Alcohol has historically, and continues to, hold an important role in social engagement and bonding for many. Social drinking or moderate alcohol consumption for many is pleasurable and perceived to reduce stress and anxiety.
However, it’s also known that alcohol consumption – especially in excess – is linked to a number of negative outcomes: as a risk factor for diseases and health impacts; crime; road incidents; and for some, alcohol dependence.
This entry looks at the data on global patterns of alcohol consumption, patterns of drinking, beverage types, the prevalence of alcoholism; and consequences, including crime, mortality and road incidents.
Data on other drug use can be found at our full entry here. Drug Use disorders are often classified within the same category as Mental Health disorders — data on mental health can be found at our entry here.
Support for alcohol dependency
At the end of this entry you will find additional resources and guidance if you, or someone you know needs support in dealing with alcohol dependency.
Long-run data on alcohol consumption from the United States gives us one perspective of drinking since 1850. In the chart below we see the average consumption (in litres of ethanol) of different beverage types per person in the USA from 1850 through to 2013.
Over this long time period we see that per capita drinking quantities have been relatively constant — typically averaging around 8 to 9 litres per year. Over the period 1920-1933, there was a ban on the production, importation, transportation, and sale of alcoholic beverages in the United States (known as the ‘National Alcohol Prohibition’). Since the statistics below reflect reported sales and consumption statistics, they assume zero consumption of alcohol over this time. However, there is evidence that alcohol consumption continued through black market and illegal sales, particularly in the sales of spirits. It’s estimated that at the beginning of Prohibition alcohol consumption decreased to approximately 30 percent of pre-prohibition levels, but slowly increased to 60-70 percent by the end of the period.1
As we see, following prohibition, levels of alcohol consumption returned to the similar levels as in the pre-prohibition period.
Alcohol consumption varies significantly across the world. The map below shows the average per capita alcohol consumption for individuals aged 15 and older. To account for the differences in alcohol content of preferred drinks (e.g. beer, wine, spirits), this is reported in litres of pure alcohol per year.
We see large geographical differences: Alcohol consumption across North Africa and the Middle East is particularly low — in many countries, close to zero. At the upper end of the scale, alcohol intake across Eastern Europe is highest at 14-17 litres per person per year across Belarus, Russia, Czech Republic and Lithuania.
The charts below shows the prevalence of drinking in adults. This is first shown as the share of adults who have drunk alcohol within the last year and it is then broken down by sex, and the prevalence of heavy drinking in adults. Heavy drinking is typically measured as having more than 6 standard alcohol drinks within a single session.
Overall we see that in terms of the share of the prevalence (not intensity) of drinking is highest across Western Europe and Australia. In 2010, close to 95 percent of adults in France had drunk alcohol in the preceding year. Again, the prevalence of drinking across North Africa and the Middle East is notably lower than elsewhere. Typically 5-10 percent of adults across these regions drunk within the preceding year, and in a number of countries this was below 5 percent.
When we look at gender differences we see that in all countries men are more likely to drink than women. This gender difference appears to be lowest in countries where the overall prevalence of drinking high. Where drinking prevalence is low-to-mid range, the prevalence of drinking in women tends to be significantly lower (often less than half the rates of men).
Alcohol consumption – whilst a risk factor for a number of health outcomes – typically has the greatest negative impacts when consumed within heavy sessions. This pattern of drinking is often termed ‘binging’, where individuals consume large amounts of alcohol within a single session versus small quantities more frequently. As shown in the charts below, the occurrence of heavy drinking shows a notably different pattern from total prevalence. In Madagascar, 65 percent of drinkers had a heavy session of drinking within the preceding month. Lithuania, Paraguay, Finland, Mongolia, Austria and Benin all had more than 50 percent of drinkers having a heavy session within the prior month.
Data on the share who drink alcohol by gender and age group in the UK is available here.
Heavy episodic drinking is defined as the proportion of adult drinkers (aged 15 and older) who have had at least 60 grams or more of pure alcohol on at least one occasion in the past 30 days. An intake of 60 grams of pure alcohol is approximately equal to 6 standard alcoholic drinks. The chart below shows the share of drinkers only (i.e those who have drank less than one alcohol drink in the last 12 months are excluded) who had a heavy episode of drinking in the previous 30 days.
Here we see large differences in drinking patterns across the world. In Madagascar, more than two-thirds of drinkers had a heavy episode of drinking in the previous month (despite their overall alcohol consumption being relatively low). In contrast, across most of Africa and South Asia this was the case for less than 5 percent of drinkers. Even within regions there are large differences between countries: in Italy, only 6 percent of drinkers had a heavy episode of drinking in contrast to nearly half in Ireland; 42 percent in Belgium one-third in the UK and France; and 20 percent in Spain.
Global trends on alcohol abstinence show a mirror image of drinking prevalence data. This is shown in the charts below as the share of adults who had not drunk in the prior year, and those who have never drunk alcohol. Here we see particularly high levels of alcohol abstinence across North Africa and the Middle East. In most countries in this region, more than 80 percent (often more than 90 percent) have never drunk alcohol.
Data on the share who don’t drink alcohol by gender and age group in the UK is available here.
