This article was originally published in Psychology Today and is republished here with permission.
Mental Health finds no net health benefit from low-level alcohol consumption and estimates a 1 in 25 lifetime risk of alcohol-attributable death among people consuming 14 drinks per week. The once-popular view that moderate drinking is healthy is increasingly challenged by current evidence, which indicates that risks such as cancer, cardiovascular disease, and injury may outweigh any potential benefits.
When I posted Just Say No to Alcohol? in 2024, I argued that the science was moving away from the old French wine paradox, that moderate drinking was good for us. The long-standing image of a nightly glass of wine as health-promoting was already beginning to crack back then. Then George et al. found no significant net health benefit from low-level drinking. Zero, nada, zilch.
George and colleagues estimated the lifetime risk of alcohol-attributable mortality and morbidity in the United States based on a person’s average lifetime alcohol consumption, also examining the impact of drinking patterns on health.
The Alcohol Intake and Health study arrived amid mounting evidence that alcohol contributes to cancer, cardiac arrhythmias, liver disease, injuries, and addiction—even among people who do not have alcohol use disorder. Alcohol remains one of the leading preventable causes of death in the United States, responsible for more than 170,000 deaths annually and millions of years of potential life lost.
Rather than asking whether drinkers live longer than nondrinkers, the Alcohol Intake and Health Study investigators estimated the lifetime risk of diseases and injuries caused by alcohol itself.
Their conclusion deserves attention from addiction specialists and the general public. Drinking 14 drinks per week—formerly the upper limit of U.S. guidance for men—was associated with roughly a 1 in 25 lifetime risk of an alcohol-attributable death.
Women generally experience greater alcohol-related health risks than men at the same level of consumption. Compared with men, women achieve higher blood alcohol concentrations from equivalent alcohol intake because of differences in body composition and first-pass alcohol metabolism. As a result, women develop alcohol-related liver disease, cardiomyopathy, neurotoxicity, and several alcohol-associated cancers at lower cumulative levels of exposure and shorter durations of drinking. Maybe some women can “drink a man under the table.” But at what health cost to the woman?
Why This Study Matters
For decades, alcohol’s reputation as healthy was supported by studies suggesting that moderate drinkers appeared healthier than abstainers. Many of those studies were limited by methodological shortcomings, including the inclusion of former drinkers in the abstainer group and inadequate adjustment for socioeconomic, behavioral, and other lifestyle differences. In the new analysis, researchers modeled diseases and injuries with established causal links to alcohol consumption, including multiple cancers, liver disease, cardiovascular disease, infectious diseases, and injuries.
There were small signals of possible cardiovascular benefits at very low consumption levels, consistent with earlier research. But when alcohol-related cancers, liver disease, infections, injuries, suicides, and other causes of death were included, those apparent benefits disappeared. This distinction is critical.
The question is no longer whether alcohol might slightly reduce the risk of one disease. The relevant question is whether drinking improves overall health when all consequences are considered together. According to this study, it does not.
Cancer Risks
For many people, alcohol still evokes images of cirrhosis, alcoholism, and drunk driving. Modern alcohol research increasingly points elsewhere: cancer. Alcohol is categorized as a Group 1 carcinogen by the International Agency for Research on Cancer, meaning there is conclusive evidence that it causes cancer in humans. Breast cancer, colorectal cancer, esophageal cancer, oral cancers, liver cancer, and several other malignancies become more common as alcohol consumption rises. Important, the risks are not limited to heavy drinkers.
One reason the public has been slow to absorb this message is that cancer develops slowly and quietly. There is no hangover from alcohol-induced DNA damage. There is no obvious warning sign when alcohol alters hormonal pathways or promotes carcinogenesis. A person can feel perfectly healthy while unknowingly increasing their long-term cancer risk through drinking. This reality has become difficult to ignore.
The study estimated that lifetime alcohol-attributable mortality exceeded 1 in 1,000 at approximately one drink per day and exceeded 1 in 100 at roughly eight to nine drinks per week. At 14 drinks weekly, the estimated risk of dying from an alcohol-caused condition reached approximately 4 percent, or 1 in 25.
Public health officials routinely use lifetime risk thresholds when evaluating environmental toxins, occupational exposures, and other hazards. If another consumer product carried a lifetime mortality risk of 1 in 25, public concern would likely be substantial. Among adults younger than 40, the study found, there is no net protective effect from alcohol. In younger populations, alcohol-related mortality is driven largely by injuries, motor vehicle crashes, violence, and self-harm rather than cardiovascular disease. The risks are immediate. Any possible cardiovascular benefits remain distant, uncertain, and largely irrelevant to younger adults.
One other lesson repeatedly emerging from alcohol research is that average consumption tells only part of the story. Seven drinks spread across seven days are not equivalent to seven drinks consumed on a Saturday night.
The study reviewed evidence showing that binge drinking can eliminate any apparent cardiovascular advantages associated with moderate average consumption. Heavy episodic drinking was associated with sharply increased risks of cardiovascular events, injury, suicide attempts, and motor vehicle crashes.
Before Alcohol Use Disorder Develops
As an addiction physician, I am especially interested in what the data mean in support of intervention before alcohol use disorder develops.
One theme I have discussed repeatedly in this blog is that we should stop waiting for people to “hit bottom” before recommending treatment. We screen for hypertension before stroke occurs. We identify prediabetes before blindness or kidney failure develops. We act early because prevention works. Alcohol should be no different.
The harms associated with alcohol are not confined to people with severe alcohol use disorder. Many harms occur among individuals who consider themselves normal drinkers. Cancer risk, injury risk, and cardiovascular complications do not require a diagnosis of alcoholism.
The traditional distinction between “problem drinkers” and everyone else is becoming increasingly difficult to defend scientifically.
The Bottom Line
Perhaps the most important implication of this study is that there is no credible medical justification for advising a nondrinker to begin drinking for health reasons. That idea sounds strange today, but physicians once offered exactly that advice.
The Alcohol Intake and Health Study does not prove that everyone who drinks should immediately stop. Nor does it suggest someone who occasionally enjoys a glass of wine is destined for illness.
What it does show is that the old narrative—that moderate drinking is good for health—has become increasingly difficult to defend.
Large international analyses have reached similar conclusions. When cancer and injury are considered alongside cardiovascular outcomes, the level of alcohol consumption associated with the lowest overall health risk appears very close to zero.
The most accurate message may be surprisingly simple: If you do not drink, there is no medical reason to start. If you do drink, less is generally better. And if your goal is maximizing health and longevity, the evidence increasingly points in the same direction: Alcohol offers considerably more risk than benefit.