Forty-year trends in heavy and high-intensity alcohol use among U.S. adults

Abstract

BACKGROUND: Attention to drinking beyond the binge threshold have primarily focused on young adults. Given recent increases in alcohol consumption across age and other demographic groups, this study examined trends in past-year heavy episodic drinking (HED; consuming 5 or more drinks in a single day) and high-intensity drinking (HID; consuming 8 or more and 12 or more drinks in a single day) for U.S. men and women by age, race and ethnicity, and socioeconomic status from 1984 to 2024.

METHODS: Nine National Alcohol Surveys of general population samples of U.S. adults ages 18 years or older were pooled from 1984 to 2024 (n = 59,514). Weighted sex-specific descriptive and time-varying effect models of past-year any use (prevalence) and number of days (frequency) of 5+, 8+, and 12 + drinks on a single day were conducted to describe trends by age, race and ethnicity, and education level.

RESULTS: Prevalence of any heavy episodic drinking (HED: 5 + ) and any high-intensity drinking (HID: 8 + and 12 + ) have declined since 1984. From 2010 to 2024, days of HED and HID (frequencies) have increased for women, but less so for men. Variations were found by age, with declines among young adults and increases among middle-aged and older adults.

CONCLUSIONS: While declines in excessive alcohol consumption were observed since 1984, increases in HED and HID frequencies since the 2010 s, particularly among women and older adults, require more tailored public health intervention to reduce alcohol-related consequences, morbidity and mortality. Monitoring heavy drinking trends is important to drive data-informed policy efforts to reduce alcohol-related harms.