Alcohol use has declined for the first time since Covid-19, with Gen Zers and millennials leading the charge

ATLANTA — Nearly seven years after the start of the Covid-19 pandemic, Dr. Brian P. Lee has seen signs that rates of alcohol use have finally begun to drop.

Lee, a hepatologist and liver transplant specialist with Keck Medicine of USC in Los Angeles, hopes the data is true of the general population.

The pandemic brought on a surge of alcohol consumption in 2020 that had not declined two years later. During that time, Lee watched his waiting rooms fill up with people who had liver-related diseases — even young people in their 20s needing liver transplants from alcohol use. That's something he hadn't seen before the pandemic.

"Seeing this first decline gives you something to hope for as a doctor, but you have to be appropriately cautious too, because one change doesn't necessarily mean a sustained trend," he said.

Lee, author of a study published Monday in the Annals of Internal Medicine, found that any alcohol use, including heavy drinking, among adults in the U.S. declined from 2022 to 2024. However, the rates are still higher than they were in 2018.

The study used cross-sectional data from 2018 to 2024 taken from more than 114,000 respondents to the National Health Interview Survey, which is administered by the U.S. Census Bureau.

The share of adults who drank any alcohol in the past year fell by nearly 2%, and the share who drank heavily fell by more than 8% from 2022 to 2024, according to the study.

The decline was seen among men and women, with men showing a larger decline in any alcohol use and women seeing a greater drop in heavy alcohol use.

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Heavy alcohol use is defined as four or more drinks per day, or eight or more per week for women, and five or more drinks per day or 15 or more drinks per week for men, according to the National Institute on Alcohol Abuse and Alcoholism.

"This is an encouraging trend — at least there's a change in direction," said, Dr. Jagpreet Chhatwal, director of the Institute for Technology Assessment at Massachusetts General Hospital, who was not involved in the study. "But overall, I would not see this as a big victory in any way because the rates have been so high, even before the pandemic."

A generational divide over alcohol

While the internet debates whether Gen Z is drinking less or more, this study suggests that, compared to their older counterparts, they appear to be leading the way on the decline in drinking rates.

Gen Z adults, who are between the ages of 18 and 29, saw the largest decline in any alcohol use, with an over 5% drop, and heavy drinking among millennials, who are between the ages of 30 and 49, dropped by 17% between 2022 and 2024.

Although Lee didn't examine why drinking was trending downward for younger adults, he hypothesized about the social dynamics, including the rise of the sober-curious movement and more awareness of the health-related harms of alcohol.

Lee and Chhatwal also noted the substitution of alcohol for other substances, like cannabis, could be the reason for the downward trend in drinking for a younger generation.

"Alcohol relates to cultural norms and societal peer pressure, so drinking less might start amongst a couple people in your peer group for certain reasons, but then it becomes a domino effect, and the whole peer group might drink less," Lee said.

What concerns Lee and Chhatwal the most are people between the ages of 50 and 64, members of Generation X and the youngest Baby Boomers, who continue to drink at rates higher than before the pandemic. They remain at high risk for alcohol-related conditions such as liver disease, cancer and cardiovascular disease.

Heavy drinking for this group increased by more than 36% and any drinking by 4% from 2018 to 2024. The average age to be diagnosed with cirrhosis from alcohol is in your 50s, and Lee said the liver is more sensitive at that age compared to someone in their 20s.

"We're seeing the biggest increases in heavy drinking in exactly the group that we're worried the most about in terms of their health related to alcohol," Lee said.

Those between the ages of 50 and 64 are over two and a half times as likely to die from chronic alcohol abuse compared to acute alcohol-related conditions, according to the National Center for Drug Abuse Statistics.

"That's a concerning sign and we need to think about interventions, something that can really reduce the impact of that high-risk drinking in that cohort," Chhatwal said.

Staging interventions

Many people might be surprised by what's considered heavy or binge drinking.

"This is a generation that really learned to drink when a few drinks a night was just what adults did," Lee said of Gen X. "That's something that we need to continue, with messaging, to informing people what they're really putting into their body."

Behavioral interventions work, if people can stick to them, Chhatwal said. The challenge for many is staying consistent.

"It's very hard for them to remain abstinent for a long time, and then relapse is high," he said.

If alcohol-related diseases are a concern for anyone, Lee says talking to doctors about screening tests for the liver is a way to stay ahead of potential issues.

"A lot of people know that alcohol isn't healthy for their body, and they make that choice for certain reasons that for them are important," he said. "Doctors understand that and it's OK to have these conversations."

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