Download Been Drinking Alcohol
Ralf Roth
Underage drinking is a significant public health problem in the U.S. Excessive drinking is responsible for more than 3,900 deaths and 225,000 years of potential life lost among people under age 21 each year.1 Underage drinking cost the U.S. $24 billion in 2010.2
Rates of current and binge drinking among high school students have generally been declining in recent decades. Although males historically had higher rates, in 2019 and 2021, female high school students were more likely to drink alcohol and binge drink than male high school students.3,4
State alcohol policy environments influence underage drinking, as well as excessive drinking among adults. Comprehensive approaches that include effective population-level policy strategies can reduce underage drinking.10,13,14 The Community Preventive Services Task Force recommends several effective strategies for preventing excessive drinking,15 including:
Binge drinking is the most common and costly pattern of excessive alcohol use in the United States.1,2 Binge drinking is defined as consuming 5 or more drinks on an occasion for men or 4 or more drinks on an occasion for women.
Most people who binge drink are not dependent on alcohol.3 However, binge drinking is harmful on its own. It is associated with serious injuries and diseases, as well as with a higher risk of alcohol use disorder.3
Alcohol is the common term for ethanol or ethyl alcohol, a chemical substance found in alcoholic beverages such as beer, hard cider, malt liquor, wines, and distilled spirits (liquor). Alcohol is produced by the fermentation of sugars and starches by yeast. Alcohol is also found in some medicines, mouthwashes, and household products (including vanilla extract and other flavorings). This fact sheet focuses on cancer risks associated with the consumption of alcoholic beverages.
According to the National Institute on Alcohol Abuse and Alcoholism, a standard alcoholic drink in the United States contains 14.0 grams (0.6 ounces) of pure alcohol. Generally, this amount of pure alcohol is found in:
These amounts are used by public health experts in developing health guidelines about alcohol consumption and to provide a way for people to compare the amounts of alcohol they consume. However, they may not reflect the typical serving sizes people may encounter in daily life.
There is a strong scientific consensus that alcohol drinking can cause several types of cancer (1, 2). In its Report on Carcinogens, the National Toxicology Program of the US Department of Health and Human Services lists consumption of alcoholic beverages as a known human carcinogen.
Numerous studies have examined whether there is an association between alcohol consumption and the risk of other cancers. For cancers of the ovary, prostate, stomach, uterus, and bladder, either no association with alcohol use has been found or the evidence for an association is inconsistent. However, evidence is accumulating that alcohol consumption is associated with increased risks of melanoma and of prostate and pancreatic cancers (4, 15).
Epidemiologic research shows that people who use both alcohol and tobacco have much greater risks of developing cancers of the oral cavity, pharynx (throat), larynx, and esophagus than people who use either alcohol or tobacco alone. In fact, for oral and pharyngeal cancers, the risks associated with using both alcohol and tobacco are multiplicative; that is, they are greater than would be expected from adding the individual risks associated with alcohol and tobacco together (10, 26).
For example, one way the body metabolizes alcohol is through the activity of an enzyme called alcohol dehydrogenase, or ADH, which converts ethanol into the carcinogenic metabolite acetaldehyde, mainly in the liver. Recent evidence suggests that acetaldehyde production also occurs in the oral cavity and may be influenced by factors such as the oral microbiome (28, 29).
Many individuals of East Asian descent carry a version of the gene for ADH that codes for a "superactive" form of the enzyme. This superactive ADH enzyme speeds the conversion of alcohol (ethanol) to toxic acetaldehyde. Among people of Japanese descent, those who have this form of ADH have a higher risk of pancreatic cancer than those with the more common form of ADH (30).
Another enzyme, called aldehyde dehydrogenase 2 (ALDH2), metabolizes toxic acetaldehyde to nontoxic substances. Some people, particularly those of East Asian descent, carry a variant of the gene for ALDH2 that encodes a defective form of the enzyme. In people who produce the defective enzyme, acetaldehyde builds up when they drink alcohol. The accumulation of acetaldehyde has such unpleasant effects (including facial flushing and heart palpitations) that most people who have inherited the ALDH2 variant are unable to consume large amounts of alcohol and therefore have a low risk of developing alcohol-related cancers.
