐occurring alcohol and mental health problems may have difficulties accessing treatment compared to those with only one of these problems [ 17 ]. These findings indicate that having a CMD is associated with a range of alcohol outcomes which have negative health implications on health; however, previous research has focused specifically on associations with AUD.

There is evidence for an association between worsening mental health and increased alcohol use [ 18 ]. Motivational models argue that individuals may be motivated to use alcohol to cope with stress [ 19 ], where benefits outweigh the cost [ 20 ]. Such models suggest that alcohol may be used to cope with symptoms of poor mental health, and used specifically due to its rapid onset of action [ 21 ]. This might be the case among those with a CMD, as drinking alcohol may be perceived to alleviate symptoms of a disorder [ 21 ].

Genome‐wide studies have shown a causal relationship between CMDs, such as major depression and alcohol dependence, while the reverse association has not been found [ 22 ]. However, associations between alcohol use and mental health comorbidity may be more complex and vary based upon the specific type of CMD [ 23 , 24 ]. Among the general population, research has shown that those with major depressive disorder (MDD) were more likely to report life‐time moderate/severe AUD compared to those without MDD [ 25 ], whereas those with generalized anxiety disorder (GAD) were more likely to report mild or severe AUD compared to those without GAD [ 25 ]. Elsewhere, a significant association with alcohol dependence among those meeting criteria for alcohol abuse was reported among those with dysthymia but not MDD compared to those without the respective disorder [ 26 ], while a review across observational studies showed differences in associations with AUD with specific types of anxiety disorders, such as panic disorder [ 27 ]. Differences in associations have also been found for other patterns of alcohol use. For example, in Portugal a positive association of binge drinking with anxiety disorder was found among individuals attending primary care, while a negative association with binge drinking was found for major depression compared to those without the respective disorders [ 10 ].

Previous systematic reviews have explored alcohol misuse and CMD in both directions; for example, the prevalence of CMD among those misusing alcohol [ 28 ] and the prevalence of alcohol misuse among those with a CMD [ 11 ]. The latter was most recently reported by Lai and colleagues, where those with an anxiety disorder or major depression were approximately 1.5 times more likely to report alcohol abuse and 2.5 and three times more likely to report dependence, respectively [ 11 ]. This indicates that those with a CMD are more likely to use alcohol at harmful levels and that there may be differences based upon the type of CMD. However, this review included bipolar disorder in their definition of CMD, which UK health guidelines on CMD exclude, together with other psychotic and related disorders [ 29 , 30 , 31 ]. This review also did not include post‐traumatic stress disorder (PTSD), despite its inclusion as a CMD in UK health guidelines [ 32 ].

To date, there has not been a systematic review or meta‐analysis reporting the prevalence of other types of alcohol use, such as binge drinking, among those with and without a CMD in the adult general population, and by specific CMD diagnoses. The current systematic review and meta‐analysis aimed to (i) estimate the pooled prevalence of alcohol use (AUD, binge drinking and alcohol consumption) in those with and without a CMD, (ii) evaluate associations between CMD and patterns of alcohol use, (iii) examine how prevalence and associations differed across specific types of CMDs and (iv) examine how results may differ by study characteristics.

This study is pre‐registered on PROSPERO (ref. CRD42019126770) and reported according to the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines [ 33 ] (see PRISMA diagram in Figure  1 and checklist in Supporting information), and in line with the condition, context, population (CoCoPop) framework [ 34 ]. The CoCoPop framework is a quality appraisal tool suitable for systematic reviews and meta‐analyses which aim to examine the prevalence of a condition, and therefore require specific information concerning groups that may not be required using other frameworks [ 35 ].

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Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) flow diagram

Inclusion and exclusion criteria

We included peer‐reviewed observational studies, comprising cross‐sectional, national surveys, cohort, prospective, longitudinal and case–control studies published in English. Where the same data set was used by multiple studies and reported the same outcome, we used the study which reported information on more CMDs. If two or more studies reported the same information, the more recent study was chosen. Reviews and intervention studies were excluded.

Studies which measured the prevalence of life‐time or 12‐month AUD, binge drinking or alcohol use, comparing those with and without a CMD and used a standardized measure of alcohol use, alcohol use disorder and CMD—for example, the Diagnostic and Statistical Manual (DSM) diagnostic instruments—were included. The authors note that definitions of binge drinking may vary among countries and details of standardized measures of alcohol use and CMD are reported in Table  1 . CMDs were defined in this review as MDD, dysthymia, GAD, panic disorder, phobias, PTSD, obsessive–compulsive disorder (OCD) or social anxiety disorder (SAD) [ 36 ]. Studies were excluded if they did not report the prevalence of alcohol use in those with and without a CMD.

Study characteristics

As this review aimed to report the global prevalence of alcohol use among those with and without a CMD within the adult general population, studies that focused upon treatment‐seeking individuals were excluded. Studies which examined the prevalence of alcohol use in those with and without a CMD within a population who experienced a specific traumatic event (e.g. military) or with a specific health condition, such as epilepsy, were also excluded (see Supporting information, Table  S1 for a full list of criteria).

Search strategy

PsycINFO, MEDLINE, PsycARTICLES, PubMed, Scopus and Web of Science were searched using Boolean methods. Key terms were chosen using databases’ own ‘MeSH’ terms or subject headings and broad enough to cover possible synonyms for alcohol use (e.g. alcohol*), CMDs (e.g. depression), comorbidity (e.g. comorbid*) and prevalence (e.g. prevalence) (see Supporting information, Table  S2 for full search terms). Titles, abstracts and keywords were searched. A manual search of reference lists of studies which met the inclusion criteria was also conducted. The search was conducted from inception until March 2020.

A second researcher (P.I.) reviewed a random sample of 10% of titles, abstracts and full texts and checked against the first author's screening to establish reliability for inclusion. A kappa score of 0.62 was confirmed between researchers, indicating moderate agreement in study inclusion [ 37 ].

Assessment of methodological quality

The Joanna Briggs Critical Appraisal Checklist for Studies Reporting Prevalence Data was used to assess the methodological quality of each study [ 34 ]. This checklist consists of nine items (scored 0 if no or unclear evidence or 1 if evidence was present) which covers different methodological aspects, such as the sampling frame, appropriateness of the analysis conducted and response rate. The maximum possible score was nine.

Data extraction

In accordance with the Joanna Briggs Institute Data Extraction Form for Prevalence Studies, the following study characteristics were extracted: name and date of study, author, titles, journal, year survey was conducted, sample size, use of methods for establishing the diagnosis of CMD and AUD, use of methods to measure socio‐economic status (SES), study population, country, description of main results and reviewer comments. We contacted authors for additional information if any key information was missing.

Synthesis of data

Statistical analyses.

Our meta‐analysis focuses on the prevalence and associations of AUD among those with and without a CMD; other alcohol outcomes were not included due to variance in the measures and cut‐offs used. In light of changes to the diagnostic criteria of AUD, we categorized AUD as mild, moderate or severe [ 5 ]. Studies that used earlier definitions of AUD, such as DSM‐IV abuse and dependence, were re‐categorized whereby abuse was considered mild and dependence as moderate or severe, given that previous research indicates that there may be differences in those meeting criteria for alcohol abuse and moderate AUD [ 38 ]. Due to the small number of studies examining the prevalence among those with and without a specific CMD (e.g. GAD), we grouped CMDs into two broad categories: mood disorder (dysthymia and MDD) and anxiety/phobic disorder (GAD, OCD, PTSD, panic disorder, social phobia, simple phobia and specific phobia). The comparison group was not meeting criteria for any CMD.

A random‐effects meta‐analysis was conducted to examine the global associations of AUD (e.g. mild, moderate or severe AUD) and any CMD. To consider both within‐ and between‐study variability [ 39 ], we then conducted an a priori random‐effects meta‐analysis to examine the global prevalence and associations of any AUD stratified by type of CMD (e.g. mood disorder), and then two post‐hoc random‐effects meta‐analyses by (i) severity of AUD (e.g. mild AUD versus no AUD excluding moderate/severe AUD and moderate/severe AUD versus no AUD excluding mild AUD) and (ii) severity of AUD by type of CMD.

For all analyses, studies which reported the total number of participants meeting criteria for a mood, anxiety/phobic disorder or no disorder were included. Studies which tested multiple CMDs within the same sample, over multiple time‐frames in the same sample (e.g. 12‐month AUD and life‐time AUD) or did not state the cut‐off used to determine AUD severity were excluded. Stratified analyses, such as severity of AUD by type of CMD, were not conducted where there were fewer than three sources of data within a group.

The metaprop command with Freeman–Tukey transformation was used to pool proportions of those with and without a CMD who reported AUD [ 40 ] using the numbers of those with a CMD who reported having an AUD and those with a CMD who did not report having an AUD, and this was repeated among those without a CMD for each study. The pooled proportions were then converted to an odds ratio (OR) using the metan command with the DerSimonian & Laird mode in Stata version 16 [ 39 ]. Forest plots and tables were generated to present the pooled prevalence, ORs and 95% confidence intervals (CIs). We conducted a sensitivity analysis by removing studies with the largest and smallest ORs to test the effect on the overall odds of having any AUD among those with a CMD, and publication bias was assessed using the Egger's test [ 41 ] and funnel plot. A planned a priori subgroup analysis by decade of data collected and continent was conducted. It was not possible to conduct other subgroup analyses due to a lack of reporting of demographic characteristics stratified by those with and without a CMD. Heterogeneity was assessed using I 2 and funnel plots using the metafunnel command [ 42 ].

