LOS ANGELES — Alcohol use among U.S. adults has fallen for the first time since the COVID-19 pandemic began, though rates remain higher than pre-pandemic levels, according to a new Keck Medicine of USC study published today in Annals of Internal Medicine .
From 2022 to 2024, any alcohol use declined by nearly 2%, while heavy drinking declined more than 8%. The decline marks the first confirmed reduction in alcohol consumption observed since the onset of the COVID-19 pandemic.
"It’s encouraging to see alcohol use decline for the first time since the start of the pandemic,” said Brian P. Lee, MD, MAS , a hepatologist and liver transplant specialist with Keck Medicine and principal investigator of the study. “However, use remains above pre-pandemic levels and certain groups continue to have concerning trends.”
Why older adults remain a concern
One of the study’s most notable findings was the variation among age groups. While younger adults reduced alcohol consumption, adults ages 50-64 continued to drink at rates higher than before the pandemic. From 2018 to 2024, any alcohol use in this age group increased by nearly 4%, while heavy drinking increased by more than 36%.
According to Lee, the increase among older adults is particularly concerning because the risk of alcohol-related conditions such as liver disease, certain cancers and cardiovascular disease increases with age. Older adults are more likely to develop these conditions even when consuming the same amount of alcohol as younger adults.
"The encouraging national decline should not overshadow the fact that some groups continue to be at increased risk," Lee said. "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.”
According to the Centers for Disease Control and Prevention, excessive alcohol consumption is one of the leading preventable causes of illness and death in the United States. Alcohol accounts for approximately half of all liver-related deaths, and alcohol-associated cirrhosis has become the leading cause of liver transplants, according to Lee.
Differences among subgroups
Because of the large sample size, researchers identified meaningful differences among some demographic groups. Men generally experienced a larger decline in any alcohol use than women (2.4% vs. 1.1%). However, women experienced a larger decline in heavy alcohol use than men (9% vs. 7.7%).
The largest decline in any alcohol use occurred among Gen Z adults, whose consumption dropped over 5%, while millennials experienced the greatest decrease in heavy drinking, with a 17% drop between 2022 and 2024.
The study did not examine why younger adults reduced drinking, though researchers noted that changing social attitudes toward alcohol has been proposed as one possible explanation.
“These findings suggest that alcohol prevention efforts need to become more tailored to specific populations,” Lee said. “Different groups are showing different patterns of alcohol use, and understanding those differences could help us develop more effective prevention and treatment strategies.”
How researchers conducted the study
Researchers analyzed National Health Interview Survey data from 114,352 U.S. adults between 2018 and 2024. Respondents were categorized based on whether they consumed alcohol and whether they met the National Institute on Alcohol Abuse and Alcoholism criteria for heavy drinking. Heavy drinking is defined as five or more drinks per day or 15 or more drinks per week for men, and four or more drinks per day or eight or more per week for women within the 12 months before the survey.
The findings build on a November 2024 study by Lee that found alcohol use increased during the COVID-19 pandemic and continued to increase for the following two years.
Researchers sought to further examine findings from a 2025 Gallup poll that suggested alcohol consumption was declining among U.S. adults. Using data from more than 100,000 respondents, Lee’s study was able to assess drinking patterns and explore trends across demographic groups. Survey methods allowed participants to complete the questionnaire privately online rather than by telephone.
“The decline in alcohol use is a positive development, but we cannot assume alcohol-related harms will decline automatically,” said Lee. “Continued attention to screening, prevention and treatment will be critical, particularly among groups where alcohol use remains elevated.”
Additional study authors include Jennifer Dodge, MPH , associate professor of research medicine and population and public health science at the Keck School of Medicine of USC and Divya Ayyala-Somayajula, MD, of Thomas Jefferson University in Philadelphia.
###
For more information about Keck Medicine of USC, please visit news.keckmedicine.org .
The research was supported by the National Institute on Alcohol Abuse and Alcoholism of the National Institutes of Health, grant number K23AA029752.
Annals of Internal Medicine