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Long-term effects of alcohol

Health effects of long-term alcohol consumption

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Beyond cancer, chronic and excessive alcohol use—as seen in alcohol use disorder—is capable of damaging nearly every part of the body. Such use is linked to alcoholic liver disease, which can progress to cirrhosis and chronic pancreatitis; various forms of cardiovascular disease, including hypertension, coronary heart disease, heart failure, and atrial fibrillation; and digestive conditions such as gastritis and stomach ulcers. Alcohol also interferes with how the body absorbs nutrients, which can lead to malnutrition. Long-term use can cause alcohol-related dementia and damage to the peripheral nervous system, leading to conditions like painful peripheral neuropathy. Drinkers are also more likely to get injured in accidents, including traffic accidents and falls, and may age faster.

Children and fetuses are especially at risk. Alcohol consumption during pregnancy can result in fetal alcohol spectrum disorders (FASDs), a range of lifelong physical, behavioral, and intellectual disabilities. In response to these risks, some countries now require alcohol packaging warning messages that mention cancer risks and pregnancy dangers.

Although some studies have proposed potential health benefits of light alcohol consumption—such as reduced risk of cardiovascular disease, type 2 diabetes, gastritis, and cholelithiasis— experts, including the World Health Organization (WHO), have questioned the validity of these studies, and say these possible benefits are small and uncertain when weighed against the well-known risks, especially cancer. While alcohol may provide short term effects of temporary stress reduction, mood elevation, or increased sociability, experts emphasize that, in the long run, the significant and cumulative health consequences of alcohol use outweigh these perceived psychosocial benefits.

Overall effect

The level of ethanol consumption that minimizes the risk of disease, injury, and death is subject to some controversy. Several studies have found a J-shaped relationship between alcohol consumption and health, meaning that risk is minimized at a certain (non-zero) consumption level, and drinking below or above this level increases risk, with the risk level of drinking a large amount of alcohol greater than the risk level of abstinence. Other studies have found a dose-response relationship, with lifetime abstention from alcohol being the optimal strategy and more consumption incurring more risk. The studies use different data sets and statistical techniques so they cannot be directly compared. Some older studies included former and occasional drinkers in the "abstainers" category, which obscures the benefits of lifetime abstention as former drinkers often are in poor health. However, the J-curve was reconfirmed by studies that took the mentioned confounders into account. Nonetheless, some authors remain suspicious that the apparent health benefits of light alcohol use are in large part due to various selection biases and competing risks. Mendelian randomization studies have been inconsistent regarding the risk curve, with three studies finding linear dose-response risks overall and two studies finding a J-shape for lipid profiles. The variance in alcohol consumption that is explained by genetics is small, requiring large sample sizes and potentially violating assumptions of the analysis.

As one reviewer noted, "Despite the wealth of observational data, it is not absolutely clear that alcohol reduces risk, because no randomized controlled trials have been performed." The National Institute on Alcohol Abuse and Alcoholism (NIAAA) announced a randomized controlled trial in 2017, but the National Institutes of Health (NIH) cancelled it in 2018 due to irregular interactions by the program staff with the alcohol industry. A trial in Spain is expected to complete in 2028.

In 2013, Norwegian psychiatrist Hans Olav Fekjær compared the situation to those of hormone replacement therapy (HRT), vitamin E, and β-carotene; similarly to alcohol, observational studies for each of these treatments showed significantly reduced risk of coronary heart disease, but initial randomized trials of these treatments failed to replicate the effect. For HRT, pooling multiple randomized control trials and stratifying the data by age and time since menopause showed the benefits were limited to treatment soon after menopause. For vitamin E, trials have shown that the benefits are limited to certain populations such as those with diabetes and a specific genotype. For β-carotene, the randomized trials have shown that β-carotene increases cardiovascular disease risk when supplemented, with all beneficial effects due to other vitamins in foods providing β-carotene.

In light of the conflicting evidence, many have cautioned against recommendations for the use of alcohol for health benefits. At a symposium in 1997, Dr. Peter Anderson of the World Health Organization (WHO) labeled such alcohol promotion as "ridiculous and dangerous". It has been argued that the health benefits from alcohol have been exaggerated by the alcohol industry, with industry participation in the wording of messages and warnings. The debate is not purely scientific, with groups such as the International Scientific Forum on Alcohol Research (ISFAR) critiquing anti-alcohol studies as distorting the evidence, scientists in turn accusing these groups of bias due to industry funding, and members of the groups responding that these are false and misleading assertions. Studies with industry funding find less risk of stroke, and industry-linked systematic reviews consistently find cardioprotective effects, compared to reviews with no associations being 54% positive.

Considered as a treatment for cardiovascular disease, alcohol is addictive, has greater risk of adverse effects, and is less effective than other interventions such as heart medications, exercise, or good nutrition.

The world

The available evidence is in agreement that current drinking levels are too high. The WHO has emphasized the need to revise alcohol control policies worldwide in order to reduce overall alcohol consumption.

Globally, assuming the J-shaped curve is correct, the age-standardised, both-sexes consumption that minimizes risk is about 5 grams of ethanol per day, and an average individual would cause themselves harm by drinking more than 17 grams per day. However, the average intake among current drinkers in 2016 was approximately 40 grams of ethanol per day. 1.03 billion males (35.1% of the male population aged ≥15 years, ~2/3 of male drinkers) and 312 million females (10.5% of the female population aged ≥15 years, ~1/3 of female drinkers) consumed harmful amounts of alcohol. The proportion of the population consuming harmful amounts of alcohol has stayed at approximately the same level over the past three decades.

