Alcohol is one of the most important risk factors for premature mortality and disability. Premature mortality disproportionately affects low- and middle-income countries (LMICs) (WHO 2011a); more than 85 percent of all deaths attributable to alcohol occur in these nations (Room and others 2013; WHO 2011a). This chapter updates the chapter on alcohol in Disease Control Priorities in Developing Countries, 2nd ed. (DCP2) (Rehm and others 2006), with new scientific evidence for interventions based on population, community, and individuals, with an emphasis on evidence from LMICs. Alcoholic beverages vary with respect to their raw material, method of production, alcohol content, and presentation. Beverages are usually classified as fermented or distilled. In addition to the alcohol that appears in official statistics, many countries have a substantial amount of unrecorded alcohol, which may include illegally produced or smuggled alcohol products, but also surrogate alcohol (nonbeverage alcohol not officially intended for human consumption) and legal but unrecorded alcohol products (Lachenmeier, Sarash, and Rehm 2009).
Alcohol consumption is common across subpopulations in the United States. However, the health burden associated with alcohol consumption varies across groups, including those defined by demographic characteristics such as age, race/ethnicity, and gender. Large national surveys, such as the National Epidemiologic Survey on Alcohol and Related Conditions and the National Survey on Drug Use and Health, found that young adults ages 18–25 were at particularly high risk of alcohol use disorder and unintentional injury caused by drinking. These surveys furthermore identified significant variability in alcohol consumption and its consequences among racial/ethnic groups. White respondents reported the highest prevalence of current alcohol consumption, whereas alcohol abuse and dependence were most prevalent among Native Americans. Native Americans and Blacks also were most vulnerable to alcohol-related health consequences. Even within ethnic groups, there was variability between and among different subpopulations. With respect to gender, men reported more alcohol consumption and binge drinking than women, especially in older cohorts. Men also were at greater risk of alcohol abuse and dependence, liver cirrhosis, homicide after alcohol consumption, and drinking and driving. Systematic identification and measurement of the variability across demographics will guide prevention and intervention efforts, as well as future research.