Researchers used two behavioral science-backed methods to prompt clinicians to prescribe the medication, called naltrexone, to qualified patients, resulting in a 15-fold increase in the likelihood that a patient would leave the emergency department with a prescription. The research from the Perelman School of Medicine at the University of Pennsylvania was recently published in the Annals of Emergency Medicine.

“Nationally, because of stigma and a lack of awareness, we are missing out on a huge opportunity to offer effective treatment to patients who struggle with alcohol,” said first author Jeffrey Ebert, PhD, the director of Applied Behavioral Science at Penn Medicine’s Nudge Unit. “Our work shows that it only takes a small adjustment to make a huge impact on who gets the medicine they need.”

Demonstrating an effective medication with few prescriptions

A 2023 national study found that only 1.9 percent of people with AUD received medication to treat their condition. The initiation of naltrexone in the emergency department is significantly lower: Just 0.5 percent of patients presenting with alcohol use disorder received a prescription from the emergency department.

But, the positive effects of naltrexone have been demonstrated: Compared to those taking placebos, 1 in 11 patients with alcohol use disorder quit drinking altogether when taking naltrexone, with the typical patient reducing their heavy drinking days­­­—characterized as four-plus drinks a day for women, and five-plus for men—by one to two days per month.

With this in mind, the Nudge Unit researchers decided to use Penn Medicine’s own emergency departments to establish a potential solution to spur higher naltrexone prescription numbers.

They employed nudges in two phases:

• The first phase, initiated in March 2024 involved establishing a standardized set of steps for caring for a patient potentially presenting with alcohol use disorder or other forms of problematic drinking, and a formatted discharge order that included a prepopulated order for a naltrexone prescription.
• The second phase began three months later, in August 2024. This phase added questions about alcohol to the typical triage questions nurses asked, and a banner alert in patients’ electronic health records if they had screened potentially positive for harmful drinking. Clicking on it immediately sent the physician to the standardized steps for treating these types of patients and the naltrexone order.

“We were very cognizant of the ‘alert fatigue’ that clinicians experience, so we were sure to make the emergency department electronic health record screening prompts and pre-populated orders seamless, user-friendly, and removed some dated components to make sure there was no extra clutter or time burden,” said senior author M. Kit Delgado, MD, MS, faculty director of the Nudge Unit and an associate professor of Emergency Medicine.

Seeing big increases

The nudges were implemented in four hospitals across the University of Pennsylvania Health System, with two others serving as controls.

At baseline, which included data from two-and-a-half years before the nudges started, only 13 (0.2 percent) of patients with an alcohol-related diagnosis received a naltrexone prescription from the emergency department.

When the nudges began, however, 2.7 percent of these patients were prescribed naltrexone during Phase 1. In Phase 2, that rate increased to 3.2 percent, resulting in 99 patients being prescribed naltrexone in just over a year.

In comparison, at the hospitals with no nudging, naltrexone prescribing remained close to 0 (just 0.3 percent of patients with an alcohol-related diagnosis received a prescription).

The jumps in ordering at the nudge hospitals translated to a 12-fold increase in the likelihood of receiving a naltrexone prescription in the Phase 1 period, and a 15-fold increase during Phase 2.

“Before our intervention, only a handful of experts prescribed naltrexone, and only one patient every couple months left with a prescription,” Ebert explained. “It just wasn’t something routinely done in the emergency department. After our intervention, 46 different clinicians prescribed it, with two patients each week, on average, getting a prescription.”

Implemented elsewhere in Philly…and Bhutan

Amid their findings, study-co-author Jeanmarie Perrone, MD, a professor of Emergency Medicine and the founding director of the Penn Medicine Center for Addiction Medicine and Policy, emphasized the opportunity for spreading the word to other physicians about naltrexone.

“There are highly effective, underutilized, low-cost medications for alcohol use disorder, a disease that affects roughly one in 10 Americans,” said Perrone. “It’s something that, likely, many in our own community have been affected by in their loved ones or personally, so it would be helpful to spread information about these good, accessible treatments.”

Already, the team is working to apply their methods to other emergency departments in the health system that didn’t originally get the nudges.

The team was also called upon to implement their work in low-resource settings like Philadelphia’s Puentes de Salud. The learnings are also being applied further afield: Emergency departments in Bhutan are adopting the nudges, too.

The researchers are also exploring how they could expand screening for alcohol misuse in primary care and effectively connect people to treatment.

This study was supported by philanthropic donations directed to the Penn Medicine Nudge Unit.

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The warning label currently required on alcohol containers in the United States has not changed since its adoption in 1988, despite new evidence linking alcohol to several diseases. The label states the risks of drinking during pregnancy and while driving or operating machinery and warns generally that drinking alcohol “may cause health problems.” The label often goes unnoticed and unremembered by consumers.

