Women and alcohol use statistics: the closing sex gap and what it costs

She scheduled the visit for fatigue and irregular periods. Midway through the history she mentioned, almost as an afterthought, that she had cut back from "a bottle of wine most nights" to four or five drinks on weekends. She was 41, worked full time, had two school-age kids, and did not think of herself as someone with a drinking problem. Her last mammogram was overdue. Her liver enzymes were already elevated.

I see a version of this visit every month. The women are not the stereotypical "problem drinker" of older textbooks. They are mid-career professionals and new mothers; some are perimenopausal patients managing anxiety with a glass that became three. The drinking often started as stress management and stayed that way long enough to rewrite their risk profile.

The national data finally caught up to the waiting room. According to the 2024 National Survey on Drug Use and Health, as summarized by the National Institute on Alcohol Abuse and Alcoholism (NIAAA), 25.2 million U.S. women ages 18 and older binge drank in the past month, and 10.7 million met criteria for past-year alcohol use disorder. Among young adults 18 to 25, women's binge-drinking rate has now edged past men's. The sex gap that shaped a century of alcohol epidemiology is closing, and the health costs are not abstract.

This article gathers the primary numbers a clinician or patient can cite with the source attached: binge drinking and alcohol use disorder, the narrowing sex gap, liver disease and mortality, breast cancer risk, and pregnancy guidance.

Period	Average annual deaths	Age-standardized rate per 100,000
2016-2017	43,565	22.7
2018-2019	46,616	23.6
2020-2021	58,701	29.4

Source: Esser et al., CDC MMWR, 2024. Deaths include fully and partially alcohol-attributable causes.

Daily intake (standard drinks)	Relative risk (95% CI)
Less than 1	1.04 (1.01-1.07)
0.5	1.05 (1.04-1.06)
1	1.10 (1.08-1.12)
2	1.18 (1.15-1.21)
3	1.22 (1.19-1.25)

Source: Sohi et al., Alcoholic beverage consumption and female breast cancer risk, Alcohol Clin Exp Res, 2024. One standard drink = 10 g ethanol in this analysis.

Group	Women / females	Men / males
Ages 18 and older	18.7%	24.9%
Ages 18 to 25	26.9%	26.5%
Ages 12 to 17	4.1%	2.9%

Source: NIAAA summaries of 2024 NSDUH. Binge drinking: 4+ drinks on an occasion for females, 5+ for males.

How much women drink now

Start with the 2024 NSDUH numbers, which NIAAA publishes by sex and age. Among women ages 18 and older, 64.2 million (47.7%) drank alcohol in the past month. Prevalence of any drinking has long been high. The risk concentrates in how people drink.

Past-month binge drinking (four or more drinks on an occasion for women) was reported by 25.2 million women ages 18 and older, or 18.7% of that group. Heavy alcohol use, defined in NSDUH as binge drinking on five or more days in the past 30 days, was reported by 5.4 million women ages 18 and older (4.0%). Past-year drinking among adult women was 65.4%; lifetime drinking was 83.0%.

Put those figures next to the men's numbers and the old story still holds at the population level: 24.9% of men ages 18 and older binge drank versus 18.7% of women. Men still drink more often and more heavily overall. What changed is the trajectory and the age structure. The gap is smaller than it used to be, and in some younger cohorts it has effectively disappeared. Harm tracks binge frequency, total volume over years, and the biology of how women's bodies process ethanol: lower average body water, different first-pass metabolism, faster progression of some alcohol-related disease at a given level of intake.

The sex gap is closing

For cohorts born around 1900, men outnumbered women roughly 3 to 1 on measures of alcohol consumption and problematic drinking. Aaron White's 2020 review in Alcohol Research: Current Reviews, drawing on birth-cohort meta-analyses including work by Tim Slade and colleagues, found many of those ratios closer to 1 to 1 in recent generations.

The mechanisms differ by age. Among adolescents and emerging adults, gaps narrowed mainly because drinking fell faster in males than in females. Among adults, gaps narrowed because women's drinking rose while men's did not. A 2018 meta-analysis by Grucza and colleagues of six U.S. national survey series from 2000 to 2016 estimated that past-year alcohol use among adult women increased by about 6% while men's fell slightly (−0.2%), and binge drinking among women increased by about 14% versus 0.5% among men. Absolute rates still favor men at most adult ages. The public-health problem is the direction and speed of change among women, especially in midlife.

