Alcohol kills more than 178,000 Americans each year. It doesn’t have to.
Drinking’s deadly toll in the U.S. is the result of decades of policy decisions, industry influence, and cultural inertia, as STAT shows in its investigative series, The Deadliest Drug. The U.S. has not made a concerted effort to reduce heavy drinking since Prohibition ended nearly a century ago.
The decades of societal and political indifference have been costly. Alcohol, while the driver of widespread death and illness, is often ignored in a fractured system. Screenings are inconsistent or superficial, resulting in a lack of follow-up for people with problematic drinking. Some groups, including pregnant adults and people with metabolic disease, face unique risks from inappropriate alcohol use but frequently fly under the radar. When people do get help for their drinking, it’s often fragmented and reliant on their individual ability to completely cut out alcohol.
Efforts at policymaking around alcohol often fail in the U.S., where states are mostly in charge of regulating alcoholic beverages. An influential alcohol industry, which nurtures deep ties to lawmakers, charitable groups, and consumers, has kept a tight grip on regulation — at the expense of public health.
“There’s got to be an environment developed that allows for smarter choices,” said Steve Schmidt, former senior vice president of public policy for the National Alcohol Beverage Control Association. “What I have seen over the last several decades has been a constant erosion of policy and regulation.”
Data and experts suggest even modest changes, far from prohibiting alcohol or even significantly restricting access, could lessen the burden of death and disease. For example, the U.S. could take notes from abroad, where a coalition of health organizations last year formed the European Health Alliance on Alcohol to oppose industry-friendly proposals and push for evidence-based public health measures.
As the Trump administration embarks on its Great American Recovery Initiative, it is seeking ideas for how to wrangle the problem, according to a callout in the Federal Register last month.
STAT’s interviews with more than 100 experts — including current and former government officials, doctors, public health advocates, substance use researchers, people in recovery, and addiction treatment leaders — identified a dozen ways the U.S. could chip away at its alcohol epidemic.
1. Screen early and often
Alcohol screenings rank among the most effective primary care interventions, on par with blood pressure checks and flu vaccines. Yet in the U.S., screening is largely inconsistent, and providers are often ill-equipped or uncomfortable asking for specifics about their patients’ drinking.
“We don’t get treated in this country until it’s a stage 4 illness,” Patrick Kennedy, the former congressman and mental health advocate, said at an event this year in Washington. “It’s harder to treat cancer effectively when you start when it’s already metastasized.”
Medicine can do a better job of asking patients about any family history of alcohol misuse and conducting thorough screenings of people deemed high risk. Several experts STAT spoke with advocated for more robust questionnaires in pediatric practices, since many substance use disorders begin in adolescence.
People with metabolic diseases, such as diabetes or obesity, are at elevated risk of alcohol-related liver damage if they drink in excess. Clinicians should pay special attention to this group. Researchers are also pushing for the widespread adoption of simple, noninvasive liver tests, such as the FIB-4, which can detect liver scarring early on.
Studies have also found that women are less likely than men to encounter a strategy known as screening, brief intervention, and referral to treatment (SBIRT). That gap can lead to generational problems: Recent estimates suggest 1 in 8 women drink while pregnant, a trend that could further drive up rates of fetal alcohol spectrum disorders, which are estimated to be more common than autism.
Medical associations ought to provide clearer guidance on how pregnant patients should be screened and treated for alcohol use disorder, researchers told STAT. Providers could even screen for excessive alcohol use during “well baby” visits that already cover other mental health topics, experts said.
“If we will give a PHQ-9 to moms, why not this?” addiction physician and pediatrician Amelia Burgess said, referring to the commonly used depression questionnaire.
Nora Volkow, head of the National Institute on Drug Abuse, told STAT the U.S. can go beyond doctors and nurses, and train dentists, pharmacists, and other health workers in substance use screening. Think of it like receiving a blood pressure check during dental visits.
2. Add ‘nudges’ to health system
Health systems can do their part to boost screening and treatment by adding alcohol questionnaires, including the well-validated and quick AUDIT-C test, to clinician workflows.
Groups like Kaiser Permanente Northern California have seen vast improvements in alcohol screening rates after adding drinking-related questions to its electronic health system.