Narrative synthesis

Due to a small number of studies reporting the prevalence of binge drinking, of which one study had a much larger sample size than others, it was not appropriate to conduct a meta‐analysis. Further, due to variances in the measures and cut‐offs used to measure alcohol consumption, we were unable to conduct a meta‐analysis of alcohol consumption. Instead, a narrative synthesis is provided for these alcohol outcomes.

The current systematic review and meta‐analysis had planned to examine the prevalence of alcohol use among those with and without a CMD from different SES backgrounds; however, studies included in this review did not report adequate information. Instead, studies generally reported the overall SES characteristics of the total sample and did not provide the required data stratified by SES.

Study selection

Our initial search yielded 2862 results, after removing duplications with 512 full texts reviewed after screening titles and abstracts. Fifty‐one studies were included in our final review and 17 in our meta‐analyses ( n  = 382 201; see PRISMA diagram in Figure  1 ). Of the 51 studies included, 33 reported the prevalence of mild, moderate or severe AUD (including earlier diagnostic classifications), five of binge drinking and 12 of alcohol consumption. Studies were conducted in 24 countries, with the majority in the United States ( n  = 10), and used data from 33 surveys. Bias scores ranged from 3 to 9 with a median of 7, indicating medium to low bias (see Table  1 ).

Of the 51 studies identified in the systematic review, 34 examined the prevalence of alcohol use among those meeting criteria for an anxiety/phobic disorder and 31 for mood disorder. The type of CMD most commonly studied was MDD (39%). None of the included studies examined alcohol use among those with and without SAD. Of the 33 studies reporting the prevalence of AUD among those with and without a CMD, 16 were not included in the meta‐analysis (see reasons in Figure 1).

Primary analysis

Prevalence and associations of any aud among those with and without a cmd.

The pooled prevalence of having any AUD among those with a CMD was higher than those without ( K  = 17, 15% versus 8%, see Table  2 ), with those with a CMD being twice as likely to report any AUD (OR = 2.02, 95% CI = 1.72–2.36, I 2  = 90.70%, see Table  2 ). When stratified by 12‐month and life‐time AUD, the prevalence remained higher for life‐time AUD among those with a CMD (12‐month: K  = 9, 10%, life‐time: K  = 8, 21%, see Table  2 ) compared to those without (12‐month: 5%, life‐time: 12%, see Table  2 ). Our meta‐analysis found that associations for both 12‐month and life‐time AUD were approximately twofold among those with a CMD compared to those without (12‐month: OR = 2.14, 95% CI = 1.75–2.62, I 2  = 78.90%; life‐time: OR = 1.91, 95% CI = 1.45–2.52, I 2  = 94.70%, see Table  2 and Figure  2 ).

Prevalence and associations of having any AUD among those with and without a CMD ( n  = 382 201)

AUD = alcohol use disorder; CMD = common mental disorders; OR = odds ratio; CO = confidence interval.

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12‐month and life‐time associations of alcohol use disorder (AUD) among those with a common mental disorder (CMD) compared to those without ( n  = 382 201)

The pooled prevalence and associations of any AUD by the type of CMD, regardless of duration, among those with an anxiety/phobic disorder was 17% ( K  = 9 compared to 10% for those without, see Table  3 ) and 11% for mood disorder ( K  = 6 compared to 5% for those without). Associations of having any AUD were similar for those with a mood or anxiety/phobic disorder (mood: OR = 2.00, 95% CI = 1.62–2.47, I 2  = 90.00%; anxiety/phobic: OR = 1.94, 95% CI = 1.35–2.78, I 2  = 91.40%, see Table  3 and Figure  3 ).

Prevalence and associations of any AUD stratified by type of CMD ( n  = 367 487)

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Associations of any alcohol use disorder (AUD) with common mental disorder (CMD), stratified by anxiety/phobic and mood disorders ( n  = 367 483)

A sensitivity analysis removing studies with the largest [ 43 ] and smallest [ 44 ] OR resulted in only a small change in the total and life‐time effect size (see Supporting information, Figures  S5 and S6 ). In light of changes to the categorization of mental disorders whereby PTSD and OCD are now two distinct diagnosis classifications (‘trauma‐ and stressor‐related disorders’ and ‘obsessive‐compulsive and related disorders’ [ 5 ]), a sensitivity analysis examining differences in associations of any AUD among those with PTSD compared to other anxiety/phobic disorder (without OCD) was conducted and showed a twofold increase in associations among those with PTSD, while associations with other anxiety/phobic disorders were non‐significant (see Supporting information, Table  S4 ). We were unable to conduct a sensitivity analysis of OCD due to an insufficient number of studies.

Exploratory analysis

When stratified by the decade (e.g. 1990s) and continent (e.g. Europe) in which the study was conducted, respectively, we found similar strengths of associations (see Supporting information, Tables  S5 and S6 ).

Heterogeneity

There was substantial heterogeneity between studies when conducting each meta‐analysis, as illustrated in the forest plots (see Figures  1 , ​ ,2, 2 , ​ ,3, 3 , ​ ,4) 4 ) where I 2 percentages were greater than 80%, which was further confirmed by our overall funnel plot (see Supporting information, Figure  S1 ). An Egger's test was non‐significant ( P  = 0.86) and a funnel plot showed that studies remained close to the overall effect size, indicating limited evidence of bias (see Supporting information, Figure  S7 ). We also explored sources of heterogeneity by conducting a subgroup analysis according to the decade during which data was collected, the continent in which the studies were conducted and bias score (see Supporting information, Figures  S2–S4 ), but these did not substantially reduce heterogeneity estimates. We were unable to explore heterogeneity according to group characteristics due to a lack of reporting among those with and without a CMD; however, there were differences in the diagnostic criteria used to assess both AUD and CMD which may explain some of the heterogeneity.

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Associations of alcohol use disorder (AUD) among those with a common mental disorder (CMD), stratified by AUD severity ( n  = 382 201)

Secondary analyses

Prevalence and associations of mild and moderate/severe aud among those with and without a cmd.

The pooled prevalence of mild AUD was higher among those with a CMD compared to those without ( K  = 6, 7 versus 5%, see Table  4 ). Those with a CMD were more likely to report mild AUD compared to those without a CMD (OR = 1.71, 95% CI = 1.31–2.23, I 2  = 75.20%, see Table  4 and Figure  4 ). We found that 12% of those with a CMD reported moderate/severe AUD compared to 6% of those without a CMD ( K  = 17, see Table  4 ) and those with a CMD were twice as likely to report moderate/severe AUD (OR = 2.19, 95% CI = 1.82–2.63, I 2  = 91.30%, see Table  4 and Figure  4 ).

Prevalence and associations of mild and moderate/severe AUD among those with and without a CMD ( n  = 382 201)

AUD = alcohol use disorder; CMD = common mental disorder; OR = odds ratio; CO = confidence interval.

Due to the small number of studies examining the prevalence of mild AUD ( n  = 6) it was not possible to conduct a subgroup analysis of mild AUD by the type of CMD, although this was possible for moderate/severe AUD. We found those with a mood or anxiety/phobic disorder were approximately twice as likely to report moderate/severe AUD (mood: K  = 6, OR = 2.02, 95% CI = 1.60–2.57, I 2  = 89.60%; anxiety/phobic: K  = 9, OR = 2.12, 95% CI = 1.43–3.14, I 2  = 92.20%, see Supporting information, Table S3 ).

Binge drinking among those with and without a CMD

Five studies reported the prevalence of binge drinking among those with and without a CMD, although there was variation in the cut‐offs used to assess this and the duration of binge drinking (see Table  5 ). Of the five studies, four examined the prevalence of binge drinking among those with and without depression, one with anxiety and one with PTSD. Four of the five studies reported a higher prevalence of binge drinking among those with a CMD (3.70–35.03%, see Table  5 ) compared to those without (1.01–31.62%). One reported a lower prevalence (12.60 versus 15.10%, see Table  5 ); this may have been due to the study measuring depressive episode or having any anxiety, whereas other studies examined specific types of CMDs or depressive symptoms.

Overview of findings of studies examining the prevalence of binge drinking among those with and without a CMD

CMD = common mental disorder; MDD = major depressive disorder; BDI = Beck depression inventory; PTSD = post‐traumatic stress disorder.

Alcohol consumption among those with and without a CMD

Twelve studies reported the prevalence of alcohol consumption among those with and without a CMD, although there was variation in the type of alcohol consumption and CMD assessed and cut‐off scores used (see Table  6 ). Three studies reported a higher prevalence of alcohol consumption among those with a CMD (1.66–24.29%) compared to those without (0.92–7.94%), six reported a lower prevalence among those with a CMD (0.00–42.00%) and three reported both higher and lower prevalence depending on the type of CMD and alcohol consumption outcome (0.00–14.81%, see Table  6 ).

Overview of findings of studies examining the prevalence of alcohol consumption among those with and without a CMD

CMD = common mental disorder; GAD = generalized anxiety disorder; MDD = major depressive disorder; BDI = Beck depression inventory; HAD = Hospital Anxiety and Depression Scale.

