Key takeaways
- In a 2023 analysis of 107 studies, light drinkers’ apparent survival edge over lifelong nondrinkers shrank from 15% to a statistically insignificant 7% once study flaws were handled7.
- A December 2024 National Academies review linked moderate drinking to lower death rates with moderate certainty, while a SAMHSA-led review found no net survival benefit at any age23.
- Both reviews tied moderate drinking to cancer, and the Surgeon General’s estimates put lifetime breast cancer risk at about 131 in 1,000 women who average a drink a day, versus 113 who drink less than one a week123.
- Alcohol can turn common medicines and herbs risky, from acetaminophen and sleep aids to warfarin, kava and valerian, and older adults face extra risk8.
- Three nonaddictive medicines treat alcohol use disorder, yet just 1.6% of adults with the disorder in the past year got a prescription for one, a 2021 analysis found910.
On June 9, 2026, the Journal of Studies on Alcohol and Drugs published a study the federal government had commissioned but never released5. It began in 2023 under SAMHSA, the federal agency for substance use and mental health, as input to the nation’s dietary guidelines5.
Its bottom line was blunt. The authors found no net health benefit from drinking5. They estimated that a drink a day carries about a 1 in 1,000 lifetime chance of dying from an alcohol-caused condition, and that men who average two a day face about a 1 in 25 chance5.
The Department of Health and Human Services (HHS) says the journal paper differs from the government’s version and was never cleared by SAMHSA5. Months earlier, in January 2026, the new Dietary Guidelines had dropped their numeric drinking limits and simply advised Americans to drink less5.
For decades, many people heard that a glass of red wine might help the heart. We walk through why that idea faded, why two federal reviews split, what the risks look like in numbers and how to cut back if you choose to.
If you read labels and care about what goes into your body, alcohol deserves the same scrutiny. Your body breaks it down into acetaldehyde, a compound that binds to and damages DNA1.
The heart-healthy drink came from comparing the wrong groups
For years, studies drew a J-shaped curve: light drinkers seemed to outlive nondrinkers, while heavy drinkers fared worst.
The weak spot was the comparison group. Many studies lumped lifelong nondrinkers together with former drinkers, some of whom had quit because they were already sick. Light drinkers also tend to be healthier in other ways, from diet to exercise to weight7.
In 2023, a team led by Jinhui Zhao of the University of Victoria in Canada measured how much those biases mattered7. The researchers pooled 107 cohort studies, which follow groups of people over time, covering 4,838,825 people and 425,564 deaths7.
Before any adjustment, low-volume drinkers, up to about 1.7 U.S. standard drinks a day by our arithmetic, had a 15% lower death rate than lifelong nondrinkers7. After the team corrected for former drinkers, illness at the start and other study flaws, the edge shrank to 7%. That gap was small enough to be chance7.
Former drinkers had a 26% higher death rate than people who never drank, which shows why mixing them in made nondrinkers look worse7. Risk rose clearly from about 25 grams of alcohol a day for women and 45 grams for men7. That’s roughly 1.8 and 3.2 U.S. standard drinks, by our arithmetic.
The work was partly paid for by a Health Canada grant, passed through a Canadian substance-use agency, and Health Canada had no role in designing or running the study7. Genetic studies point the same way, as our article on observational studies explains.
Two federal reviews asked different questions
For the first time, the government ran two separate alcohol reviews to inform the 2025–2030 Dietary Guidelines4.
The National Academies of Sciences, Engineering, and Medicine (NASEM) released the first in December 2024, at the request of Congress2. It compared people who drank within the old limits, up to two drinks a day for men and one for women, with people who never drank2. It used studies from 2010 on and dropped those that mixed former drinkers into the nondrinker group2.
The SAMHSA-led Alcohol Intake and Health study, released as a draft in January 2025, came from a federal committee on underage drinking34. It compared drinkers at every level with lifelong abstainers and counted deaths from injuries as well as disease3.
| National Academies, Dec. 2024 | Alcohol Intake and Health draft, Jan. 2025 | |
|---|---|---|
| Who asked | Congress; funded through USDA2 | Federal underage-drinking committee led by SAMHSA34 |
| Drinking studied | Only within the old daily limits2 | All levels3 |
| Deaths from all causes | Lower in moderate drinkers, moderate certainty2 | No significant net benefit at any age3 |
| Heart | Lower heart-disease deaths, moderate certainty2 | No significant drop in heart disease at one to three drinks a day for men3 |
| Breast cancer | Higher risk, moderate certainty2 | Counted among alcohol-caused cancers3 |
| Mouth and esophageal cancers | No conclusion possible2 | Higher risk at one drink a day4 |
The draft estimated that a woman averaging a drink a day has a 19.5 in 1,000 lifetime chance of an alcohol-caused cancer, versus 8.2 for men3. Light drinking did lower a few risks, such as ischemic stroke, the kind caused by a clot, but those gains never added up to a net survival benefit at any age3.
