Alcohol continues to be one of our favourite drugs. Global consumption of alcohol in 2017 was 6.5 litres per person and is estimated to rise to 7.6 litres by 2030 (Manthey et al., 2019).
The harms associated with alcohol are wide ranging, including increasing the risk of various cancers, heart disease, premature mortality, depression and dependence. The good news is that most of these risks and harms are preventable if alcohol is avoided or consumption is reduced.
The World Health Organisation (WHO) has set a target for countries to reduce consumption of alcohol by 20% by no later than 2030. This gives us an indication of how concerned WHO is about not only the amount of alcohol consumed but the harms and risks this drug poses to human health.
So, it is timely and helpful to have a study by Shield and colleagues (2025) that explores the progress being made to achieving this goal set by WHO.
Alcohol remains the world’s favourite drug; does its global toll on health continue to rise faster than our will to stop it?
Methods
Broadly the data focussed on two aspects: a) first consumption of alcohol and b) on the estimates of risks and harm associated with these consumption levels.
The authors drew on a variable set of available data sources, which included surveys, alcohol sales and traveller data (inbound and outbound travellers). Then data on individual drinking status and problematic consumption, such as past 30-day use of alcohol was gathered from 540 surveys from 174 countries.
Data on mortality due to alcohol was collected and crucially harms associated with alcohol. In the main, this was done by the established metric of Disability Adjusted Life Years (DALYs). Although deaths to alcohol are clearly important, DALYs measure quality of life related to health, so although an individual may live to a certain age it is the quality of their life that is measured via DALYs.
Results
The main finding of this study is that most countries will not meet the target set by WHO of reducing alcohol consumption by 20% in their respective populations. As one would expect from a global assessment there are significant variations in the findings. Some of the contrasts they highlight are those between Eastern Europe and Sub-Saharan Africa. Both regions experienced high levels of alcohol-attributable disease despite contrasting levels of consumption, with Sub-Saharan Africa populations drinking less than their European counterparts. It’s worth noting that overall consumption in Europe has been falling even though harms and mortality persist. In part, this can be explained by the time lag between drinking alcohol and for example cancers attributable to alcohol developing.
It is valuable reading the full paper of the study for further details about individual countries and regions, the authors report a significant and wide range of results for each. Rather than summarise each of those here, I thought it would be worth highlighting some headline trends and results instead. One of these relates to gender, consistent with other studies males were found to be more likely to drink than females, 52.2% compared to 35.4%. It is also important to note that globally there are more teetotallers than drinkers, 56.2% versus 43.8%.
The gender gap widens when heavy episodic drinking (HED) is examined, male prevalence was 23.5% in contrast to females at 9.7%. Suggesting that it is important not just to look at overall consumption, but drill down into demographic details and drinking patterns.
This study suggests that most countries will not hit WHO’s alcohol reduction targets by 2030.
Conclusions
The authors argue that the projected failure of reduced alcohol consumption is a result of countries not adopting policies that would address the harms associated with alcohol.
The burden on health due to alcohol is significant. The authors estimate that there are 2.6 million premature deaths worldwide due to alcohol, which we can all agree is an astonishing figure. Although it does help explain why WHO have made it a focus in their campaigning to reduce overall consumption. As mentioned earlier, it is not just premature death that alcohol causes, but poorer quality of life as measured by DALYs, here the authors estimate that 60.5 million DALYs are attributable to alcohol.
As the authors point out, unlike other drugs, such as cocaine and cannabis, there is no international policy or agreement on alcohol. This typifies the way that alcohol is treated differently to other drugs (Hamilton et al., 2020). This is no accident, as the alcohol industry has proved to be one of the most adept at influencing national and international policy in its favour (McCambridge et al., 2018). The industry has a long track record of fighting tooth and nails any policies that would threaten their business model and profits.
The global community is far from meeting its alcohol reduction goals, partly because strong policies are not in place and industry influence acts as a major barrier.
Strengths and limitations
The authors are to be congratulated for the scope and quality of the data they draw on; this would have been a time-consuming task. In particular, they have explored data from regions that rarely get a mention, such as Sub-Saharan Africa. This matters as Western markets have been saturated as far as the alcohol industry is concerned, they have turned to other parts of the world to ensure growth.
The authors are clear and candid about the limitations to their research. Understandably, when trying to gather global data there will be variations in how and what is measured and the reliability of some of the sources used. They explain that the sources they used were difficult to compare, as they often used differing ways of defining hazardous or heavy alcohol consumption for example.
There are also important demographic details that aren’t included such as race and ethnicity. This really matters as we know that some cultures are very wary about seeking help for problems due to alcohol or even admitting to consuming alcohol. For example, those of South Asian heritage are known to be particularly reluctant to seeking help due to the stigma surrounding alcohol consumption. If we have information about particular ethnic groups, then interventions can be tailored to meet their needs and ensure they have access to specialist support when needed.
Finally, some of the data used is based on three-year averages, this clearly risks missing important annual fluctuations which would need further exploration.
This study’s breadth is impressive, offering insight into under-researched regions, but omitted demographic details remind us how complex global comparisons can be.
Implications for practice
Really what this study tells us is that alcohol is responsible for a wide range of health problems, some of which will unfortunately prove to be fatal. Although many people are aware of the risk of addiction due to alcohol, many people including us elves are not so clued up about the number of cancers that alcohol is associated with, as well as other physical problems such as diabetes.
The good news is that most, if not all, physical and psychological problems related to alcohol are preventable if caught in time. As with other drugs, the frequency and quantity with which alcohol is consumed increase the risk of problems. This provides healthcare workers with the intelligence to potentially reduce alcohol related harm. We can do this by recognising the risks and harms that alcohol can cause, and are uniquely placed to help and support those we work with to think about their relationship with alcohol, and how that might change for the better. For example, encouraging clients to keep an alcohol diary is often a good first step, as this helps the individual recognise how and how often they are drinking and how they might start reducing consumption.
But make no mistake, this is a truly David and Goliath fight. We are up against a powerful and wily player in the alcohol industry, that will do all it can to increase consumption of its product, even if this is at the expense of global health. As with climate change, we can either give up thinking we can’t make a difference or take on the challenge, knowing that collectively we can make a difference by advocating for each person we encounter that has an unhealthy relationship with alcohol. Cheers to that!
Tackling alcohol-related harms requires both evidence-informed practice and determination to challenge the forces that keep harmful drinking in place.
Statement of Interest
No conflicts to declare.
Links
Primary paper
Shield, K., Franklin, A., Wettlaufer, A., Sohi, I., Bhulabhai, M., Farkouh, E.K., Radu, I.G., Kassam, I., Munnery, M., Remtulla, R. and Richter, S., 2025. National, regional, and global statistics on alcohol consumption and associated burden of disease 2000–20: a modelling study and comparative risk assessment. The Lancet Public Health, 10(9), pp.e751-e761.
Other references
Hamilton, I. Alcohol: a drug in a class of its own. Mental Elf, 12th June 2020.
McCambridge, J., Mialon, M. and Hawkins, B., 2018. Alcohol industry involvement in policymaking: a systematic review. Addiction, 113(9), pp.1571-1584.
Manthey, J., Shield, K.D., Rylett, M., Hasan, O.S., Probst, C. and Rehm, J., 2019. Global alcohol exposure between 1990 and 2017 and forecasts until 2030: a modelling study. The lancet, 393(10190), pp.2493-2502.
