Nearly 33 Million Americans Have a Drinking Problem and Millions More Engage in Risky Alcohol Use | Center on Addiction

Nearly 33 Million Americans Have a Drinking Problem and Millions More Engage in Risky Alcohol Use

Nearly 33 Million Americans Have a Drinking Problem and Millions More Engage in Risky Alcohol Use


The journal JAMA Psychiatry recently published a widely reported study demonstrating that alcohol use disorders affect almost 33 million adults in the U.S. and most have never sought treatment.

The Treatment Gap

These findings are consistent with CASAColumbia’s research on this issue, presented in our 2012 Addiction Medicine report, which describes the large gap between the need for treatment and the number of people who receive it as well as the primary reasons for this gap. We found that nearly half of the adults sampled said they would turn to a health professional if someone close to them needed help for addiction; yet national data indicate that health care providers are one of the least likely sources of referrals to addiction treatment.

There are many reasons for the ‘treatment gap,’ including inadequate awareness about addiction as a treatable medical disease, reluctance on the part of health professionals to address it, and insufficient funding for effective research-based treatment.

The Silent Epidemic of Risky Drinking

Although the emphasis on the millions of adults who have diagnosable alcohol problems is warranted, it is important not to dismiss the millions more who engage in risky or excessive drinking, but do not have an alcohol use disorder diagnosis.

Analysis of national data by CASAColumbia researchers found that 20 to 30 percent of adults aged 21 and older engage in risky or excessive drinking. Nearly one in five engages in binge drinking and almost 5 percent engage in heavy binge drinking (binge drinking five or more times in the past 30 days) without meeting the criteria for an alcohol use disorder. 

The limited role health care professionals play in connecting people with alcohol use disorders to addiction treatment is driven largely by the limited role most play in identifying any alcohol problems in their patients. Most health professionals do not adequately screen for alcohol use and often overlook excessive or risky drinking among their patients. The screening tools that some do use to detect alcohol use risk largely focus on symptoms that might be indicative of alcoholism and are less able to detect risky or excessive drinking and their associated problems. This is despite the facts that:

  1. The vast majority (about 90 percent) of excessive drinkers do not have a diagnosable alcohol problem
  2. Excessive alcohol use itself is a leading preventable cause of death in the U.S., accounting for one in 10 deaths among working-age adults nationally
  3. Detecting excessive drinking early and intervening appropriately can help to reduce the incidence of alcohol use disorders, and the need for more extensive and costly treatment 

Impact of Alcohol

Aside from death, the more immediate health effects of excessive drinking include impairment in cognition, reaction time, coordination, and neural, hormonal and respiratory functioning. Long-term alcohol use is associated with a host of health problems, including an increased risk of cancer, high blood pressure, stroke, liver problems, diabetes and psychiatric disorders.

The economic costs of alcohol-related health care, productivity loss, and other consequences are staggering. And excessive drinking has been associated with the use of other addictive substances and other mental health problems, as the JAMA study and CASAColumbia’s research demonstrate.

Ensuring adequate treatment for the millions of people with alcohol use disorders is essential. However, focusing only on individuals who meet the diagnostic criteria for alcohol use disorders risks missing an important opportunity to help the even larger proportion of adults who engage in risky, but not disordered, drinking. 

  Linda Richter, PHD

  Linda Richter is Director of Policy Research and Analysis at 





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