As a physician trained in both internal medicine and pediatrics, I’ve witnessed alcohol play a starring role in the lives — and deaths — of my patients. In the emergency room, it’s the invisible force behind trauma cases, the culprit in new diagnoses of liver cirrhosis, and the reason for the muted tears of those struggling to overcome addiction. On the wards, it’s the common denominator in countless social histories, chronic diseases, and repeat admissions. Beyond the confines of the hospital, alcohol’s ripple effects destroy families, upend careers, and are responsible for innumerable missed opportunities. The Covid-19 pandemic only amplified these realities, driving a surge in alcohol-related harms and injury.
And yet, unlike illicit drugs, alcohol escapes the stigma of being labeled as a “drug.” It’s the go-to social lubricant for any event, toasted at gatherings, and seamlessly woven into the fabric of our day-to-days. It’s sold in brightly lit aisles, glorified on and off screen, and marketed as the must-have accessory to our lives — on TV, at weddings, and essential to a balanced lifestyle. For many, it’s a symbol of benign indulgence, but the truth is sobering: alcohol is a leading cause of preventable death, linked to everything from strokes to car crashes. The recently announced surgeon general’s call for warning labels on alcoholic beverages underscores this reality, highlighting alcohol’s clear link to cancer, a fact that has been undercommunicated to the public for far too long.
So why, despite mounting evidence, are alcohol’s dangers largely ignored or dismissed? The answer lies in a cultural chokehold that normalizes alcohol, protects its status, and blocks meaningful policy advancement. This isn’t because we lack evidence or effective solutions. Instead, it’s the stories we tell ourselves about alcohol, steeped in tradition and resistance to regulation, that undermine even the most promising of initiatives — a reality that echoes lessons from America’s past. To address alcohol’s role in society, we must first confront these stories.
Alcohol is not just another consumer product — it’s America’s favorite drug and its most dangerous.
Attempts to regulate America’s love affair with alcohol have always been contentious, embedded in cultural, economic, and political forces that remain as potent today as they were a century ago. Prohibition, enacted in 1920, was a well-intentioned failure aimed at shielding Americans from the “scourge of drunkenness” and quickly became a cautionary tale of unintended consequences. Rather than reducing alcohol consumption, it drove drinking underground, fueling organized crime and making speakeasies a staple of the era.
Today, the speakeasy, a once illicit refuge — has become a trendy, upscale representation of rebellion turned refinement. This evolution epitomizes our paradoxical relationship with alcohol: what began as defiance against government regulation is now rebranded as cultural sophistication. Prohibition failed not because alcohol wasn’t harmful, but because it underestimated the cultural power of alcohol and the need for public buy-in.
Where the temperance movement fell short, tobacco control succeeded, offering a blueprint for change. In the mid-20th century, smoking was as ubiquitous and glamorized as drinking is today — Don Draper’s cigarette was as vital to his image as his whiskey glass. But decades of public education and awareness, advertising restrictions, and policy interventions reframed smoking as a deadly habit. The result? Smoking rates plunged, and public health earned a measurable win. The campaign against tobacco shows us that cultural attitudes can shift and with them, policy and behavior.
Alcohol parallels these narratives in many ways. Like tobacco, alcohol is a public health threat. However, where tobacco use — especially in the form of cigarettes — has become socially unacceptable in much of the U.S., alcohol maintains a level of cultural acceptance. To rewrite alcohol’s narrative is to learn from both Prohibition’s failures and tobacco control’s victories: We need a cultural transformation that doesn’t alienate the public but rather invites them to reconsider alcohol’s place in our lives.
America’s alcohol policy landscape is a fragmented patchwork of federal, state, and local regulations that reflect the nation’s ambivalence toward alcohol. While its harms — accounting for more than 178,000 deaths every year — are well-documented, the political and cultural response to addressing these issues is mired in resistance, misinformation, and powerful industry lobbying. Consumer and public health advocates face an uphill battle as they attempt to introduce and implement evidence-based policies in the face of public opposition and competing economic priorities.
Unlike tobacco, which is regulated through consistent national standards, alcohol policy in the United States is a decentralized system of governance, leading to marked variation in how alcohol is taxed, marketed, and sold. Federal excise taxes, a proven deterrent to excessive drinking, have not been adjusted for inflation since 1991. As a result, alcohol remains cheap and readily accessible. Meanwhile, states and municipalities face ongoing strain between public health goals and economic interests.