Key findings

Our systematic review and meta‐analysis aimed to examine the prevalence and associations of AUD, binge drinking and alcohol consumption among those with and without a CMD, respectively. We found that those with a CMD were twice as likely to report an AUD compared to those without, and these associations were similar among types of CMD throughout decades and continents. Based on the ORs, associations between CMD and AUD were stronger for moderate/severe AUD compared to mild AUD. In addition, our narrative review identified both positive and negative associations for CMD with binge drinking and alcohol consumption, indicating that more research using similar methods is required.

Our findings identified that those with a CMD were more likely to report severe levels of AUD and that most studies focused upon associations with a specific type of CMD, such as MDD. We were unable to identify any studies examining associations with SAD. In addition, much of the research has focused upon AUD as opposed to other problematic drinking patterns, such as binge drinking, despite the high prevalence in the general population [ 3 ] and the known negative health impacts [ 6 , 14 ].

Models of comorbidity and comparisons to previous research

Models of comorbidity have debated whether alcohol worsens mental health or vice versa [ 18 ] and previous longitudinal research assessing both pathways indicate stronger support for the notion that poor mental health increases alcohol use [ 45 ]; however, there is likely to be a bidirectional association. Psychological models, such as the stress–coping and incentive–motivation models, hypothesize that individuals may be motivated to use alcohol to cope with stress and enhance positive affect [ 19 ], and that benefits of drinking outweigh the consequences of not drinking [ 20 ]. Considering that symptoms of a CMD include low mood and irritability [ 32 ], alcohol may be used to cope with symptoms initially, increasing alcohol use [ 46 ]. The self‐medication model argues further that alcohol may be used specifically because of its rapid onset of action and differs according to the individuals’ symptoms [ 21 ]. Our findings are based on cross‐sectional research, therefore we cannot infer causality. We found associations between AUD and CMD regardless of the type of CMD and severity of AUD. It may be that individuals with a CMD may use alcohol to enhance positive affect and cope with symptoms of poor mental health. Further qualitative and longitudinal research is required to understand the reasons why those with a CMD use alcohol.

Our narrative review of associations between binge drinking and CMDs and consumption, respectively, showed mixed evidence. Studies included in this review suggest that alcohol use and CMD comorbidity may be more complex, as some studies reported increases in binge drinking or consumption while others did not. This may have been due to the range of CMDs measured or the measures used to assess alcohol use and CMDs. However, previous research suggests that this may also be explained by additional factors such as gender [ 10 , 15 ], age [ 14 , 47 ] and specific CMD diagnoses [ 9 ]. Future research should consider such characteristics when examining associations between alcohol use and CMD. In addition, further research is required on associations of CMDs with other alcohol outcomes, given that they are more prevalent in the general population compared to AUD [ 3 ] and are known to have implications on health [ 6 ].

A previous systematic review reported a twofold increase in the odds of reporting any AUD among those with an anxiety disorder and 2.5‐fold increase for those with major depression, in addition to a 2.3‐fold and threefold increase in the odds of reporting alcohol dependence for any anxiety disorder and major depression, respectively. We found slightly weaker associations, with a twofold increase in the odds of any AUD (and the same for moderate/severe AUD) for any anxiety or mood disorder, respectively. This difference could be explained by the types of CMDs included in our review in which we included MDD, dysthymia, GAD, panic disorder, phobias, PTSD, OCD or SAD, whereas Lai and colleagues [ 11 ] included agoraphobia, GAD, panic disorder, social phobia, bipolar disorder, dysthymia and MDD. Our sensitivity analysis also showed a twofold increase in the odds of having any AUD among those with PTSD, while a non‐significant association was found among those with any other anxiety disorder, excluding OCD.

Other psychological models suggest that comorbid alcohol and mental health problems are due to shared vulnerabilities, such as SES factors [ 23 , 48 , 49 , 50 ]. We attempted to explore this by reviewing evidence examining the prevalence of alcohol use among those with and without a CMD based on SES characteristics; however, studies included in this review did not report this and thus we cannot support or reject these suggestions.

Strengths and limitations

With regard to the studies included in this review, the majority of studies used large sample sizes representative of the general population and standardized criteria to assess alcohol use and CMD, particularly those reporting the prevalence of AUD. There are some limitations to note. First, the majority of studies focused upon the prevalence of alcohol use among those with and without types of CMDs, namely MDD, rather than other disorders such as SAD. Therefore, we were unable to explore associations beyond broad mood and anxiety/phobic disorders, including more specific disorders. Secondly, we were unable to conduct a meta‐analysis on the prevalence and association of binge drinking or alcohol consumption due to variations in the measures and cut‐offs used; therefore, we cannot conclude whether those with a CMD are more likely to report different patterns of alcohol use compared to those without beyond AUD.

With regard to our review, we conducted an extensive search of the literature across multiple databases and included a range of CMDs and types of alcohol use, with large sample sizes. There are also some limitations to note. First, there was substantial heterogeneity between studies. While the majority of studies used diagnostic criteria to establish the presence of CMD and AUD, different versions of criteria were used between studies. There was also limited reporting of group characteristics among those with and without a CMD, which may explain some of the heterogeneity. We overcame this by exploring differences in associations between the severity of AUD and type of CMD, as well as the continent and decade in which the study was conducted. Secondly, we included published research, therefore we may have missed some grey literature. However, given that multiple databases and references were searched, we believe our review was inclusive. Thirdly, some of the associations may have been driven by specific types of CMD, as found in previous research [ 25 ]; we conducted a sensitivity analysis with PTSD but were unable to conduct further analyses to due to insufficient numbers. Fourthly, the stratified prevalence by AUD severity would equal the overall any AUD prevalence for studies that provided these stratified data; however, some studies reported moderate/severe AUD only. For those studies which reported the stratified prevalence by AUD severity, the sum of the mild and moderate/severe prevalence would then equal the overall prevalence, but some studies only reported the prevalence for moderate/severe AUD and, in these cases, this was the same as the numbers included in the overall meta‐analysis. Finally, while studies included in this review generally included individuals aged 18 years and over, in some cases studies had a minimum age in adolescence (e.g. 15 years and over). Due to the way in which data were presented in these studies, it was not possible to exclude these participants and restrict the prevalence estimates to those aged 18 years and over. However, in large population studies the numbers aged under 18 years would be in the minority, and this should not impact upon the prevalence reported.

CONCLUSIONS

Our review and meta‐analysis show that having a CMD is associated with increased odds of having an AUD, particularly moderate/severe AUD. There was little difference in associations based on the type of CMD. There is a need to ensure that alcohol and mental health problems are treated in parallel, while more research is required to investigate group characteristics and differences beyond broad CMD classifications. Additional research examining associations between having a CMD with other alcohol outcomes is required to provide a more holistic understanding of drinking patterns among individuals with a CMD.

DECLARATION OF INTERESTS

J.P. is funded as part of a PhD Studentship by the Society for the Study of Addiction.

AUTHOR CONTRIBUTIONS

Jo‐Anne Puddephatt: Conceptualization; data curation; formal analysis; funding acquisition; investigation; methodology; project administration; resources; software; validation. Patricia Irizar: Data curation; investigation; resources; validation. Andrew Jones: Conceptualization; formal analysis; methodology; supervision. Suzanne Gage: Conceptualization; formal analysis; methodology; supervision. Laura Goodwin: Conceptualization; formal analysis; funding acquisition; methodology; supervision.

Supporting information

Table S1: Study Inclusion and Exclusion Criteria

ACKNOWLEDGEMENTS

This work was supported as part of a PhD Studentship by the Society for the Study of Addiction.

Puddephatt J‐A, Irizar P, Jones A, Gage SH, Goodwin L. Associations of common mental disorder with alcohol use in the adult general population: a systematic review and meta‐analysis . Addiction . 2022; 117 :1543–1572. 10.1111/add.15735 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]

Funding information Society for the Study of Addiction

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Researcher explains the human toll of language that makes addiction feel worse 

When Mass General transplant hepatologist Wei Zhang says he wants his colleagues to think before they speak, he has the tragedy of a recent patient in mind.

Admitted to intensive care for advanced alcohol-associated liver disease, the 36-year-old woman hid the truth when asked about her drinking. “She was like, ‘No, I quit over a year ago, I didn’t drink at all,’” said Zhang, also director of the hospital’s Alcohol-Associated Liver Disease Clinic. “But we have tools that can detect the use of alcohol in the past three, four weeks.”

The patient, who had been traumatized by years of physical abuse, was denied a liver transplant, in part because she withheld information about her alcohol use. Her death days later was “a consequence of stigma,” Zhang said. Patients too often “feel they’re being judged and may fear that their condition is seen as a result of personal failing rather than a medical issue that needs treatment.” 

Amid increases in high-risk drinking and alcohol-associated liver disease across the country , he hopes  that new research can help complete the years-long work of erasing that stigma, saving lives in the process. 

For decades, medical terminology has labeled liver disease and other alcohol-related conditions as “alcoholic”: alcoholic liver disease, alcoholic hepatitis, alcoholic cirrhosis, alcoholic pancreatitis. Meanwhile, clinicians and administrators have described patients as addicts and alcoholics. 

More recently, specialists and advocates have sought with some success to revise how we talk about substance use and those struggling to overcome it, not just to reduce stigma but also to combat bias among medical professionals. According to the  National Institute on Alcohol Abuse and Alcoholism , the term “alcohol use disorder” is now preferable to “alcohol abuse,” “alcohol dependence,” and “alcoholism.”

“Emphasizing non-stigmatizing language is crucial not only for fostering honesty but also for supporting the overall treatment process and patient outcomes,” Zhang said. 

