Alcohol has become a fixture at festivals, workplace socials, sporting events, and family gatherings around the world, appearing at open bars at weddings, in toasts at holiday dinners, and in public celebrations such as Independence Day. However, in stark contrast to this "social protagonist" status, alcohol causes millions of deaths worldwide every year and is closely linked to cancer, liver disease, unintentional injuries, violence, dependence and addiction. There is a clear disconnect between the huge public health burden of alcohol and its popularity in culture.
According to estimates from the World Health Organization, there are approximately 2.3 billion people around the world who drink alcohol. Drinking behavior is highly diverse in different countries and cultures, but it is generally deeply integrated into social life. At the same time, alcohol is responsible for approximately 2.6 million deaths each year, accounting for nearly one-twentieth of all deaths globally, meaning that on average one in 20 deaths is alcohol-related. A clinician who has been working on the front line of addiction medicine for a long time pointed out that among the patients he received, alcohol has an impact on almost all organ systems in the human body. Many people did not realize for the first time until they were hospitalized due to serious complications that alcohol damages far more than the liver.
The idea that drinking was once considered "safe in moderation" is continuing to be challenged by new evidence. More and more studies show that even "moderate drinking" in the traditional sense is not harmless, and its health risks have previously been seriously underestimated by the public and even some professionals. In most people's perceptions, alcohol risks are often mainly linked to legal issues such as addiction and drunk driving. However, the long-term effects of alcohol go far beyond these categories and penetrate into almost every aspect of an individual's physical and mental health. Although alcohol can improve mood and relieve social anxiety in the short term, long-term use can lead to mood worsening, cognitive decline, and sleep disturbances. These problems can in turn worsen alcohol dependence, trapping people in a vicious cycle.
Several studies have further quantified the relationship between alcohol and injury risk. A 2021 literature review found that consuming about two standard drinks roughly doubles the likelihood of a traffic accident and other non-traffic injuries. The same review noted that heavy intermittent drinking (i.e., binge drinking) increases the risk of injury by 20 to 50 times, depending on the amount consumed and the type of injury. In addition to its well-known liver damage, alcohol can cause serious gastrointestinal complications and heart disease, which is far more harmful than commonly realized.
Public awareness of the link between alcohol and cancer lags even further. The World Health Organization classifies alcohol as a "Group 1 carcinogen," which is in the same category as tobacco and asbestos, which means that existing evidence has fully proven that it can cause cancer in humans. In 2025, the U.S. Surgeon General issued a special announcement emphasizing that alcohol increases the risk of at least seven types of cancer, including breast cancer, colorectal cancer, liver cancer, and cancers of the oral cavity, esophagus, and throat, and called for the update of relevant warning labels. Despite this, less than half of the U.S. population recognizes that alcohol is a risk factor for cancer, especially for cancers such as breast cancer that are not usually intuitively linked to alcohol consumption. The gap in knowledge is particularly obvious.
The relationship between alcohol and cancer risk is not always clear. In the 1990s and early 2000s, some observational studies suggested that moderate drinking may be beneficial to cardiovascular health. Over the past decade, however, higher-quality studies have overturned this "protective effect" hypothesis. These studies pointed out that the early observations were largely due to differences in the overall health and lifestyle of moderate drinkers compared with non-drinkers or heavy drinkers, rather than the true cardiovascular protective effects of alcohol itself. The U.S. version of the Dietary Guidelines also points out that existing evidence increasingly shows that even low-level drinking may increase the risk of cancer, and that the overall health of adults is closely related to "drinking less."
It is worth noting that the Dietary Guidelines made important adjustments in the 2025-2030 edition: the previous specific quantitative recommendations for no more than one drink per day for women and no more than two drinks for men were deleted, and the relationship between alcohol and cancer was no longer explicitly discussed. The change prompted criticism from public health experts who said the new version downplayed the growing evidence of alcohol-related harms and provided less specific guidance for consumers. In this policy context, Mehmet Oz, director of the Centers for Medicare and Medicaid Services, described alcohol as a "social lubricant," emphasizing its role in bringing people closer in the short term without fully highlighting its well-documented health risks. Experts in the field of addiction medicine point out that similar statements ignore the key issue of dependence formation - when society relies too much on alcohol as a "social lubricant", people are likely to unknowingly develop chemical and psychological dual dependence. This short-sighted logic puts immediate social effects above deep, long-term risks.
Among many dangerous psychoactive substances, alcohol is not hidden from public view, but is often placed openly in the center of social scenes. This trend shows no obvious signs of reversal in the short term. Large companies have also benefited from this, accurately reaching young audiences through advertisements, and using narratives such as "cool", "free" and "social" to strengthen the psychological connection between drinking and an ideal lifestyle. Comparing the history of tobacco control may provide a reference: in 1965, the proportion of smokers in the United States was as high as 42.4%. By 2022, this number had dropped to 11.6%. This upheaval does not stem from a single initiative, but is the combined result of decades of accumulation of scientific evidence, public education campaigns, warning labels, advertising restrictions, smoke-free policies, increased tobacco taxes, and changes in social norms, which have combined to promote the transformation of smoking from "a generally accepted social behavior" to "a behavior that is widely regarded as a major health risk and increasingly socially unacceptable."
Although alcohol consumption has shown a mild downward trend in recent years, unlike cigarettes, drinking is still deeply embedded in all aspects of social life, ranging from family gatherings to business negotiations. Many people believe that as long as a substance is legal, common, encouraged or even acquiesced in social situations, it should be safe. Yet the history of public health reminds us time and again that such assumptions are neither reliable nor immutable. As scientific evidence continues to accumulate, policy guidance gradually improves, and social attitudes slowly but continuously shift, people's understanding of alcohol is likely to experience a "cultural earthquake" similar to tobacco: from a "legal, common, and socially friendly" symbol to a "high-risk health risk" warning symbol.