Grant and colleagues, analyzing NESARC and NESARC-III data in JAMA Psychiatry in 2017, reported that between 2001-2002 and 2012-2013, 12-month alcohol use, high-risk drinking, and DSM-IV alcohol use disorder all rose in U.S. adults, with the largest increases among women, older adults, racial and ethnic minority groups, and people with lower education and income. High-risk drinking rose from 9.7% to 12.6% overall; DSM-IV AUD rose from 8.5% to 12.7%.

Alcohol also co-travels with mood symptoms more often in women than in men. Our review of women's anxiety and depression statistics and the data on postpartum depression sit next to these drinking trends for a reason: self-medication and untreated mood disorders are common threads in clinic, even when the surveys measure them separately.

Young women have caught up

If you want a single table that unsettles the old narrative, use the 2024 young-adult numbers. Among people ages 18 to 25, 26.9% of women and 26.5% of men reported past-month binge drinking, according to NIAAA's summary of the 2024 NSDUH. Past-month any drinking was 48.3% among young women and 46.7% among young men. That is not a large absolute difference. It is a historic reordering. For most of the modern survey era, young men led both measures by a wide margin.

The adolescent pattern is sharper still. In 2024, 4.1% of girls ages 12 to 17 binge drank in the past month versus 2.9% of boys. Past-year alcohol use disorder among adolescents was 4.1% for girls and 1.9% for boys, more than double. Heavy alcohol use among young adult women remains lower than among young men (5.4% versus 6.6% ages 18-25). The convergence is furthest along for binge occasions, not yet for the most frequent heavy use. Clinically, binge occasions are still the visits that produce blackouts and emergency department encounters, along with elevated sexual assault risk.

Alcohol use disorder in women

Alcohol use disorder is not the same as binge drinking. AUD, measured in recent NSDUH waves with DSM-5 criteria, reflects impaired control, social or occupational harm, plus tolerance or withdrawal. In 2024, 10.7 million women ages 18 and older (8.0%) met past-year AUD criteria, compared with 16.4 million men (12.9%). Among females ages 12 and older, the figure was 11.2 million (7.6%).

Treatment receipt remains low. KFF, citing 2022 NSDUH detailed tables, reported that only 7.6% of people ages 12 and older with past-year AUD received any treatment, and 2.1% received evidence-based AUD medication. Stigma and under-recognition in primary care both suppress identification in women, as does the idea that "real" alcoholism looks male.

Women with AUD often progress faster from first heavy use to dependence (sometimes called telescoping) and develop liver and cognitive complications at lower cumulative exposure than men. The data quality on telescoping is mixed across study designs; the clinical observation that women present later and sicker, often with more psychiatric comorbidity, is more consistent. Alcohol worsens anxiety and depression over time even when it briefly blunts symptoms. Patients with PMDD or perimenopausal mood instability sometimes escalate evening drinking precisely when hormones are least stable.

Liver disease and mortality

Mortality is where the sex-gap story stops being about survey percentages and becomes about death certificates.

CDC's Alcohol-Related Disease Impact analysis, published in MMWR in 2024, estimated average annual deaths from excessive alcohol use (including fully and partially alcohol-attributable causes) among females at 43,565 during 2016-2017, 46,616 during 2018-2019, and 58,701 during 2020-2021. That is a 34.7% increase from the first period to the last, compared with a 26.8% increase among males. Age-standardized death rates among females rose from 22.7 to 29.4 per 100,000. Among females, death rates were highest from heart disease and stroke among the broad cause categories CDC reports. Alcohol mortality is not limited to cirrhosis.

Alcohol-associated liver disease remains a core driver. NIAAA reports that of 96,610 liver disease deaths among people ages 12 and older in 2023, 44.5% (43,004) involved alcohol, including 15,319 deaths among females and 27,684 among males.

KFF's February 2026 analysis of alcohol-induced deaths (a narrower death-certificate definition than CDC's ARDI estimates) found that overall alcohol-induced deaths peaked at 54,258 in 2021 and stood at 46,714 in 2024, still about 20% above 2019 levels. Female alcohol death rates in 2024 remained about 20% above 2019, while male rates had moved closer to pre-pandemic levels. White's 2020 review also documented steeper increases in alcohol-related emergency department visits for women than men between 2006 and 2014 (about 70% versus 58%). The gap is closing on the wrong side of the ledger. ARDI absolute counts are model-based (they attribute fractions of partially alcohol-related deaths) and remain the best national estimates that include both fully and partially alcohol-attributable mortality.