Penn Medicine integrated “nudges” into its system to get emergency department providers to ask patients about their alcohol concerns and, if needed, prescribe naltrexone, an affordable medication that reduces cravings.
“We had already done that with prescribing buprenorphine for opioid use disorder,” said Kit Delgado, an associate professor of emergency medicine who developed the new approach. “It kind of dawned on us … alcohol is something that we see so much more commonly.”
In the first couple of years, researchers saw an increase in naltrexone prescriptions (up to 3% from 0.2% of alcohol-related discharges) at study hospitals. The two control hospitals had no increase during the same time period.
3. Get creative with funding
STAT’s reporting finds that fixing the country’s alcohol epidemic will require smarter investments and clear guidance from federal health officials.
For instance, the Department of Health and Human Services, which already spends billions of dollars on addiction-related grants each year, can make alcohol a central priority. That could be something as simple as listing alcohol use disorder prevention, screening and treatment on new Notice of Funding Opportunities and requests for proposals.
“It sends a really clear message,” said Tracy McPherson, a research psychologist from NORC, a research group at the University of Chicago. Suicide prevention grants, for example, could reasonably be used for alcohol work, since the two issues are closely tied.
Centers for Disease Control and Prevention-funded “drug-free communities” would be another obvious place to incorporate messaging about alcohol use, she said.
In West Virginia this year, legislators passed the Make West Virginia Healthy Act, which funds county-level public health projects. Such money could be used for alcohol prevention efforts, even though it’s not explicitly for that, because of how drinking affects community health, a state official told STAT in the spring.
States could open up existing funding streams to include alcohol work or establish new, dedicated pools of money. (That is a big ask as many states tighten their belts; alcohol sales tax revenue could help cover the cost of new programs.)
4. Get the word out
HHS could also reinvest in public messaging about the health risks of alcohol, such as the defunct “Drink Less, Be Your Best” campaign.
States and cities can act, too. This spring, the New York City Health Department launched a monthlong ad campaign called “Buzzkill,” warning about alcohol’s links to cancer.
“While this is a hard truth to swallow, we have to keep it straight with New Yorkers by warning them of this lesser-known fact while pointing to where they can learn more and seek help,” public health commissioner Alister Martin said in a statement.
The $1 million initiative spread the word through vivid messaging on radio and social media, in newspapers, and in the streets: on subway screens, in bars, and at neighborhood pharmacies. It was viewed over 41 million times, a health department spokesperson told STAT.
While President Trump has impaired public health messaging from agencies like the CDC during his second administration, he had a vastly different perspective less than a decade ago. In 2017, he wanted ads warning about the risks of substance use as part of his plan to reduce opioid overdoses.
“The fact is: If we can teach young people — and people generally — not to start, it’s really, really easy not to take them. And I think that’s going to end up being our most important thing: really tough, really big, really great advertising so we get to people before they start.”
5. Overhaul payment
In the clinic, payment continues to be a barrier to detection and treatment of alcohol-related problems. While health care reforms in the past two decades have boosted reimbursement for mental health treatment, including substance use disorder work, physicians say parity is still not enforced well enough.
Last week, Rep. Tom Kean Jr. (R-N.J.), who said his monthslong absence from Congress was due to depression, introduced a bill to impose financial penalties on payers who violate parity requirements for mental health and substance use treatment. Federal and state regulators are key enforcers of parity rules.
Pediatric behavioral health specialists who take care of children with fetal alcohol spectrum disorders, report receiving dismal reimbursement despite being in high demand. This leads many clinics to not accept insurance. For families, that could mean missing out on needed treatment or even a proper diagnosis. FASDs are often confused for other disorders.
Several advocates and researchers interviewed by STAT mentioned collaborative care codes as another area of opportunity. The Centers for Medicare and Medicaid Services could improve reimbursement rates collaborative substance use disorder treatment.
Other issues, including bare-bones Medicare coverage for addiction care, must be fixed by Congress.
“You can get outpatient counseling, you can get some medications, and you can get acute inpatient treatment — like, you’ve overdosed and you almost died. That’s all you get,” said Tim Clement, vice president of federal government affairs at Mental Health America.
6. Dive into data
Even without spending more on alcohol interventions, the country could use information it already has, plus a bit of cleverness, to tackle the issue.