Headshot of Wei Zhang.

The new study is a step toward that goal. Inspired by his patients, Zhang set out to observe whether the terminology used by institutions that treat alcohol-associated liver disease reflects or rejects stigma. He and his team reviewed messages on more than 100 accredited liver transplant center websites, along with language used by addiction psychiatry sites. They found that almost nine of 10 transplant center websites use stigmatizing language such as “alcoholic.” Less than half of addiction psychiatry websites do the same.

“The gap between professional society recommendations and actual practice is concerning, since patients frequently use these online resources for information which can significantly influence their behavior and perceptions about alcohol-associated liver disease,” Zhang said.

Zhang’s anti-stigma efforts are grounded in strong evidence, according to Harvard Medical School psychiatrist  John F. Kelly , who published “Does It Matter How We Refer to Individuals with Substance-Related Conditions?” in 2009.

“Emphasizing non-stigmatizing language is crucial not only for fostering honesty but also for supporting the overall treatment process and patient outcomes.”

“Drug use disorder and alcohol use disorder are among the most stigmatized conditions universally across different societies because people feel that it’s self-induced — that people are to blame because they put it in their body,” said Kelly, also the founder of Mass General’s  Recovery Research Institute . “Just because they made that decision initially, doesn’t mean they plan on becoming addicted.”

In the 2009 study, Kelly and his colleagues described patients to more than 600 clinicians, alternating between “substance abuser” and “having a substance use disorder.” Those in the latter category were viewed more sympathetically and as more worthy of treatment. 

“I was quite surprised just how susceptible they were,” Kelly said. “These were passionate, dedicated clinicians. They were still susceptible to the negative punitive bias.”

They still are today, Zhang’s findings suggest. 

“We are very good at seeing patients with liver disease but if we add this behavioral mental disorder, it is somewhat out of our scope,” he said. “I think education could at least have them be more familiar with this topic and be willing to at least listen to the adoption and use of non-stigmatizing language.” 

“I think education could at least have them be more familiar with this topic and be willing to at least listen to the adoption and use of non-stigmatizing language.”

Building on the new study, Zhang has recommended to healthcare institutions and professional societies that they implement website feedback mechanisms and carry out regular content audits to guard against potentially harmful language. 

“The steps we are recommending should not only help to align clinical practice with sound language guidelines, but also foster a more empathetic and supportive healthcare environment for patients,” he said. 

Zhang also said healthcare institutions should look to leverage technology to support adoption of appropriate standards.

His team is collaborating with Mass General’s Research Patient Data Registry to obtain de-identified patient records, which they plan to review for instances of stigmatizing language. He hopes the process will help researchers quantify the prevalence of such language in clinical notes and identify patterns that can inform interventions. The team will also analyze the association of stigmatizing language with patient outcomes.  

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  • Alcohol use disorder

Alcohol use disorder is a pattern of alcohol use that involves problems controlling your drinking, being preoccupied with alcohol or continuing to use alcohol even when it causes problems. This disorder also involves having to drink more to get the same effect or having withdrawal symptoms when you rapidly decrease or stop drinking. Alcohol use disorder includes a level of drinking that's sometimes called alcoholism.

Unhealthy alcohol use includes any alcohol use that puts your health or safety at risk or causes other alcohol-related problems. It also includes binge drinking — a pattern of drinking where a male has five or more drinks within two hours or a female has at least four drinks within two hours. Binge drinking causes significant health and safety risks.

If your pattern of drinking results in repeated significant distress and problems functioning in your daily life, you likely have alcohol use disorder. It can range from mild to severe. However, even a mild disorder can escalate and lead to serious problems, so early treatment is important.

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Alcohol use disorder can be mild, moderate or severe, based on the number of symptoms you experience. Signs and symptoms may include:

  • Being unable to limit the amount of alcohol you drink
  • Wanting to cut down on how much you drink or making unsuccessful attempts to do so
  • Spending a lot of time drinking, getting alcohol or recovering from alcohol use
  • Feeling a strong craving or urge to drink alcohol
  • Failing to fulfill major obligations at work, school or home due to repeated alcohol use
  • Continuing to drink alcohol even though you know it's causing physical, social, work or relationship problems
  • Giving up or reducing social and work activities and hobbies to use alcohol
  • Using alcohol in situations where it's not safe, such as when driving or swimming
  • Developing a tolerance to alcohol so you need more to feel its effect or you have a reduced effect from the same amount
  • Experiencing withdrawal symptoms — such as nausea, sweating and shaking — when you don't drink, or drinking to avoid these symptoms

Alcohol use disorder can include periods of being drunk (alcohol intoxication) and symptoms of withdrawal.

  • Alcohol intoxication results as the amount of alcohol in your bloodstream increases. The higher the blood alcohol concentration is, the more likely you are to have bad effects. Alcohol intoxication causes behavior problems and mental changes. These may include inappropriate behavior, unstable moods, poor judgment, slurred speech, problems with attention or memory, and poor coordination. You can also have periods called "blackouts," where you don't remember events. Very high blood alcohol levels can lead to coma, permanent brain damage or even death.
  • Alcohol withdrawal can occur when alcohol use has been heavy and prolonged and is then stopped or greatly reduced. It can occur within several hours to 4 to 5 days later. Signs and symptoms include sweating, rapid heartbeat, hand tremors, problems sleeping, nausea and vomiting, hallucinations, restlessness and agitation, anxiety, and occasionally seizures. Symptoms can be severe enough to impair your ability to function at work or in social situations.

What is considered 1 drink?

The National Institute on Alcohol Abuse and Alcoholism defines one standard drink as any one of these:

  • 12 ounces (355 milliliters) of regular beer (about 5% alcohol)
  • 8 to 9 ounces (237 to 266 milliliters) of malt liquor (about 7% alcohol)
  • 5 ounces (148 milliliters) of wine (about 12% alcohol)
  • 1.5 ounces (44 milliliters) of hard liquor or distilled spirits (about 40% alcohol)

When to see a doctor

If you feel that you sometimes drink too much alcohol, or your drinking is causing problems, or if your family is concerned about your drinking, talk with your health care provider. Other ways to get help include talking with a mental health professional or seeking help from a support group such as Alcoholics Anonymous or a similar type of self-help group.

Because denial is common, you may feel like you don't have a problem with drinking. You might not recognize how much you drink or how many problems in your life are related to alcohol use. Listen to relatives, friends or co-workers when they ask you to examine your drinking habits or to seek help. Consider talking with someone who has had a problem with drinking but has stopped.

If your loved one needs help

Many people with alcohol use disorder hesitate to get treatment because they don't recognize that they have a problem. An intervention from loved ones can help some people recognize and accept that they need professional help. If you're concerned about someone who drinks too much, ask a professional experienced in alcohol treatment for advice on how to approach that person.

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Genetic, psychological, social and environmental factors can impact how drinking alcohol affects your body and behavior. Theories suggest that for certain people drinking has a different and stronger impact that can lead to alcohol use disorder.

Over time, drinking too much alcohol may change the normal function of the areas of your brain associated with the experience of pleasure, judgment and the ability to exercise control over your behavior. This may result in craving alcohol to try to restore good feelings or reduce negative ones.

Risk factors

Alcohol use may begin in the teens, but alcohol use disorder occurs more frequently in the 20s and 30s, though it can start at any age.

Risk factors for alcohol use disorder include:

  • Steady drinking over time. Drinking too much on a regular basis for an extended period or binge drinking on a regular basis can lead to alcohol-related problems or alcohol use disorder.
  • Starting at an early age. People who begin drinking — especially binge drinking — at an early age are at a higher risk of alcohol use disorder.
  • Family history. The risk of alcohol use disorder is higher for people who have a parent or other close relative who has problems with alcohol. This may be influenced by genetic factors.
  • Depression and other mental health problems. It's common for people with a mental health disorder such as anxiety, depression, schizophrenia or bipolar disorder to have problems with alcohol or other substances.
  • History of trauma. People with a history of emotional trauma or other trauma are at increased risk of alcohol use disorder.
  • Having bariatric surgery. Some research studies indicate that having bariatric surgery may increase the risk of developing alcohol use disorder or of relapsing after recovering from alcohol use disorder.
  • Social and cultural factors. Having friends or a close partner who drinks regularly could increase your risk of alcohol use disorder. The glamorous way that drinking is sometimes portrayed in the media also may send the message that it's OK to drink too much. For young people, the influence of parents, peers and other role models can impact risk.

Complications

Alcohol depresses your central nervous system. In some people, the initial reaction may feel like an increase in energy. But as you continue to drink, you become drowsy and have less control over your actions.

Too much alcohol affects your speech, muscle coordination and vital centers of your brain. A heavy drinking binge may even cause a life-threatening coma or death. This is of particular concern when you're taking certain medications that also depress the brain's function.

