Summary: A new comprehensive review reinforces the substantial toll alcohol consumption takes on global health. The research highlights that over 60 diseases and injuries are 100% attributable to alcohol.
While some short-term and cardiovascular harms can be reversed or slowed through abstinence, the authors conclude that alcohol remains a major driver of disease and injury, with its overall harms decisively outweighing any potential benefits.
Key Facts
- 100% Attributable Conditions: The World Health Organization’s ICD-11 lists over 60 diseases and injuries completely caused by alcohol, including alcoholic cardiomyopathy, liver cirrhosis, and fetal alcohol syndrome.
- Infectious Disease Susceptibility: Alcohol impairs liver function and weakens immune responses, significantly increasing the risk of contracting infectious diseases such as tuberculosis, pneumonia, and HIV/AIDS.
- Broad Systemic Harms: Alcohol consumption is a known partial cause of five major categories of non-communicable diseases, spanning type 2 diabetes, neuropsychiatric disorders (dementia, epilepsy), gastrointestinal diseases, and multiple cancers.
- Reversibility Is Conditional: Short-term injury risks decrease immediately upon stopping drinking, and some cardiovascular markers improve within weeks. However, brain damage may only partially recover, and chronic diseases like cirrhosis are not fully reversible.
Source: Society for the Study of Addiction
A new review published in the journal Addiction confirms drinking causes substantial harm to health.
Some of those harms may be reversible if the person reduces or stops drinking.
- Over sixty diseases and injuries are 100% attributable to alcohol consumption: The World Health Organization’s current (11th) edition of the International Classification of Diseases lists over 60 diseases and injuries that are 100% attributable to alcohol, including alcoholic cardiomyopathy (heart disease), alcoholic liver diseases such as cirrhosis, and foetal alcohol syndrome. Most of these are a result of heavy drinking.
- Several infectious diseases are partly attributable to alcohol consumption: Recent reviews confirm that alcohol increases the risk of infectious disease, including tuberculosis, pneumonia, HIV/AIDS, and other sexually transmitted diseases. Alcohol damages liver function and weakens immune responses, making people more susceptible to infections.
- Many non-infectious diseases are partly attributable to alcohol consumption: There are five broad categories of non-communicable diseases linked to alcohol consumption:
- cancer (mouth, pharynx, larynx, oesophagus, colon, rectum, liver, breast, cervix)
- cardiovascular disease (high blood pressure, cardiomyopathy, ischaemic heart disease, atrial fibrillation, stroke)
- type 2 diabetes
- neuropsychiatric disease (dementia, epilepsy)
- gastrointestinal disease (liver cirrhosis, pancreatitis).
- Many injuries are partly attributable to alcohol consumption: Alcohol impairs balance, reaction time, and judgment even at low intake levels, increasing the risk of injuries. Injury risk depends on both how much is consumed and contextual factors such as environment, activity, and other substance use. Alcohol increases the risk of traffic injuries, falls, and violence – including harm to others.
Some of the above harms can be reversed by reducing or stopping drinking:
- Short‑term risks, such as injuries or sexually transmitted infections, mainly occur during intoxication and the risk decreases when drinking stops.
- Alcohol temporarily weakens the immune system. Although the immune system may recover after stopping drinking, long‑term heavy drinking can cause lasting damage.
- Many chronic alcohol‑related diseases, such as cirrhosis and heart disease, are not fully reversible. However, reducing drinking can slow disease progression, even if some damage remains. Some cardiovascular harms improve within days to weeks of abstinence.
- Brain damage from heavy drinking may partially recover with long‑term abstinence, though risks such as dementia can persist.
Senior author Dr. Jürgen Rehm, Senior Scientist at the Canadian Centre for Addiction and Mental Health (CAMH), comments: “Even though we now know a lot about alcohol’s effects on health, it is still controversial whether a little drinking is good for your heart.
“When examining both cohort studies and Mendelian randomisation studies, and all their potential strengths and biases, we conclude that there is not enough evidence to rule out a beneficial effect of drinking on ischaemic heart disease and ischaemic stroke.”
