Lena Savoie
Alcohol-related deaths have been on the rise over the past two decades, with liver disease deaths and cancer deaths linked to alcohol consumption doubling in recent years. The Covid pandemic saw a significant acceleration in alcohol-related deaths, particularly among women and young people. While alcohol-induced deaths have decreased overall, alcohol remains the leading driver of substance use-related fatalities in the US, with excessive drinking causing approximately 178,000 deaths annually. American Indian and Alaska Native communities are disproportionately affected by alcohol-related deaths, with historical trauma, cultural challenges, poverty, and mental health issues contributing to higher mortality rates.
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What You'll Learn
Alcohol-related liver disease
There are several stages of ARLD, beginning with alcoholic fatty liver disease. This is when fat accumulates in the liver, causing enlargement and upper abdominal discomfort. Fatty liver disease rarely causes symptoms, but it is a warning sign that a person is drinking at a harmful level. This stage is reversible, and if a person stops drinking for several months or years, their liver should return to normal.
The next stage is alcoholic hepatitis, which is a potentially serious condition caused by alcohol misuse over a long period. Alcoholic hepatitis may be the first indication that a person is damaging their liver through alcohol consumption. In less severe cases, alcoholic hepatitis is reversible if a person stops drinking permanently. However, severe alcoholic hepatitis is life-threatening.
The final and most advanced stage of ARLD is alcoholic cirrhosis, where the liver has become significantly scarred. Cirrhosis is generally irreversible, but stopping alcohol consumption immediately can prevent further damage and increase life expectancy. A liver transplant may be required in severe cases where the liver has stopped functioning and does not improve with alcohol abstinence.
The treatment for ARLD primarily involves stopping alcohol consumption, which can be challenging for those dependent on alcohol. Support, advice, and medical treatment are available through local alcohol addiction support services. In addition to alcohol abstinence, dietary changes, vitamins, and certain medications may be recommended to manage ARLD and improve the liver's function.
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Alcohol-induced cancer
The seven alcohol-related cancers are breast, liver, colorectal, throat, voice box, mouth, and oesophageal. Breast cancer is the most common cancer in the UK, and alcohol is a leading risk factor, causing around 10% of cases, or 4,400 cases per year. Women who have one drink per day have a higher risk of breast cancer than those who drink less than one per week, and the risk increases further for heavy drinkers and binge drinkers.
Alcohol consumption can also increase the risk of cancers of the oral cavity, pharynx, larynx, and oesophagus by causing changes to the cells in the mouth and throat. These changes make it easier for the cells to absorb harmful chemicals, including those found in tobacco smoke. Alcohol can also increase levels of certain hormones, such as oestrogen and insulin, which can encourage cell division and the development of cancer.
The number of alcohol-related cancer deaths in the US has doubled in recent years, rising from 11,896 in 1990 to 23,207 in 2021. This increase was particularly pronounced during the Covid pandemic and among men aged 55 and older. However, an increasing number of women have become heavy drinkers, and more young women binge drink than men.
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Alcohol use disorder
A person's risk of developing AUD depends on how much, how often, and how quickly they consume alcohol. Other factors that increase the risk of AUD include binge drinking, heavy alcohol use, and drinking at an early age. Research shows that among people ages 26 and older, those who began drinking before age 15 were more likely to report having AUD in the past year compared to those who waited until age 21 or later to start drinking. The risk is higher for females in this group. Genetics and family history also play a role, with hereditability accounting for approximately 60%. Mental health conditions and a history of trauma are also associated with AUD.
The severity of AUD is assessed by healthcare professionals using criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Severity is categorised as mild (two to three criteria), moderate (four to five criteria), or severe (six or more criteria). Evidence-based treatments for AUD include behavioural therapies, mutual-support groups, and/or medications such as naltrexone, acamprosate, and disulfiram. These medications are non-addictive and can be used alone or in combination with behavioural treatments.
The number of alcohol-related deaths in the United States has been rising over the past two decades, including during and after the Covid pandemic. Liver disease deaths have doubled over the past 20 years, and alcohol consumption is a known cause of liver damage. Alcohol-related cancer deaths have also doubled in recent years, with increases seen mainly in men aged 55 and older. However, an increasing number of women have become heavy drinkers, and more young women binge drink than men.
