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Mental Health and Substance Use Challenges (Volume 103)
Quarterly Article
David H. Jernigan
Mental Health and Substance Use Challenges
September 2024
December 2019
Back to The Milbank Quarterly
Policy Points:
See all articles in the special issue, Mental Health and Substance Use Challenges Facing the United States: What Can State Policymakers Do?
Alcohol is a causal factor in more than 200 disease and injury conditions in the human body.1 The Centers for Disease Control and Prevention (CDC) define excessive drinking as binge drinking (4 or more drinks for women, 5 or more for men on one occasion in the past month), heavy drinking (8 or more drinks for women, 15 or more for men in a week), and any drinking during pregnancy or by persons younger than age 21 years.2 In the United States, excessive drinking is responsible for more than 178,000 deaths per year, which is nearly 500 deaths per day,2 and causes 1 in 8 deaths of persons of working age.3 Among persons aged 15 to 49 years old, it is the number two cause of death and disability, only outstripped by other drug use.4 Alcohol is a carcinogen, causing cancer in at least seven sites in the human body, with approximately 100,000 cases and 20,000 cancer deaths in the United States annually caused by alcohol use.5, 6 Alcohol is also a significant factor in violent deaths, including domestic violence and violent crime: the CDC estimates that 21% of suicides and 29% of homicides are alcohol-attributable, i.e., they would not have happened without alcohol use.7
World Health Organization. Global Status Report on Alcohol and Health and Treatment of Substance Use Disorders. World Health Organization; 2024. Accessed July 7, 2024. iris.who.int/bitstream/handle/10665/377960/9789240096745-eng.pdf?sequence=1
Alcohol use and your health. Centers for Disease Control and Prevention. Accessed December 18, 2024. cdc.gov/alcohol/about-alcohol-use/index.html#cdc_behavioral_basics_ty%20pes-effects-of-short-term-alcohol-useSee all articles in the special issue, Mental Health and Substance Use Challenges Facing the United States: What Can State Policymakers Do?
Esser MB, Leung G, Sherk A, et al. Estimated deaths attributable to excessive alcohol use among US adults aged 20 to 64 years, 2015 to 2019. JAMA Network Open. 2022; 5(11): e2239485–e2239485. https://doi.org/10.1001/jamanetworkopen.2022.39485
GBD Compare. Institute for Health Metrics and Evaluation. 2025. Accessed January 25, 2025. https://vizhub.healthdata.org/gbd-compare/
Islami F, Marlow EC, Thomson B, et al. Proportion and number of cancer cases and deaths attributable to potentially modifiable risk factors in the United States, 2019. CA Cancer J Clin 2024; 74(5): 405–432. https://doi.org/10.3322/caac.21858
Esser MB, Sherk A, Liu Y, Henley SJ, Naimi TS. Reducing alcohol use to prevent cancer deaths: estimated effects among U.S. adults. Am J Prev Med. 2024; 66(4): 725–729. https://doi.org/10.1016/j.amepre.2023.12.003
Alcohol-related disease impact (ARDI) application. Centers for Disease Control and Prevention. Accessed March 3, 2024. nccd.cdc.gov/DPH_ARDI/default/default.aspx