Sinclair Carr, first author of the review, adds: “Our review of the current evidence on alcohol’s effects on health leads to a cautious but clear conclusion: alcohol is a major cause of disease and injury, and its harms outweigh any potential benefits.”
Sinclair Carr is a PhD candidate at the Department of Epidemiology, Harvard T.H. Chan School of Public Health.
Funding information Research reported in this publication was supported by the National Institute on Alcohol Abuse and Alcoholism of the National Institutes of Health (NIAAA), grant number 1R01AA028224. Content is the responsibility of the authors and does not reflect official positions of NIAAA or the National Institutes of Health.
Key Questions Answered:
A: It remains controversial. Senior author Dr. Jürgen Rehm notes that looking at cohort and genetic studies, scientists cannot entirely rule out a slight beneficial effect on ischaemic heart disease and stroke. However, first author Sinclair Carr warns that the cumulative evidence shows alcohol’s overall harms heavily outweigh any potential benefits.
A: Your body gets an immediate break. Short-term risks from intoxication disappear, your immune system bounces back from temporary suppression, and certain cardiovascular harms can show measurable improvement within days to weeks of abstinence.
A: It depends on the stage. While early immune and liver functions can recover, chronic alcohol-related diseases like full-blown cirrhosis are not fully reversible. Quitting or reducing intake won’t erase the scarring, but it will crucially slow down the disease’s progression.
Editorial Notes:
- This article was edited by a Neuroscience News editor.
- Journal paper reviewed in full.
- Additional context added by our staff.
About this health and addiction research news
Author: Jean O’Reilly
Source: Society for the Study of Addiction
Contact: Jean O’Reilly – Society for the Study of Addiction
Image: The image is credited to Neuroscience News
Original Research: Open access.
“A review of the relationship between dimensions of alcohol consumption and the burden of disease: 2026 update including Mendelian randomisation studies” by Sinclair Carr, Ana Lucia Espinosa Dice, Gerhard E. Gmel Sr., Ahmed S. Hassan, Kevin D. Shield, Jürgen Rehm. Addiction
DOI:10.1111/add.70435
Abstract
A review of the relationship between dimensions of alcohol consumption and the burden of disease: 2026 update including Mendelian randomisation studies
Background and aims
Evidence on the causal impact and corresponding risk relationships between dimensions of alcohol consumption and health outcomes continues to evolve, with some contradictory findings across study designs. This review aimed to update current knowledge on causality and risk relationships to inform global and national comparative risk assessments for alcohol.
Methods
Fully alcohol-attributable conditions were identified using International Classification of Diseases (ICD) 10th and 11th revision codes. We conducted a scoping review of meta-analyses of cohort studies on average consumption and health outcomes (56 reviews), a systematic review of Mendelian randomisation (MR) studies on alcohol and ischaemic heart disease (IHD; 20 studies), and narrative syntheses on injuries, biological pathways, and reversibility of effects.
Results
ICD-11 provides more detailed categories, defining 62 fully alcohol-attributable conditions compared with 48 in ICD-10. Meta-analyses support monotonic increasing dose–response relationships between average consumption and most attributable health outcomes within infectious diseases, cardiovascular diseases, cancers, and digestive diseases.
Relationships are J-shaped for IHD, ischaemic stroke, and type 2 diabetes, with lower risk at low-to-moderate consumption (generally only without heavy episodic drinking).
For dementia, heavy drinking is harmful and, among non-heavy drinkers, relationships are age-specific. MR evidence for IHD largely suggested null or harmful relationships, but only three studies tested non-linear effects. In our view, the overall synthesis indicates that current MR evidence is insufficient to refute a J-shaped relationship for IHD.
Injury risk is driven primarily by acute intoxication and includes substantial harm to others. Acute risks are reversible with reductions in drinking or abstention, whereas many chronic disease processes are only partly reversible.
Conclusions
Epidemiological evidence to inform comparative risk assessments for alcohol is comprehensive, but prone to major limitations. Triangulation, alongside biological plausibility, can strengthen synthesis across cohort and Mendelian randomisation studies, and the target trial framework can help future studies avoid design-induced biases. Comparative risk assessments with ischaemic heart disease should, at this point, prioritise evidence from cohort studies.