Impact on your safety

Excessive drinking can reduce your judgment skills and lower inhibitions, leading to poor choices and dangerous situations or behaviors, including:

  • Motor vehicle accidents and other types of accidental injury, such as drowning
  • Relationship problems
  • Poor performance at work or school
  • Increased likelihood of committing violent crimes or being the victim of a crime
  • Legal problems or problems with employment or finances
  • Problems with other substance use
  • Engaging in risky, unprotected sex, or experiencing sexual abuse or date rape
  • Increased risk of attempted or completed suicide

Impact on your health

Drinking too much alcohol on a single occasion or over time can cause health problems, including:

  • Liver disease. Heavy drinking can cause increased fat in the liver (hepatic steatosis) and inflammation of the liver (alcoholic hepatitis). Over time, heavy drinking can cause irreversible destruction and scarring of liver tissue (cirrhosis).
  • Digestive problems. Heavy drinking can result in inflammation of the stomach lining (gastritis), as well as stomach and esophageal ulcers. It can also interfere with your body's ability to get enough B vitamins and other nutrients. Heavy drinking can damage your pancreas or lead to inflammation of the pancreas (pancreatitis).
  • Heart problems. Excessive drinking can lead to high blood pressure and increases your risk of an enlarged heart, heart failure or stroke. Even a single binge can cause serious irregular heartbeats (arrhythmia) called atrial fibrillation.
  • Diabetes complications. Alcohol interferes with the release of glucose from your liver and can increase the risk of low blood sugar (hypoglycemia). This is dangerous if you have diabetes and are already taking insulin or some other diabetes medications to lower your blood sugar level.
  • Issues with sexual function and periods. Heavy drinking can cause men to have difficulty maintaining an erection (erectile dysfunction). In women, heavy drinking can interrupt menstrual periods.
  • Eye problems. Over time, heavy drinking can cause involuntary rapid eye movement (nystagmus) as well as weakness and paralysis of your eye muscles due to a deficiency of vitamin B-1 (thiamin). A thiamin deficiency can result in other brain changes, such as irreversible dementia, if not promptly treated.
  • Birth defects. Alcohol use during pregnancy may cause miscarriage. It may also cause fetal alcohol spectrum disorders (FASDs). FASDs can cause a child to be born with physical and developmental problems that last a lifetime.
  • Bone damage. Alcohol may interfere with making new bone. Bone loss can lead to thinning bones (osteoporosis) and an increased risk of fractures. Alcohol can also damage bone marrow, which makes blood cells. This can cause a low platelet count, which may result in bruising and bleeding.
  • Neurological complications. Excessive drinking can affect your nervous system, causing numbness and pain in your hands and feet, disordered thinking, dementia, and short-term memory loss.
  • Weakened immune system. Excessive alcohol use can make it harder for your body to resist disease, increasing your risk of various illnesses, especially pneumonia.
  • Increased risk of cancer. Long-term, excessive alcohol use has been linked to a higher risk of many cancers, including mouth, throat, liver, esophagus, colon and breast cancers. Even moderate drinking can increase the risk of breast cancer.
  • Medication and alcohol interactions. Some medications interact with alcohol, increasing its toxic effects. Drinking while taking these medications can either increase or decrease their effectiveness, or make them dangerous.

Early intervention can prevent alcohol-related problems in teens. If you have a teenager, be alert to signs and symptoms that may indicate a problem with alcohol:

  • Loss of interest in activities and hobbies and in personal appearance
  • Red eyes, slurred speech, problems with coordination and memory lapses
  • Difficulties or changes in relationships with friends, such as joining a new crowd
  • Declining grades and problems in school
  • Frequent mood changes and defensive behavior

You can help prevent teenage alcohol use:

  • Set a good example with your own alcohol use.
  • Talk openly with your child, spend quality time together and become actively involved in your child's life.
  • Let your child know what behavior you expect — and what the consequences will be for not following the rules.

Alcohol use disorder care at Mayo Clinic

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  • What is A.A.? Alcoholics Anonymous. https://www.aa.org/what-is-aa. Accessed April 1, 2022.
  • Mission statement. Women for Sobriety. https://womenforsobriety.org/about/#. Accessed April 1, 2022.
  • Al-Anon meetings. Al-Anon Family Groups. https://al-anon.org/al-anon-meetings/. Accessed April 1, 2022.
  • Substance-related and addictive disorders. In: Diagnostic and Statistical Manual of Mental Disorders DSM-5. 5th ed. American Psychiatric Association; 2013. https://dsm.psychiatryonline.org. Accessed April 26, 2018.
  • Rethinking drinking: Alcohol and your health. National Institute on Alcohol Abuse and Alcoholism. https://www.rethinkingdrinking.niaaa.nih.gov/. Accessed April 1, 2022.
  • Treatment for alcohol problems: Finding and getting help. National Institute on Alcohol Abuse and Alcoholism. https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/treatment-alcohol-problems-finding-and-getting-help. Accessed April 1, 2022.
  • Alcohol's effect on the body. National Institute on Alcohol Abuse and Alcoholism. https://www.niaaa.nih.gov/alcohols-effects-health/alcohols-effects-body. Accessed April 1, 2022.
  • Understanding the dangers of alcohol overdose. National Institute on Alcohol Abuse and Alcoholism. https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/understanding-dangers-of-alcohol-overdose. Accessed April 1, 2022.
  • Frequently asked questions: About alcohol. Centers for Disease Control and Prevention. https://www.cdc.gov/alcohol/faqs.htm. Accessed April 1, 2022.
  • Harmful interactions: Mixing alcohol with medicines. National Institute on Alcohol Abuse and Alcoholism. https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/harmful-interactions-mixing-alcohol-with-medicines. Accessed April 1, 2022.
  • Parenting to prevent childhood alcohol use. National Institute on Alcohol Abuse and Alcoholism. https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/parenting-prevent-childhood-alcohol-use. Accessed April 1, 2022.
  • Tetrault JM, et al. Risky drinking and alcohol use disorder: Epidemiology, pathogenesis, clinical manifestations, course, assessment, and diagnosis. https://www.uptodate.com/contents/search. Accessed April 1, 2022.
  • Holt SR. Alcohol use disorder: Pharmacologic management. https://www.uptodate.com/contents/search. Accessed April 1, 2022.
  • Saxon AJ. Alcohol use disorder: Psychosocial treatment. https://www.uptodate.com/contents/search. Accessed April 1, 2022.
  • Charness ME. Overview of the chronic neurologic complications of alcohol. https://www.uptodate.com/contents/search. Accessed April 1, 2022.
  • Chen P, et al. Acupuncture for alcohol use disorder. International Journal of Physiology, Pathophysiology and Pharmacotherapy. 2018;10:60.
  • Ng S-M, et al. Nurse-led body-mind-spirit based relapse prevention intervention for people with diagnosis of alcohol use disorder at a mental health care setting, India: A pilot study. Journal of Addictions Nursing. 2020; doi:10.1097/JAN.0000000000000368.
  • Lardier DT, et al. Exercise as a useful intervention to reduce alcohol consumption and improve physical fitness in individuals with alcohol use disorder: A systematic review and meta-analysis. Frontiers in Psychology. 2021; doi:10.3389/fpsyg.2021.675285.
  • Sliedrecht W, et al. Alcohol use disorder relapse factors: A systematic review. Psychiatry Research. 2019; doi:10.1016/j.psychres.2019.05.038.
  • Thiamin deficiency. Merck Manual Professional Version. https://www.merckmanuals.com/professional/nutritional-disorders/vitamin-deficiency,-dependency,-and-toxicity/thiamin-deficiency. Accessed April 2, 2022.
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  • Marcus GM, et al. Acute consumption of alcohol and discrete atrial fibrillation events. Annals of Internal Medicine. 2021; doi:10.7326/M21-0228.
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  • What people recovering from alcoholism need to know about osteoporosis. NIH Osteoporosis and Related Bone Diseases National Resource Center. https://www.bones.nih.gov/health-info/bone/osteoporosis/conditions-behaviors/alcoholism. Accessed April 2, 2022.
  • How to tell if your child is drinking alcohol. Substance Abuse and Mental Health Services Administration. https://www.samhsa.gov/talk-they-hear-you/parent-resources/how-tell-if-your-child-drinking-alcohol. Accessed April 2, 2022.
  • Smith KE, et al. Problematic alcohol use and associated characteristics following bariatric surgery. Obesity Surgery. 2018; doi:10.1007/s11695-017-3008-8.
  • Fairbanks J, et al. Evidence-based pharmacotherapies for alcohol use disorder: Clinical pearls. Mayo Clinic Proceedings. 2020; doi:10.1016/j.mayocp.2020.01.030.
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Home / Healthy Aging / Common myths and misconceptions about alcohol use

Common myths and misconceptions about alcohol use

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Alcohol is ingrained in our culture — so much so that it can be hard to know what’s true and what’s not about drinking and how it affects the body.

Below, Tyler S. Oesterle, M.D., M.P.H., a psychiatrist who researches and treats addiction disorders at Mayo Clinic, helps sort out fact from fiction as he addresses common myths about alcohol use.

Myth: Drinking one glass of alcohol a night has no impact on your health.

Unfortunately, this is not necessarily the case.

While the problems with alcohol are most pronounced when you consume it chronically and in large amounts, even small amounts of alcohol can lead to problems. International and domestic health authorities, including the World Health Organization and the National Institute on Alcohol Abuse and Alcoholism agree: Drinking alcohol is health risk.

“There’s no medical reason to drink alcohol,” says Dr. Oesterle. “It’s just something people do for fun. Fun is good; I don’t hate fun. But there’s other ways to have fun that don’t include ingesting a toxin.”

While drinking in moderation — defined by guidelines from the Dietary Guidelines for Americans as at most two standard drinks a day for men and one a day for women — is typically OK, it can still cause trouble for some people, Dr. Oesterle says.

