Over the past several years, research on the impact of alcohol consumption on health has revealed facts that contradict many of our long-standing ideas about the health risks of alcohol. Many of us can remember hearing – repeatedly – in the 1980s and 1990s that drinking one or two glasses of wine was good for the heart, for stress management and overall health and wellbeing.
With regards to safe alcohol consumption, official entities in the U.S. such as the Substance Abuse and Mental Health Services (SAMHSA), the National Institute on Drug Abuse (NIDA), and the National Institute on Alcohol Abuse and Alcoholism (NIAA) have created clear guidelines on levels of drinking and their association with problematic alcohol use.
They define moderate alcohol consumption as follows:
- 1 drink a day or less for women
- 2 drinks a day or less for men
Binge drinking is defined as:
- 4 drinks in less than 2 hours for women, or:
- 4 or more drinks in one two-hour period in the past month for women
- 5 drinks in 2 hours for men, or:
- 5 or more drinks in one two-hour period in the past month for men
They define heavy alcohol use as:
- 3 drinks or more on any day, or more than 7 drinks per week for women, or:
- Binge drinking 5 or more times per month
- 4 drinks or more on any day, or more than 14 drinks per week
- Binge drinking 5 or more times per month
SAMHSA, NIDA, and NIAA all indicate the following:
“Binge drinking and heavy alcohol use can increase an individual’s risk of alcohol use disorder.”
The research we mention above shows that binge and heavy drinking aren’t the only types of drinking that can cause problems. We discuss this in an article we posted in the blog section of our website:
Moderate Drinking, Binge Drinking, and Alcohol-Related Problems
For a full report on our new understanding of the health risks of moderate and binge drinking, please read that article. We’ll summarize the salient points below, because they’re important to our discussion of alcohol-related deaths.
Alcohol Consumption: The New Perspective
There truly is a new perspective on what experts consider safe alcohol consumption. This new take is evidence-based, data-driven, and clearly elucidated in this warning published by the Centers for Disease Control (CDC):
“Emerging evidence suggests that even drinking within the recommended limits may increase the overall risk of death from various causes, such as from several types of cancer and some forms of cardiovascular disease. Alcohol has been found to increase risk for cancer, and for some types of cancer, the risk increases even at low levels of alcohol consumption (less than 1 drink in a day).”
It may come as a shock to some of us that “…even drinking within the recommended limits may increase the overall risk of death from various causes,” when we heard for most of our lives that moderate consumption was not dangerous, and possibly even beneficial.
And the warning is about “risk of death,” which is a real eye-opener. Most people know excess alcohol use can cause serious health problems, and know chronic heavy alcohol use almost guarantees serious negative health consequences.
But death?
That’s what the data indicate, and that’s why the research report on 20-year trends in alcohol-related death piqued our attention. We wanted to explore this data, learn more about alcohol-related problems up to and including death, and share this latest information here.
Before we get to the study, we’ll review what we know about alcohol and general health problems, then address the trends in alcohol-related deaths between 1999 and 2020.
The Health Risks of Alcohol, Revisited
The NIAA identifies the following documented risks of chronic, heavy alcohol use on the major organs of the human body:
The Brain and Central Nervous System
Chronic alcohol use exposure can damage the structure and impair the proper functioning of the brain and central nervous system. One severe consequence is Wernicke’s-Korsakoff Syndrome (WKS), which can lead to dementia, memory loss, and significant problems learning and retaining new information.
The Heart and Cardiovascular System
Chronic alcohol use is associated with cardiomyopathy. This is a serious heart condition, with symptoms that include dizziness, fainting, shortness of breath, and irregular pulse. Heavy drinkers may miss or ignore these symptoms for years, and only recognize their presence when a physician informs them that they’re at risk of heart failure.
The Liver
Chronic, heavy alcohol consumption damages the liver. It can cause liver disease which can lead to liver failure, which, in turn, can lead to death. Medical experts indicate there are three types of liver disease associated with chronic alcohol consumption:
- Alcoholic cirrhosis refers to scarring of the liver caused by alcohol. Alcoholic cirrhosis is not reversible, and results in permanent damage. However, early detection can prevent further damage.
- Alcoholic hepatitis causes severe symptoms, including stomach pain, fever, jaundice, nausea, vomiting, and loss of appetite. Alcoholic hepatitis is common among chronic, heavy drinkers, and can lead to significant complications. Undiagnosed alcoholic hepatitis can lead liver failure and death. However, when detected early, the condition can be reversed.
- Alcoholic fatty liver disease describes a buildup of fat in the liver that disrupts liver function. It’s the least dangerous of alcohol-related liver disease, and can be reversed.
The Kidneys
The function of our kidneys is to eliminate waste, control levels of fluid in our body, process toxic chemicals, and produce urine. Healthy kidneys also generate chemicals that improve the health of our bones, regulate blood pressure, and stimulate production of new red blood cells. Chronic, excess alcohol use can impair these critical functions, which can lead to kidney disease, and problems with some or all of the physiological systems the kidneys support.