“We wanted to test whether new warnings could better inform consumers about alcohol’s harms and better encourage people to consider cutting back on their drinking,” says lead author Anna H. Grummon, Ph.D., M.S.P.H., assistant professor at the Stanford University School of Medicine. The study was conducted as part of a larger project co-led with Marissa G. Hall, Ph.D., associate professor at the University of North Carolina.

Designed to compare the effects of differently worded and designed warning labels, the study recruited a nationally representative sample of 1,036 adults of legal drinking age (21 and older) who reported drinking at least once a week.

Participants viewed 10 messages — one control, eight new warning labels, and the current U.S. warning label — in random order. They then rated each message on how well it encouraged them to drink less alcohol, reminded them of alcohol’s harms, and informed them of something new.

“Each participant rated multiple warnings covering a range of health harms — such as cancer, liver disease, hypertension, and dementia, among others — so we could make direct, apples-to-apples comparisons between them,” says Grummon.

All the new alcohol warnings in the study outperformed the current U.S. warning label, but those highlighting cancer risk were particularly effective. This finding is notable as policymakers in the United States and abroad debate whether to adopt a cancer warning on alcohol products.

“Ireland, for example, is set to require cancer warnings on alcohol containers in the coming years, and Alaska already requires a cancer warning to be posted in bars, restaurants, and liquor stores where alcohol is sold,” says Grummon. “Our findings suggest these policies could help people understand the risks of drinking and potentially reduce consumption.”

Study participants also rated the effectiveness of warning icons and label design. Triangles and octagons were perceived as more effective and attention-grabbing than other icons, such as a magnifying glass.

More research is underway. Grummon and Hall are currently running a randomized trial to test whether new alcohol warnings effectively lead people to drink less. The study will also measure whether the warnings improve knowledge of alcohol-related harms over time.

“We know from tobacco control that well-designed warnings can inform consumers and encourage healthier choices,” says Grummon. “Given that alcohol-related deaths are increasing, we hope policymakers will consider whether updating alcohol warnings should be part of a broader strategy to address alcohol-related harms.”
—–
Grummon, A. H., Lee, C. J. Y., Campos, A. D., Lazard, A. J., Brewer, N. T., Whitesell, C., Ruggles, P. R., Greenfield, T. K., & Hall, M. G. (2026). New alcohol warnings outperform the current U.S. warning in a national survey experiment. Journal of Studies on Alcohol and Drugs, 87(3), 433-443. https://doi.org/10.15288/jsad.25-00226

By W.B. Kagan

image: “Government warning” alcohol label

View more Credit: Journal of Studies on Alcohol and Drugs

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Safe Sips: Navigating Drink Spiking is a free event in which members of ARU’s Spiking Research Team will explain what drink spiking is, outline its effects on survivors and share the latest national findings.

Since 2021, forensic science academics at ARU have partnered with the UK’s leading alcohol charity Drinkaware to track the prevalence of drink spiking through national surveys, undertaken by YouGov.

The most recent survey, carried out in summer 2025 and involving 7,256 UK adults, found that approximately 2% of adults reported being a victim of drink spiking in the previous 12 months. When extrapolated across the UK population, this equates to nearly one million people.

However, fewer than one in four (23%) of those who experienced drink spiking contacted the police. The most common reasons given for not reporting were not believing action would be taken by the police (39%) and not clearly remembering what had happened (38%).

Women were more likely to experience spiking, accounting for 58% of cases. The most frequently reported locations were bars (41%), social events (26%) and nightclubs (25%), with the highest number of incidents reported by adults aged 25-34.

Drink spiking involves adding a substance to someone’s drink without their knowledge. Substances may include illegal or pharmaceutical drugs, or alcohol, and incidents are most commonly associated with sexual assault, physical assault, theft and “pranks”. Giving someone stronger alcohol than they asked for, for example a double shot rather than a single, would also be classed as drink spiking.

As well as investigating the scale of drinking spiking in the UK, the ARU Spiking Research Team carry out extensive research into the types of samples that can be tested following suspected spiking and the detection kits and protective products that are marketed to the public.

The Cambridge Festival event will be led by Dr Lata Gautam, an expert in forensic and analytical chemistry, whose research focuses on drug analysis, the detection of drugs in spiked drinks and drug-facilitated sexual assaults.

Dr Gautam, Associate Professor in Forensic Science at ARU, said: “Drink spiking has increased in the public’s consciousness in recent years, but our latest findings show that far too many cases still go unreported. With more than three quarters of victims not coming forward, it’s vital that we raise awareness about the importance of contacting the police and seeking support.

