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JAMA Patient Page
July 13, 2021

Unhealthy Alcohol Use

Author Affiliations
  • 1University of Mississippi Medical Center, Jackson
  • 2University of Nebraska Medical Center, Omaha
JAMA. 2021;326(2):196. doi:10.1001/jama.2020.2015

Unhealthy alcohol use refers to drinking that can lead to negative health effects.

Risky Alcohol Use and Alcohol Use Disorder

Unhealthy alcohol use encompasses a range of alcohol use from risky drinking to alcohol use disorder. Risky alcohol use is drinking that can lead to health consequences and may develop into alcohol use disorder. The National Institute on Alcohol Abuse and Alcoholism (NIAAA) defines risky alcohol use for men aged 65 years or younger as having more than 4 drinks on any day or more than 14 standard drinks per week. For women or men older than 65 years, risky alcohol use is defined as having more than 3 drinks on any day or more than 7 standard drinks per week. A standard drink is 12 oz of beer, 8 to 9 oz of malt liquor, 5 oz of wine, or 1.5 oz of distilled spirits. Binge drinking is when blood alcohol concentration meets or exceeds 0.08%, which typically occurs when women have 4 or more drinks and men have 5 or more drinks within about 2 hours.

Alcohol use disorder is a pattern of drinking that significantly impairs health and functioning. The following 11 criteria are used to diagnose alcohol use disorder, and severity is based on the number of criteria met. A score of 2 to 3 is mild, 4 to 5 is moderate, and 6 or more is severe alcohol use disorder.

  • Drinking in larger amounts or for longer than intended

  • Wanting to cut down or stop drinking but not able to do so

  • Spending a lot of time to get alcohol, to drink, or to recover from drinking

  • Experiencing a strong urge or craving to drink

  • Inability to fulfill commitments at school, work, or home due to drinking

  • Continuing to drink when it causes problems in relationships

  • Giving up important work or social activities due to drinking

  • Alcohol use in situations that could be dangerous (eg, driving)

  • Continuing to drink even if it worsens physical or psychological problems

  • Needing to increase amount of drinking to get the same effect

  • Experiencing withdrawal symptoms when not drinking (eg, nausea, restlessness, irritability, trouble sleeping)

Nearly 1 in 3 US adults have risky alcohol use according to NIAAA estimates. Alcohol use disorder has been estimated to affect 29% of adults in the US in their lifetimes.

Health Effects of Unhealthy Alcohol Use

Unhealthy alcohol use can contribute to the development or worsening of many medical conditions, including high blood pressure, cardiovascular disease, liver disease, pancreatitis, and cancers of the mouth, throat, esophagus, liver, and breast. Risky drinking is also linked to risk for and worsening of psychiatric disorders, including anxiety, depression, and posttraumatic stress disorder, and is associated with other substance use disorders. Alcohol use during pregnancy can result in fetal alcohol spectrum disorder, the most common preventable cause of birth defects and developmental disabilities.

Unhealthy Alcohol Use and Mortality

Excessive alcohol use is the third most common cause of preventable death in the US and is estimated to cause 1 in 10 deaths among working-age adults in the US. Alcohol-related deaths are often due to medical conditions that are caused or worsened by alcohol, accidental deaths, or suicide.

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Article Information

Conflict of Interest Disclosures: None reported.

Sources: Office of the Surgeon General. Facing Addiction in America. DHHS; 2016.

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. American Psychiatric Association; 2013.

Stahre M, Roeber J, Kanny D, et al. Contribution of excessive alcohol consumption to deaths and years of potential life lost in the United States. Prev Chronic Dis. 2014;11:E109. doi:10.5888/pcd11.130293

Grant BF, Goldstein RB, Saha TD, et al. Epidemiology of DSM-5 alcohol use disorder. JAMA Psychiatry. 2015;72(8):757-766. doi:10.1001/jamapsychiatry.2015.0584

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