You could look at drinking alcohol like skydiving, Dr. Oesterle says. There is no recommended number of times that someone should jump out of a plane. It’s fun for some people, but there is no medical reason to do it or health benefit from it.

Similarly, drinking alcohol can be fun, but there are risks associated with it — so people should be aware of those risks, he says. Unlike skydiving injuries, alcohol use disorder is very common, affecting over 28 million U.S. adults in the past year, according to 2022 data .

Myth: Alcohol really just impacts your liver.

Not true. In addition to affecting the liver, alcohol affects the brain, the heart, and both the central nervous system and the peripheral nervous system.

The toll that excess alcohol use takes on the body is immense. Drinking too much over time can:

  • Lead to high blood pressure and increase your risk of an enlarged heart, heart failure or stroke.
  • Make it harder for your body to resist disease, increasing your risk of various illnesses, especially pneumonia.
  • Interfere with your body’s ability to get enough B vitamins and other nutrients.
  • Increase risk of many cancers, including mouth, throat, liver, esophagus, colon and breast cancers.
  • Damage your nervous system, causing numbness and pain in your hands and feet, disordered thinking, dementia, and short-term memory loss.

Alcohol can be especially problematic in older adults because it can conflict with medications and worsen the symptoms of other health problems that are common among older people.

Additionally, alcohol can damage the nerves in the inner ear, affecting balance. This is a recipe for falls, which are typically much more traumatic in older adults and can even be deadly.

Myth: One glass of alcohol a day, especially if it’s red wine, is good for you.

This also is a myth, says Dr. Oesterle. This belief really took hold when a few studies came out years ago stating that there was a correlation between red wine and fewer deaths from cardiovascular disease , sometimes attributed to the antioxidants in red wine.

“That really got taken and blown out of proportion,” Dr. Oesterle says. “All of a sudden wine became this health must-do, that you must drink wine otherwise you’re not going to live very long. And it was just factually inaccurate. The data behind it was pretty loose.”

The data in the studies was correlative data, not direct causation data.

“So the actual cause (of any health benefit) probably wasn’t the alcohol at all,” Dr. Oesterle says.

Myth: You’re not in danger of health or addiction problems if you only drink alcohol socially.

Again, this is untrue. Cultural norms would have you believe that drinking is integral to certain activities, like a wedding reception, football game, brunch or night out on the town. It’s important to be aware that alcohol doesn’t have to be a part of those things, Dr. Oesterle says.

“It’s addictive for people … and then it’s causing problems. We can’t then get frustrated with those people because we built out a cultural norm around it,” he says.

Myth: If you’ve been drinking responsibly for years, you’re not going to become addicted to alcohol.

Dr. Oesterle leads Mayo Clinic’s inpatient rehabilitation program for addiction and says he often sees alcohol use become a problem for people after they retire. When these people were employed, they may have been too busy to consume copious amounts of alcohol. But without a routine or daily responsibilities, alcohol use can more easily spiral, he says.

“There’s nothing keeping them from drinking all day,” Dr. Oesterle says. “We know that the amount of alcohol exposure predicates the likelihood of developing an alcohol use disorder. So if you have very little alcohol exposure to the brain, your chance of getting addicted to alcohol is very low. But the more alcohol you expose your brain to, the more likely you are to get addicted.”

Myth: Being able to “hold your liquor” means alcohol is not damaging your body as much.

Actually, it can be the opposite. Those who maintain that they can hold their liquor, meaning that they can drink larger amounts with fewer apparent effects, may drink in excess to feel intoxicated. A higher tolerance for alcohol does not mean the body is impervious to the effect of alcohol; it means that drinkers should be more cautious.

The alcohol is still affecting their bodies, even if they do not immediately feel it, and they are still at higher risk of falls, cognitive impairment and other negative effects because they are drinking more.

Myth: If you’re menopausal and having trouble sleeping, alcohol can help you sleep better.

Nope. In fact, alcohol can make sleep worse and menopausal symptoms like hot flashes and night sweats more pronounced. Consuming alcohol during menopause can also increase the risk of heart disease and osteoporosis, says Dr. Jewel M. Kling , M.D., M.P.H., a physician with Mayo Clinic Women’s Health in Arizona.

Alcohol can exacerbate hot flash symptoms, which occur because of disruption to the body’s thermoregulatory zone. Alcohol also interferes with this zone, making the hormone-driven changes worse.

Dr. Kling recommends that people going through menopause limit alcohol to one drink a day or less, in addition to eating a balanced diet and exercising regularly.

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  • Excessive alcohol use can have immediate and long-term effects.
  • Excessive drinking includes binge drinking, heavy drinking, and any drinking during pregnancy or by people younger than 21.
  • Drinking less is better for your health than drinking more.
  • You can lower your health risks by drinking less or choosing not to drink.

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Why it's important

  • The rest of the alcohol can harm your liver and other organs as it moves through the body.
  • Using alcohol excessively on occasion or over time can have immediate and long-term health risks.
  • By drinking less alcohol, you can improve your health and well-being.

Deaths from excessive alcohol use‎

Understanding alcohol use, excessive alcohol use.

Excessive alcohol use is a term used to describe four ways that people drink alcohol that can negatively impact health. Excessive drinking can also be deadly.

Excessive alcohol use includes:

  • Binge drinking—Four or more drinks for women, or five or more drinks for men during an occasion.
  • Heavy drinking—Eight or more drinks for women, or 15 or more drinks for men during a week.
  • Underage drinking —any alcohol use by people younger than 21.
  • Drinking while pregnant—any alcohol use during pregnancy .

Moderate alcohol use

Moderate drinking is having one drink or less in a day for women, or two drinks or less in a day for men.

Keep in mind‎

Effects of short-term alcohol use.

Drinking excessively on an occasion can lead to these harmful health effects:

  • Injuries— motor vehicle crashes , falls, drownings, and burns.
  • Violence—homicide, suicide, sexual violence, and intimate partner violence.
  • Alcohol poisoning—high blood alcohol levels that affect body functions like breathing and heart rate.
  • Overdose—from alcohol use with other drugs , like opioids.
  • Sexually transmitted infections or unplanned pregnancy—alcohol use can lead to sex without protection, which can cause these conditions.
  • Miscarriage, stillbirth, or fetal alcohol spectrum disorder (FASD) —from any alcohol use during pregnancy.

Effects of long-term alcohol use

Over time, drinking alcohol can have these effects:

Text that says,

  • The risk of some cancers increases with any amount of alcohol use. 2 This includes breast cancer (in women). 2 A
  • More than 20,000 people die from alcohol-related cancers each year in the United States. 3

Other chronic diseases

Excessive alcohol use can lead to:

  • High blood pressure.
  • Heart disease.
  • Liver disease.
  • Alcohol use disorder—this affects both physical and mental health. B
  • Digestive problems.
  • Weaker immune system—increasing your chances of getting sick.

Social and wellness issues

  • Mental health conditions, including depression and anxiety.
  • Learning problems, and issues at school or work.
  • Memory problems, including dementia.
  • Relationship problems with family and friends.

You can take steps to lower your risk of alcohol-related harms.

The less alcohol you drink, the lower your risk for these health effects, including several types of cancer.

Check your drinking‎

  • The risk of alcohol use leading to breast cancer in men has not been established.
  • Most people who drink excessively do not have alcohol use disorder (also known as "alcohol dependence" or "alcoholism"). Many people who drink excessively can lower their alcohol use without specialized medical treatment. Facts about alcohol use disorder are available at: https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/understanding-alcohol-use-disorder .
  • Esser MB, Sherk A, Liu Y, Naimi TS. Deaths from excessive alcohol use — United States, 2016-2021. MMWR Morb Mortal Wkly Rep . 2024;73:154–161. doi: http://dx.doi.org/10.15585/mmwr.mm7308a1
  • Bagnardi V, Rota M, Botteri E, et al. Alcohol consumption and site-specific cancer risk: a comprehensive dose-response meta-analysis. Br J Cancer . 2015;112(3):580-593. doi: 10.1038/bjc.2014.579
  • Esser MB, Sherk A, Liu Y, Henley SJ, Naimi TS. Reducing alcohol use to prevent cancer deaths: estimated effects among U.S. adults. Am J Prev Med . 2024;66(4):725–729. doi: 10.1016/j.amepre.2023.12.003

Alcohol Use

Excessive alcohol use can harm people who drink and those around them. You and your community can take steps to improve everyone’s health and quality of life.

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Reducing Alcohol Use May Help Curb Opioid Misuse, Study Finds

Man with alcoholic drink in one hand and pouring pills onto a table with other hand. Photo shows hands only.

Intervening to reduce alcohol use is associated with a lower likelihood that an individual will receive a new opioid prescription or develop an opioid use disorder, according to a study led by researchers at Duke University and the Durham Veterans Affairs (VA) Medical Center.

The research, which appears in the May 6 issue of the American Journal of Psychiatry, suggests that delivering a brief alcohol-related intervention coincided with less opioid use, fewer opioid use disorder diagnoses, and potentially fewer opioid-related emergency department visits and hospitalizations.

“People are still dying. People are still struggling with addiction. People are still struggling to taper down opioid use. We can’t rest on our laurels. Instead, we need to look at different avenues where we can make improvements.” — Dan V. Blalock, PhD

Dan Blalock

“The opioid epidemic is something we’ve made a lot of progress on in a lot of ways, but there’s still much work to be done,” said lead author Dan V. Blalock, PhD , associate consulting professor in the Department of Psychiatry & Behavioral Sciences and a clinical research psychologist at the Durham VA’s Center of Innovation to Advance Discovery and Practice Transformation. “People are still dying. People are still struggling with addiction. People are still struggling to taper down opioid use. We can’t rest on our laurels. Instead, we need to look at different avenues where we can make improvements.”