“At the same time, there remain significant challenges in identifying the different substances used in spiking. This talk will share our latest research into analysing drink residues, as well as our evaluations of drink testing kits and other anti-spiking products that are being sold to the public.”

Annabelle Bonus, Director of Research, Strategy and Impact at Drinkaware, said: “Drink spiking is a serious crime that can happen to anyone, anywhere. With our survey suggesting that more than a million people are affected each year, it is vital that victims feel confident reporting it to the police.

“For more information, advice and support visit the Drinkaware website or the UK government support pages on drink spiking.”

Safe Sips: Navigating Drink Spiking will take place at ARU’s Cambridge campus on Saturday, 21 March at 3pm and is one of more than 40 free Cambridge Festival events hosted by ARU. To register, visit https://www.aru.ac.uk/events/cambridge-festival/safe-sips-navigating-drink-spiking

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Alcohol-induced deaths have been increasing over the past two decades. Particularly concering are increases between 2019 and 2021, when the population was under significant stress from isolation due to the COVID-19 pandemic, and people with alcohol-use disorders were less able to access treatment. Quantifying mortality trends and determining whether alcohol-induced deaths have returned to pre-pandemic levels is essential for understanding long-term temporal patterns and dynamics. To examine these trends, the authors of this study analyzed data from the Centers for Disease Control and Prevention’s National Vital Statistics System, focusing on 14 specific alcohol-induced causes of death.

Wong et al. found that rates of alcohol-induced deaths in the United States nearly doubled between 1999 and 2024, reaching their highest level in 2021. Most deaths are due to alcoholic liver disease and, to a lesser degree, alcohol-related mental and behavioral disorders. The largest overall increase in alcohol-induced mortality across all race, sex, age groups occurred in 2021 when fatalities peaked at 54,258 deaths overall. By 2024, fatalities had declined, but the average alcohol-induced mortality rate across U.S. counties remained approximately 25% higher than in 2019.

American Indian/Alaska Native populations (AIAN) remain the most affected, with male AIAN rates of alcohol-induced mortality three times higher than that of white males, and female AIAN mortality rates four times higher than that of white females, over the entire period of investigation.

The largest increase by demographic was among females aged 25-34, which rose from 0.9 deaths per 100,000 in 1999 to 3.2 per 100,000 in 2024 — a 255 percent increase. The second largest increase was in males aged 25-34, from 2.3 fatalities per 100,000 in 1999 to 6.5 in 2024 — a 188 percent increase. As deaths from chronic diseases related to alcohol use, such as certain cancers or cardiovascular events, were not included in this study, the overall fatality counts may be underestimated. These findings underscore the critical need for targeted policies to reduce excessive alcohol consumption and improve access to treatment for those who need it most.

Senior author Maria R D’Orsogna adds: “The rapid rise of alcohol-induced deaths among women is particularly concerning. Although men still die at higher rates, the gender gap appears to be closing. Notably, for the population aged 25-34, the male-to-female mortality ratio has decreased from three-to-one in 1999 to two-to-one in 2024.”

The authors conclude: “The rise in alcohol-induced mortality is widespread and affects the entire country, with particularly large surges arising during the COVID-19 pandemic. In the early months of the pandemic, alcohol-induced deaths among AIAN males increased by as much as 40% in a single month and remained unusually high for nearly four years. Similar trends were observed among AIAN and Black females, whose alcohol-induced death rates rose by over 30% in one month.”

PLOS Global Public Health: https://plos.io/4nra5UI

Citation: Wong T, Böttcher L, Chou T, D’Orsogna MR (2025) Alcohol-induced deaths in the United States across age, race, gender, geography, and the COVID-19 pandemic. PLOS Glob Public Health 5(9): e0004623. https://doi.org/10.1371/journal.pgph.0004623

Author Countries: United States

Funding: This work was supported by the ARO through a grant [W911NF-23-1-0129 to LB and MRD], and by the U.S. National Science Foundation through a grant [OAC-2320846 to MRD]. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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In the early part of the pandemic, retail alcohol sales volume in Canada increased by 2% (2020/21 v. 2019), the highest increase in 10 years, despite few international visitors. More than 1 in 4 people (26%) reported drinking more, and 18% reported heavy drinking (defined as ≥ 5 drinks for men, ≥ 4 for women in a single sitting).

To understand the effect of changing patterns of alcohol use during the pandemic, researchers looked at deaths and hospitalizations between 2016 and 2022, comparing a prepandemic period and a pandemic period. They found that deaths from alcohol use increased about 18% over the 3-year period, with higher increases mainly in 2020 and 2021 (about 24%), resulting in 1600 more deaths than expected. Alcohol-related hospitalizations also increased 8% over the pandemic period studied, with higher increases (about 14%) in 2020/21.

