Alcohol use disorder is a chronic disease

Alcohol use disorder (AUD) is a chronic, relapsing brain disease with profound health, societal, and economic consequences. Alcohol misuse not only leads to AUD, but it is also a driver of multimorbidity, exacerbating a wide range of chronic comorbidities, including cancer. Despite being formally recognized over six decades ago as a medical condition, AUD remains one of the most prevalent and costly public health issues in the United States. Alcohol misuse contributes to more than 90,000 deaths annually in the United States, with hundreds of billions of dollars lost annually due to healthcare costs, lost productivity, and criminal justice expenditures. Beyond its economic burden, alcohol adversely affects nearly every organ system. Chronic heavy alcohol use changes brain structure and impairs brain function, drives neuroinflammation and neurodegeneration, and contributes to neurological and psychiatric comorbidities as well as cognitive decline. Alcohol-associated liver disease is a leading cause of cirrhosis and hepatocellular carcinoma. In addition, chronic alcohol misuse leads to cardiomyopathy, hypertension, and arrhythmia, and increased risk for pulmonary disease. Through alterations in endocrine signaling, alcohol leads to reproductive dysfunction, osteoporosis, and metabolic derangements including diabetes and obesity. Alcohol compromises musculoskeletal integrity, impairs immune responses, alters gut microbiota and increases cancer risk. Particularly concerning is the rising prevalence of alcohol misuse in women and older adults, populations with increased physiological vulnerability. There are three FDA-approved treatments for AUD, but they are underutilized, and patient response rates are variable, highlighting the need for continued investment in translational alcohol research. This paper summarizes the widespread and systemic impact of alcohol misuse on the health of US citizens and US society. Given the substantial burden of disease, disability, and death associated with alcohol, and the clear benefits yielded by alcohol research to date, sustained and enhanced support for alcohol-related biomedical research remains a public health imperative.