Written by Erin Yeh
Alcohol consumption remains one of the leading causes of illness and death in the United States, yet knowledge remains limited about how much alcohol drinking can be considered truly low-risk. To fill this gap, researchers at Columbia University’s Mailman School of Public Health conducted a comprehensive analysis to estimate the risk of alcohol-related disease and death over different levels of alcohol consumption. Their findings were published in Journal of Alcohol and Drug Studies (DOI: 10.15288/jsad.25-00435).
Reassessing low-risk drinking
The 2020-2025 US Dietary Guidelines recommend no more than two drinks per day for men and one drink per day for women on days they drink. However, the researchers believe that these recommendations should be reconsidered as new scientific evidence emerges, and should better reflect the cumulative health risks associated with alcohol over a lifetime.
To estimate those risks, the team first reviewed previous systematic reviews and meta-analyses linking alcohol consumption to a wide range of diseases and injuries. They then applied these risk estimates to real-world data on alcohol consumption, disease, and mortality. Finally, the team compared people with different drinking styles with lifelong abstainers.
The analysis was based on several large population-based surveys in the United States, including the National Alcohol Survey, the National Survey on Drug Use and Health, the National Health Interview Survey, the National Epidemiological Survey on Alcohol and Related Conditions-III, and the Behavioral Risk Factor Surveillance System. Mortality data were taken from the 2022 National Vital Statistics System.
The team estimated the lifetime risk of alcohol-related death or disease by developing models that took into account a person’s age, sex at birth, and drinking habits. This approach has also been used to calculate how much alcohol contributes to the risk of disease and death.
Lifetime risks still increase even when eating a smaller amount
The results showed that consuming more than seven drinks per week was associated with a risk of alcohol-related death of one in 1,000 for both men and women. This risk rises to one in 100 when consumption increases to more than 8.5 drinks per week for both sexes. For men who drank 14 drinks per week, their chances increased to one in 25. Moderate consumption (such as one drink per day) is associated with an increased risk of death from cirrhosis, cancer of the esophagus and mouth, and injury-related deaths. Among women, these risks extend to liver cancer, but some protective effect against diabetes has been observed.
The researchers also note that alcohol-related harms may be underestimated because risk estimates do not fully account for alcohol’s interactions with other substances, especially opioids. As drug use continues to rise in the United States, the exacerbation of alcohol’s risks when used with other substances must be taken into account when evaluating what is considered an acceptable risk.
Drinking patterns may also have influenced the results. While older adults may be more vulnerable to alcohol abuse due to age-related health conditions, younger adults are particularly at risk for frequent bouts of binge drinking, which contributes to an increased risk of alcohol-related injuries.
Some studies suggest that reduced alcohol consumption may have a positive effect on stroke, but this benefit can be negated by large amounts of alcohol, even if rare. The researchers also acknowledge that the BAC thresholds that were used to attribute injuries in the study do not take into account that alcohol can still impair a person’s abilities at lower levels. Research has shown that a BAC level of 0.02 to 0.04% actually shows a decline in driving skills, with 0.05% showing significant impairment. Studies show that drinking alcohol slowly while eating can reduce peak BAC levels. These results suggest that the risk of infection increases gradually as BAC levels rise and not just after a person reaches the legal limit.
Limitations to consider
There were several limitations to the study. First, researchers found no systematic reviews on how alcohol consumption increases the risk of sexually transmitted infections, cervical cancer, depression, or alcohol use disorder. As such, these conditions were not included in the analysis.
Second, the team adjusted alcohol consumption to match alcohol sales data, while risk estimates from previous studies were based on self-reported drinking habits. For this reason, the results reflect average drinking patterns across the population and not differences in how individuals drink.
Previous studies may also have different definitions of lifetime abstinence. Some participants who were classified as lifelong abstainers may be former drinkers who stopped drinking due to health problems, causing bias (also known as “morbidity bias”). This may have made the abstinent group appear less healthy than they were, and influenced their estimate of the true health risks of alcohol.
Estimates of alcohol-related injury also have limitations due to varying methods and definitions of injury. Although alcohol clearly increases the risk of injury, these differences make it difficult to estimate the exact number of injuries and deaths caused by alcohol. Finally, the researchers note that lifetime risk estimates depend on how uncertainty is measured, meaning that true risks may be higher or lower than reported estimates.
Revisiting alcohol guidelines
The findings suggest that the health risks associated with alcohol begin at lower levels of consumption than most people may realize. Health risks increase even when consuming only one drink a day, and excessive drinking increases the risk of breast cancer, cardiovascular disease, and injuries. The team also emphasizes that a person’s age, drinking patterns, and other individual factors can influence alcohol-related risks.
According to a 2025 survey, only 56% of American adults reported being aware that alcohol can cause cancer. The research team calls for broader public education efforts and media interventions to raise public awareness of the health risks associated with alcohol. They also advise reducing alcohol consumption at the population level through control policies and restrictions on when alcohol is sold. Public health policies and programs should focus specifically on drinking patterns, especially heavy drinking, rather than focusing only on average consumption. Routine alcohol screening and tracking drinking patterns among different population groups can help guide more effective public health policies.