The Link between Alcohol and Opioids

Simultaneous overuse of alcohol and opioid misuse is common. According to research from the National Institutes of Health, roughly 26 percent of people with an opioid use disorder consume high levels of alcohol. These individuals are more than two and a half times as likely to also have an alcohol use disorder than those without an opioid use disorder.* Additionally, people who binge drink (consuming four or five drinks in a single setting) are almost twice as likely to misuse prescription opioids, even after accounting for other relevant factors.

Alcohol use also undermines pain relief—the reason why many people take opioids. Initially, alcohol consumption can reduce pain sensations, much like opioids. However, high use of both substances over time can trigger an increase in pain sensitivity. As a result, a person may boost their alcohol and opioid use to achieve the same level of pain relief, increasing the risk of overdose and death.

With these factors in mind, Blalock and his team examined how reducing alcohol use could be a first-line defense to curbing opioid misuse. 

“Many people use alcohol to self-medicate for some pain. But this creates a spiral because excessive alcohol use is associated with higher levels of chronic pain,” he said. “Reducing alcohol use may help with some of the pain issues that lead people to seek out opioids in the first place and prompt them to examine other lifestyle factors.”

Examining an Alcohol-Based Intervention

To determine whether addressing alcohol use could reduce opioid use, including new prescriptions, opioid use disorder, and hospitalizations, Blalock’s team studied the impact of an alcohol-based intervention.

“If you’re using opioids and alcohol, that really increases your risk of harm because they’re both depressants on the system. You’re more likely to have an overdose, some other medical event, or death.” — Dan V. Blalock, PhD

“We know that alcohol use disorder and opioid use disorder co-occur at high rates. If you have one, you’re more likely to have the other,” Blalock said. “If you’re using opioids and alcohol, that really increases your risk of harm because they’re both depressants on the system. You’re more likely to have an overdose, some other medical event, or death.”

In a retrospective review study of medical records from almost 500,000 VA patients, the team determined that about 63,800 patients had elevated alcohol use. They also examined how many of those patients received a brief five- to 15-minute intervention in which providers explained the normative trends of drinking and the health effects of excessive drinking. Referrals for any necessary additional treatment may have been placed.

Among all study participants with elevated alcohol screenings, 72 percent were documented to have received the intervention. Within one year, 8.5 percent had a new opioid prescription, 1.1 percent received a new opioid use disorder diagnosis, and 0.8 percent experienced an opioid-related hospitalization. Patients who didn’t receive the intervention had higher rates of new opioid prescriptions and disorder diagnoses, and although not quite statistically significant, a strong trend toward more opioid-related hospitalizations as well. 

Based on these results, Blalock and his team want to dive deeper into the relationship between reduced alcohol consumption and opioid use.

“I want to spend the next several years looking further into the impact of pulling back on alcohol. Even if you’re using opioids to the same extent, it makes sense that there would be less risk involved,” he said. “You’re taking away a risk factor, so there’s a chance that reducing alcohol could also reduce opioid-related harms.”

An Overlooked Approach

While the alcohol-based intervention examined in this study isn’t new, Blalock’s team is the first to assess its impact on opioid use.

“We were trying for some outside-the-box thinking. There’s nothing different happening here with this questionnaire and intervention,” he said. “Instead, we’re looking at an existing tool to see if it may have some effects that we’re missing on other problems that are also happening.”

The hope, he says, is that providers will recognize the value of conducting the annual alcohol screening and intervention and consider it to be part of their opioid risk mitigation strategy. 

“We’re hoping that providers’ ears might perk up and that they will be sure to not only check these boxes because they have to, but actively look to administer this intervention anytime it might be indicated,” he said. “Doing so can contribute to building a strong alcohol-opioid surveillance system. And more concretely and directly, it might improve patients’ lives in more ways than we previously thought.”

“We’re hoping that providers’ ears might perk up and that they will be sure to not only check these boxes because they have to, but actively look to administer this intervention anytime it might be indicated. Doing so can contribute to building a strong alcohol-opioid surveillance system. And more concretely and directly, it might improve patients’ lives in more ways than we previously thought.” — Dan V. Blalock, PhD

*Statistic derived from two sources: NIAA and “ Co-Occurring Substance Use And Mental Disorders Among Adults With Opioid Use Disorder ”

Funding for the study was provided by a U.S. Department of Veterans Affairs Health Services Research and Development Career Development Award 19-035 (IK2HXOO3085-01A2, K2HX003087), The Duke Endowment (grant 6754-SP SUB #21 P3630024), and the Center of Innovation to Accelerate Discovery and Practice Transformation at the Durham VA Health Care System (CIN 13-410).

CITATION: “Associations Between a Primary-Care Delivered Alcohol-Related Brief Intervention and Subsequent Opioid-Related Outcomes,” David Blalock, Sophia Berlin, Theodore Berkowitz, Valerie Smith, Charlie Wright, Rachel Bachrach, Janet Grubber. American Journal of Psychiatry, May 1, 2024. DOI: 10.1176/appi.ajp.20230683  

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How Binge Drinking Shifted Research On Alcohol Use Disorders

W ith the new Amy Winehouse biopic "Back to Black " in U.S. theaters as of May 17, 2024, the late singer's relationship with alcohol and drugs is under scrutiny again. In July 2011, Winehouse was found dead in her flat in north London from "death by misadventure" at the age of 27. That's the official British term used for accidental death caused by a voluntary risk.

Her blood alcohol concentration was 0.416%, more than five times the legal intoxication limit in the U.S. – leading her cause of death to be later adjusted to include "alcohol toxicity" following a second coroner's inquest.

Nearly 13 years later, alcohol consumption and binge drinking remain a major public health crisis , not just in the U.K. but also in the U.S.

Roughly 1 in 5 U.S. adults report binge drinking at least once a week, with an average of seven drinks per binge episode . This is well over the amount of alcohol thought to produce legal intoxication, commonly defined as a blood alcohol concentration over 0.08% – on average, four drinks in two hours for women, five drinks in two hours for men.

Among women, days of "heavy drinking" increased 41% during the COVID-19 pandemic compared with pre-pandemic levels , and adult women in their 30s and 40s are rapidly increasing their rates of binge drinking , with no evidence of these trends slowing down. Despite efforts to comprehend the overall biology of substance use disorders, scientists' and physicians' understanding of the relationship between women's health and binge drinking has lagged behind.

I am a neurobiologist focused on understanding the chemicals and brain regions that underlie addiction to alcohol . I study how neuropeptides – unique signaling molecules in the prefrontal cortex , one of the key brain regions in decision-making, risk-taking and reward – are altered by repeated exposure to binge alcohol consumption in animal models.

My lab focuses on understanding how things like alcohol alter these brain systems before diagnosable addiction, so that we can better inform efforts toward both prevention and treatment.

Signaling molecules in the prefrontal cortex are altered by repeated exposure to excessive alcohol consumption in animal models. jambojam/iStock via Getty Images

The Biology Of Addiction

While problematic alcohol consumption has likely occurred as long as alcohol has existed, it wasn't until 2011 that the American Society of Addiction Medicine recognized substance addiction as a brain disorder – the same year as Winehouse's death. A diagnosis of an alcohol use disorder is now used over outdated terms such as labeling an individual as an alcoholic or having alcoholism.

Researchers and clinicians have made great strides in understanding how and why drugs – including alcohol, a drug – alter the brain. Often, people consume a drug like alcohol because of the rewarding and positive feelings it creates, such as enjoying drinks with friends or celebrating a milestone with a loved one. But what starts off as manageable consumption of alcohol can quickly devolve into cycles of excessive alcohol consumption followed by drug withdrawal.

While all forms of alcohol consumption come with health risks, binge drinking appears to be particularly dangerous due to how repeated cycling between a high state and a withdrawal state affect the brain. For example, for some people, alcohol use can lead to " hangxiety ," the feeling of anxiety that can accompany a hangover.

Repeated episodes of drinking and drunkenness, coupled with withdrawal, can spiral, leading to relapse and reuse of alcohol. In other words, alcohol use shifts from being rewarding to just trying to prevent feeling bad.

It makes sense. With repeated alcohol use over time, the areas of the brain engaged by alcohol can shift away from those traditionally associated with drug use and reward or pleasure to brain regions more typically engaged during stress and anxiety .

All of these stages of drinking, from the enjoyment of alcohol to withdrawal to the cycles of craving, continuously alter the brain and its communication pathways . Alcohol can affect several dozen neurotransmitters and receptors , making understanding its mechanism of action in the brain complicated.

Work in my lab focuses on understanding how alcohol consumption changes the way neurons within the prefrontal cortex communicate with each other. Neurons are the brain's key communicator, sending both electrical and chemical signals within the brain and to the rest of your body.

What we've found in animal models of binge drinking is that certain subtypes of neurons lose the ability to talk to each other appropriately. In some cases, binge drinking can permanently remodel the brain. Even after a prolonged period of abstinence, conversations between the neurons don't return to normal .

These changes in the brain can appear even before there are noticeable changes in behavior . This could mean that the neurobiological underpinnings of addiction may take root well before an individual or their loved ones suspect a problem with alcohol.

