Something is rotten in the state of drink.
In 2023, Americans consumed less beer than they had in a generation. Wine sales shrank for the third consecutive year. Spirits sales were flat.
Prominent observers of the alcohol industry are crying foul. "The U.S. government's coming attack on wine," a public relations consultant wrote earlier this year of updated dietary guidelines that could reduce recommended thresholds of healthy drinking. "The worst thing I have seen in 25 years," a long-time wine industry writer said in late 2023 of the World Health Organization (WHO) report that low levels of alcohol increase the risk of cancer and that "no safe amount of alcohol consumption for cancers and health can be established."
Some alcohol industry insiders see a conspiracy between what they describe as dubious science and advocates with undue influence, including Amanda Berger, PhD, a vice president of the trade group the U.S. Distilled Spirits Council. "There are efforts underway, both at the global level and in the [United States], to develop alcohol policies driven by anti-alcohol activist agendas," she wrote in an email to Think Global Health. "We have returned to the neo-prohibition era," warned Silicon Valley Bank in its 2020 report.
Considering that each year excess drinking kills, by various estimates, 1.8 million to 3 million people worldwide (178,000 in the United States alone), the clamor for safeguards isn't exactly surprising—nor that people who profit from selling alcohol would object.
Yet when it comes to shaping alcohol policies in the United States and abroad, it's the industry that wields true political power. Framing the current turbulence as a "war on alcohol" could cloud the picture and delay a reckoning with reality.
War on Alcohol: Fact or Fiction?
The alcohol industry would not be the first industrial group, on encountering regulatory headwinds, to depict itself as unfairly maligned. The past decade has featured the war on cops, the war on beef, the war on business, and who could forget the war on Christmas.
In 2023, Americans consumed less beer than they had in a generation
Kristin Goss, a professor of political science at Duke University's Sanford School of Public Policy, has studied numerous social movements. She said you can measure their vitality by the number and resources of advocates, the media coverage they generate, and their influence on the legislative and regulatory machinery of government. Under these criteria, she is skeptical that a meaningful, present-day campaign against alcohol is under way.
"If there was a war on wine in particular, the middle-aged women in America would have noticed," she joked.
When it comes to lobbying and legislating about alcohol policies in the United States, alcohol businesses appear to hold nearly undisputed sway. In Congress in 2023, the industry had 303 federal lobbyists and reported nearly $30 million in spending, according to Open Secrets. The most notable organization working on even a narrow piece of alcohol's harms, Mothers Against Drunk Driving, reports spending barely 1% that amount.
That's far fewer lobbyists than Big Pharma's phalanx of 1,854, but exceeds the 261 registered for Big Tobacco. Arguably, the most significant action Congress has taken toward alcohol in the last decade has been to reduce federal alcohol taxes, which happened in late 2020 with bipartisan support.
The picture doesn't differ much in state legislatures, which have allowed alcohol taxes to fall by more than 30% since 1990. In an interview, Adam Hoffer, director of excise tax policy at the Tax Foundation, notes that recently lawmakers in a few states have attempted to reverse that trend—notably in New Mexico and Oregon—but the alcohol industry has readily squelched those efforts.
Alcohol Excise Taxes Drop in United States
State alcohol taxes have nearly halved since 1982 primarily because of deficient adjustments for inflation
As part of a national picture, those local efforts are exceptions that prove the rule. "The alcohol space has been the most interesting I've seen in years," Hoffer said, but that is due to "an active battle being waged between the spirits industry and the beer industry" over how to tax ready-to-drink cocktails, not any effort to reduce alcohol consumption.
The major trends in lawmaking, as reflected in hundreds of alcohol-related bills tracked by the National Conference of State Legislatures, are toward expanding alcohol sales by enabling direct shipping, licensing new types of retailers, or legalizing the delivery and takeout of alcoholic beverages from restaurants. If a war is raging, alcohol is winning, and it's a rout.
The sides are not evenly matched. Decades ago, major philanthropies funded public health advocacy to address and reduce the harms of excessive drinking, but those funders have largely abandoned those efforts, leaving scattered activists with few resources and little coordination. A 2024 study estimated annual global aid and philanthropic spending on the prevention of alcohol's harms at $5 million to $10 million, less than a thousandth of the $10 billion given to HIV/AIDS, even though alcohol accounts for three times as many deaths worldwide.
The U.S. Alcohol Policy Alliance, a nonprofit that styles itself as the leading domestic advocacy group, does not currently have any paid staff. Its total 2023 revenue, $323,000, is less than the monthly paycheck of Heineken CEO Dolf van den Brink.
Evolving Science
If anything has changed in recent years, it is the science about how much alcohol is safe to drink and the tenor of international health guidance stemming from this research. In particular, representatives of the alcohol industry have questioned the WHO's conclusion that alcohol is causally linked to seven types of cancer and when it comes to that risk, "no safe amount of alcohol consumption" can be established.
The wine industry—whose U.S. sales grew rapidly in the 1990s thanks to widely publicized studies showing an association between moderate drinking and cardiac health—has been particularly defensive about the updated research. A recent article in WineBusiness Monthly attributed the WHO's change in messaging to the influence of "abstinence groups" such as Movendi International, which "are being allowed to drive global health policy."
