The effect of resilience on alcohol use and alcohol-related outcomes: A systematic review and meta-analysis

Resilience, defined as the capacity to recover from difficulties or to adapt well to stressors, challenges, and adversities in life, is increasingly studied, yet its role in a range of alcohol-related outcomes remains unclear, including alcohol consumption, risky drinking, and alcohol use disorder. This review synthesises available evidence while considering variability across populations, contexts, and measurement approaches.

We systematically searched MEDLINE, PsycINFO, CINAHL, and Web of Science for observational studies examining the relationship between individual-level resilience and alcohol-related outcomes. Two independent reviewers screened records and extracted data, with disagreements resolved by consensus. We included studies published on or after 1 January 2014 that reported an association or provided sufficient data to determine its direction. Random-effects meta-analysis was used to estimate pooled associations for studies reporting comparable effect sizes (odds ratios or correlation coefficients), and narrative synthesis was used for studies not amenable to meta-analysis.

A total of 66 studies met the inclusion criteria and were included in the review. Approximately two-fifths (42.6%) were conducted in high school or college student populations, and 65.3% were conducted in high-income countries, primarily the United States. Meta-analysis of 24 studies showed that higher resilience was associated with lower odds of alcohol-related outcomes (pooled OR = 0.91, 95% CI = 0.87-0.95), although the observed heterogeneity was substantial (I² = 99.9%, p < 0.001). Consistent with this, the narrative synthesis indicated that associations between resilience and alcohol outcomes varied by life stage, high-risk or clinically vulnerable populations, cultural context, and resilience dimensions, with emotion-regulation and coping-related components showing more consistent protective associations than competence- or achievement-oriented traits.

While resilience shows a small protective association with alcohol use and related harms, but effects are highly context-dependent and specific by dimension. Given most evidence is cross-sectional with substantial heterogeneity, resilience should not be considered as a standalone target for prevention. Future research should prioritise longitudinal designs, standardised measurement and a clear differentiation between resilience components to clarify how specific dimensions of resilience influence alcohol outcomes across diverse populations. Prospero Registrationhttps://www.crd.york.ac.uk/PROSPERO/view/CRD42024520281.