Blog Behavioral/Mental Health

Alcohol use as a high-risk health behavior

Written by Vivia McCutcheon, PhD, assistant professor of psychiatry at the School of Medicine

Alcohol is the most commonly used drug in the United States. The figure below from the Surgeon General’s Report on Alcohol, Drugs, and Health illustrates the rates of binge drinking in people aged 12 and older from 2002-2014, compared to the lower rates of illicit drug use.1

Most adults who use alcohol drink moderately, and alcohol use among adolescents has declined in recent years, as shown in the figure below from the 2013 National Survey on Drug Use and Health.2 But people who drink alcohol beyond recommended levels put themselves and others at increased risk for a host of negative consequences related to physical and mental health and social and economic functioning.

What Is High-Risk Alcohol Use?

High-risk alcohol use is defined by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) as more than four drinks per day or 14 in a week for men, and more than three drinks a day or seven per week for women. Binge drinking is drinking an amount in about two hours that brings the blood alcohol concentration (BAC) to a level of .08 g/dl, typically four drinks for women and five drinks for men. Here is a web site where you can find out how your own drinking compares to the drinking patterns of adults in the United States, and also defines some of the risks associated with high-risk drinking:

High-risk drinking and alcohol use disorders (AUDs) have increased in the U.S. population in recent years, with especially steep increases in women, adults aged 65 and older, and racial and ethnic minorities.3 Historically, men have had higher rates of AUDs than women, but rates of AUDs in younger women are increasing and the gender gap is closing.4,5 The estimated cost of AUDs to society in terms of motor vehicle crashes related to alcohol, lost workplace productivity and alcohol-related costs to the health care system, law enforcement and the criminal justice system was $249 billion in 2010. As rates of high-risk drinking increase, so too will the costs to society. But what are the risks to the person who drinks excessively?

Health Risks

Excessive alcohol use increases a person’s risk for developing several forms of cancer including breast, colon, and liver cancers; cardiovascular diseases; alcoholic liver disease including cirrhosis; pancreatitis; and psychiatric disorders, including depression, anxiety, and of course AUDs.6 Risky alcohol use is also associated with high blood pressure, heart disease, and stroke.7 Even lower levels of alcohol use can increase risk for some health problems. For example, the amount of alcohol consumed between ages 18 and 40 predicted increased risk of breast cancer in women at average age of 60, and even just 3 to 6 drinks a week had an effect.8

Behavioral Risks

Excessive alcohol use also increases a person’s risk for experiencing or participating in violence, including intimate partner violence,9 physical assault, 10,11 and serious accidents and injury.12,13 Alcohol use is also linked to unsafe sex practices and increased risk of contracting STDs and HIV/AIDs.14

High-Risk Drinking And Effects on Families and Social Networks

It is estimated that 1 in 4 children in the U.S. lives in a household with one or more adults who has an AUD.15 Children with a parent who has an AUD are at increased risk of experiencing early adversity, such as physical and sexual abuse and witnessing domestic violence, as well as increased risk for depression and alcohol problems as adults.16 Adults who have high-risk drinkers in their lives report lower levels of satisfaction with life as a whole and lower levels of personal well-being, including standard of living, health, and personal relationships, even after accounting for their own drinking, when compared to adults with no heavy drinkers in their lives.17

These are just a few of the negative consequences associated with high-risk drinking. If you or someone you know is a risky drinker, there are resources to help you think about treatment options. Here is one put together by the NIAAA:

If you are a young person or know a young person who may be at risk for developing alcohol problems, the Surgeon General’s Report offers a good summary of risk and protective factors for adolescents and young adults, as well as links to information about prevention and intervention programs in Appendix C, Resource Guide.1


1U.S. Department of Health and Human Services OotSG. Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health. In: (HHS) HaHS, ed. Washington, DC: HHS, 2016.

2(SAMHSA) SAaMHSA. Results from the 2013 National Survey on Drug Use and Health: Summary of National Findings. In: Services USDoHaH, ed. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2014.

3Grant BF, Chou SP, Saha TD, et al. Prevalence of 12-Month Alcohol Use, High-Risk Drinking, and DSM-IV Alcohol Use Disorder in the United States, 2001-2002 to 2012-2013: Results From the National Epidemiologic Survey on Alcohol and Related Conditions. JAMA Psychiatry 2017 doi: 10.1001/jamapsychiatry.2017.2161[published Online First: Epub Date]|.

4Grucza RA, Bucholz KK, Rice JP, Bierut LJ. Secular trends in the lifetime prevalence of alcohol dependence in the United States: a re-evaluation. Alcohol Clin Exp Res 2008;32(5):763-70

5Keyes KM, Li G, Hasin DS. Birth cohort effects and gender differences in alcohol epidemiology: a review and synthesis. Alcohol Clin Exp Res 2011;35(12):2101-12 doi: 10.1111/j.1530-0277.2011.01562.x[published Online First: Epub Date]|.

6Rehm J, Mathers C, Popova S, Thavorncharoensap M, Teerawattananon Y, Patra J. Global burden of disease and injury and economic cost attributable to alcohol use and alcohol-use disorders. Lancet 2009;373(9682):2223-33 doi: S0140-6736(09)60746-7 [pii] 10.1016/S0140-6736(09)60746-7[published Online First: Epub Date]|.

7Association AH. Alcohol and heart health. Secondary Alcohol and heart health 2017.

8Chen WY, Rosner B, Hankinson SE, Colditz GA, Willett WC. Moderate alcohol consumption during adult life, drinking patterns, and breast cancer risk. JAMA 2011;306(17):1884-90 doi: 10.1001/jama.2011.1590[published Online First: Epub Date]|.

9Lipsky S, Kernic M, Qiu Q, Wright C, Hasin D. A Two-Way Street for Alcohol Use and Partner Violence: Who’s Driving It? J Fam Violence 2014:1-14 doi: 10.1007/s10896-014-9635-0[published Online First: Epub Date]|.

10Scott KD, Schafer J, Greenfield TK. The role of alcohol in physical assault perpetration and victimization. J Stud Alcohol 1999;60(4):528-36

11Hingson R, Heeren T, Zakocs R. Age of drinking onset and involvement in physical fights after drinking. Pediatrics 2001;108(4):872-7

12Hingson R, Heeren T, Levenson S, Jamanka A, Voas R. Age of drinking onset, driving after drinking, and involvement in alcohol related motor-vehicle crashes. Accid Anal Prev 2002;34(1):85-92

13Hingson RW, Heeren T, Jamanka A, Howland J. Age of drinking onset and unintentional injury involvement after drinking. JAMA 2000;284(12):1527-33

14Rehm J, Shield KD, Joharchi N, Shuper PA. Alcohol consumption and the intention to engage in unprotected sex: systematic review and meta-analysis of experimental studies. Addiction 2012;107(1):51-9 doi: 10.1111/j.1360-0443.2011.03621.x[published Online First: Epub Date]|.

15Grant BF. Estimates of US children exposed to alcohol abuse and dependence in the family. Am J Public Health 2000;90(1):112-5

16Anda RF, Whitfield CL, Felitti VJ, et al. Adverse childhood experiences, alcoholic parents, and later risk of alcoholism and depression. Psychiatr Serv 2002;53(8):1001-9

17Casswell S, You RQ, Huckle T. Alcohol’s harm to others: reduced wellbeing and health status for those with heavy drinkers in their lives. Addiction 2011;106(6):1087-94 doi: 10.1111/j.1360-0443.2011.03361.x[published Online First: Epub Date]|.