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, shared in toasts at gatherings, and seamlessly woven into the fabric of our day-to-days. 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 recent call by US Surgeon General Dr. Vivek Murthy for warning labels on alcoholic beverages underscores this reality, highlighting alcohol's clear link to cancer, a fact that has been under-communicated 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, the stories we tell ourselves about alcohol, steeped in tradition and resistance to regulation, 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. 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.
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 it 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 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, Ala., a proposal to limit late-night alcohol sales -- intended to decrease community disruption, violence, and drunken driving -- was vetoed by the city's mayor following intense public backlash. And in Maryland, Governor 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 the 1996 case 44 Liquormart Inc. v. Rhode Island, 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 2025-2030 Dietary Guidelines for Americans, which provide recommendations for how much alcohol Americans should be consuming, among other recommendations, is at the center of contentious debate among scientists, policy makers, and industry stakeholders due to the potential recommendation of 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 opt to 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. 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. Members of Gen Z, with their love of irony and knack for redefining norms, are increasingly skeptical of drinking. Although a reason for hope, 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 and 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.
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 reexamining their relationship with alcohol. Policy makers 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 drunken 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.