“The 1596 excess deaths and 7142 excess hospitalizations fully attributable to alcohol we observed in Canada during the pandemic period that we studied speak to the substantial harms of increased alcohol consumption that can occur given circumstances and availability, and speak to the need for robust interventions,” writes Dr. Yipu Shi, Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, Ontario, with coauthors.

There were regional variations, with the highest increases in deaths in the Prairie provinces (28%) and in British Columbia (24%), excess rates 3 times higher than in Ontario and the Atlantic provinces, and 6–7 times higher than in Quebec. Hospitalizations were also higher in the Prairies and especially in the territories. Younger adults had the highest increases in both excess deaths (age 25–44 yr) and hospitalizations (age 15–44 yr).

Deaths and hospitalizations were largely due to alcoholic liver disease (ALD) and alcohol use disorder (AUD). As increases in hospitalizations were 3 times higher in females, the authors suggest this could be an early warning of future liver-related disease in this group.

These findings echo those from other countries, including the United States, which had a 29% increase in alcohol-related deaths (2020/21), and Europe (18%).

Increased alcohol consumption may have been driven by stress, boredom, deteriorating mental health, and other factors, including easier access to alcohol.

“Our findings highlight the importance of timely interventions to prevent high-risk drinking from developing into AUD or ALD. A comprehensive approach to preventing and managing high-risk drinking, AUD, and ALD in the aftermath of the pandemic should comprise both public health and clinical management interventions,” the authors conclude.

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The findings, published in JAMA Psychiatry, showed that weekly injections of semaglutide – compared with placebo injections – reduced alcohol craving, drinking quantity and the frequency of heavy drinking days in adults with symptoms of alcohol use disorder. Results also showed that after treatment, those in the semaglutide group consumed lower amounts of alcohol in the laboratory, as measured by grams of alcohol consumed and breath alcohol concentration.

The discovery could help address an important treatment gap: An estimated 178,000 U.S. deaths per year can be attributed to alcohol, which is linked to liver disease, cardiovascular disease and is a known cause of cancer, as noted recently by the U.S. Surgeon General. A significant proportion of American adults have met criteria for alcohol use disorder at some point in their lives — yet relatively few seek or receive treatment. The three drugs currently approved by the FDA to treat alcohol use disorder are under-utilized. The popularity of Ozempic and other GLP-1 receptor agonists could increase the chances of broad adoption of these treatments for alcohol use disorder.

The Clinical Trial

For the trial, researchers recruited 48 adults with alcohol use disorder who weren’t actively seeking treatment. Alcohol use disorder is defined by a range of possible symptoms, including the inability to stop or control one’s drinking despite negative consequences.

One week prior to the first injection, researchers invited participants to drink their preferred alcohol beverages over a two-hour period in a comfortable lab setting, with instructions to delay drinking if they wished. Researchers documented delays and drinks consumed.

Participants were then randomly assigned to receive weekly injections of Ozempic or a placebo for nine weeks, during which time their weekly drinking patterns were also measured. Afterward, participants and researchers returned to the drinking lab to repeat the process.

Results showed that after treatment, those in the semaglutide group consumed lower amounts of alcohol in the laboratory, as measured by grams of alcohol consumed and breath alcohol concentration.

Clinical assessments also indicated that semaglutide (compared to placebo injections) reduced weekly alcohol craving, reduced average drinks on drinking days, and led to greater reductions in heavy drinking days, relative to placebo. A key finding was that the magnitude of semaglutide’s effects on several drinking outcomes appeared potentially greater than is often seen in similar studies with existing AUD medications, even though semaglutide was only administered at the lowest clinical doses.

Among a small subgroup of participants who smoked cigarettes at baseline, those treated with semaglutide had significantly greater reductions in average cigarettes per day compared to those in the placebo group. This finding is potentially important because there are no medications currently approved for both alcohol reduction and smoking cessation.

“The first clinical trial testing the impact of an older GLP-1 receptor agonist on alcohol use in humans was inconclusive,” said Klein. “However, as prescription of semaglutide and similar medications escalated, anecdotal reports of reduced alcohol use became very common, and suggested the potential of these more potent therapies for treatment of alcohol use disorder.”

Research is needed to understand the mechanisms by which GLP-1 receptor agonists reduce alcohol cravings. Dr. Klein says that preclinical studies suggest that these effects are likely mediated in the brain and involve changes in reward processing.

Although exciting, these data are preliminary and there is a need to learn more. As clinical use of this medication increases, the findings call for additional studies to evaluate long-term effect on alcohol consumption, and the ideal doses and treatment durations, which may be different from the current recommendations for people living with diabetes and obesity.

