Few substances are as deeply woven into everyday life as alcohol. It is a fixture at holiday celebrations, work-related social gatherings, sporting events, airports, and brunch or dinner tables. All demonstrate how deeply alcohol has become embedded in social customs and cultural traditions.
Yet alcohol contributes to millions of deaths globally each year and is linked to cancer, liver disease, unintentional accidents, violence and, importantly, dependence and addiction. Despite this, the disconnect between alcohol’s cultural role and its serious health burden is striking. An estimated 2.3 billion people worldwide consume alcohol.
As a physician working in addiction medicine, I regularly care for patients whose alcohol use affects nearly every organ system. It is often not until these patients end up admitted to the hospital that they learn the effects of alcohol on various parts of their body besides their liver.
Newer evidence challenges assumptions about what was long considered “safe drinking.” Even moderate drinking carries risk and is not as harmless as people, including experts, once thought.
Many people associate alcohol risk primarily with addiction or dangerous behaviors such as driving while intoxicated. However, its effects extend far beyond this, into nearly every aspect of a person’s well-being.
While alcohol may transiently improve mood and ease social anxiety, long-term alcohol use can lead to a worsening of mood, cognition and sleep, which can further compound use.
A 2021 literature review found that consuming approximately two standard drinks roughly doubles the odds of sustaining injuries — with or without a vehicle involved. The review also found that heavy episodic (binge) drinking can increase the risk of injury by 50-fold, depending on the amount of alcohol consumed and the type of injury. While alcohol’s effects on the liver are well known, it can also lead to gastrointestinal complications and heart disease
The World Health Organization estimates that 2.6 million deaths each year are attributable to alcohol, accounting for nearly 1 in every 20 deaths worldwide.
While many people recognize the risks of alcohol addiction, people are generally much less aware of the links between alcohol use and cancer risk.
The World Health Organization classifies alcohol as a Group 1 carcinogen — the same category as tobacco and asbestos. In 2025, the U.S. surgeon general emphasized that alcohol increases the risk of at least seven cancers, including cancers of the breast, colorectal, liver, oral, esophagus and larynx. An advisory called for updated warning labels.
Yet fewer than half of Americans recognize alcohol as a risk factor for cancer, particularly for cancers such as breast cancer that are not commonly associated with alcohol use.
Throughout the 1990s and early 2000s, observational studies suggested that moderate alcohol consumption might offer cardiovascular benefits. Over the past decade, however, higher-quality studies have challenged these findings, suggesting that much of the apparent benefit may have reflected differences in the health and lifestyles of moderate drinkers rather than a protective effect of alcohol itself.
Current evidence increasingly suggests that even low levels of alcohol may increase cancer risk.
Federal guidelines acknowledge that adults should “consume less alcohol for better overall health.” However, the most recent version of the “Dietary Guidelines for Americans,” updated in January, removed the previous recommendation to limit intake to no more than one drink per day for women and two for men. It also omitted explicit discussion of alcohol’s links to cancer.
These changes have drawn criticism from public health experts, who argue that the revised language plays down the growing evidence of alcohol-related harms and provides less specific guidance to consumers. The current administrator of the Centers for Medicare & Medicaid Services characterized alcohol as a “social lubricant” that brings people together, rather than emphasizing its well-established health risks.
This may be true physiologically, at least temporarily, but obscures the fact that relying on it as a social lubricant can lead to chemical and psychological dependency. In my view, statements to that effect are shortsighted, prioritizing short-term social effects over more insidious and long-term issues, including addiction.
While many dangerous mind-altering substances are hidden from public perception, alcohol is often placed at the center of it – a trend that shows no sign of changing imminently.
Further, large companies often profit from ads that appeal to young people.
Looking back at the history of tobacco smoking provides some helpful insights. In 1965, 42.4% of the U.S. population smoked. By 2022, that figure had dropped to 11.6%.
This steep decline did not happen because of a single intervention, but through decades of accumulating scientific evidence, public education campaigns, warning labels, restrictions on advertising, smoke-free policies, higher tobacco taxes and shifts in social norms. Together, these efforts transformed smoking from a widely accepted social behavior into one broadly recognized as a major health risk and correspondingly, less socially accepted.
Although alcohol consumption has modestly declined in recent years, it remains deeply embedded in social life in ways cigarette smoking no longer is.
People often assume that if a substance is legal, common and widely socially accepted — even encouraged — it must also be safe. But public health history suggests those assumptions can and should change.
Emma Fenske is an addiction medicine fellow and internal medicine physician at Oregon Health & Science University. This article was produced in partnership with the Conversation.
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