Breast cancer risk

Alcohol is an established cause of female breast cancer. That sentence is not controversial in oncology or epidemiology. It is still under-communicated in primary care and OB/GYN visits.

A 2024 systematic review and meta-analysis by Sohi and colleagues in Alcohol Clinical and Experimental Research estimated relative risks of breast cancer of 1.05, 1.10, 1.18, and 1.22 for 0.5, 1, 2, and 3 standard drinks per day compared with nondrinking. Even consumption of less than one standard drink per day carried a relative risk of 1.04 (95% CI 1.01-1.07). Each additional standard drink per day was associated with higher risk for both premenopausal (RR 1.03) and postmenopausal (RR 1.10) breast cancer, with a stronger association after menopause. In that analysis, one standard drink equals 10 grams of ethanol, slightly less than the 14-gram U.S. standard drink used in many American guidelines. The direction of the dose-response does not depend on that detail: risk rises with volume, and there is no clear safe threshold.

NIAAA states that alcohol is the third-highest preventable cause of cancer in the United States and cites estimates that roughly 5.6% of cancer cases and 4.1% of cancer deaths are attributable to alcohol. For women, breast cancer is the alcohol-attributable cancer that matters most in absolute numbers. Our review of breast cancer screening statistics covers detection; this page covers a modifiable risk factor screening cannot erase. From a breast cancer standpoint, red wine is not different. Ethanol is ethanol.

Alcohol and pregnancy

CDC analysis of 2021-2024 Behavioral Risk Factor Surveillance System data, published in MMWR in 2026, found that 15.2% of U.S. pregnant women ages 18-49 reported current drinking (one or more drinks in the past 30 days), 4.9% reported binge drinking (four or more drinks on an occasion), and 2.2% reported heavy drinking (eight or more drinks in a week). Among those who reported current drinking, 33.2% also reported binge drinking.

Current drinking appears higher than the 2018-2020 estimate of 13.5%, while binge drinking (4.9%) is similar to the earlier 5.2% estimate. More than one in seven pregnant women reporting recent alcohol use is not a success story for prenatal counseling. Prevalence was higher among unmarried women and those reporting frequent mental distress.

CDC and the American College of Obstetricians and Gynecologists are aligned: there is no known safe amount, no safe time, and no safe type of alcohol during pregnancy. Alcohol is a teratogen across gestation. Fetal alcohol spectrum disorders (FASDs) are lifelong. CDC estimates that up to 1 in 20 U.S. school-aged children may have an FASD based on community studies using in-person assessment; administrative diagnosis rates are far lower, which means under-recognition is the norm.

A patient who is trying to conceive, or who could become pregnant, needs the same clear message: if pregnancy is possible, stop drinking. For patients already pregnant who drank before they knew, shame is counterproductive; accurate dating and an honest history, with supportive follow-up, are the work. Tools that help people track cycles when planning pregnancy (including our ovulation calculator, period calculator, and IVF date calculator) are not alcohol interventions, but they sit in the same preconception conversation as folate and substance use.

What clinicians should screen for

Screening works when it is routine, not reserved for people who "look like" they have a problem. Single-item questions about heavy drinking days catch more risk than open-ended "Do you drink?" followed by a nod. Validated tools (AUDIT-C; T-ACE or TWEAK in prenatal settings) take under two minutes. Ask the number of drinks on a typical day and on the heaviest day in the past month; blackouts and failed cut-down attempts; mood symptoms and trauma history; and pregnancy intention or contraception for every patient who can become pregnant.

Medication for AUD (naltrexone or acamprosate; disulfiram in selected cases) is underused in women. Mutual-help groups and trauma-informed therapy matter at least as much as pills. Liver enzymes and, when indicated, fibrosis assessment belong in the workup of anyone with sustained heavy use. The policy layer (taxes, outlet density, treatment coverage) moves population rates. Clinicians still own the conversation in the room. The numbers on this page are meant to make that conversation specific rather than moralistic.

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