Alcoholism is our worst substance use problem: Don’t cut research funding

When Americans think about the nation’s substance use crisis, opioids, fentanyl, cocaine and methamphetamine dominate the conversation. But the substance causing the greatest harm is not illicit. It is alcohol — legal, normalized and often overlooked.  

How could that be? Federal data show some of the lowest rates of youth drinking ever measured. The overall rate of drinking in the adult U.S. population has recently decreased by about 8 percent.   

Despite these improvements, however, alcohol use still claims about 178,000 lives each year in the U.S. That’s far more than the peak of roughly 105,000 annual overdose deaths from all other drug abuse combined. Its overall annual economic impact is projected to reach $588 billion, factoring in inflation, lost productivity, health care costs and criminal justice expenses. 

Founded in 1974, the National Institute on Alcohol Abuse and Alcoholism is the only National Institutes of Health agency solely dedicated to understanding alcohol’s unique biological, behavioral and cultural impacts. As we recognize Alcohol Awareness Month this April, we must avoid underestimating alcohol’s continuing toll. And policymakers must not underfund or dismantle the very institution best equipped to address it.

The risks of alcohol use are real, and they start at low levels of consumption. Alcohol is a known carcinogen, third only to tobacco and obesity in its contribution to preventable cancer deaths. Just one drink per day has been convincingly associated with increased risk of breast cancer. Even moderate alcohol consumption is associated with decreased cognitive abilities among aging persons, even those without an alcohol use disorder.

A major health challenge posed by alcohol is that its effects are not limited to alcohol use disorder and chronic illnesses. A single episode of drinking can result in serious injury, violence or fatal crashes, even among those who drink moderately. In 2023 alone, the National Highway Traffic Safety Administration reported that in 2024, 11,904 lives were lost in alcohol-impaired traffic crashes, accounting for nearly one-third of all traffic deaths in the U.S.

The harms of drinking extend beyond those who consume alcohol. Children are particularly vulnerable. Nearly 20 million children live in households with a parent who has an alcohol use disorder: That’s one in four American children. Up to 5 percent of first graders in the U.S. are affected by fetal alcohol spectrum disorders — an entirely preventable consequence of alcohol exposure during pregnancy.

The consequences of alcohol use ripple through generations, affecting child development, family stability, community safety and mental health. This is why continued investment in research, education and prevention is so essential. 

Behind these numbers are real people — parents, family members, colleagues, friends, neighbors — lost to liver disease, alcohol-related cancers, injuries, suicide and other preventable outcomes. A liver specialist recently shared that she loses a patient every month, often someone in their 30s or 40s who needs a transplant but doesn’t get one in time. These are not always people with diagnosed alcohol use disorders. Many are individuals who engage in what is commonly thought of as moderate or safe drinking.

Thanks to National Institute on Alcohol Abuse and Alcoholism, we have powerful research findings and evidence-based tools for prevention, treatment and recovery like. This includes innovative research on alcohol and polysubstance use, alcohol’s role in liver disease, cancer, cognitive decline and the developing adolescent brain, as well as key factors to support prevention and recovery. 

The institute has also created “Rethinking Drinking,” an online resource that helps people assess and reduce risky drinking, as well as CollegeAIM, a practical guide for colleges to reduce student alcohol harms. The institute also built the Healthcare Professional’s Core Resource on Alcohol, which provides health practitioners with clinical guidance on alcohol’s effects and tools for prevention and treatment. 

Alcohol is not just another drug. It is legal, inexpensive, widely available, socially embedded and deeply intertwined with cultural norms, making its risks more easily dismissed and its regulation more complex. Lumping alcohol research into broader behavioral health or addiction funding risks diluting attention from the specific public health challenges it presents.

Because of the National Institute on Alcohol Abuse and Alcoholism, we know what works: education, prevention, early screening, treatment and public awareness rooted in facts. We have seen progress, and we can make more. But that depends on protecting the integrity and independence of alcohol-specific research.  

William F. Wieczorek is chair of the Friends of the National Institute on Alcohol Abuse and Alcoholism.

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