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Alcohol contributes to 79,000 deaths and $223.5 billion in societal costs annually
in the United States.1,2 Almost 9% of U.S. adults (approximately 13% of those who
drink) meet the criteria for an alcohol-use disorder3 (Table 1)4,5; the prevalence of
alcohol-use disorders is higher in clinical settings.5 Alcohol consumption can have
adverse social, legal, occupational, psychological, and medical consequences. The
risk of harmful consequences and disability exists on a continuum6 (Fig. 1). Risk
drinking is defined as an average of 15 or more standard drinks per week or 5 or
more on an occasion for men and 8 or more drinks weekly or 4 or more on an occasion
for women and people older than 65 years of age.5 A standard drink (i.e.,
12 oz of beer, 5 oz of wine, or 1.5 oz of 80-proof liquor) contains 14 g of ethanol.
High average consumption or frequent heavy drinking can be clinically silent yet
have adverse health and social consequences7,8 (see Fig. S1 and S2 in the Supplementary
Appendix, available with the full text of this article at NEJM.org).
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