US Alcohol Use Falls, but Not for Adults Aged 50 to 64, With Brian Lee, MD

Alcohol use among US adults declined between 2022 and 2024, marking the first confirmed reduction since the onset of the COVID-19 pandemic, according to a national cross-sectional study published in Annals of Internal Medicine.¹˒² Any alcohol use fell by nearly 2%, and heavy drinking fell by more than 8%, though both remain above 2018 levels.¹˒²

"It's encouraging to see alcohol use decline for the first time since the start of the pandemic," said Brian P. Lee, MD, MAS, hepatologist and liver transplant specialist with Keck Medicine of USC and principal investigator of the study in a statement. "However, use remains above pre-pandemic levels and certain groups continue to have concerning trends."²

Lee and colleagues analyzed National Health Interview Survey data from 114,352 US adults between 2018 and 2024, classifying heavy drinking by National Institute on Alcohol Abuse and Alcoholism criteria.² These criteria define heavy drinking as ≥5 drinks per day or ≥15 drinks per week for men and ≥4 drinks per day or ≥8 drinks per week for women.²

The declines were uneven across age groups. Gen Z adults showed the largest drop in any alcohol use, at more than 5%, while heavy drinking among millennials fell by 17% between 2022 and 2024.² Among adults aged 50 to 64, any alcohol use rose by nearly 4% and heavy drinking rose by more than 36% from 2018 to 2024.²

Men saw a larger decline in any alcohol use than women (2.4% vs 1.1%), while women saw a larger decline in heavy drinking (9% vs 7.7%).²

In the following interview, Lee discusses what clinicians can do to sustain the decline, why adults aged 50 to 64 remain a concern, and how much pandemic-era drinking explains the rise in alcohol-associated liver disease.

Q&A: Declining Alcohol Use and Heavy Drinking in Adults 50 to 64

HCPLive: What can clinicians and patients do to help the recent decline in alcohol use continue?

Brian P. Lee, MD, MAS: The decline occurred largely independent of clear clinical intervention as far as we know. What clinicians can do is to stop relying on patients to bring alcohol use up in conversation. Alcohol use should be asked about at every visit, like smoking, with a validated screen like the AUDIT-C, and for patients where the history is uncertain there's now a biomarker, phosphatidylethanol, that gives an objective measure of intake over the prior 4 weeks.

The thresholds for heavy drinking are lower than most patients and a fair number of physicians assume, so being knowledgeable about those thresholds (≥15 drinks per week or ≥5 drinks on any given day for men and ≥8 drinks per week or ≥4 drinks on any given day for women) is important. Physician messaging is part of this too. Many patients, and some physicians, still believe a glass of wine a day is good for the heart. That idea came from observational studies that compared drinkers with abstainers who had often quit because they were already sick, and when that bias is accounted for, the protective effect largely disappears.

The current evidence is that cancer and liver risk can begin even at low alcohol levels and rise with dose, and the message coming from physicians should reflect that. A patient who hears "moderate drinking is fine" from their doctor has no reason to cut back. And when a patient does meet criteria for alcohol use disorder, we have effective medications that are prescribed far less often than they should be.

HCPLive: Heavy drinking among adults 50 to 64 rose by more than a third since 2018. What are the implications for liver disease in this group?

Brian P. Lee, MD, MAS: This is the group in which the combination of exposure and timing is most concerning. Fibrosis accumulates over decades, so a 55-year-old who increased their drinking in 2020 is often adding to damage that's already there rather than starting from a healthy liver.

This is also the decade when cirrhosis and hepatocellular carcinoma most often declare themselves, and there's less physiologic reserve to absorb an insult. In practical terms, patients with heavy drinking, particularly those above the age of 50, should be considered for liver fibrosis screening.

HCPLive: Women reduced heavy drinking more than men, yet their alcohol-associated liver disease has been rising faster. What might explain that discrepancy?

Brian P. Lee, MD, MAS: The reduction from 2022 to 2024 is real, but it's a recent step down from a large step up. Heavy drinking among women is still about 13% above 2018, and I should mention that in this survey the prevalence of heavy drinking among women is now slightly higher than among men, because the thresholds are sex-specific and women's drinking has been converging with men's for years.

Women develop fibrosis at lower cumulative exposure, they progress faster once it's established, and the increase in women's drinking predated the pandemic by at least a decade. So the liver disease we're seeing in women now reflects 15 or 20 years of rising intake. Two years of modest decline won't change that trajectory quickly.

We've also published on co-factors for the rise in alcohol-associated liver disease; if a co-factor rises in prevalence, alcohol-associated liver disease can increase even if alcohol consumption is stable. In a separate study that we published in Annals of Internal Medicine a couple years ago, we showed that the rise of metabolic syndrome among women may be contributing to the rise in alcohol-associated liver disease, independent of changes in alcohol consumption.

HCPLive: With drinking now falling, to what extent do you attribute the rise in alcohol-associated liver disease among young adults to pandemic-era drinking?

Brian P. Lee, MD, MAS: Only partly. Alcohol-associated hepatitis in young adults was rising well before 2020, and the pandemic accelerated a trend rather than creating one. If younger adults' drinking stays below 2018 levels, I'd expect those acute presentations to ease sooner than the cirrhosis burden in older patients.

That's a hypothesis rather than something this study can show, and it doesn't account for co-factors of alcohol-associated liver disease that are changing in prevalence independent of alcohol consumption.

Editor's Note: This transcript has been edited for grammar and clarity using artificial intelligence tools. Lee reports consulting for Gilead Sciences, Novo Nordisk, GlaxoSmithKline, Altimmune, Bausch Health, and others.

References

1. Ayyala-Somayajula D, Dodge JL, Lee BP. Alcohol use between 2018 and 2024: a national cross-sectional study. Ann Intern Med. Published online September 22, 2026. doi:10.7326/ANNALS-26-01824

2. Keck Medicine of USC. U.S. alcohol use falls for first time since the COVID-19 pandemic, but remains above pre-pandemic levels. Published September 21, 2026. Accessed September 30, 2026. https://news.keckmedicine.org/us-alcohol-use-falls-for-first-time-since-the-covid-19-pandemic-but-remains-above-pre-pandemic-levels/