A Look at the Latest Alcohol Death Data and Change Over the Last Decade

Alcohol use disorder (AUD) is often an underrecognized substance use disorder (SUD) despite its substantial consequences. Over half of US adults (54%) say that someone in their family has struggled with an alcohol use disorder, making it the most prevalent non-tobacco substance use disorder. Yet, only one-third of adults view alcohol addiction as a crisis, compared to over half who see opioids as such. Federal data show that 1 in 10 people had an alcohol use disorder in the past year, over 4 in 10 alcohol users report binge drinking in the past month, and per capita alcohol consumption is higher than the decade prior. Treatment rates for alcohol use disorders are notably low, especially for the use of medication, a recommended AUD treatment component. Although the opioid crisis has been declared a public health emergency by the U.S. Department of Health and Human Services since 2017, no similar declaration exists regarding alcohol deaths. However, HHS has set a priority goal of reducing emergency department visits for acute alcohol use, mental health conditions, suicide attempts, and drug overdoses by 10% by 2025.

This analysis focuses on the narrowest definition of alcohol deaths known as “alcohol-induced deaths” (referred to as “alcohol deaths” throughout the brief). These alcohol deaths are caused by conditions directly attributable to alcohol consumption, such as alcohol-associated liver diseases. Broader definitions of alcohol deaths extend this definition to also encompass cases where an alcohol-induced condition was a contributing factor, but not the underlying cause of death. Key takeaways from this analysis of CDC WONDER data from 2012 to 2022 include the following:

• Alcohol deaths increased steadily over the past decade with sharp rises during the pandemic years. Overall, the national alcohol death rate has risen 70% in the past decade, accounting for 51,191 deaths in 2022, up from 27,762 deaths in 2012.
• Alcohol deaths in 2022 were highest among people aged 45 to 64, American Indian and Alaska Native (AIAN) people, and males. Alcohol death rates for AIAN people are the highest–5 times higher than death rates for White people, the racial group with the next highest prevalence. Deaths are rising fastest among adults aged 26 to 44, AIAN people, and females–with these groups experiencing nearly or more than a 100% rise in alcohol mortality rates in the last decade.
• Rates of alcohol deaths varied considerably across states in 2022. While all states and D.C. experienced increases in deaths rates over the past decade and during the pandemic, the rate of change varied by state and year, with some states’ death rates rising most sharply during the pandemic and other state experiencing rises more evenly before and during the pandemic. Rural areas have a higher rate of alcohol deaths and experienced greater growth in death rates both over the past decade.
• The number of alcohol-related deaths rises to 105,308 under a broader definition that counts deaths where alcohol-induced conditions are either the underlying cause or a contributing factor. This exceeds the numbers for opioid and suicide deaths, which also use this broader definition, totaling 83,437 and 49,594, respectively. 

What are the trends in alcohol deaths?

Alcohol deaths have steadily climbed over the past decade, a trend that accelerated during the pandemic (Figure 1). When adjusted for population growth and age, the alcohol death rate has risen by 70% from 2012 to 2022, moving from 7.97 to 13.53 deaths per 100,000 people. Although deaths fell somewhat in 2022, they remain far higher than a decade ago. From 2012 to 2019, the year over year rise in deaths rates averaged about 4% per year, and then jumped during early pandemic years, with the biggest rise from 2019 to 2020. Other data mirror this trend – emergency department (ED) visits for SUD are on the rise and account for twice the number of ED visits compared to opioids. Alcohol related ED visits account for nearly half of all SUD related visits (45%), far higher than the next highest group, opioids, accounting for 13% of ED visits.

How do alcohol death rates vary and how have they changed across demographics groups?

Alcohol deaths in 2022 were highest among people aged 45 to 64, males, people living in rural areas, and AIAN people. Alcohol death rates for AIAN people are by far the highest–5 times higher than death rates for White people, the racial group with the next highest prevalence. Across age groups, people aged 45 to 64 have the highest alcohol death rate, followed by 65+. Death rates in males are more than double that of females and people who reside in rural areas have death rates higher than those who live in urban areas (Figure 2).

Over the past decade (2012-2022), alcohol death rates grew fastest among people 26 to 44, AIAN people, and females (Figure 3). Overall alcohol consumption has risen somewhat in recent years, but increases may have been concentrated among certain populations as well as other risk factors.

• People aged 26 to 44. Individuals aged 26 to 44 experienced the fastest increase in alcohol death rates, with a rise of 144% over the past decade and over 50% during the pandemic. While this younger age group showed the steepest rate of increase, the largest overall growth in the number of deaths occurred among those aged 45 to 64. This somewhat older group already had the highest death rates and experienced the largest increase in death rates (12 additional deaths/100,000) in the past decade, more than any other group.
• AIAN people. Alcohol deaths for AIAN people have nearly doubled in the last 10 years. During the pandemic years, alcohol death rates increased by almost 25 deaths per 100,000 AIAN people. Increases in alcohol deaths among AIAN people follows worsening trends in other areas related to behavioral health, where AIAN have both the highest rate and fastest growing suicide and overall drug overdose death rates.
• Females. Although males die of alcohol causes more often than females, the relative growth was faster for females over the past 10 years, increasing by 86% for females compared to 61% for males. Heavier drinking may impact women more quickly than men, which may result in the faster development of serious health consequences that contribute to death.

How do alcohol death rates vary and how have they changed across geography?

