Who drinks most of the alcohol in the US? The policy implications

Objective: The concentration of alcohol consumption in the U.S. among the h eaviest drinkers is analyzed with data from two recent probability samples of the adult population. Method: Pooled data from four national telephone s urveys (N = 7,049; 4,784 drinkers) with uniform methodology are used for th e primary analysis, and data from an in-person national household survey (N = 2,058; 1,308 drinkers) are used for confirmatory analysis. Each survey s ystematically measured self-reported alcohol consumption during the prior y ear using a "graduated frequencies" approach designed to capture drinking a t a series of amount-per-day levels. Results: The two studies produced very similar estimates: the top 2.5% of drinkers by volume account for 27% and 25% of the nation's total self-reported alcohol consumption in the telephon e and in-person surveys, respectively; the top 58 account for 42% and 39%; and the top 20% of drinkers account for 89% and 87% in each survey, respect ively. Men were overrepresented at the highest volumes, contributing about 76% of the country's total reported consumption. Similarly, young adults ag ed 18 to 29 are disproportionately represented in the heaviest drinking lev els; constituting 27% of the population, they account for about 45% of over all adult drinking. Conclusions: The bulk of the alcohol reported drunk in the U.S, is consumed by a relatively small population of very heavy drinker s. Prevention policies implied by this concentration include strengthening of social norms discouraging heavy consumption, restricting marketing pract ices that target heavy drinkers, and implementing measures to reduce consum ption by the heaviest drinkers.