Both reviews drew fire. Watchdogs said some NASEM panelists had alcohol-industry ties, while 25 members of Congress and nearly two dozen alcohol trade groups criticized the SAMHSA-led process4. NASEM’s chair, Ned Calonge, called the evidence base “imperfect,” and no NASEM finding reached high certainty2.
One review was never finalized, and the guidelines dropped their numbers
The administration never released a final version of the SAMHSA-led report, a decision STAT News reported in September 20255. In January 2026, a House Oversight Committee report called the study “irretrievably flawed”5.
The Dietary Guidelines released that month removed the old advice of up to one or two drinks a day. They now tell adults to drink less for better overall health, with no daily number5. A former SAMHSA official, Robert Vincent, says the administration leaned on the National Academies review instead6. HHS calls any claim that the study was sidelined inaccurate and says it weighed the work alongside the broader evidence6.
The June 2026 journal version recommends no more than one drink a day for men and women alike5. Some of its authors contend the work was kept from the public because its conclusions threaten powerful interests5. HHS says the published paper adds authors, policy advice and analysis changes, and that the guidelines reflect the whole scientific record rather than one report5.
Strip away the politics, and the two camps share a direction: for health, less alcohol beats more.
Cancer risk, counted per 1,000 drinkers
Our Mediterranean diet article covered the Surgeon General’s January 2025 advisory. Here is its less-quoted part: absolute risk.
Breast cancer drives much of the harm for women. The advisory estimated that alcohol was behind 44,180 U.S. breast cancers in 2019, or 16.4% of cases1. Breast cancer makes up about 60% of alcohol-related cancer deaths in women; in men, liver and colorectal cancers lead1.
The advisory also gave lifetime risks, drawn from an Australian study of 226,162 adults. The comparison group drank less than one drink a week, not zero1.
| Average drinking | Women: any alcohol-related cancer | Women: breast cancer | Men: any alcohol-related cancer |
|---|---|---|---|
| Less than 1 drink a week | 165 in 1,000 | 113 in 1,000 | 100 in 1,000 |
| 1 drink a day | 190 in 1,000 | 131 in 1,000 | 114 in 1,000 |
| 2 drinks a day | 218 in 1,000 | 153 in 1,000 | 131 in 1,000 |
By our arithmetic, a daily drink adds about 25 alcohol-related cancers per 1,000 women and 14 per 1,000 men over a lifetime. Two a day adds about 53 and 31. The SAMHSA-led draft’s figures, built a different way, run somewhat lower3.
In relative terms, breast cancer risk runs about 10% higher at up to one drink a day1. NIAAA, the National Institute on Alcohol Abuse and Alcoholism, puts it at 5% to 15% per daily drink11.
Wine gets no pass. The type of drink, whether beer, wine or spirits, doesn’t change the link1. Beyond acetaldehyde, alcohol fuels inflammation, can raise estrogen and helps tobacco’s cancer-causing chemicals soak into the mouth and throat1.
Light drinkers aren’t exempt, either. About 17% of alcohol-related cancer deaths occur in people who drank within the old daily limits1.
When the advisory came out, the alcohol warning label hadn’t changed since 1988, and only Congress can change it; the advisory asked for a cancer warning1.
The hopeful part: quitting or cutting back is linked to lower risk of mouth and esophageal cancers1.
Beyond cancer: livers, injuries, medicines and pregnancy
Women’s livers appear more sensitive. In the SAMHSA-led draft, women averaging one drink a day had about 2.3 times the cirrhosis risk of lifelong abstainers; for men at that level, the risk was 37% higher3.
Injuries add up fast. NIAAA reports that alcohol is a factor in about 65% of fatal falls, half of fatal drownings and homicides, and 31% of traffic deaths11. The draft found net harm from even one drink a week for people 15 to 39, and for those 15 to 20, traffic crashes caused most of the alcohol-related deaths3.
