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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

Alcohol-associated liver disease (ALD) is a leading cause of morbidity and mortality in people with alcohol use disorder (AUD).¹ Alcohol exerts its effect on the liver through both direct and indirect pathways and can eventually lead to steatosis, steatohepatitis, fibrosis, hepatocellular carcinoma, and cirrhosis.² However, only approximately 10% to 20% of patients with ALD develop...

Introduction

Alcohol misuse is the most common form of substance misuse and is associated with liver, cardiovascular, and metabolic diseases as well as with infections and cancers.¹ Although an estimated 20% to 25% of people who drink heavily develop alcohol-related liver disease,² 40% to 60% of people with alcohol misuse have alcohol-related myopathy.³ Evidence that alcohol use leads to skeletal...

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 a necessary cause of fetal alcohol spectrum disorders (FASD), a group of alcohol-related conditions characterized by neurodevelopmental problems. Although PAE is associated with many adverse physical, neurodevelopmental, and social outcomes, the most commonly studied are neurodevelopmental—primarily behavioral and cognitive—outcomes. Associations...

Introduction

Alcohol use disorder (AUD) is prevalent worldwide, and the burden of heavy alcohol consumption has been increasing over time. An important complication of prolonged, heavy alcohol use is alcohol-associated liver disease (ALD), which can progress from liver steatosis to fibrosis and cirrhosis and frequently involves alcohol-associated hepatitis. In particular, cirrhosis—the most...

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...

Alcohol is frequently used in association with cannabis, with co-use now perceived as normative with expanding cannabis legalization. Cannabinoid products are increasingly used for a number of medical and recreational purposes, including to enhance alcohol-reinforcing properties or in some cases to substitute for alcohol. Rates of alcohol use disorder (AUD) are higher among cannabis users relative...

Introduction

Endogenous cannabinoids, or endocannabinoids (eCBs), are bioactive lipid molecules that modulate signaling activity of several physiological processes involved in pain, appetite, energy balance, stress/anxiety, immune signaling, and learning and memory. Although understanding of the eCB system has grown in complexity since its discovery by Raphael Mechoulam, it is now widely known...

Introduction

The establishment of the National Institute on Alcohol Abuse and Alcoholism (NIAAA) in 1971 was bracketed by three seminal papers that laid the groundwork for the field of fetal alcohol spectrum disorders (FASD) research. In 1968, Lemoine et al.¹ described children with birth defects and neurodevelopmental disorders associated with prenatal alcohol exposure (PAE). This French...