Systems that states and federal officials have built to monitor suicide risk and opioid overdoses can be repurposed for alcohol, said Allison Arwady, the recently departed director of the National Center for Injury Prevention and Control.
Take the State Unintentional Drug Overdose Reporting System, or SUDORS, which helps public health workers identify “missed opportunities,” like people who recently received treatment in an emergency department or rehab facility, or who might have just gotten out of jail.
“Within the data, there are opportunities for alcohol, to do some more with the missed-opportunities work,” she said, adding that follow-up outreach from health workers can help people who had a recent alcohol-related emergency department visit get connected with local resources or treatment.
“Many problems that affect lots of Americans are movable with tried-and-true public health approaches,” Arwady told STAT.
7. Require more doctor training
Medical school education about drinking and alcohol use disorder is often cursory, leaving many of America’s doctors without the skills necessary to screen patients for heavy drinking and intervene if necessary.
Experts said training should be woven into all aspects of medical education to reflect alcohol’s role as a contributor to numerous cancers, metabolic diseases, and behavioral health disorders.
One good way to reverse engineer a culture of alcohol education could be for accrediting groups to add questions about alcohol screening and treatment to board exams.
“If you require it on a test, it will be studied,” said Daniel Blaney-Koen, an attorney who works on state legislative advocacy at the American Medical Association.
8. Align price of alcohol with inflation
Levying specific taxes on products that societies deem to be harmful, like tobacco or gambling, is an age-old concept. But today, alcohol taxes are notably low: about 13 cents for a standard shot of liquor.
Raising alcohol taxes is one of the top tactics experts recommend to help curb consumption. At the very least, lawmakers could ensure that taxes on alcohol rise with inflation, so drinking doesn’t become cheaper over time, researchers say.
“Domestic violence, car accidents, sexual violence, addiction, and heavy use — there is a direct correlation with the cost of alcohol,” said Michael Botticelli, who served as drug czar during the Obama administration. “Meaning, the higher the cost, the lower the negative health consequences.”
9. Embrace harm reduction
Alcohol consumption is often painted as a binary: social drinkers versus “people with a problem.” Many Americans live somewhere in between. While people who struggle with heavy alcohol use can find it helpful to pursue total abstinence, some experts say the principles of harm reduction have been lost.
Alcohol messaging could focus on helping a lot of people drink less, instead of trying to get a few people to go cold turkey. Some have already adopted this strategy, like public health officials in Vermont, who recently launched a campaign called “One Less.”
A wider embrace of harm reduction could yield significant results: If every American who consumes alcohol limited themselves to one drink per day, the country would see 17,400 fewer cancer deaths attributable to alcohol each year, according to a CDC analysis.
10. Tighten marketing rules
Public health experts told STAT that cracking down on marketing that reaches underage drinkers could help delay young people’s initial exposure to alcohol brands and potentially reshape their associations with alcohol for the better.
Others suggest going significantly further and effectively regulating alcohol marketing akin to tobacco, where language used in print ads is tightly controlled and TV or radio commercials are banned altogether.
Currently, the alcohol industry is its own watchdog: Companies are bound only by a voluntary advertising guideline. That is particularly concerning on social media, where invisible algorithms can expose underage users to alcohol marketing and other drinking-related content with little oversight.
11. Improve alcohol labels
Buy a pack of cigarettes in Europe and you’ll encounter a warning that smoking causes cancer or other negative health effects. More jarringly, you’ll find a picture on the packaging: mouth cancer, a man in a body bag, a woman coughing up blood.
It may seem extreme, but European officials’ efforts have proved to be highly effective.
Public health experts say improving warning labels on alcohol packaging could similarly help raise awareness about alcohol’s links to cancer and other negative consequences. While few are advocating for the same type of shock-and-awe imagery, it’s widely agreed that featuring warning labels more prominently could reduce drinking — or, at the very least, arm Americans with information and help them make healthier choices overall.
Such warnings have been used in other nations, such as Chile, to help buyers discern which drinks have a lot of sugar, or which packaged snacks are highly caloric, for example. U.S. health officials are considering similar front-of-package labels for food here.
Alcohol warnings would follow the same logic. Researchers say the ideal label is highly visible: large, colorful, and includes graphics or images, like a triangle or octagon shape. Warnings can be even more effective if the labels change over time, so consumers don’t become desensitized.