Estimates of the worldwide number of deaths per year caused by alcohol vary. The 2016 Global Burden of Disease (GBD) study estimated 2.8 million, while the 2020 GBD study estimated 1.78 million. The WHO estimates 3 million deaths per year from harmful use of alcohol, representing 5.3% of all deaths across the globe. All of these numbers are net deaths, subtracting deaths prevented from deaths caused. Professor Tim Stockwell, former director of the Canadian Institute for Substance Use Research argues that alcohol may not prevent any deaths and guesses that as many as 6 million deaths may be caused by alcohol. Besides this, the WHO attributes 5.1% of the global burden of disease and injury to alcohol, as measured in disability-adjusted life years (DALYs). The WHO does not list alcohol in its 2019 list of the top 20 leading causes of DALYs, but alcohol use disorder (AUD) would rank around #39, combining AUD with alcohol-related cirrhosis and liver cancer would rank between malaria (#19) and refractive errors (#20), and all alcohol-attributed DALYs would rank between stroke (#3) and lower respiratory infections (#4). Similarly the number of alcohol-attributed deaths would rank between chronic obstructive pulmonary disease (#3) and lower respiratory infections (#4).

Research of Western cultures has consistently shown increased survival associated with light to moderate alcohol consumption. Australasia and Europe are also the locations with the highest levels of harmful alcohol consumption. Researchers have investigated cultures with different alcohol consumption norms and found conflicting results.

The risks of alcohol consumption are age-dependent. Risk is greatest among males aged 15–39 years, due to binge drinking which may result in violence or traffic accidents. It is less risky and potentially more beneficial for an older individual to consume a given amount of alcohol, compared to a similar younger individual, as they are less likely to develop cancer during their remaining lifespan, less likely to be involved in accidents, and more likely to benefit from alcohol's cardiovascular effects. Taking the lower bound of the confidence intervals, the GBD 2020 study suggests that people do not need to drink until age 25, and in many regions, the study did not find any significant benefit for drinking over abstinence even as late as ages 45 or 60. Other studies have found similar patterns.

India

A study of 4,465 subjects in India confirmed the association of alcohol consumption with coronary risk in men. Compared to lifetime abstainers, alcohol users had higher blood sugar (2 mg/dl), blood pressure (2 mm Hg) levels, and high-density lipoprotein cholesterol (HDL-C) levels (2 mg/dl) and significantly higher tobacco use (63% vs. 21%). Indians who consume alcohol had a 60% higher risk of heart attack, which was greater with local spirits (80%) than branded spirits (50%). The harm was observed in alcohol users classified as occasional as well as regular light, moderate, and heavy consumers. Five percent of all cancers diagnosed in Indians in 2021 were attributed to alcohol consumption, with cancers of the esophagus, liver, and breast accounting for the most number of cases.

Russia

As of 2014, male life expectancy was lower in Russia than other countries. For example, at 2005 mortality rates, only 7% of UK men but 37% of Russian men would die before the age of 55 years. A study by Zaridze et al. in 2009 found that "excessive alcohol consumption in Russia, particularly by men, has in recent years caused more than half of all the deaths at ages 15–54 years." The study used 43,802 deaths linked to alcohol or tobacco but only 5475 other deaths as controls. Further studies have confirmed that heavy drinking and smoking are the main cause of high death rates in Russia as of 2014. The high consumption of vodka in the context of binge drinking is a significant factor. For smokers aged 35-54, the 20-year risk of death was 35% for men who had reported drinking three or more bottles of vodka a week and 16% for men who had reported consuming less than one bottle a week.

South Asia

The landmark INTERHEART Study has revealed that alcohol consumption in South Asians was not protective against Acute Myocardial Infarction (AMI).

United Kingdom

A governmental report from Britain has found that there were "8,724 alcohol-related deaths in 2007, lower than 2006, but more than double the 4,144 recorded in 1991. The alcohol-related death rate was 13.3 per 100,000 population in 2007, compared with 6.9 per 100,000 population in 1991." In Scotland, the NHS estimate that in 2003 one in every 20 deaths could be attributed to alcohol. A 2009 report noted that the death rate from alcohol-related disease was 9,000, a number three times that of 25 years previously.

A UK report came to the result that the effects of low-to-moderate alcohol consumption on mortality are age-dependent. Low-to-moderate alcohol use increases the risk of death for individuals aged 16–34 (due to increased risk of cancers, accidents, liver disease, and other factors), but decreases the risk of death for individuals ages 55+ (due to decreased risk of ischemic heart disease).

A study in the United Kingdom found that alcohol causes about 4% of cancer cases in the UK (12,500 cases per year).

United States

Excessive alcohol use was the third leading behavioral cause of death for people in the United States in the year 2000. In 2001, an estimated 75,766 deaths were attributable to alcohol. From 2006 through 2010, there were approximately 87,798 deaths on average attributable to alcohol occurred in the United States each year. Alcohol-related deaths among Americans about doubled from 1999 to 2020. In 2020, alcohol was linked to nearly 50,000 deaths among adults aged 25 to 85, a sharp rise from just under 20,000 in 1999. All age groups experienced increases, with the most significant rise occurring in individuals aged 25 to 34, where death rates nearly quadrupled during this period. In 2025, the US Surgeon General advocated for cancer risk warnings on alcoholic beverages.

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