Alcohol use can affect your health, finances, and even your freedom. But it’s not just about direct use. In a new study, researchers quantified the second-hand use effect that alcohol and drugs have on people’s families, friends, and even strangers. The study suggests that alcohol, in particular, has a severe second-hand impact, affecting nearly 160 million Americans.

According to recent data, more than half of U.S. adults report drinking alcohol regularly, with the average adult consuming around 2.3 gallons of pure alcohol annually, which translates to approximately 500 drinks per adult per year. This figure includes beer, wine, and spirits. While most drinking occurs within moderate levels, a significant portion involves binge drinking or heavy alcohol use, contributing to both personal and societal health risks.

The researchers surveyed a nationally representative, population-based sample of 7,799 people. They asked participants about their experiences with second-hand harms caused by others’ use of alcohol, cannabis, opioids, or other drugs.

Alcohol use accounted for the majority of reported second-hand harms. The lifetime prevalence of such harms stood at 34.2%. In other words, if the results carry over to the entire population, well over 100 million Americans have been affected by alcohol second hand. This far surpasses the 14% attributed to drug-related harms.

The sheer scale of alcohol’s impact is striking. For instance, 6.2% of respondents reported experiencing alcohol-related harms in the past year alone. These incidents ranged from minor disputes to life-altering events such as domestic violence or fatal car accidents.

“There are more harms than people think,” said study co-author William Kerr, Ph.D., of the Alcohol Research Group at the Public Health Institute, in Emeryville, Calif. “They affect families, relationships and communities.”

Who suffers the most

While less common than alcohol, secondhand harms from cannabis (5.5%), opioids (7.6%), and other drugs (8.3%) were also significant. The study also found considerable overlap between these categories, with nearly 30% of individuals harmed by alcohol also experiencing drug-related harms.

These harms were not confined to any single demographic. However, women were slightly more likely to report alcohol-related harms, and individuals with a family history of alcohol problems faced significantly higher risks.

Middle-aged individuals (40–49 years) reported the highest rates of alcohol-related harms, while opioid-related harms were slightly lower among older adults. Meanwhile, black respondents reported lower rates of alcohol- and opioid-related harms but higher rates of cannabis-related harms. These variations may stem from systemic inequities, such as disproportionate legal and social consequences for cannabis use in black communities.

Interestingly, cannabis presented a unique dynamic. Frequent cannabis users reported fewer second-hand harms from cannabis compared to non-users, possibly due to normalized perceptions of its effects. However, these individuals were more likely to experience alcohol- or opioid-related harms, highlighting the interconnected nature of substance use.

Why this matters

Alcohol remains one of the most widely consumed and socially accepted substances, yet its second-hand effects are often ignored. From domestic violence and traffic fatalities to emotional and financial harm, alcohol use by one person can create cascading risks for others. Studies suggest that individuals exposed to second-hand alcohol harms are more likely to experience chronic stress, anxiety, and depression — issues that strain mental health systems and contribute to broader public health challenges.

This means that alcohol is even more of a public health issue than we thought. In turn, this suggests that alcohol taxes should be even higher to offset damage. Quantifying the public health risks of alcohol and drug use, including their second-hand effects, provides a foundation for evidence-based policies and taxes.

This isn’t the first study to show that drinking alcohol affects others around you. People may overlook the impact that consuming alcohol (and other drugs) can have on others, but this effect is very real. And it has a big cost.

Journal Referece: Rosen, E. M. et al.. Prevalence and correlates of alcohol and drug harms to others: Findings from the 2020 U.S. National Alcohol Survey. Journal of Studies on Alcohol and Drugs (2024). DOI: 10.15288/jsad.23-00387