In 2022 there was wide variation in alcohol death rates. In 2022, New Mexico’s death rate was the highest at 42.7 per 100,000 people, which was more than six times higher than Hawaii, the state with the lowest rate at 7.1 per 100,000 people (Figure 4).

While all states experienced an increase in alcohol deaths, those rates varied widely.  Nationally, alcohol death rates increased by 70% over the past decade, including a 30% rise during the pandemic years alone (2019-2022). However, the extent of these increases varied substantially across states. For instance, the District of Columbia saw a relatively low increase of 24% over the decade, whereas Connecticut experienced a much larger rise of 167%. During the pandemic, increases ranged from 9% in Wyoming and New Jersey to 86% in Mississippi. Some states, like Vermont, had most of their rises in alcohol death rates before the pandemic, with only 12% of the growth occurring during pandemic years. In contrast, Mississippi’s rates more than doubled over the past decade, and over half of that increase happened during pandemic years. Many factors may contribute to the differences in alcohol mortality rates across states, some of which may include differences in alcohol consumption and cultural attitudes, state-specific alcohol policies, and treatment rates (Figure 4).

Rural areas experienced faster growth in alcohol deaths than urban areas, driven by sharp rises during the pandemic. Deaths grew across both rural and urban areas in the past decade; however growth was fastest in rural areas–nearly doubling in the past decade and increasing by 35% during pandemic years. Existing shortages of mental health and substance use treatment professionals may make it particularly difficult to access care in rural areas, where the supply of behavioral health workforce is even more scarce. During the pandemic, telehealth services for behavioral health and other care may have been more accessible to those living in urban areas, where an internet connection is more likely to be available or reliable (Figure 5).

What factors may contribute to the increases in alcohol deaths in the past 10 years?

Alcohol contributes to more deaths than opioids and suicides when the alcohol conditions that contribute to death are included. Defining alcohol deaths can be complex due to the gradual onset of many conditions caused by or linked to alcohol and its ability to exacerbate or increase the risk of developing other health conditions. This analysis adopts the strictest definition of alcohol deaths, focusing on deaths that were directly caused by conditions directly due to alcohol, such as alcohol-related liver diseases. However, if deaths where alcohol conditions are a contributing factor listed on the death certificate —termed ‘alcohol-related deaths’—are included, the number of deaths increases to 105,308 in 2022, though some cases may overlap. This exceeds the numbers for opioid and suicide deaths, which also use this broader definition, totaling 83,437 and 49,594, respectively. Unlike the immediate effects of opioid overdoses or suicides, alcohol-related conditions often develop slowly over many years. These conditions can directly cause death or worsen other illness. For instance, it may take many years of heavy drinking before alcohol-associated liver diseases, the most common cause of alcohol deaths, to develop. This slower disease progression as well as the role of alcohol in exacerbating other conditions may contribute to the higher number of deaths counted under the expanded definition. The number of alcohol deaths rise even more when the criteria are broadened to include alcohol’s role in increasing the risk of death by other conditions or events, such as cancer or car accidents involving alcohol (Figure 6).

Rises in alcohol deaths may be attributed to a variety of factors including, in part, increases in drinking and low treatment rates. Alcohol consumption and some indicators of binge drinking have been on the rise in recent years, particularly among some demographic groups. Excessive alcohol consumption is tied to the development of alcohol-related diseases, which can be fatal. A variety of factors may have contributed to increases in drinking including a growing social acceptability of alcohol and loosening of alcohol policies at a state level. Other factors, such as increased stressors due to the pandemic and other issues may have increased drinking behaviors.

Treatment rates for alcohol use disorder are very low. Federal survey data show that in 2022, only 7.6% of people (12+) with a past year alcohol use disorder received any treatment. Although medications for alcohol use disorder have been shown to reduce or stop drinking, uptake of these medications is extremely low; with only 2.1% of people who meet criteria for an alcohol use disorder (diagnosed or not) receive medication treatment. Treatment rates are slightly higher among those who do receive a diagnosis–for instance, 10% of Medicaid enrollees diagnosed with an alcohol use disorder received medication, 34% received counseling services, and 74% received some type of interaction with a treatment, such as therapy, medication, assessment, or supportive service.

Barriers to alcohol use disorder treatment include a combination of provider, patient, financial, and infrastructure factors. Providers often lack confidence or knowledge in treating alcohol use disorder and are uncomfortable with medication and other treatment options, which may decrease the likelihood that they will manage treatment or make referrals. To address this, recent initiatives are enhancing education for both practicing and training providers through mandatory training programs and curriculum enhancements in medical schools. Further, recent changes to SUD confidentiality regulations are expected to simplify the diagnosis and coordination of care for individuals with substance use disorders (SUD). Insufficient treatment infrastructure or a shortage of a skilled workforce to staff facilities and deliver care can also play a role in treatment rates.

From the patient perspective, limited understanding of what constitutes problematic drinking and attitudes towards seeking treatment can hinder recognition of the need for help. For example, among those who meet the criteria for SUD—which may include symptoms like increased tolerance, repeated attempts to quit or control use, or social problems related to use–95% of adults did not seek treatment and didn’t think they needed it. Initiatives aimed at early screening in non-traditional settings, such as schools may help early detection and lead to more timely linkages of individuals to treatment resources. When people think they might need treatment, practical issues such as insurer coverage of services, locating a provider that will accept the patient’s insurance, availability of time off from work, childcare, and the affordability of treatment/out of pocket costs can also influence decisions about seeking or staying in treatment.