From the CEO: Drinking in America — Alcohol’s Hidden Toll and the Treatments We Continue to Overlook

Drinking is declining in America, especially among younger people.

The most recent National Survey on Drug Use and Health found that the share of people 12 and older who met criteria for alcohol use disorder fell to 8.9% in 2025 from 10.6% in 2021 — about 4 million fewer people.
 
That is welcome news. But alcohol remains one of the nation’s most normalized, damaging and accessible substances. It kills more people than any other drug, with deaths due to alcohol reaching 46,714 in 2024, the most recent year for which annual data is available.

It is not as if we don’t know the risks. Harvard researchers reported that 62 diseases are entirely attributable to alcohol, with dozens more exacerbated by alcohol. This does not mean every person who drinks alcohol will develop disease. It means our guidance should be clearer: less alcohol generally means less risk, and high levels of consumption are consistently dangerous.

So where are we falling short, and what can we do better?

Underused Treatments for Alcohol Use Disorder

Medication is alarmingly underused for alcohol use disorder (AUD), despite the fact that there are multiple medications approved by the Food and Drug Administration (FDA) to treat AUD. Naltrexone, acamprosate and disulfiram are the three most commonly prescribed medications (two other drugs are available but not widely prescribed).

Beyond medications proven to be effective, other potential treatments for AUD are emerging. GLP-1 receptor agonists, including semaglutide, are best known for treating diabetes and obesity, but they have shown promise in reducing alcohol use. They are not FDA-approved for AUD, but the potential seems clear. A small 2025 randomized trial found that once-weekly semaglutide reduced laboratory alcohol consumption, drinks per drinking day and craving.

Another small phase 2 trial of oral semaglutide also reported fewer heavy-drinking days. Larger studies, including a new Department of Veterans Affairs trial, are underway. The potential for GLP-1 medications to affect reward pathways and reduce craving and consumption deserves further study.

Barriers to Access and System Challenges

Having medications is one thing. Making them available to the people who need them is another.

A nationwide JAMA Network Open study found that the share of U.S. counties with a substance use treatment facility offering even one of the three FDA-approved medications to treat AUD rose from 34% in 2017 to 44% in 2021 and then stalled through 2023, with still fewer than half of all counties having a facility offering any MAUD. Rural, smaller and socioeconomically disadvantaged counties were least likely to have access.

This is a system failure. We have effective medications for AUD, but too many people still cannot get them. People with plaque psoriasis have an estimated 80 FDA-approved medications to choose from. That condition affects 1% of the nation’s population. Why do people with AUD – which affects an estimated 8.9% of the population, or 25.7 million people – have just three primary medications to choose from?

Improving Care and Reducing Stigma

We need routine screening in primary care, honest risk communication, treatment that respects both reduction and abstinence goals, broader access to medications, counseling and recovery supports. We also need to remove stigma from the equation because a person with AUD deserves evidence-based care, not judgment.

AUD is not a moral failure. It is a treatable medical condition. People can benefit from care whether their immediate goal is abstinence or reducing heavy drinking.

Recovery Resources and Support

As we observe Recovery Month, check out the resources we shared last week on AUD. The Providers Clinical Support System – Medications for Alcohol Use Disorder (PCSS-MAUD) and the National Council provided five new digital resources designed to provide practical, evidence-based information on alcohol use disorder (AUD) and related topics:

• Brief Conversations About Alcohol Use: A How-to Guide
• Alcohol-induced Cardiomyopathy
• Addressing Alcohol Use on College Campuses: A Communication Pathway
• Preventing Relapse and Return to Alcohol Use: A Clinical Conversation Guide
• Fetal Alcohol Spectrum Disorders: Fetal Alcohol Syndrome and Beyond

And I hope you will share this column with others who need to know that treatment works and recovery is possible. Let’s do all we can to make mental wellbeing — the foundation of living a strong, healthy and fulfilling life — a reality for everyone.