Study finds US alcohol consumption fell as older adults increased drinking
Overall alcohol consumption in the United States declined between 2022 and 2024, marking the first confirmed drop since the COVID-19 pandemic began, according to a study published in the Annals of Internal Medicine. While younger demographics such as Generation Z and millennials drove significant decreases in drinking rates and heavy consumption, a counter-trend emerged among middle-aged adults aged 50 to 64, whose heavy drinking increased by more than 36 percent over a six-year period.
Key Clinical Takeaways:
- U.S. alcohol use fell by nearly 2% and heavy drinking dropped by over 8% from 2022 to 2024, though rates remain higher than pre-pandemic baselines.
- Adults aged 50 to 64 experienced a 36% surge in heavy drinking and a 4% increase in overall alcohol use between 2018 and 2024.
- Clinicians are advised to screen for alcohol use and liver fibrosis routinely using validated tools like the AUDIT-C and noninvasive tests such as the Fibrosis-4 score.
National Declines and Generational Divides in Drinking Habits
The nationwide drop in alcohol consumption followed years of elevated drinking patterns established during the pandemic. Analyzing National Health Interview Survey data from 114,352 adults between 2018 and 2024, researchers found that Generation Z adults led the reduction in overall consumption with a 5% decline from 2022 to 2024. Millennials posted the largest drop in heavy drinking, decreasing by 17% over the same timeframe. Regionally and across sex lines, men experienced a larger decrease in any alcohol use at 2.4% compared to 1.1% for women, while women achieved a larger reduction in heavy drinking at 9% versus 7.7% for men.
Dr. Brian P. Lee, a hepatologist and liver transplant specialist at Keck Medicine of USC in Los Angeles and the principal investigator of the study, noted that younger populations possess less disposable income for alcohol compared to older adults, and observed that regular drinking is no longer viewed as a default social expectation among Gen Z and millennials.
Surging Alcohol Consumption Among Older Americans
In sharp contrast to younger generations, Americans aged 50 to 64 increased both their overall alcohol use and heavy drinking rates. General alcohol consumption in this cohort rose by nearly 4% between 2018 and 2024, while heavy drinking climbed by more than 36%. Dr. Chris Tuell, clinical director of addiction services at the University of Cincinnati College of Medicine, attributed the trend among older adults to feelings of polarization, disconnection, retirement-related loss of structure, coping with grief, and seeking relief from physical pain and health issues.
The study defined heavy drinking as five or more drinks per day or 15 or more drinks per week for men, and at least four daily drinks or eight weekly drinks for women over the preceding 12 months.
Experts Recommend Screening Tools to Detect Liver Disease Risks
The rise in heavy drinking among middle-aged adults carries distinct clinical implications for long-term organ health, particularly regarding alcohol-associated liver disease. Binge alcohol intake may increase the risk of fibrosis progression in MASH patients.
To address diagnostic blind spots, gastroenterology and hepatology experts recommend integrating validated screening tools such as the AUDIT-C into every clinical encounter, paralleling routine assessments for smoking and blood pressure. For patients with uncertain histories, clinicians can utilize phosphatidylethanol testing as an objective biomarker reflecting intake over the prior four weeks. Noninvasive evaluations such as the Fibrosis-4 score and transient elastography remain the primary modalities for assessing hepatic fibrosis.
Reducing Alcohol Consumption Can Reverse Liver Injury
Managing progressive liver conditions requires structured intervention strategies. Mandana Khalili, chief of clinical hepatology at Zuckerberg San Francisco General Hospital, stated that reducing alcohol consumption short of complete abstinence is meaningful clinically in this population with chronic liver disease and is also consistent with a model of harm reduction.
Researchers emphasized that liver injury driven by alcohol remains structurally reversible prior to the onset of cirrhosis. Dr. Gonzalez noted that even patients with progressive liver disease can avoid end-stage scarring and experience functional recovery if alcohol intake is successfully modified or halted.
Disclaimer: The information provided in this article is for educational and scientific communication purposes only and does not constitute medical advice. Always consult with a qualified healthcare provider regarding any medical condition, diagnosis, or treatment plan.