“These data suggest the potential of semaglutide and similar drugs to fill an unmet need for the treatment of alcohol use disorder,” said Klein. “Larger and longer studies in broader populations are needed to fully understand the safety and efficacy in people with alcohol use disorder, but these initial findings are promising.”

About this Study

In addition to Hendershot and Klein, other authors of the study are Michael Bremmer, Michael Paladino, Georgios Kostantinis, Thomas Gilmore, Neil Sullivan, Amanda Tow and Robyn Jordan, all of University of North Carolina at Chapel Hill; Sarah S. Dermody of Toronto Metropolitan University; Mark Prince of Keck School of Medicine; Sherry A. McKee of Yale School of Medicine; Paul J. Fletcher of University of Toronto; and Eric D. Claus of Pennsylvania State University.

This research was supported by National Institute on Alcohol Abuse and Alcoholism grant R21AA026931.

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“This trend in the reduction of substance use among teenagers is unprecedented,” said Nora D. Volkow, M.D., director of NIH’s National Institute on Drug Abuse (NIDA). “We must continue to investigate factors that have contributed to this lowered risk of substance use to tailor interventions to support the continuation of this trend.”

Reported use for almost all measured substances decreased dramatically between 2020 and 2021, after the onset of the COVID-19 pandemic and related changes like school closures and social distancing. In 2022 and 2023, most reported substance use among adolescents held steady at these lowered levels, with similar trends and some decreases in use in 2024.

The Monitoring the Future survey is conducted by researchers at the University of Michigan, Ann Arbor, and funded by NIDA. The survey is given annually to students in eighth, 10th, and 12th grades who self-report their substance use behaviors over various time periods, such as past 30 days, past 12 months, and lifetime. The survey also documents students’ perceptions of harm, disapproval of use, and perceived availability of drugs. The survey results are released the same year the data are collected. From February through June 2024, the Monitoring the Future investigators collected 24,257 surveys from students enrolled across 272 public and private schools in the United States.

When breaking down the data by specific drugs, the survey found that adolescents most commonly reported use of alcohol, nicotine vaping, and cannabis in the 12 months prior to the survey, and levels generally declined from or held steady with the lowered use reported over the past few years. Compared to levels reported in 2023, data reported in 2024 show:

• Alcohol use remained stable for eighth graders, with 12.9% reporting use in the past 12 months. Alcohol use declined among the other two grades surveyed, with 26.1% of 10th graders reporting alcohol use in the past 12 months (compared to 30.6% in 2023), and 41.7% of 12th graders reporting alcohol use in the past 12 months (compared to 45.7% in 2023). 
• Nicotine vaping remained stable for eighth and 12th graders, with 9.6% of eighth graders and 21.0% of 12th graders reporting vaping nicotine in the past 12 months. It declined among 10th graders, with 15.4% reporting nicotine vaping in the past 12 months (compared to 17.6% in 2023).
• Nicotine pouch use remained stable for eighth graders, with 0.6% reporting use within the past 12 months. It increased among the two older grades with 3.4% of 10th graders reporting nicotine pouch use in the past 12 months (compared to 1.9% in 2023) and 5.9% of 12th graders reporting nicotine pouch use in the past 12 months (compared to 2.9% in 2023).
• Cannabis use remained stable for the younger grades, with 7.2% of eighth graders and 15.9% of 10th graders reporting cannabis use in the past 12 months. Cannabis use declined among 12th graders, with 25.8% reporting cannabis use in the past 12 months (compared to 29.0% in 2023). Of note, 5.6% of eighth graders, 11.6% of 10th graders, and 17.6% of 12th graders reported vaping cannabis within the past 12 months, reflecting a stable trend among all three grades.
• Delta-8-THC (a psychoactive substance found in the Cannabis sativa plant) use was measured for the first time among eighth and 10th graders in 2024, with 2.9% of eighth graders and 7.9% of 10th graders reporting use within the past 12 months. Reported use of Delta-8-THC among 12th graders remained stable with 12.3% reporting use within the past 12 months.
• Any illicit drug use other than marijuana declined among eight graders, with 3.4% reporting use in the past 12 months compared to 4.6% in 2023). It remained stable for the other two grades surveyed, with 4.4% of 10th graders and 6.5% of 12th graders reporting any illicit drug use other than marijuana in the past 12 months. These data build on long-term trends documenting low and declining use of illicit substances reported among teenagers – including past-year use of cocaine, heroin, and misuse of prescription drugs, generally.
• Use of narcotics other than heroin (including Vicodin, OxyContin, Percocet, etc.) are only reported among 12th graders, and decreased in 2024, with 0.6% reporting use within the past 12 months (reflecting an all-time low, down from a high of 9.5% in 2004).
• Abstaining, or not using, marijuana, alcohol, and nicotine in the past 30 days, remained stable for eighth graders, with 89.5% reporting abstaining from use of these drugs in the past 30 days prior to the survey. It increased for the two older grades, with 80.2% of 10th graders reporting abstaining from any use of marijuana, alcohol, and nicotine over the past 30 days (compared to 76.9% in 2023) and 67.1% of 12th graders reporting abstaining from use of these drugs in the past 30 days (compared to 62.6% in 2023).