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Alcohol-impaired driving fatalities
In 2022, 13,524 people died in alcohol-impaired crashes, a slight decrease of 1% from 2021. These crashes accounted for 32% of all crash fatalities. The NHTSA also reports that drinking and driving kills 37 people a day in the US, resulting in more than 11,000 deaths every year. In 2023, among children (aged 14 and younger) killed in motor vehicle crashes, 25% were killed in drunk-driving crashes, with more than half of those deaths occurring when the child was in the vehicle driven by the drunk driver. Motorcycle operators involved in fatal crashes were found to have the highest percentage (26%) of alcohol-impaired drivers compared to other vehicle types.
The highest percentage of drunk drivers in 2023 was in the 21-24 age group, and men are four times more likely to be involved in drunk driving crashes than women. Drunk driving laws have changed significantly over the years, with states adding their own specifications to federal traffic laws. Impaired driving offenses can result in misdemeanors or felony charges, with penalties including fines, license suspension or revocation, and even jail time. Repeat DUI offenders often face harsher consequences, including jail time and permanent license revocation.
While there was a decrease in alcohol-impaired driving fatalities from 1982 to 2011, and the overall drunk driving fatality rate fell between 2016 and 2019, the numbers began rising again in 2020. The increase in alcohol-related deaths has also been observed outside of driving fatalities, with liver disease deaths doubling over the past 20 years, and cancer deaths linked to alcohol also on the rise. These trends highlight the urgent need for enhanced prevention strategies and public health interventions to address the growing public health crisis associated with alcohol misuse.
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Alcohol-related suicides
Alcohol-related deaths have been rising over the past two decades, with liver disease deaths doubling over 20 years and cancer deaths linked to alcohol doubling in the last three decades. Alcohol misuse is a major contributor to suicide deaths. Alcohol use disorder (AUD) is the second most common mental disorder identified among suicide victims worldwide. AUD is a potent risk factor for suicidal behaviour, with the risk increasing with the amount of alcohol consumed.
In the United States, approximately 36% of male and 29% of female suicide victims aged 18 and older have a postmortem blood alcohol concentration (BAC) of 0.001 g/dL or more, and 24% of males and 17% of females have BAC levels that exceed 0.08 g/dL, the US national legal limit for drinking and driving. The risk for suicide attempts increases markedly at high levels of BAC, defined by a concentration of more than 0.10 g/dL.
Alcohol can increase the risk of suicide in several ways, including alcohol-related increases in psychological distress, depressed mood, aggressiveness, and impulsivity. Alcohol can also lead to cognitive constriction, a narrowing of attention to one's present emotional state and circumstances, which can further increase the risk of suicide. Additionally, alcohol intoxication is associated with the use of firearms, the most common method of suicide in the US.
The relationship between alcohol and suicide is complex, and other factors such as mental health conditions, history of trauma, chronic illness, social factors, and personal stressors also play a role. However, addressing alcohol misuse through prevention programs, harm reduction strategies, and substance use disorder treatments can help reduce the risk of suicide.
To promote suicide prevention and reduce the impact of alcohol on suicidal thoughts and behaviours, individuals should reflect on their alcohol consumption, be aware of their limits, and monitor their intake. Considering one's emotional state before drinking alcohol and understanding the potential stimulating and sedating effects of alcohol can also help reduce the risk of alcohol-related suicide.
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Frequently asked questions
Alcohol-related deaths have increased due to several reasons. Firstly, excessive alcohol consumption has become more common, with 45% of Americans reporting binge drinking in 2022. Secondly, alcohol is a leading cause of liver disease, and liver disease deaths have doubled over the past 20 years. The COVID-19 pandemic also contributed to a spike in alcohol-related deaths. Additionally, alcohol-related cancer deaths have doubled in the past three decades, with an increase in deaths among men in 47 states and women in 16 states.
Alcohol-related deaths are caused by a range of factors, including liver disease, cardiovascular disease, and various types of cancer, such as liver, colorectal, and breast cancer. Alcohol use disorder (AUD) is also a significant contributor to alcohol-related deaths, and it is the second most common mental disorder among people who die by suicide. Alcohol-impaired driving fatalities account for a considerable number of deaths as well.
Alcohol-related deaths disproportionately affect certain demographic groups. American Indian and Alaska Native communities have the highest rates of alcohol-related deaths due to historical trauma, cultural navigation challenges, poverty, and higher rates of mental health conditions. Additionally, young people aged 20-39 are more susceptible, with the highest proportion of alcohol-attributable deaths occurring within this age group in 2019.
