Heavy drinking spiked during the COVID-19 pandemic and continued to rise in the years that followed, new research shows.
Overall, 66.34% of Americans said they consumed alcohol in 2018. That figure rose to 69.03% in 2020 and 69.3% in 2022. Similarly the percentage of heavy drinkers increased from 5.1% in 2018 to 6.13% in 2020 and 6.3% in 2022, the study found.
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Drinking rates also spiked more among women than men. The number of women who reported heavy drinking rose from 5.19% in 2018 to 6.45% in 2022. For men, it jumped from 5.01% to 6.12%.
Stress from the pandemic and disrupted access to medical services may explain the rise in heavy drinking from 2018 to 2020. What is significant is that heavy drinking rates have persisted, suggesting that "drinking to cope with stress became maybe possibly more culturally acceptable in our communities," said Dr. Divya Ayyala-Somayajula, a gastroenterologist at the Sidney Kimmel Medical College at Thomas Jefferson University.
The researchers used the National Institute on Alcohol Abuse and Alcoholism's definition of heavy drinking – four or more drinks a day or eight or more in a week for women, and five or more drinks a day or 15 or more in a week for men.
The study was spurred by a greater number of patients being admitted to hospitals for the first time with issues related to end-stage liver disease during the pandemic, said Ayyala-Somayajula, who conducted the research with colleagues from the University of Southern California.
"We were initiating all these expedited transplant evaluations and transplanting a lot of these patients, so that really led us to continue to want to understand alcohol use patterns during the pandemic and see if these things are sustained post pandemic as well," Ayyala-Somayajula said.
The researchers used data from adults 18 and older who took part in the National Health Interview Survey from 2018 to 2022. More than 20,000 people responded to the survey each year. The group was representative of the national population.
The study was limited by its reliance on surveys. People tend to lowball how much they drink when self-reporting data. Also, the database did not include people who had been institutionalized or who had served in the armed forces – populations that are "more vulnerable to harmful alcohol use" – so the heavy drinking rates reported might be underestimated, Ayyala-Somayajula said.
"For health care providers, the No. 1 message is we should be screening very aggressively for alcohol use and educating the public what heavy or harmful alcohol use is, because it may not be what the general public thinks," Ayyala-Somayajula said.
Earlier studies found light to moderate drinking is associated with a lower risk of cardiovascular disease. But those research methods lately have been called into question because "mounting evidence suggests these associations might be due to systematic biases that affect many studies," according to a 2023 meta-analysis of 107 studies. Much of the past research has used a population base with a majority of white men. Also, those studies did not remove former drinkers who stop for health reasons from the "abstainer" group, which may have added bias to the conclusion that light to moderate drinking offers cardiovascular health benefits, according to the analysis.
These studies "made it difficult to conclude whether positive cardiovascular outcomes were due to low alcohol consumption or instead, for example, to diet, genetics, health history, or behavioral differences between people who do and do not drink." But more recent research has shown that even moderate drinking increases the risk for stroke, cancer and premature death, according to the NIAAA.
An often-cited 2018 WHO study about the global health consequences of alcohol use determined that the "safest level of drinking is none."
Dr. Laura Catena, a longtime emergency medicine physician and fourth-generation winemaker, has pushed back on these findings.
"Such declarations fail to acknowledge the nuances in the data and dismiss decades of research in reputable journals showing cardiovascular protective effects for moderate drinkers," Catena, wrote Tuesday in SevenFiftyDaily, an online magazine that covers the alcohol beverage industry.
"I believe the 'no safe level' or 'two drinks a week' positions are based on inconclusive science and prohibitionist ideology, and if they become entrenched – such as could happen in the upcoming update to the U.S. Dietary Guidelines – then governmental ethics committees and research institutions will potentially stop approving alcohol research. This could result in the public not getting a definitive answer to the question of alcohol's impact on health, which is so important to the many people who drink in moderation."
Research presented Wednesday at the annual meeting of the American Association for the Study of Liver Diseases found that people who drink beer have lower-quality diets, are less active and are more likely to smoke than those who drink wine, liquor or a combination. This research has not yet been peer reviewed or published.
The Department of Health and Human Services, along with the U.S. Department of Agriculture, are due to publish new overall dietary guidelines – including for alcohol consumption – by the end of 2025. Dietary guidelines are updated every five years.
According to the 2020-2025 U.S. Dietary Guidelines, women should limit themselves to one drink or less a day, and men should drink no more than two. The guidelines note that they "are not intended as an average but as a daily limit."
The guidelines define binge drinking as resulting in a person's blood alcohol concentration reaching 0.08% or more, which typically happens if a woman has four or more drinks, or a man has five or more drinks, within about two hours.
A drink is defined as about 14 grams of pure alcohol. That equates to about 12 ounces of beer, 5 ounces of wine and 1.5 ounces of distilled spirits.