“Kids who were in eighth grade at the start of the pandemic will be graduating from high school this year, and this unique cohort has ushered in the lowest rates of substance use we’ve seen in decades,” said Richard A. Miech, Ph.D., team lead of the Monitoring the Future survey at the University of Michigan. “Even as the drugs, culture, and landscape continue to evolve in future years, the Monitoring the Future survey will continue to nimbly adapt to measure and report on these trends – just as it has done for the past 50 years.”

The results were gathered from a nationally representative sample, and the data were statistically weighted to provide national numbers. This year, 35% of students who took the survey identified as Hispanic. Of those who did not identify as Hispanic, 14% identified as Black or African American, 1% as American Indian or Alaska Native, 4% as Asian, 1% as Middle Eastern, 37% as white, and 7% as more than one of the preceding non-Hispanic categories.  The survey also asks respondents to identify as male, female, other, or prefer not to answer. For the 2024 survey, 47% of students identified as male, 49% identified as female, 1% identified as other, and 3% selected the “prefer not to answer” option.

All participating students took the survey via the web – either on tablets or on a computer – with 99% of respondents taking the survey in-person in school in 2024.

The 2024 Monitoring the Future data tables highlighting the survey results are available online from the University of Michigan.

If you or someone you know is struggling or in crisis, help is available. Call or text 988 or chat at 988lifeline.org. To learn how to get support for mental health, drug or alcohol conditions, visit FindSupport.gov. If you are ready to locate a treatment facility or provider, you can go directly to FindTreatment.gov or call 800-662-HELP (4357).

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The study, which is published in eClinicalMedicine, looked at whether a type of diabetes medication, called GLP-1 receptor agonists (GLP-1 RAs), could also be used to help people cut down on drinking.

The study was led by Dr Mohsen Subhani, Clinical Assistant Professor of Gastroenterology at the NIHR Nottingham Biomedical Research Centre, in the School of Medicine, at the University of Nottingham. It was funded by the National Institute for Health and Care Research (NIHR) and the NIHR Nottingham Biomedical Research Centre.

In the new study, researchers evaluated existing literature on GLP-1 RAs use and the change in alcohol consumption.

They gathered studies up to August 2024 that examined whether GLP-1 RAs affect alcohol use, alcohol-related health problems, hospital visits, and brain reactions to alcohol cues. The team evaluated six articles, including two randomised control trials made up of 88,190 participants, of these 38,740 (43.9%) of participants received GLP-1RA.

Dr Subhani said: “Our findings show that this type of diabetes medication shows promise in reducing alcohol consumption, potentially by targeting the brain’s reward centre, especially in people with a BMI over 30.”

The key findings:

• In one main study, the medication exenatide did not significantly reduce drinking overall after six months, but people with obesity showed some positive results.
• Another study found that people taking the drug dulaglutide were 29% more likely to reduce drinking than those on a placebo.
• Observational studies (non-randomised) showed fewer alcohol-related health problems and lower alcohol use in people taking GLP-1 RAs compared to other treatments.

“Whilst further research is needed, our findings suggest this could be a potential treatment option in the future for excessive alcohol use and subsequently could lead to a reduction in alcohol-related deaths,” adds Dr Subhani.

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“The pandemic gave us a unique opportunity to see how wide-spread mitigation measures like social distancing and bar/restaurant closures may have affected alcohol consumption,” said lead author Kasey Creswell, associate professor of psychology at Carnegie Mellon University. “We focused on young adults who were engaging in heavy drinking before the onset of the pandemic, and we followed them over time to see if there were any pandemic-related changes to their alcohol consumption and alcohol problems.”

Unlike most prior studies of drinking habits during the pandemic, this study prospectively examined the drinking patterns of 234 heavy-drinking young adults ages 21 to 29 years from before to well after the onset of the pandemic. Prior to the pandemic, these individuals had to report binge drinking at least four times in the past month, defined as consuming 5 or more drinks per occasion (for males) and 4 or more drinks per occasion (for females). The team gathered data every six months from February 2018 to March 2022.