We cannot say there is not a risk of drinking a couple of glasses a day. That's not true to the evidence that we have
Rüdiger Krech, WHO director of health promotion
Writers at trade outlet Beernet.com described Movendi as "a huge organization with significant resources." According to Movendi's director of strategy and advocacy, Maik Dünnbier, it has seven full-time staff and an annual budget of 700,000 euros ($761,000), a trivial sum relative to the billions of dollars alcohol companies spend each year promoting their wares.
In an interview, Rüdiger Krech, WHO director of health promotion, strongly disputed the assertion that the alcohol guidance was dictated by outside organizations. The WHO convenes independent scientific committees to review peer-reviewed research, he said, and its secretariat staff do not make such judgments; neither civil society organizations nor industry groups participate in the process.
Krech rejected the suggestion that the WHO wants to dictate how much people drink.
"If I decide to have a risky behavior, that's up to me—I need to have that freedom—but I do need to know what the risks are," he said. "We cannot say there is not a risk of drinking a couple of glasses a day. That's not true to the evidence that we have."
Tim Stockwell, a scientist at the University of Victoria whose research helped inform WHO's message, acknowledges that the precise health impacts of moderate drinking remain disputed and, like all science, are a work in progress. But for a decade, studies have shown that alcohol's perceived benefits for cardiovascular health were overstated. In Stockwell's view, "the evidence is firming up that regular, low-dose alcohol presents a measurable risk for cancer—not huge at low levels [of consumption] but it's there."
As more scientists examine these questions, Stockwell expects a firmer consensus to emerge: "It's going to have to be resolved because it's fundamental to estimating what effect our favorite drug has on us humans, and there's several billion of us using alcohol around the planet."
For some in the alcohol industry, the evolving science is hard to digest. Rob McMillan, executive vice president and founder of Silicon Valley Bank Wine Division, said he wants studies that show "what the real risks are, as close to unbiased, so that I can make my own personal decisions," but feels that existing research on alcohol is "just not well presented." Referring to a recent study that compared the relative increase in cancer-risk attributable relative to drinking alcohol versus smoking cigarettes, he said, "That's not science; that's marketing."
Real Storm Clouds
How the general population views alcohol is rapidly changing, however, and the guidance of a distant international organization such as the WHO may have little to do with it. Between 2016 and 2023, Gallup found that the share of Americans who view moderate drinking as "good for health" fell from 19% to 10%, whereas the share who view it as "bad for health" rose from 26% to 39%.
A Shift in U.S. Drinking Culture
A greater share of Americans now believe alcohol is harmful to health rather than beneficial
Kevin Asato, executive director of the National Black Brewers Association and an industry veteran, said these changing perceptions are driven by a cultural shift toward moderation, not press releases from the WHO. Competing mind-altering substances such as cannabis and psilocybin are rising as well. In 2022, for the first time, more Americans reported near-daily use of cannabis than of alcohol. People are tailoring their alcohol consumption with greater awareness of gluten allergies and gut health.
"There are socially acceptable alternatives, if you're forced to be in a bar setting, in the form of mocktails and [nonalcoholic] products," Asato said.
Wine historian Rod Phillips made a similar argument in June, writing that the label "neo-Prohibition" is "a spectre conjured up by alarmists," and called on the industry to face up to changes in attitudes and consumption rather than "indulge in fantasies about recovering lost markets."
Danny Brager, another alcohol industry consultant, agrees. Social moderation is "not a bad trend; it's just a trend that's out there. So, how do you meet it?”
The alcohol industry's response could hinge on whether it characterizes these changes as the influence of powerful advocates trying to trick people into abstinence—or of the slowly clarifying science that drinking healthfully calls for modesty. Some alcohol industry members would rather not state their position. Both Jim Trezise, the president of WineAmerica, and a spokesperson for the Beer Institute declined interview requests. So did Justin Kissinger, president and CEO of the World Beer Alliance, but in an op-ed in January he declared his organization's commitment to helping people moderate their drinking by offering lower- and no-alcohol products. He acknowledged that alcohol makers have the capacity, through their products and policies, to reduce the risks their products pose for their customers.
Alcohol makers have the capacity, through their products and policies, to reduce the risks their products pose for their customers
"The public health community has goals to reduce the harmful effects of alcohol, and shifting consumers towards lower-alcohol beverages is a time-tested, evidence-based way to achieve those goals," he wrote.
Accepting some agency over how their products are consumed is not typical of the alcohol industry, whose members routinely fall back on the message that their customers just need to drink with "responsibility," implying that any harm attributable to alcohol is really the fault of the drinker. As Sean O'Leary, an attorney specializing in liquor law, put it in an interview, "The problem with alcohol is the people that abuse it."
Few alcohol makers seem eager to reckon with data showing more than half of their sales by volume are consumed by just 10% of their customers—or to support meaningful changes in public policy to help reduce the undeniably harmful consumption of these heaviest drinkers. To the contrary, some seem eager to undercut such measures. After Oregon established minimum unit pricing for liquor, which studies elsewhere have shown to reduce alcohol abuse, Sazerac offered its customers hefty rebates as a means of evading the mandated price floor.
But if alcohol's sales strategy comes at the cost of its customers' health, no one wins.
