No Such Thing as “Moderate” with Alcohol Consumption

By Irene Yeh 

Alcohol consumption remains one of the leading causes of disease and death in the U.S., yet there is still limited knowledge about how much drinking can truly be considered low risk. To address that gap, researchers at Columbia University Mailman School of Public Health conducted a comprehensive analysis to estimate the lifetime risk of alcohol-related illness and death across different levels of alcohol consumption. Their findings were published in Journal of Studies on Alcohol and Drugs (DOI: 10.15288/jsad.25-00435). 

Reassessing Low-Risk Drinking 

The 2020-2025 U.S. Dietary Guidelines recommends no more than two drinks per day for men and one drink per day for women on days they drink. However, the researchers argue that these recommendations should be revisited 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 those risk estimates to real-world data on alcohol consumption quantity, disease, and mortality. Finally, the team compared people with different drinking patterns with lifetime abstainers.  

The analysis drew on several large U.S. population-based surveys, including the National Alcohol Survey, the National Survey on Drug Use and Health, the National Health Interview Survey, the National Epidemiologic Survey on Alcohol and Related Conditions–III, and the Behavioral Risk Factor Surveillance System. Mortality data was taken from the 2022 National Vital Statistics System.  

The team estimated lifetime risk of alcohol-related death or illness by developing models that considered the person’s age, sex-at-birth, and drinking habits. This approach was also used to calculate how much alcohol contributes to both the risk of disease and death.  

Lifetime Risk Still Increases Even at Lower Intake 

The results showed consuming more than seven drinks per week was associated with a one in 1,000 lifetime risk of alcohol-related death for both men and women. This risk increased to one in 100 when consumption increased to more than 8.5 drinks a week for both sexes. For men who drank 14 drinks a week, their chances increased to one in 25. Moderate consumption (e.g. one drink per day) correlated with increased risk of death from liver cirrhosis, esophageal and oral cancers, and injury-related deaths. Among women, these risks extend to liver cancer, but there was some protective effect against diabetes mellitus observed.  

The researchers also note that alcohol-related harm may be underestimated because risk estimates do not fully account for alcohol’s interactions with other substances, particularly opioids. As substance abuse continues to rise in the U.S., compounding risks of alcohol when used with other substances must be factored in when evaluating what is considered an acceptable risk. 

Drinking patterns may have also affected the outcomes. While older adults may be more susceptible to alcohol because of age-related health conditions, younger adults are especially at risk of more frequent binge drinking episodes, which contribute to increased risk of alcohol-related injuries.  

Some studies suggest that low alcohol consumption may have a positive influence on ischemic stroke, but this benefit could be negated by heavy drinking occasions, even if it’s infrequent. The researchers also acknowledge that BAC thresholds that were used to attribute injuries in the study do not account that alcohol can still impair a person’s abilities at lower levels. Research has shown that a BAC level of .02 to .04% already show a decline in driving skills, with a .05% showing noticeable impairment. Studies show that consuming alcohol slowly while eating can reduce peak BAC levels. These findings suggest that the risk of injury increases gradually as BAC levels rise rather than only after a person reaches the legal limit. 

Limitations to Consider 

There were several limitations to the study. First, the researchers found no systemic reviews on how alcohol consumption may increase risk of STDs, 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 the risk estimates from previous studies were based on self-reported drinking habits. Because of this, the results reflect average drinking patterns across the population rather than the differences in how individual people drink.  

Previous studies may also have had different definitions of lifetime abstainers. Some participants categorized as lifetime abstainers may be former drinkers who quit because of health issues, causing bias (also known as “sick-quitter bias”). This may have made the abstainer group appear less healthy than it was and affect the estimation of the true health risks of alcohol. 

Alcohol-related injury estimations also have limitations because of  different methods and definitions of injury. Although alcohol clearly increases injury risk, these differences make it harder 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 the true risks may be higher or lower than the reported estimates. 

Rethinking Alcohol Guidance 

The findings suggest that alcohol-related health risks begin at lower levels of consumption than most people may realize. Health risks increase even at just one drink a day, and heavy drinking further 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 information interventions to raise public awareness of alcohol-related health risks. They also advise reducing alcohol intake on a population level through control policies and limits on when alcohol can be sold. Public health policy and programs should particularly focus on drinking patterns, especially binge drinking, rather than focus only on average intake. Routine alcohol screening and tracking drinking patterns across different populations could also help inform more effective public health policies.