Results showed that these young adults significantly reduced how much and how often they were drinking from before to after the onset of the pandemic. Notably, they decreased their monthly alcohol consumption by nearly 13 drinks, and they also reported significantly fewer alcohol-related problems. Notably, these reductions in alcohol use and alcohol problems were still evident up to two years after the start of the pandemic.

According to Creswell, the results may in part be explained by the environment. Alcohol was still available to these young adults during the pandemic, but the context in which they were drinking likely changed pretty drastically for most of them. Due to pandemic restrictions, they weren’t able to drink with friends at parties or in bars, contexts that are usually associated with heavy alcohol use in young adults. The study authors highlight the impact of social settings in problematic alcohol use.

“Alcohol is a social drug,” said Aidan Wright, the Phil F. Jenkins Research Professor of Depression at the Eisenberg Family Depression Center and professor of psychology at the University of Michigan. Wright is a contributing author on this study. “These results highlight the social nature of drinking and speak to the importance of the social context in driving drinking behavior.”

The study also found significant decreases in negative emotions during the pandemic but did not find any change in the use of alcohol as a coping mechanism during the pandemic. The results for men and women followed similar patterns.

“Although there are overall trends that show declining patterns in drinking, it doesn’t mean that people did not have high periods of drinking,” said Wright. “The averages hide a lot of information, smearing over a lot of different trajectories that people took.”

Of note, solitary drinking did increase during the pandemic, with participants reporting a 4% increase in this habit. Creswell’s previous research has associated solitary drinking with an increased risk of developing alcohol problems. Creswell acknowledges the increase in solitary drinking in this study remained fairly muted, considering the constraints in accessing alcohol in social settings due to pandemic-related mitigation measures.

“Drinking to cope is the main reason young people engage in solitary drinking,” said Creswell. “But in this study, we actually saw a decrease in drinking to cope motives along with decreases in negative affectivity, so we think this increase in solitary drinking is less of a signal of something problematic happening and more a result of pandemic-related restrictions on social drinking settings.”

The study is limited to drinking-age adults (21 years or older) in a primarily white population. The results may not be broadly generalizable to other groups. Creswell notes that future studies are needed to evaluate the effect of the pandemic on alcohol consumption and related problems in different populations.

Alcohol-related problems were assessed in the study using the Alcohol Use Disorder Identification Test and the Brief Young Adult Alcohol Consequences Questionnaire. Negative affect was assessed using the Personality Inventory for DSM-5.

“The pandemic was really hard on a lot of people, but for this group of young adults who were engaging in heavy drinking, the pandemic seems to have had a long-term positive effect.”

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In a study of over 2,000 US children, aged between just nine to ten, those who reported drinking caffeinated soda daily, were found a year later twice as likely to state they had sipped alcohol.

Published in the peer-reviewed journal Substance Use & Misuse, the results of the study also demonstrate that daily drinkers of caffeinated soda were more impulsive and have a poorer working memory.

Each of the findings took into consideration other factors such as family history of drug use and low parental education.

Although strong associations between caffeinated beverage consumption and future substance use have been well documented in adolescence and adults, the Korean team’s findings are the first to demonstrate similar results in young children. In teens, previous research has shown that those regularly drinking energy drinks are five times more likely to use alcohol or marijuana within one to two years.

This new paper used data from the Adolescent Brain Cognitive Development (ABCD) Study, the large longitudinal study of brain development and child health in the United States.

The expert team aimed to not only see if there was a connection between alcohol use and caffeinated soda consumption in younger children, but also better understand the relationship between drinking the beverage and well-known risk factors of substance use disorder such as reduced working memory (for example holding a short sequence of numbers in our head for a few minutes) and increased impulsivity.

To test these cognitive functions, the children were given a series of tasks to do while their brain activity was recorded. For example, in one task, participants had to determine whether an object presented to them was the same as that shown in the two preceding trials.

The results showed that both high impulsivity and low working memory were significantly associated with daily caffeinated soda consumption.

Interestingly, children who regularly drank caffeinated soda also showed distinct brain activity compared to their non-drinking peers.
For example, when performing the impulse control task, daily drinkers showed lower activity in a brain region called the anterior cingulate cortex (ACC). Reduced activity in the ACC is frequently observed in children with attention deficit hyperactivity disorder (ADHD) and individuals with substance use disorders.

Meanwhile, in the working memory test, daily drinkers showed less activation in a brain region called the inferior frontal gyrus (IFG), which is a part of the frontal lobe. Prior studies have shown that reduced activation in the frontal cortex is related to lower working memory capacity.

Taken together, these findings strongly suggest an association between daily soda consumption and low working memory and high impulsivity, which are themselves recognized as risk factors for substance use disorders.