The Pancreas
The pancreas produces critical chemicals in our bodies called hormones. The hormones produced in the pancreas affect blood sugar levels and the enzymes used in digestion. Chronic, heavy alcohol use can cause alcoholic pancreatitis, which severely impairs the function of the pancreas, and has a negative effect on the systems associated with the hormones generated in the pancreas. Untreated alcohol pancreatitis can, in some cases, causes complications that lead to death.
Cancer
When we think of alcohol use, we rarely think of cancer: that’s associated with smoking and other more risky activities. However, The American Cancer Society (ACS) links several types of cancer to chronic, excess alcohol use, including: cancer of the mouth, throat, voice box, esophagus, colon, rectum, and breasts.
Those are the primary physical consequences of heavy, chronic alcohol use. An individual who drinks heavily – binge or heavy use, as described above – is at elevated risk of the alcohol-related health problems described above.
With that understanding of the very real health risks associated with alcohol use, let’s look at the latest information on long-term trends in alcohol-related death.
Risks of Alcohol Consumption: Deaths from 1990-2020
In July 2023, a research team conducted a retrospective examination of 605,948 deaths attributed to alcohol between 1999 and 2020, in order to answer a basic question:
Are there sex-based differences in the contemporary burden and trends of alcohol-related mortality in the US?
In other words, over the past twenty years, did people of one gender (male) die more than another (female) from alcohol-related causes?
First, we’ll take a look at the big-picture facts.
Gender Differences in Alcohol-Related Death, 1999-2020
- Overall trends, men and women:
- 1999-2007: Stable for men and women, with no annual percentage change
- 2007-2018: 3.0% increase per year
- 2018-2020: 14.1% increase per year
- Trends, men:
- 1999-2009: Stable for men
- 2009-2018: 3.0% increase per year
- 2018-2020: 12.5% increase per year
- Trends, women:
- 1999-2007: 1.0% increase per year
- 2007-2018: 4.3% increase per year
- 2018-2020: 14.7% increase per year
Those figures show us something important. In the 20-year period under review, alcohol-related death rates increased more for women than for men. The annual rate of increase grew over time, with the largest increase occurring between 2018 and 2020.
Now let’s take a closer look at the data.
Alcohol-Related Death, 1999-2020: Detailed Trends, Yearly Averages
(Reported as number of deaths per 100,000 people)
Overall:
- 3 deaths per year per 100,000
- Men: 12.7
- Women: 4.3
- Ratio of Difference: 2.88 men for every 1 woman
By Age Group (Men/Women/Ratio of Difference):
- 15-24:
- Men: 0.5
- Women: 0.2
- RD:2.9
- 25-44:
- Men: 8.3
- Women: 3.5
- RD: 2.3
- 45-64:
- Men: 32.5
- Women: 1.1
- RD: 2.9
- 65+:
- Men: 23.6
- Women: 6.0
- RD: 4.2
By Ethnicity (Men/Women/Difference):
- American Indian/Alaskan Native:
- Men: 50.9
- Women: 27.6
- RD: 1.76
- Asian/Pacific Islander:
- Men: 3.5
- Womnen: 0.7
- RD: 4.6
- Black:
- Men: 11.6
- Women: 3.6
- RD: 2.9
- Hispanic:
- Men: 16.9
- Women – 3.2
- RD: 4.7
- White:
- Men: 12.4
- Women: 4.6
- RD: 2.7
There are three key components to this data. Two are not germane to this discussion, but we’ll point them out. First, males die of alcohol-related causes far more often than women, across all age, demographic, and ethnic groups. The average difference, as noted above, is expressed in a ratio: for every woman that dies of alcohol-related causes, almost three men die. Second, we observe the highest rates of alcohol-related mortality in American Indian/Alsakan Native men and women, with rates three to four times greater than other ethnic groups.
The third component is germane to our discussion: gender differences. Over the twenty years examined in the study, the rate of increase in alcohol-related death was far greater for women than for men. This is new data for us, but we’ve seen hints of this trend in other areas. For instance, we’ve published two articles on this topic:
The Normalization of Excess Alcohol Use Among Older Women
Alcohol Use, Women, and COVID-19
We’ll discuss these trends below.
Alcohol Use and Women: New Challenges in Treatment
Here’s how the authors of this study describe the results:
“These findings underscore the need for further research to understand the specific factors associated with this trend. The development of targeted interventions and evidence-based treatments for alcohol use among female individuals becomes imperative in effectively addressing the increasing rates of alcohol-related deaths.”
The study above, and the two articles we link to above, address the phenomenon of increased drinking among women in the U.S. The data tell the story, but they don’t explain why. That’s what we need to learn, in order to tailor treatment to meet the needs of women in the 21st century.
Are women drinking more because of the gradual reduction of stigma around women becoming more independent from men overall, with the advent of women’s rights, and the increased prevalence of women in business, trades, and other areas of life?
In other words, are women drinking more simply because they can?
Or is there something unique about the physiology of women that makes them more vulnerable to the negative effects of alcohol, compared to men?
That’s why we need more research: we need to get ahead of this trend and learn ways to create targeted treatment for alcohol use disorder (AUD) that meets the specific needs of women, so that we can halt the increasing rates of alcohol-related death among women, and work to reduce the harm women experience from alcohol use, misuse, and disordered use.