The charts below show global consumption of beer, first in terms of beer as a share of total alcohol consumption, and then the estimated average consumption per person. These are both measured in terms of pure alcohol/ethanol intake, rather than the total quantity of the beverage.
The charts below show global consumption of wine, first in terms of wine as a share of total alcohol consumption, and then the estimated average consumption per person. These are both measured in terms of pure alcohol/ethanol intake, rather than the total quantity of the beverage.
The charts below show global consumption of spirits (which are distilled drinks including gin, rum, whisky, tequila and vodka), first in terms of spirits as a share of total alcohol consumption, and then the estimated average consumption per person. These are both measured in terms of pure alcohol/ethanol intake, rather than the total quantity of the beverage.
Alcohol use disorder, also known as alcohol dependence, is defined by the IHME based on the definition within the WHO’s International Classification of Diseases (ICD-10). At the end of this entry we provide a number of potential sources of support and guidance for those concerned about uncontrolled drinking or alcohol dependency.
A definite diagnosis of dependence should usually be made only if three or more of the following have been present together at some time during the previous year:
- (a) a strong desire or sense of compulsion to take the substance;
- (b) difficulties in controlling substance-taking behaviour in terms of its onset, termination, or levels of use;
- (c) a physiological withdrawal state when substance use has ceased or been reduced, as evidenced by: the characteristic withdrawal syndrome for the substance; or use of the same (or a closely related) substance with the intention of relieving or avoiding withdrawal symptoms;
- (d) evidence of tolerance, such that increased doses of the psychoactive substance are required in order to achieve effects originally produced by lower doses (clear examples of this are found in alcohol- and opiate-dependent individuals who may take daily doses sufficient to incapacitate or kill nontolerant users);
- (e) progressive neglect of alternative pleasures or interests because of psychoactive substance use, increased amount of time necessary to obtain or take the substance or to recover from its effects;
- (f) persisting with substance use despite clear evidence of overtly harmful consequences, such as harm to the liver through excessive drinking, depressive mood states consequent to periods of heavy substance use, or drug-related impairment of cognitive functioning; efforts should be made to determine that the user was actually, or could be expected to be, aware of the nature and extent of the harm.
The charts shown below present global data on the prevalence, disease burden and mortality cost of alcohol use disorders.
It’s estimated that globally around 1.4 percent of the population have an alcohol use disorder. At the country level, as shown in the chart below, this ranges from around 0.5 to 5 percent of the population. In Russia, for example, the prevalence is 4.7 percent meaning that almost 1-in-20 have an alcohol dependence at any given time.
When we look at the variance in prevalence across age groups we see that globally the prevalence is highest in those aged between 25 and 34 years old (for which around 2.5 percent of the population have an alcohol use disorder). At the extreme of country-level figures, prevalence amongst Russians aged 30-34 years old is just under 10 percent. This means 1-in-10 Russians in this age group has an alcohol dependency.
Globally, 107 million people are estimated to have an alcohol use disorder. This breakdown can be viewed by gender for any country here; 70 percent globally (75 million) were male relative to 32 million females.
The scatterplot below compares the prevalence of alcohol use disorders in males versus that of females. In 2017 — with the exception of Ukraine — the prevalence of alcohol dependence in men was higher than in women across all countries.
Deaths from alcohol dependence can occur both directly or indirectly. Indirect deaths from alcohol use disorders can occur indirectly through suicide. In our entry on Mental Health, we discuss the link between mental health and substance use disorders with suicide. Although clear attribution of suicide deaths is challenging, alcohol use disorders are a known and established risk factor. It’s estimated that the relative risk of suicide in an individual with alcohol dependence is around 10 times higher than an individual without.2
The chart below shows direct death rates (not including suicide deaths) from alcohol use disorders across the world. In 2017, Belarus had the highest death rate with around 19 people per 100,000 individuals dying from alcoholism. For most countries this rate ranges from 1 to 5 deaths per 100,000 individuals.
It’s estimated that globally, around 185,000 people died directly from alcohol use disorders in 2017. The total estimated number of deaths by country from 1990 to 2017 are found here.
Measuring the health impact by mortality alone fails to capture the impact that alcohol use disorders have on an individual’s wellbeing. The ‘disease burden‘ – measured in Disability-Adjusted Life Years (DALYs) – is a considers not only mortality, but also years lived with disability or health burden. The map below shows DALYs per 100,000 people which result from alcohol use disorders.
DALY rates differentiated by age group can be found here.
Global data on the prevalence and effectiveness of alcohol use disorder treatment is very incomplete. In the chart below we see data across some countries on the share of people with an alcohol use disorder who received treatment. This data is based on estimates of prevalence and treatment published by the World Health Organization (WHO).
Does alcohol consumption increase as countries get richer? In the chart below we see the relationship between average per capita alcohol consumption (in litres of pure alcohol per year) versus gross domestic product (GDP) per capita, across countries.
When we look at national averages in this way there is not a distinct relationship between income and alcohol consumption. As shown by clusters of countries (for example, Middle Eastern countries with low alcohol intake but high GDP per capita), we tend to see strong cultural patterns which tend to alter the standard income-consumption relationship we may expect.