Lead author Mina Kwon, from the Department of Psychology, Seoul National University, explains: “Our findings suggest that daily consumption of caffeinated soda in children is predictive of substance use in the near future. One possible explanation is that the substances contained in caffeinated soda (caffeine and sugar) could induce a toxicological effect on the brain, making the individual more sensitive to the reinforcing effects of harder drugs like alcohol.”

This is known as the ‘gateway hypothesis’, however an alternative theory, known as the “common liability hypothesis,” is also possible.
The idea behind this theory is that children who are naturally less able to regulate their impulses are more likely to seek out and try substances like caffeine at an early age. Then as they get older and it becomes easier to access illicit substances, they may progress onto harder drugs like alcohol.

“Frequently consuming caffeinated soda could indicate a higher risk of initiating substance use in the future, due to the common risk factors between the two behaviours,” adds Professor Woo-Young Ahn, who is the Director of the Computational Clinical Science Laboratory at Seoul National University.

“Our results have important implications for public health recommendations, as our study provides novel insight into the neurobehavioral correlates of caffeinated soda consumption in children, which has rarely been evaluated.

“It’s vital, therefore, to develop evidence-based recommendations for caffeinated soda consumption in minors. There is no consensus on a safe dose of caffeine in children, and some children might be more vulnerable to adverse effects associated with frequent caffeine consumption than others.”

Limitations of the team’s findings include a “substantial number” of samples with missing data, which led to their exclusion from the analyses.

“As a result,” the paper details, “there is a possibility that the excluded data is missing not at random, potentially influencing our findings.

“Although we supported the robustness of our main results by applying statistical methods that could control for other confounding variables, we also acknowledge that multiple variables other than caffeinated soda intake may mediate the relationship between neurobehavioral risk factors and future alcohol use.”

The expert team recommends a “critical need” for future research to see if there is a pattern between the consumption of caffeinated soda among nine-to-10-year-olds and their use of other harder substances as they age.

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Drinking less than the UK’s recommended limit of 14 units of alcohol per week still increases the risk of cardiovascular issues such as heart and cerebrovascular disease, according to new research published in the journal Clinical Nutrition.

Academics from Anglia Ruskin University (ARU) examined hospitalisations related to cardiovascular events among more than 350,000 UK residents aged between 40 and 69 from data obtained from the UK Biobank study.

The sample included 333,259 people who drank alcohol. Participants had been asked about their overall weekly alcohol intake and their intake of specific types of alcohol including beer, wine and spirits. Those participants were followed up for a median of approximately seven years, capturing all incidents where patients had been hospitalised through cardiovascular events.

Anyone who had suffered a previous cardiovascular event was excluded from the analysis, as were former drinkers or those who had not completed information on alcohol intake.

The analysis found that, for those participants that drank less than 14 units of alcohol per week — the limit recommended by the UK’s Chief Medical Officers — each additional 1.5 pints of beer at 4% strength (alcohol by volume) is associated with a 23% increased risk of suffering a cardiovascular event.

The authors argue that biases in existing epidemiological evidence have resulted in the widespread acceptance of the “J-shaped curve” that wrongly suggests low to moderate alcohol consumption can be beneficial to cardiovascular health.

These biases include using non-drinkers as a reference group when many do not drink for reasons of existing poor health, pooling of all drink types when determining the alcohol intake of a study population, and embedding the lower risk observed of coronary artery disease among wine drinkers, potentially distorting the overall cardiovascular risk from the drink.

Lead author Dr Rudolph Schutte, course leader for the BSc Hons Medical Science programme and Associate Professor at ARU, said:

“The so-called J-shaped curve of the cardiovascular disease-alcohol consumption relationship suggesting health benefit from low to moderate alcohol consumption is the biggest myth since we were told smoking was good for us.

“Among drinkers of beer, cider and spirits in particular, even those consuming under 14 units a week had an increased risk of ending up in hospital through a cardiovascular event involving the heart or the blood vessels. While we hear much about wine drinkers having lower risk of coronary artery disease, our data shows their risk of other cardiovascular events is not reduced.

“Biases embedded in epidemiological evidence mask or underestimate the hazards associated with alcohol consumption. When these biases are accounted for, the adverse effects of even low-level alcohol consumption are revealed.

“Avoiding these biases in future research would mitigate current confusion and hopefully lead to a strengthening of the guidelines, seeing the current alcohol guidance reduced.”

Journal Reference:

1. Rudolph Schutte, Lee Smith, Goya Wannamethee. Alcohol – The myth of cardiovascular protection. Clinical Nutrition, 2022; 41 (2): 348 DOI: 10.1016/j.clnu.2021.12.009

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