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Introduction

In 2020, an estimated 17% of the U.S. population was older than age 65; this proportion is projected to rise to about 23% by 2060.^1,2 This prompts an urgent need for identifying potential and modifiable risk factors contributing to health decline.^3,4 After tobacco, alcohol is the most misused substance in the United States and abroad.⁵ Even prior to the coronavirus disease 2019 (COVID...

Introduction

Although historically cisgender women (i.e., women whose sex assigned at birth is consonant with their gender) in the United States have had lower levels of alcohol consumption than cisgender men, recent analyses of historical and cohort data suggest that overall gender differences are narrowing.¹ This narrowing is largely due to substantial increases in cisgender women's alcohol use...

Introduction

Although the awareness of the negative impact of prenatal alcohol exposure (PAE) was already alluded to in ancient writings¹ and the impact of ethanol embryopathy in animal models was studied as early as 1910,² the conceptualization of a syndrome associated with PAE was not recognized within modern medicine until the mid-20th century.^3,4 The syndrome or disorder was not uniformly...

Introduction

Prenatal alcohol exposure (PAE) is linked to miscarriage, stillbirth, preterm birth, sudden infant death syndrome, and fetal alcohol spectrum disorders (FASD).¹ Although PAE is the sole necessary cause of FASD, the etiology of this leading preventable cause of disability is multifaceted and complex, including lifestyle, maternal, sociodemographic, social, gestational, and genetic...

Introduction

According to national surveys, more than 85% of U.S. adults have consumed alcohol at some point in their lifetime, and about 70% did so in the last year.¹ Most individuals drink responsibly and without adverse effects. However, a substantial proportion of people misuse alcohol.^1,2 Drinking patterns associated with alcohol misuse include binge drinking, heavy drinking, and high...

Introduction

For the past 25 years, a growing number of U.S. states have been progressively legalizing cannabis markets, first through the early adoption of medical cannabis laws, which enabled the purchase and possession of cannabis for specific medicinal purposes, and then more recently through laws regarding adult (i.e., “recreational”) use of cannabis. As of May 2021, more than 70% of U.S...

Introduction

Alcohol consumption, including any alcohol use; patterns of high-risk use, including binge drinking; and alcohol use disorder (AUD) incidence and prevalence, differs substantially over time and by life stage. Variation also occurs across demographic groups, and such differences themselves vary across time and place. In the first quarter of the 21st century, changes in incidence and...

In recent decades, the term “recovery” as it pertains to alcohol use disorder (AUD) and drug use disorders has taken on increasing cultural and scientific significance in the United States and around the world. Its growing prominence as a culturally recognized and, importantly, positively valenced organizing concept has occurred in large part in direct response to help counter the pervasive and...

Introduction

This perspective focuses on the relatively recent topic of recovery-oriented systems of care; although influential in practice, this concept has yet to be evaluated empirically and thus cannot yet be the object of a review. In lieu of such evidence, this article offers one perspective on the origins of this concept and its present status prior to considering possible directions in...

Introduction

It is estimated that nearly 14.6 million Americans currently meet the diagnostic criteria for alcohol use disorder (AUD)¹ included in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5),² and approximately 88,000 die from alcohol-related causes in the United States each year.³ An older term, “alcohol dependence,” is equivalent to the DSM-5 criteria for AUD...