The plant secondary compound resveratrol, found in grapes used to make red wine and some other plants, has been investigated for many possible health effects, including cancer prevention. However, researchers have found no association between moderate consumption of red wine and the risk of developing prostate cancer (32) or colorectal cancer (33).
Most of the studies that have examined whether cancer risk declines after a person stops drinking alcohol have focused on head and neck cancers and on esophageal cancer. In general, these studies have found that stopping alcohol consumption is not associated with immediate reductions in cancer risk. The cancer risks eventually decline, although it may take years for the risks of cancer to return to those of never drinkers.
For example, ex-drinkers still had higher risks of oral cavity and pharyngeal cancers than never drinkers even 16 years after they stopped drinking alcohol, although it was lower than before they stopped drinking (34). One study estimated that it would take more than 35 years for the higher risks of laryngeal and pharyngeal cancers associated with alcohol consumption to decrease to the level of never drinkers (35).
Cao Y, Willett WC, Rimm EB, Stampfer MJ, Giovannucci EL. Light to moderate intake of alcohol, drinking patterns, and risk of cancer: Results from two prospective US cohort studies. BMJ 2015; 351:h4238.
Drinking at college has become a ritual that students often see as an integral part of their higher education experience. Some students come to college with established drinking habits, and the college environment can lead to a problem. According to the 2021 National Survey on Drug Use and Health (NSDUH), 49.3% of full-time college students ages 18 to 22 drank alcohol in the past month. Of those, about 27.4% engaged in binge drinking during that same time frame.1 For the purposes of this survey, binge drinking was defined as consuming 5 drinks or more on one occasion for males and 4 drinks or more for females. However, some college students drink at least twice that amount, a behavior that is often called high-intensity drinking.2
Drinking this way can pose serious health and safety risks, including car crashes, drunk-driving arrests, sexual assaults, and injuries. Over the long term, frequent binge drinking can damage the liver and other organs.
The most recent statistics from the National Institute on Alcohol Abuse and Alcoholism (NIAAA) estimate that about 1,519 college students ages 18 to 24 die from alcohol-related unintentional injuries, including motor vehicle crashes.3
In a national survey, college students who binge drank alcohol at least three times per week were roughly six times more likely to perform poorly on a test or project as a result of drinking (40% vs. 7%) than students who drank but never binged. The students who binge drank were also five times more likely to have missed a class (64% vs. 12%).9
Other consequences include suicide attempts, health problems, injuries, unsafe sexual behavior, and driving under the influence of alcohol, as well as vandalism, damage, and involvement with the police.
To avoid binge drinking and its consequences, college students (and all people who drink) are advised to track the number of drinks they consume over a given period of time. That is why it is important to know exactly what counts as a drink.
In the United States, a standard drink (or one alcoholic drink-equivalent) is one that contains 0.6 fl oz or 14 grams of pure alcohol (also known as an alcoholic drink-equivalent), which is found in the following:
Unfortunately, although the standard drink (or alcoholic drink-equivalent) amounts are helpful for following health guidelines, they may not reflect customary serving sizes. A large cup of beer, an overpoured glass of wine, or a single mixed drink could contain much more alcohol than a standard drink. In addition, the percentage of pure alcohol varies within and across beverage types (e.g., beer, wine, and distilled spirits).
Factors related to specific college environments also are significant. Students attending schools with strong Greek systems or prominent athletic programs tend to drink more than students at other types of schools. In terms of living arrangements, alcohol consumption is highest among students living in fraternities and sororities and lowest among commuting students who live with their families.
An often-overlooked preventive factor involves the continuing influence of parents. Research shows that students who choose not to drink often do so because their parents discussed alcohol use and its adverse consequences with them.
Ongoing research continues to improve our understanding of how to address the persistent and costly problem of harmful and underage student drinking. Successful efforts typically involve a mix of strategies that target individual students, the student body as a whole, and the broader college community.
Individual-level interventions target students, including those in higher risk groups such as first-year students, student athletes, members of Greek organizations, and mandated students. The interventions are designed to change student knowledge, attitudes, and behaviors related to alcohol so they drink less, take fewer risks, and experience fewer harmful consequences.
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