In New Mexico, where alcohol-related death rates are the highest in the country, lawmakers have repeatedly killed legislation to raise alcohol taxes due to industry lobbying and political hesitation. In Montgomery, Alabama, a proposal to limit late-night alcohol sales — intended to decrease community disruption, violence, and drunk driving — was vetoed by the city’s mayor following intense public backlash, with critics framing the ordinance as government overreach. And in Maryland, Gov. Wes Moore’s support for lifting the state’s ban on selling alcohol in grocery stores is being pushed as “putting people first” and aligning with national norms, despite evidence connecting expanded availability to increased consumption and related harms.
The judicial system hasn’t necessarily been helpful for progress, either. In 44 Liquormart Inc v. Rhode Island (1996), the Supreme Court struck down a ban on advertising alcohol prices, citing commercial free speech. The court’s opinion exemplified how legal constraints can dilute state power in regulating alcohol marketing. This legal precedent complicates efforts to curb alcohol consumption through public education and transparency.
Nationally, the development of the 2025 Dietary Guidelines for Americans, which provides recommendations for how much alcohol Americans should be consuming, is at the center of contentious debate among scientists, policymakers, and industry stakeholders due to potentially recommending stricter limits. The final guidelines will appreciably influence public health messaging for years, yet they remain vulnerable to the same cultural and political forces that have long plagued alcohol policy reform.
As frustrating as this state of affairs is, there is some reason for hope among alcohol policy experts: Dry January — a 31-day challenge in which millions ditch the drinks to temporarily embrace a life of abstinence. What started as a wellness trend with humble beginnings has grown into a global movement. This cultural pause has prompted people to rethink their relationship with alcohol. For some, it’s a revelation, a chance to experience life without the default adult beverage in hand. For others, it’s a personal reckoning that unmasks alcohol as a social or emotional necessity. The movement’s real power lies in what it exposes: the scaled consequences of just how deeply alcohol is integrated into our lives.
This flipping of the script parallels what we’re seeing in how younger generations perceive and interact with alcohol, adopting a more sober-curious mindset. Gen Z, with their love of irony and knack of redefining norms, are increasingly skeptical of drinking, often labeling it “unhealthy” or “mid” — a mediocre relic of generations past, similar to smoking’s ultimate downfall. Although hopeful, Dry January alone can’t and won’t rewrite America’s drinking story, which is already full of contradictions.
Alcohol’s privileged status keeps it safe from the scrutiny that tobacco or other harmful substances face. Without a personal reckoning becoming a collective one with respect to how we talk about and regulate alcohol, policies like higher taxes and ad restrictions will struggle to gain traction, if at all. Dry January starts the New Year off strong, but the change we need requires a complete societal overhaul of how we view everyone’s problematic fav.
The question isn’t just whether we can forgo a drink for a month — it’s whether we can redefine our cultural obsession with alcohol in a way that’s healthy. And as Dry January continues to build momentum and popularity, maybe we’re getting closer to an answer.
America has a drinking problem, but it doesn’t have to stay that way. Alcohol’s role in society isn’t fixed; it can be redefined, just as smoking was. However, progress requires more than personal reflection. It demands action to bridge science and public values, counter industry misinformation, and combat apathy with momentum.
Research provides a clear roadmap for addressing alcohol-related harm: raise taxes, limit availability, restrict marketing, enforce minimal legal drinking age, and fund prevention and treatment programs. As seen in national dialogues about fluoride and vaccines, science frequently clashes with public mistrust and individual values. To succeed, alcohol policy must be reframed to protect families and communities, not as government infringement. By centering shared goals like saving lives and reducing injury, we can position science with public values and build trust.
The alcohol industry relies on the myth of “responsible enjoyment” to downplay its products’ risks while spreading misinformation to stifle regulation. Advocates must expose these tactics, much as tobacco control efforts did. Transparent campaigns that expose the deceptive nature of industry lobbying, coupled with strategically crafted anecdotes of alcohol’s human cost, can dismantle this dominant narrative and galvanize public support for reform.
The only thing worse than public opposition is public apathy, but it isn’t impossible to overcome. Movements like Dry January signal individuals are open to re-examining their relationship with alcohol. Policymakers must capitalize on this momentum, connecting personal behavior modifications to broader societal and public health goals, such as funding substance use treatment or decreasing the incidence of drunk driving.
Our path forward must combine cultural shifts with bold policies. Higher taxes, targeted education and awareness campaigns, and stricter marketing regulations aren’t just abstract ideas, they’re necessary steps to advance the betterment of public health. Alcohol-related harm and injury touches every corner of our reality, and the cost of inaction is too much.
It’s time to move from questioning our relationship with alcohol to transforming it.
America has a drinking problem. It’s about time we sober up.
Luis Seija is a postdoctoral fellow in the National Clinician Scholars Program and associate fellow in the Leonard Davis Institute of Health Economics at the University of Pennsylvania.