Goal 2: Identify Patterns, Trends, and Public Health Impact of Alcohol Misuse

Objective 1: Identify and Track Trends in Alcohol Misuse and Related Consequences

Collection and analysis of national data on alcohol use are essential for surveilling the patterns and impact of alcohol misuse on public health. For example, recent data have revealed some successes, such as declining alcohol use among youth. These studies also indicate, however, that the recent decrease has been slower among females than males. Among adults, however, alcohol use is increasing, with larger increases found among women, Black men, and older adults. A growing number of studies have also revealed higher levels of alcohol misuse and harms among adolescents and adults in sexual and gender minority populations.

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Each year, approximately 5 million people visit emergency departments for alcohol-related reasons, from injuries to diseases.¹ The rate of alcohol-related deaths in the United States more than doubled between 1999 and 2021. Additional epidemiological reports also indicate that alcohol-associated liver diseases (ALD), such as cirrhosis, are increasing, particularly among women and young adults, and alcohol now accounts for almost half of liver disease deaths in the United States.² Research tracking the patterns and correlates of alcohol involvement in morbidity and mortality can inform decisions about where to direct prevention and treatment efforts.

NIAAA encourages research to understand the scope and scale of alcohol misuse—for example:

• Identifying patterns, trends, and disparities in alcohol misuse, AUD, alcohol-related consequences, as well as treatment access and utilization across demographic groups, including but not limited to age, race, ethnicity, sex, gender identity, geographic location, socioeconomic status, and career
• Characterizing patterns and trends in co-use of alcohol, cannabis, opioids, and other substances and their contributions to adverse health and social outcomes
• Identifying and characterizing secondhand effects of alcohol misuse (e.g., interpersonal violence, assault, homicide, child maltreatment, and motor vehicle crashes)
• Improving assay methodologies for validated biomarkers of alcohol consumption considering cost, timeliness, and accessibility in clinical settings
• Applying innovative data measurement technologies and approaches for more accurate and/or real-time assessment of alcohol use, related behaviors, and associated changes over time (e.g., ecological momentary assessment, biomarkers, and biosensors)
• Utilizing cutting-edge data collection and analytic approaches, such as artificial intelligence, social network analyses, and data analytics to study and predict patterns and trends in alcohol misuse to facilitate timely intervention
• Examining the long-term health and societal effects of the increase in alcohol misuse and alcohol-related consequences due to the COVID-19 pandemic, particularly due to coping with stress

¹ White AM, Slater ME, Ng G, Hingson R, Breslow R. Trends in alcohol-related emergency department visits in the United States: results from the Nationwide Emergency Department Sample, 2006 to 2014. Alcohol Clin Exp Res. 2018 Feb;42(2):352-9. doi: 10.1111/acer.13559. Epub 2018 Jan 2. PubMed PMID: 29293274

² Estimated liver disease deaths include deaths with underlying causes coded as alcoholic liver disease (K70); liver cirrhosis, unspecified (K74.0–K74.2, K74.6, K76.0, K76.7, and K76.9); chronic hepatitis (K73); portal hypertension (K76.6); liver cancer (C22); or other liver diseases (K71, K72, K74.3–K74.5, K75, K76.1–K76.5, and K76.8). Number of deaths from Multiple Causes of Deaths Public-Use Data File, 2022 (https://wonder.cdc.gov/mcd.html). Alcohol-attributable fractions (AAFs) from CDC Alcohol-Related Disease Impact (http://nccd.cdc.gov/DPH_ARDI/Default/Default.aspx), accessed March 13, 2024. Prevalence of alcohol consumption from the National Survey on Drug Use and Health, 2022, for estimating indirect AAFs for chronic hepatitis and liver cancer.

Objective 2: Explore How Social Determinants of Health Convey Risk for and Resilience to Alcohol Misuse and Associated Outcomes

Structural and social determinants of health, or environmental factors that are associated with general health outcomes, are related to the risk for and resilience to alcohol misuse and related harms in both adolescents and adults. Social determinants include social environment (e.g., discrimination, racism, social isolation, growing up in a home with parental AUD), physical environment (e.g., alcohol outlet density, exposure to violence), health care services (e.g., access to and quality of care), economic stability (e.g., job security, income), and education access and quality (e.g., educational opportunities and support).

Social determinants of health can contribute to accumulating stress. In turn, stress leads some individuals to drink alcohol to cope and results in chronic disease and other adverse outcomes. Exposure to stressors (e.g., job loss) is a key contributor to a return to drinking and plays a role in “deaths of despair,” such as alcohol-involved suicides, drug overdoses, and liver disease deaths linked to underemployment and hopelessness.³ Moreover, adverse childhood experiences (e.g., racial discrimination, parental AUD, and exposure to violence in homes and neighborhoods) are associated with an earlier onset of alcohol use, more frequent binge drinking during adolescence, consuming more drinks per binge occasion during adulthood, and poorer physical and emotional well-being in general.

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In contrast, protective factors against the initiation and escalation of alcohol misuse have also been identified. Supportive relationships with parents/caregivers and other adults, for example, are associated with a lower likelihood of adolescent drinking and related harms.

Advancing research on social determinants provides important opportunities to address health disparities and improve overall public health. Such studies can shed light on the underlying factors that contribute to interactions of alcohol misuse with health disparities as well as targets for intervention.

NIAAA encourages research to better understand how social determinants of health contribute to alcohol-related risk and resilience—for example:

• Elucidating the ways in which social determinants of health—such as discrimination, trauma, workplace stress, homelessness, and adverse childhood experiences—influence the risk for alcohol misuse, AUD, and associated harms
• Understanding the effects of economic fluctuations on alcohol misuse and related outcomes
• Characterizing the influence of the family environment, such as parental/caregiver AUD and recovery, on alcohol-related behaviors and consequences among youth
• Exploring the influence of a person’s social context, such as social media exposure, social network interactions, and peer networks, on alcohol misuse and associated outcomes, such as recovery from AUD
• Elucidating how social determinants of health interact with biological pathways to contribute to health disparities and adverse health outcomes
• Exploring how social determinants of health confer protection against alcohol misuse and identify ways to strengthen their influence
• Examining the impact of helping young people cope with stress, anxiety, and depression on alcohol-related attitudes and behaviors

³ Case A, Deaton A. Rising morbidity and mortality in midlife among white non-Hispanic Americans in the 21st century. Proc Natl Acad Sci U S A. 2015 Dec 8;112(49):15078-83. doi: 10.1073/pnas.1518393112. Epub 2015 Nov 2. PubMed PMID: 26575631