“Adopting new alcohol warnings about cancer, dementia, liver disease, or hypertension may be especially promising,” a 2026 study of nine alternate alcohol labels found.
The Alcohol and Tobacco Tax and Trade Bureau is currently developing a more modest proposal around what basic nutrition information, if any, alcohol producers must include on packaging. A separate rule could mandate allergen disclosures on bottles. There is no clear timeline for when those will be finalized.
12. Streamline bureaucracy
The U.S. has an alphabet soup of federal agencies focused on addiction and behavioral health. The White House even maintains a specific unit, the Office of National Drug Control Policy, to serve as a clearinghouse for the nation’s drug-related efforts, ranging from addiction treatment to cracking down on cartels.
But no agency is formally tasked with reducing alcohol’s harms.
This has created an uncoordinated and even contradictory landscape for policies focused on drinking. Empowering a single agency to oversee alcohol policy across the government could help streamline public health efforts and help regulate a powerful alcohol industry.
Trump could also get the nation in line by declaring a public health emergency around alcohol-related death, as he did in 2017 to help address the opioid epidemic. Such a move not only would send a strong public message about the nature of the problem, but it would create a sense of political urgency and allow for more dedicated alcohol funding.
When Trump made the opioid crisis announcement, he invoked his brother Fred Trump Jr.’s premature death — of alcohol abuse.
“He would tell me, ‘Don’t drink, don’t drink,’” the president said. “He had a very, very, very tough life because of alcohol. … I learned because of Fred.”
Goal: a ‘perceptual shift’
The U.S. can save lives and drive down excessive alcohol use without taking drastic measures. It will, however, require making an intentional effort and confronting the power of special interests.
Government officials can take the lead by creating funding opportunities, whether via the Great American Recovery Initiative, new taxes, or existing pots of money that might be flexibly used for alcohol work. Better coordination of addiction efforts, and stronger labels on alcoholic beverages could also help reduce overall drinking levels and improve consumer awareness — a key priority for the Make America Healthy Again movement.
Public health departments can decide to confront the toll of alcohol, which outpaces that of opioids in most places, and develop marketing campaigns to oppose the overwhelming messaging from the alcohol industry. Local experts can be empowered to focus on alcohol, and creative uses of federal or state money can fund it.
Epidemiologists with the know-how to monitor illicit drug activity can similarly watch for upswings in alcohol poisonings, accidents, and hospitalizations. Community health workers used to intervening with substance use disorder patients can prioritize people at risk of serious harm or death from alcohol. Health systems can take simple steps, like adding validated alcohol screening questions to their electronic health records or flagging high-risk patients, to identify more people in need of treatment.
Insurance coverage, physician payment, and medical training will all be important if the nation wants to meaningfully reduce the rate of alcohol-related harm. So will a warmer embrace of practices proven to work in other addictions, such as harm-reduction approaches.
But more than anything, the U.S. must first come to terms with its drinking problem.
The tobacco parallel comes to mind for David Kessler, the former Food and Drug Administration commissioner known for taking on smoking in the 1990s. Many people may not even recall how strongly smoking was associated with being “cool, adventuresome, sexy” in previous generations, he said.
“The banning of smoking on planes, the focus on secondhand smoke, the surgeon general’s warning — those were all important chapters,” he said. “But in the end, what they helped achieve was this perceptual shift.”
While some might argue the tobacco industry is doing fine, smoking has sharply declined in the U.S., reaching an all-time low among adults in 2025. There is no longer any confusion about just how bad cigarettes are for health.
Drunk driving has gone through a comparable transformation, thanks to victim advocacy groups and tougher laws. But excessive drinking itself often does not carry the same stigma until it turns disastrous, sometimes years down the road. The solutions laid out above can begin reshaping the nation’s perception of heavy alcohol use, and force America to take a sober view of its largest, most ignored drug epidemic.
“The sense that, ‘I have been manipulated. This is an engineered environment and I am not really in control of my own decision-making,’ it’s a very powerful force, probably more important than any regulation or any form of tax,” Kessler said.
STAT’s coverage of chronic health issues is supported by a grant from Bloomberg Philanthropies. Our financial supporters are not involved in any decisions about our journalism.