Excessive alcohol use is one of the leading preventable causes of illness and death in the U.S. according to the U.S. Centers for Disease Control and Prevention.

The good news is that drinking among U.S. adults has decreased for the first time since the COVID-19 pandemic, a team led by researchers at the University of Southern California has recently found. Between 2022 and 2024, overall alcohol use declined by almost two percent and heavy drinking declined by more than eight percent.

The bad news is that rates of alcohol use are still higher than they were before the pandemic. Alcohol use of any kind remains three percent above pre-pandemic levels and heavy drinking is about 13 percent above those levels, Brian Lee, principal investigator on the study, told TheDoctor in an email.

The threshold for heavy drinking is lower than most people think: more than 14 drinks a week for men and seven for women or more than three or four a day.

This works out to almost five million more adults drinking at all and almost two million more drinking heavily than before the pandemic. Although the study did not look at reasons for this, Lee said, “You worry that drinking habits that formed because of the effects of the pandemic on daily life have become more permanent or even dependence or an addiction."

The researchers analyzed data from over 111,000 U.S. adults who participated in the National Health Interview Survey between 2018 and 2024. They were divided into two groups: those who drank any alcohol and those who met the National Institute on Alcohol Abuse and Alcoholism criteria for heavy drinking: five or more drinks a day or 15 or more drinks a week for men, and four or more drinks a day or eight or more drinks a week for women.

Although younger adults drank less than before the pandemic, older adults between the ages of 50 and 64 years old drank more. Between 2018 and 2024, any alcohol consumption among older adults increased by almost four percent, while rates of heavy drinking increased by more than 36 percent.

Older adults face some of the greatest health risks from drinking, including cirrhosis of the liver and alcohol-related cancers, making the increase in heavy drinking in this group a real concern, Lee explained. Today's seniors came of age when heavy drinking was more common and socially acceptable. “They settled into a higher rate of heavy drinking during the pandemic that never decreased,” he added.

Between 2022 and 2024, alcohol use declined the most among Generation Z, born between 1997 and 2012, decreasing by more than five percent. Heavy drinking declined the most among Millennials, born between 1981 and 1996, decreasing by 17 percent.

Heavy drinking declined the most among Millennials, born between 1981 and 1996. It rose by more than 36 percent among people over 50, the group for whom the health consequences of drinking are the greatest health concern.

Young adults may face less social pressure to drink than earlier generations did, and they may be more aware of the health risks, said Lee. Alcohol may also be expensive relative to their income.

The researchers were surprised how concentrated according to age groups the decline in alcohol use was, Lee said. In 2018, the rates of heavy drinking among different age groups were similar, with the rate for older adults being just a little higher.

Because the study was so large, the researchers were able to identify differences in alcohol consumption among small subgroups. Alcohol use declined by 2.4 percent among men and by 1.1 percent among women between 2022 and 2024. More significantly, heavy drinking declined by nine percent among women versus almost eight percent among men.

If you feel you are drinking more than before the pandemic, talk to your doctor about it, especially if you are over 50, urged Lee, a hepatologist and liver transplant specialist at Keck Medicine of USC.

The threshold for heavy drinking is lower than most people think: more than 14 drinks a week for men and seven for women or more than three or four a day. “If you are near that, it's worth a conversation with your doctor, and asking for liver testing is reasonable,” he said.

The study is published in the Annals of Internal Medicine.