Medicines raise the stakes. NIAAA warns that alcohol can make some drugs less effective or more toxic, even when you don’t take them together, and some cough syrups contain up to 10% alcohol8.
| If you take | What alcohol can add, per NIAAA8 |
|---|---|
| Acetaminophen (Tylenol) | Liver damage |
| Ibuprofen, naproxen and similar pain relievers | Stomach bleeding and ulcers |
| Sleep aids, benzodiazepines or opioid pain pills | Drowsiness, overdose, slowed breathing |
| Allergy pills such as Benadryl | Drowsiness, dizziness |
| Warfarin | Internal bleeding; with heavy drinking, also clots or stroke |
| Diabetes medicines | Abnormally low blood sugar, flushing |
| Blood pressure medicines | Dizziness, fainting, irregular heartbeat |
| Kava | Liver damage, drowsiness |
| Valerian, chamomile or lavender | Added drowsiness |
Age matters. As you get older, your body clears alcohol more slowly, and you’re more likely to take several interacting medicines and to fall8. Don’t change a medicine on your own; ask your pharmacist how alcohol fits with what you take.
Pregnancy is the clearest line. The CDC says there is no known safe amount, time or type of alcohol during pregnancy or while trying to conceive, and that it’s never too late to stop13. A later article on blood pressure habits covers how drinking less fits into lowering your readings.
Rethink your drinks: a four-step worksheet
This worksheet is ours, built from the federal sources above. Fill it in over two weeks.
Step 1: Count your week. A U.S. standard drink holds 14 grams of pure alcohol: 12 ounces of regular beer, 5 ounces of wine or 1.5 ounces of spirits11. A regular 750-milliliter bottle of wine holds five11. Jot each drink in a phone note or on a calendar before you have it, which NIAAA says can help you slow down11.
Step 2: Find your row. These are model estimates for average adults, not your personal forecast.
| Your usual week | What the federal estimates link to it |
|---|---|
| 0 to 3 drinks | Any protective effect at this level wasn’t statistically significant5 |
| About 7 (one a day) | About a 1 in 1,000 lifetime risk of dying from alcohol35; about 25 extra alcohol-related cancers per 1,000 women and 14 per 1,000 men, by our arithmetic1 |
| About 9 or more | Lifetime risk of dying from alcohol near 1 in 10034 |
| About 14 (two a day) | About a 1 in 25 lifetime risk of dying from alcohol for men5; about 53 extra alcohol-related cancers per 1,000 women, by our arithmetic1 |
| Any day with 4+ drinks (women) or 5+ (men) in about two hours | Binge drinking11, which raises the risk of heart attack, stroke and injury5 |
Step 3: Pick three tactics. These come from NIAAA’s Rethinking Drinking guide, in our words11:
- Choose your drinking days and a cap for each, and build in alcohol-free days.
- Keep little or no alcohol at home.
- Have a polite “no, thanks” ready, plus a drink you enjoy instead, such as sparkling water with citrus or an iced herbal tea.
- Plan for urges: recall your reasons, call someone, or ride it out.
- Swap the routine tied to drinking, like a walk after work instead of a beer.
Step 4: Know when to get help. Use the box below.
Treatment works, and few people get it
Millions of U.S. adults have alcohol use disorder, and NIAAA says most can benefit from some form of treatment9. Options include counseling, such as cognitive behavioral therapy, and three approved medicines9:
- Naltrexone, a pill or an injection, reduces the urge to drink.
- Acamprosate eases the discomfort many people feel once they stop.
- Disulfiram causes unpleasant symptoms if you drink.
All three are nonaddictive, and a primary care clinician can prescribe them without special training910. NIAAA says medicines and behavioral treatments work about equally well10. Even so, a 2021 analysis found that just 1.6% of adults with the disorder in the past year got a prescription for one10.
Community counts, too. For people aiming to quit, NIAAA says SMART Recovery, LifeRing and Women for Sobriety look roughly as effective as 12-step groups10. A review found that counselor-guided 12-step programs plus Alcoholics Anonymous cut how much people drank about as well as cognitive behavioral therapy at 12 months10.
Many natural-health readers prefer to start with counseling, community and daily habits, and those paths have real evidence. A craving medicine isn’t a moral failure; it’s one more tool, and it doesn’t create a new dependence9. NIAAA’s online Alcohol Treatment Navigator helps you find qualified care, including telehealth9.
