Dr. Brian P. Lee watched his waiting room change after 2020. Patients with liver disease arrived younger, some in their 20s needing transplants because of alcohol. On Monday, his new study offered a marker the United States had not seen since Covid-19: a national decline in drinking.
The study in the Annals of Internal Medicine used cross-sectional data from the National Health Interview Survey, which the U.S. Census Bureau runs. More than 114,000 respondents were included from 2018 to 2024.
Between 2022 and 2024, the share of adults who had consumed any alcohol in the past year fell by nearly 2%. Heavy drinking dropped by more than 8%. Dr. Jagpreet Chhatwal, director of the Institute for Technology Assessment at Massachusetts General Hospital, called the change “an encouraging trend” but said it was no big victory because rates were high before the pandemic.
Men and women both declined, but on different measures: men had the larger fall in any alcohol use, while women posted the bigger drop in heavy drinking. Rates are still above 2018 levels.
Younger adults lead the turn
Gen Z adults, ages 18 to 29, cut any alcohol use by over 5%, the largest decline of any group. Heavy drinking among millennials, ages 30 to 49, fell 17% from 2022 to 2024.
Lee, a liver transplant specialist at Keck Medicine of USC in Los Angeles, pointed to the sober-curious movement and more attention to health risks from alcohol. He and Chhatwal said some younger people may be replacing alcohol with cannabis.
Lee described drinking as a social signal. A few people pulling back can trigger “a domino effect” across a peer group, he said.
Middle age moves the other way
Adults 50 to 64 broke from the trend. Heavy drinking in that group rose more than 36% from 2018 to 2024. Any drinking climbed 4%.
The steepest rise is in the group whose alcohol-related health worries doctors most, Lee said.
Chhatwal called it a concerning sign and said interventions should target high-risk drinking in that cohort. The National Center for Drug Abuse Statistics estimates that among people ages 50 to 64, death from chronic alcohol abuse is over two and a half times more likely than death from acute alcohol-related conditions. The average age for an alcohol-related cirrhosis diagnosis is in the 50s. The liver also becomes more sensitive at that age, Lee said.
For women, the National Institute on Alcohol Abuse and Alcoholism counts heavy drinking as four or more drinks per day. The weekly cutoff is eight or more drinks per week. For men, the daily threshold is five or more drinks. The weekly threshold is 15 or more drinks.
Lee said many in Gen X learned to drink when a few drinks a night was simply what adults did. Messaging, he added, needs to keep telling them what they are putting into their bodies. Chhatwal said staying consistent is the hard part for people who try to stop. “Relapse is high,” he said.
A lower national average does not tell the whole story. Prevention and treatment may need to be aimed by age rather than at a single national figure, researchers said.
Vinetur reported that the split has commercial weight for the beverage industry. A sustained fall among younger drinkers could alter long-term demand for beer, wine and spirits, while continued heavy use in middle age could complicate forecasts.
Lee said people often know alcohol is not healthy but choose to drink for reasons that matter to them. “Doctors understand that and it’s OK to have these conversations,” he said.
Sources
- Alcohol consumption has declined for the first time since Covid-19 | CNN
- U.S. Alcohol Use Declines for the First Time Since the Pandemic, Study Finds
