Alcohol use among U.S. adults has fallen for the first time since the COVID-19 pandemic began, but one age group is moving in the opposite direction. Heavy drinking among adults ages 50 to 64 rose by more than 36% from 2018 to 2024, according to a Keck Medicine of USC study published Sept. 21 in Annals of Internal Medicine.
Nationally, any alcohol use fell by nearly 2% and heavy drinking by more than 8% between 2022 and 2024. Drinking remains above pre-pandemic levels.
For adults in their late 20s and 30s, the most important part of the finding may involve their parents. The age group with rising heavy drinking faces growing risks of liver disease, cancer, and heart disease as it approaches retirement.
A National Decline with One Major Exception
Researchers analyzed National Health Interview Survey data from 114,352 U.S. adults between 2018 and 2024. Heavy drinking was defined as five or more drinks a day or 15 or more a week for men, and four or more a day or eight or more a week for women.
Younger adults drove the national decline. Any alcohol use among Gen Z adults dropped more than 5%, while heavy drinking among millennials fell 17% between 2022 and 2024. Men saw a larger decline in any drinking than women, 2.4% versus 1.1%, while women saw a slightly larger drop in heavy drinking, 9% versus 7.7%.
Adults 50 to 64 were the exception. Their any alcohol use rose nearly 4% from 2018 to 2024, and heavy drinking climbed by more than a third.
"Heavy drinking among ages 50-64 is up by more than a third since 2018, a concerning trend because this age group faces some of the greatest risks of harm from alcohol, including cirrhosis and alcohol-related cancers," said Dr. Brian P. Lee, a hepatologist and liver transplant specialist at Keck Medicine and the study's principal investigator.
Why Age Raises the Stakes
Lee noted that older adults are more likely to develop alcohol-related conditions even when they drink the same amount as younger people. He said alcohol accounts for roughly half of all liver-related deaths and that alcohol-associated cirrhosis has become the leading cause of liver transplants.
The stakes are national. Excessive drinking caused about 178,000 deaths a year in the U.S. during 2020 and 2021, a 29% increase from 2016 and 2017, according to a CDC report.
The new findings build on Lee's November 2024 study, which found that alcohol use rose during the pandemic and kept rising for the following two years.
Limits of Self-Reported Survey Data
The study relies on self-reported survey answers, which can undercount drinking. It measured trends, not causes, and it did not examine why younger adults drank less or why adults 50 to 64 drank more. The researchers noted that changing social attitudes toward alcohol have been proposed as one explanation for the decline among younger adults. The survey allowed participants to answer privately online rather than by phone.
The research was supported by the National Institute on Alcohol Abuse and Alcoholism. "The decline in alcohol use is a positive development, but we cannot assume alcohol-related harms will decline automatically," Lee said. The full study appears in Annals of Internal Medicine.
Talking with Parents About Drinking
Adults in this age group often take medications that can interact with alcohol, including some drugs for blood pressure, sleep, and pain. People with liver disease, diabetes, or heart problems, and anyone who drinks to cope with stress, caregiving, or isolation, may face greater risk.
Warning signs of a problem include needing more alcohol to feel the same effect, drinking more than planned, trying and failing to cut back, or continuing to drink despite health or relationship problems. Signs of liver trouble, such as yellowing skin or eyes, swelling in the abdomen, or unusual fatigue, warrant a medical visit.
Anyone can compare their habits with federal guidelines using the NIAAA's free Rethinking Drinking tool. Primary care doctors can screen for unhealthy alcohol use, and Medicare covers alcohol misuse screening and brief counseling. People who drink heavily should not stop suddenly without medical guidance, since withdrawal can be dangerous. The free, confidential SAMHSA National Helpline, 1-800-662-4357, offers treatment referrals around the clock.
For adult children, a calm conversation that focuses on health rather than blame can open the door. The national numbers are improving, but for many families the more important trend may be the one happening at home.
Key Questions Answered
What did the study find? Any alcohol use fell nearly 2% and heavy drinking fell more than 8% from 2022 to 2024, but heavy drinking among adults 50 to 64 rose more than 36% since 2018.
What counts as heavy drinking? For men, five or more drinks a day or 15 or more a week. For women, four or more a day or eight or more a week.
Why are adults 50 to 64 at higher risk? Their risk of alcohol-related liver disease, certain cancers, and heart disease rises with age, even at the same level of drinking.
Which groups drank less? Gen Z adults cut any alcohol use by more than 5%, and millennials cut heavy drinking by 17%.
Does the study explain why drinking changed? No. It tracked trends in self-reported survey data and did not examine causes.
Where can people get help? Talk with a primary care doctor or call the free SAMHSA National Helpline at 1-800-662-4357.