However, when we looking at consumption data within given countries, we sometimes do see a clear income correlation. Taking 2016 data in the UK as an example we see that people within higher income brackets tend to drink more frequently. This correlation is also likely to be influenced by other lifestyle determinants and habits; the UK ONS also report that when grouped by education status, those with a university tend to drink more in total and more frequently than those of lower education status. There are also differences when grouped by profession: individuals in managerial or professional positions tend to drink more frequently than those in intermediate or manual labour roles.3
However, we also find correlates in drinking patterns when we look at groupings of income, education or work status. Although those in lower income or educational status groups often drink less overall, they are more likely to have lower-frequency, higher-intensity drinking patterns. Overall these groups drink less, but a higher percentage will drink heavily when they do.
The chart below shows the average share of household expenditure which is spent on alcohol. Data on alcohol expenditure is typically limited to North America, Europe and Oceania. Alcohol expenditure typically ranges from 0.5 percent up to 7.7 percent (in Ireland) of household expenditure.
Do countries with higher average alcohol consumption have a higher prevalence of alcohol use disorders? In the chart below we see alcohol dependency prevalence versus the average per capita alcohol consumption. Overall there is not a clear relationship between the two, although there may be a slight positive correlation, particularly when viewed by region (e.g. in Europe). There is not, however, clear evidence that high overall consumption (particularly in moderate quantities) is connected to the onset of alcohol dependency.
Alcohol consumption is a known risk factor for a number of health conditions and potential mortality cases. Alcohol consumption has a causal impact on more than 200 health conditions (diseases and injuries).
In the chart below we see estimates of the alcohol-attributable fraction (AAF), which is the proportion of deaths which are caused or exacerbated by alcohol (i.e. that proportion which would disappear if alcohol consumption was removed). Across most countries the proportion of deaths attributed to alcohol consumption ranges from 2 to 5 percent. However, across a range of countries this share is much higher; across Eastern Europe (Russia, Ukraine, Belarus and Lithuania), nearly one-third of deaths are attributed to alcohol consumption.
Many of the risk factors for alcohol dependency are similar to those of overall substance use disorders (including illicit drug disorders). Further discussion on these risk factors can be found at our entry on Substance Use.
In the chart below we show results from a study conducted published by Swendsen et al. (2010).4 In this study the authors followed a cohort of more than 5000 individuals, with and without a mental health disorder (but without a substance use disorder) over a 10-year period. Following the 10 year period they re-assessed such individuals for whether they had either a nicotine, alcohol or illicit drug dependency.5
The results in the chart below show the increased risk of developing alcohol dependency (we show results for illicit drug dependency in our entry on Substance Use) for someone with a given mental health disorder (relative to those without). For example, a value of 3.6 for bipolar disorder indicates that illicit drug dependency became more than three time more likely in individuals with bipolar disorder than those without. The risk of an alcohol use disorder is highest in individuals with intermittent explosive disorder, dysthymia, ODD, bipolar disorder and social phobia.
Whilst the World Health Organization (WHO) and most national guidelines typically quantify one unit of alcohol as equal to 10 grams of pure alcohol, the metric used as a ‘standard measure’ can vary across countries. Most countries across Europe use this 10 grams metric, however this can vary with several adopting 12 or 14 grams per unit.
In North America, a unit is typically taken as 14 grams of pure alcohol. In Japan, this is as high as 20 grams per unit.
Institute of Health Metrics & Evaluation (IHME), Global Burden of Disease (GBD)
- Data: Deaths, DALYs and prevalence of mental health and substance use disorders, by age and sex
- Geographical coverage: Global by country and region
- Time span: 1990 – 2016
- Available at: http://ghdx.healthdata.org/gbd-results-tool
World Health Organization (WHO) International Classification of Diseases (ICD)
World Health Organization. (1992). The ICD-10 classification of mental and behavioural disorders: clinical descriptions and diagnostic guidelines (Vol. 1). World Health Organization.
- Data: Definitions and classifications of mental and substance use disorders
- Available at: ICD-10 Classification of Mental and Behavioural Disorders
World Health Organization (WHO) Global Health Observatory (GHO)
- Data: Prevalence of substance use disorders, trends in alcohol consumption
- Geographical coverage: Global by country
- Time span: Variable depending on datasets. Most inconsistent years post-2000
- Available at: http://www.who.int/gho/en/
Alcohol Rehab Guide
- Information: Guidance on the signs of alcoholism, unhealthy drinking behaviours, and support on where to go for help
- Geographical coverage: universal guidance; support options for the United States
- Available at: https://www.alcoholrehabguide.org/support/
- Information: List and contact details of a range of places for support on alcohol issues
- Geographical coverage: United Kingdom
- Available at: https://www.drinkaware.co.uk/alcohol-support-services/
Alcohol Help Center
- Information: Free guidance, support and discussion groups on concerns related to alcohol
- Geographical coverage: global
- Available at: http://www.alcoholhelpcenter.net/
- Information: Test to assess your drinking patterns relative to the US population
- Geographical coverage: Global; assesses relative to US drinking patterns
- Available at: What’s your drinking pattern?