Researchers like us don't yet fully understand why some people may be more susceptible to this shift, but it likely has to do with genetic and biological factors, as well as the patterns and circumstances under which alcohol is consumed.

Work in the author's lab explores how alcohol use can alter the way neurons communicate in the prefrontal cortex brain region. Estrogen receptors are labeled in purple and receptors for somatostatin, a key regulatory hormone, in blue. Victora Nudell

Women are Forgotten

While researchers are increasingly understanding the medley of biological factors that underlie addiction, there's one population that's been largely overlooked until now: women.

Women may be more likely than men to have some of the most catastrophic health effects caused by alcohol use, such as liver issues, cardiovascular disease and cancer . Middle-aged women are now at the highest risk for binge drinking compared with other populations.

When women consume even moderate levels of alcohol, their risk for various cancers goes up, including digestive, breast and pancreatic cancer , among other health problems – and even death. So the worsening rates of alcohol use disorder in women prompt the need for a greater focus on women in the research and the search for treatments.

Yet, women have long been underrepresented in biomedical research.

It wasn't until 1993 that clinical research funded by the National Institutes of Health was required to include women as research subjects. In fact, the NIH did not even require sex as a biological variable to be considered by federally funded researchers until 2016. When women are excluded from biomedical research, it leaves doctors and researchers with an incomplete understanding of health and disease, including alcohol addiction.

There is also increasing evidence that addictive substances can interact with cycling sex hormones such as estrogen and progesterone . For instance, research has shown that when estrogen levels are high, like before ovulation, alcohol might feel more rewarding , which could drive higher levels of binge drinking. Currently, researchers don't know the full extent of the interaction between these natural biological rhythms or other unique biological factors involved in women's health and propensity for alcohol addiction.

Middle-aged women are at the highest risk for some of the most severe health consequences of binge drinking. Peter Dazeley/The Image Bank via Getty Images

Looking Ahead

Researchers and lawmakers are recognizing the vital need for increased research on women's health. Major federal investments into women's health research are a vital step toward developing better prevention and treatment options for women.

While women like Amy Winehouse may have been forced to struggle both privately and publicly with substance use disorders and alcohol, the increasing focus of research on addiction to alcohol and other substances as a brain disorder will open new treatment avenues for those suffering from the consequences.

For more information on alcohol use disorder, causes, prevention and treatments, visit the National Institute on Alcohol Abuse and Alcoholism .

Nikki Crowley is an Assistant Professor of Biology, Biomedical Engineering and Pharmacology at Penn State. This article is republished from The Conversation under a Creative Commons license . Read the original article .

How Binge Drinking Shifted Research On Alcohol Use Disorders

COMMENTS

  1. Advances in the science and treatment of alcohol use disorder

    Abstract. Alcohol is a major contributor to global disease and a leading cause of preventable death, causing approximately 88,000 deaths annually in the United States alone. Alcohol use disorder is one of the most common psychiatric disorders, with nearly one-third of U.S. adults experiencing alcohol use disorder at some point during their lives.

  2. Advances in the science and treatment of alcohol use disorder

    Only a small percent of individuals with alcohol use disorder contribute to the greatest societal and economic costs ().For example, in the 2015 National Survey on Drug Use and Health survey (total n = 43,561), a household survey conducted across the United States, 11.8% met criteria for an alcohol use disorder (n = 5124) ().Of these 5124 individuals, 67.4% (n = 3455) met criteria for a mild ...

  3. Sobering Perspectives on the Treatment of Alcohol Use Disorder

    Alcohol misuse is a leading cause of preventable suffering globally. Each year in the United States, alcohol misuse contributes to 140 000 deaths and nearly 3.6 million years of potential life lost. 1,2 Economic losses and health costs are staggering because alcohol can contribute to death and disability early in life. In 2010, the economic burden of alcohol misuse in the United States was ...

  4. National Institute on Alcohol Abuse and Alcoholism (NIAAA)

    Learn up-to-date facts and statistics on alcohol consumption and its impact in the United States and globally. Explore topics related to alcohol misuse and treatment, underage drinking, the effects of alcohol on the human body, and more. Find up-to-date statistics on lifetime drinking, past-year drinking, past-month drinking, binge drinking ...

  5. Alcohol

    NIDA works closely with the National Institute on Alcohol Abuse and Alcoholism (NIAAA), the lead NIH institute supporting and conducting research on the impact of alcohol use on human health and well-being. For information on alcohol and alcohol use disorder, please visit the NIAAA website. Because many people use alcohol while using other ...

  6. National Institute on Alcohol Abuse and Alcoholism (NIAAA)

    December 31, 1970—NIAAA was established under authority of the Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment, and Rehabilitation Act of 1970 (Public Law 91-616) with authority to develop and conduct comprehensive health, education, training, research, and planning programs for the prevention and treatment of alcohol abuse ...

  7. Alcohol

    Alcohol consumption is a causal factor in more than 200 diseases, injuries and other health conditions. Drinking alcohol is associated with a risk of developing health problems such as mental and behavioural disorders, including alcohol dependence, and major noncommunicable diseases such as liver cirrhosis, some cancers and cardiovascular ...

  8. Why alcohol-use research is more important than ever

    Recent research has focused on areas such as the genetics of addiction, links between excessive alcohol use and mental health and other disorders, harm to long-term brain health that can be caused by adolescent alcohol use, and the effects of prenatal alcohol exposure, among others. "We want everyone from pharmacists and nurses to addiction ...

  9. Alcohol Abuse Is on the Rise. Here's Why Doctors Fail to Treat It

    Alcohol abuse can be driven by a complex array of factors, including stress, depression and anxiety, as well as a person's genetics, family history and socioeconomic circumstances. Many people ...

  10. Binge drinking is a growing public health crisis − a neurobiologist

    Binge drinking is a growing public health crisis − a neurobiologist explains how research on alcohol use disorder has shifted Published: May 13, 2024 8:17am EDT Nikki Crowley , Penn State

  11. What is Alcohol Misuse?

    The National Institute on Alcohol Abuse and Alcoholism (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. This typically happens if a woman has four or more drinks, or a man has five or more drinks, within about two hours.

  12. Associations of common mental disorder with alcohol use in the adult

    Research has shown that alcohol use and common mental disorders (CMDs) co‐occur; however, little is known about how the global prevalence of alcohol use compares across different CMDs. ... Previous systematic reviews have explored alcohol misuse and CMD in both directions; for example, the prevalence of CMD among those misusing alcohol ...

  13. Alcohol is dangerous. So is 'alcoholic.'

    Amid increases in high-risk drinking and alcohol-associated liver disease across the country, he hopes that new research can help complete the years-long work of erasing that stigma, ... the term "alcohol use disorder" is now preferable to "alcohol abuse," "alcohol dependence," and "alcoholism. ...

  14. National Institute on Alcohol Abuse and Alcoholism (NIAAA)

    National Institute on Alcohol Abuse and Alcoholism (NIAAA) NIAAA supports and conducts research on the impact of alcohol use on human health and well-being. Learn About Alcohol's Effects on Health. NIAAA Strategic Plan: Fiscal Years 2024-2028

  15. Alcohol use disorder

    The National Institute on Alcohol Abuse and Alcoholism defines one standard drink as any one of these: 12 ounces (355 milliliters) of regular beer (about 5% alcohol) ... Some research studies indicate that having bariatric surgery may increase the risk of developing alcohol use disorder or of relapsing after recovering from alcohol use disorder.

  16. National Institute on Alcohol Abuse and Alcoholism (NIAAA)

    Alcohol use disorder (AUD) is a medical condition characterized by an impaired ability to stop or control alcohol use despite adverse social, occupational, or health consequences. It encompasses the conditions that some people refer to as alcohol abuse, alcohol dependence, alcohol addiction, and the colloquial term, alcoholism.

  17. Common myths and misconceptions about alcohol use

    While the problems with alcohol are most pronounced when you consume it chronically and in large amounts, even small amounts of alcohol can lead to problems. International and domestic health authorities, including the World Health Organization and the National Institute on Alcohol Abuse and Alcoholism agree: Drinking alcohol is health risk.

  18. Alcohol Use and Your Health

    Effects of short-term alcohol use. Drinking excessively on an occasion can lead to these harmful health effects: Injuries— motor vehicle crashes, falls, drownings, and burns. Violence—homicide, suicide, sexual violence, and intimate partner violence. Alcohol poisoning—high blood alcohol levels that affect body functions like breathing and ...

  19. Reducing Alcohol Use May Help Curb Opioid Misuse, Study Finds

    Simultaneous overuse of alcohol and opioid misuse is common. According to research from the National Institutes of Health, roughly 26 percent of people with an opioid use disorder consume high levels of alcohol. These individuals are more than two and a half times as likely to also have an alcohol use disorder than those without an opioid use ...

  20. Alcohol's Effects on Health

    Science-based information on alcohol from NIAAA, including alcohol's effects on the brain and body, drinking levels, ... National Institute on Alcohol Abuse and Alcoholism (NIAAA) ... PDF materials for patient education and free, research-focused print materials. Short Takes These brief, informative videos from NIAAA offers researched based ...

  21. How Binge Drinking Shifted Research On Alcohol Use Disorders

    Roughly 1 in 5 U.S. adults report binge drinking at least once a week, with an average of seven drinks per binge episode. This is well over the amount of alcohol thought to produce legal ...