Alcohol use dips, but adults 50 to 64 keep drinking more

Clinical takeaway: Ask patients ages 50 to 64 about alcohol; heavy use in this group has risen steadily since 2018 even as national consumption turned downward. 

Alcohol-related deaths in the US have climbed for the past decade, and the pandemic years accelerated the rise. The drinking surge made news, and its apparent reversal will too. When coverage of a national downturn reaches exam rooms, it will arrive as reassurance, and for the patients at greatest risk of alcohol-related harm that reassurance is misplaced. 

Whether pandemic-era drinking had actually begun to recede was harder to establish than the headlines implied. A 2025 Gallup poll suggested Americans were cutting back, but it surveyed roughly 1,000 adults, too few to settle the question and without the safeguards against misreporting that alcohol surveys demand. A new research letter in Annals of Internal Medicine puts the question to a far larger, nationally representative survey designed with those safeguards, confirms a real but modest decline, and identifies which patients the decline has passed by. 

In 2024, roughly one fewer adult in every 100 reported drinking than in 2022, and one fewer in every 200 reported heavy drinking. The declines are the first in either measure since the pandemic began, though the broader estimate only narrowly excluded no change. Both measures remained at or above 2018 levels. Adults ages 50 to 64 moved against the trend on both counts. Since 2018, two more adults per 100 in this group report heavy drinking, a rise exceeding 30% against that group's 2018 rate. The climb was steady across the study period. Any use in this group rose two to three per 100 over the same span. 

Any use fell most among males and among Gen Z adults. That generation's drop of about 5% was the largest in any subgroup. Heavy use fell most among adults ages 30 to 49 and among millennials. The millennial group's heavy drinking fell by about one in six. Point estimates favored larger reductions in men than women. Heavy drinking among Hispanic adults rose steadily from 2018 to 2024, the only steady climb besides midlife adults. 

Researchers analyzed serial cross-sectional data on 114,352 adults from the National Health Interview Survey, 2018 through 2024. Heavy use followed the NIAAA definition: five or more drinks in a day or 15 or more per week for men, four or more or eight or more for women. 

Whether the decline reaches alcohol-related deaths is a question this study did not measure. The authors point toward prevention for women and older adults, whose declines lagged the national trend, as candidates for targeted intervention. But the study did not examine why younger adults cut back, or why midlife drinking keeps rising. 

"The encouraging national decline should not overshadow the fact that some groups continue to be at increased risk," said Brian P. Lee, MD, MAS, hepatologist at the Keck School of Medicine of the University of Southern California and the study's principal investigator. "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." 

Source: Ayyala-Somayajula D, et al. (2026 Sep 21) Ann Intern Med. Alcohol Use Between 2018 and 2024: A National Cross-Sectional Study