How strong is the evidence?
| Claim | Evidence level | What it rests on |
|---|---|---|
| Alcohol causes several cancers, and risk rises with the amount | Surgeon General’s review of causal evidence1 | |
| Light drinking helps you live longer | NASEM saw a link at moderate certainty; analyses that handle biases find it shrinks or vanishes; no trial237 | |
| Wine is safer than beer or spirits for cancer | Drink type doesn’t change the link1 | |
| Some alcohol during pregnancy is safe | No known safe amount, time or type13 | |
| Counseling and approved medicines treat alcohol use disorder | NIAAA review of treatment options910 | |
| SMART Recovery and similar groups match 12-step results | NIAAA says they appear about as effective10 |
Questions readers ask
Isn’t red wine different because of its plant compounds?
Not for cancer. The Surgeon General’s advisory found that beer, wine and spirits carry the same link1. If you love what grapes offer, whole grapes and other colorful plants bring their compounds without the acetaldehyde.
I’ve had a glass of wine most nights for 30 years. Is the damage done?
No. Quitting or cutting back is linked to lower risk of mouth and esophageal cancers1. How much to change is your decision, and the per-1,000 numbers above can help you weigh it.
Should I quit cold turkey?
Withdrawal is the main danger, and it follows long, heavy drinking11. If you drink heavily every day, don’t stop suddenly on your own; ask a clinician to help you plan a safe stop911.
The bottom line
The daily drink as heart medicine rested on studies that compared drinkers with the wrong people. Better analyses shrink that benefit toward zero, while cancer, liver and injury risks climb with each drink. Federal experts still argue over the size of the risk at low levels, but none of them recommend drinking more.
You get to decide what alcohol is worth to you. Count your week, check your medicines and herbs, pick a few tactics, and reach out early if cutting back gets hard.
Related reading
About this article
This article was researched using a Surgeon General’s advisory, National Academies and SAMHSA-led reviews, NIAAA, SAMHSA and CDC pages, a peer-reviewed meta-analysis and news reports on the 2025–2026 federal process, all listed below. It was reviewed in October 2026. It is general education, not medical, legal or financial advice.
Sources
- Office of the U.S. Surgeon General, HHS. “Alcohol and Cancer Risk” (2025 Surgeon General’s Advisory). January 2025. hhs.gov
- National Academies of Sciences, Engineering, and Medicine. “New Report Reviews Evidence on Moderate Alcohol Consumption and Health Impacts” (on “Review of Evidence on Alcohol and Health”). News release, December 17, 2024. nationalacademies.org
- Interagency Coordinating Committee on the Prevention of Underage Drinking (ICCPUD), led by SAMHSA. “Report on Alcohol Intake and Health.” Draft for public comment, January 2025. stopalcoholabuse.gov
- STAT News. News report comparing the draft Alcohol Intake and Health study with the National Academies review. January 14, 2025. statnews.com
- STAT News. News report on the Journal of Studies on Alcohol and Drugs publication of the Alcohol Intake and Health study. June 9, 2026. statnews.com
- Scientific American. Interview with former SAMHSA official Robert Vincent on the Alcohol Intake and Health study. June 2026. scientificamerican.com
- Zhao J, Stockwell T, Naimi T, Churchill S, Clay J, Sherk A. “Association Between Daily Alcohol Intake and Risk of All-Cause Mortality: A Systematic Review and Meta-analyses.” JAMA Network Open, 2023;6(3):e236185 (abstract via University of Portsmouth; full text via Movendi International, an alcohol-policy advocacy group). researchportal.port.ac.uk and movendi.ngo
- National Institute on Alcohol Abuse and Alcoholism. “Harmful Interactions: Mixing Alcohol With Medicines.” NIH Publication No. 13-5329, revised 2014. niaaa.nih.gov
- National Institute on Alcohol Abuse and Alcoholism. “Treatment for Alcohol Problems: Finding and Getting Help.” Updated February 2025. niaaa.nih.gov
- National Institute on Alcohol Abuse and Alcoholism. “Recommend Evidence-Based Treatment: Know the Options.” Core Resource on Alcohol, released May 9, 2025. niaaa.nih.gov
- National Institute on Alcohol Abuse and Alcoholism. “Rethinking Drinking: Alcohol and Your Health.” NIH Publication No. 23-AA-3770, updated April 2024. niaaa.nih.gov
- Substance Abuse and Mental Health Services Administration. “National Helpline.” SAMHSA, updated March 25, 2026. samhsa.gov
- Centers for Disease Control and Prevention. “About Alcohol Use During Pregnancy.” CDC, updated April 2, 2026. cdc.gov