Alcohol use disorder (AUD) is a growing public health crisis in the United States, impacting millions of individuals, families, and communities. Yet for much of the past decade, the national conversation around substance use has centered mainly on the opioid epidemic. That focus has driven policy, funding, and clinical infrastructure in critical ways. But while attention was directed elsewhere, AUD quietly surged. The data now demands a reckoning.
Understanding the Scope: Who Is Affected and Why
As of 2023, an estimated 28.9 million Americans aged 12 and older struggled with alcohol use disorder. This is not just a statistic; it represents more than 10% of the U.S. population, encompassing all age groups, genders, and ethnicities. In addition, alcohol-related deaths increased by 29% between 2016-2017 and 2020-2021, and the alcohol-induced death rate rose 70% from 2012 to 2022.
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Certain regions and populations are especially hard-hit. States in the Upper Midwest, Plains, and Mountain West—such as North Dakota, South Dakota, and Montana—consistently report high rates of binge drinking and AUD. New Mexico stands out for having nearly double the national average of alcohol-related deaths, followed by Alaska, Wyoming, and South Dakota. These regional disparities are often linked to cultural norms, rural isolation, and limited access to care.
Other concerning trends are emerging. While men remain more likely to die from alcohol-related causes, the rate of increase in deaths among women has been faster in recent years. From 2016-2017 to 2020-2021, excessive alcohol use deaths among females rose by nearly 35%, compared to a 27% increase among males. American Indian and Alaska Native populations experience the highest alcohol-induced death rates, more than five times that of White Americans. The fastest-growing age group for alcohol-induced deaths is those aged 26 to 44, with a 144% increase over the past decade.
Overlooked in the Shadow of the Opioid Crisis
The opioid epidemic rightfully commanded urgent national attention. It remains a devastating public health emergency, and the infrastructure built to address it has saved lives. But one consequence of that necessary focus is that alcohol use disorder has been chronically underprioritized by the systems best positioned to address it: health plans, providers, and state agencies.
For health plans, the financial stakes are significant. AUD drives elevated costs across medical, behavioral, and emergency care, including hospitalizations for liver disease, cardiovascular events, injuries, and mental health crises. Members with untreated AUD are among the highest-cost, highest-utilization populations in any plan, yet alcohol use often goes unscreened and unaddressed in routine care.
For providers, AUD frequently coexists with depression, anxiety, PTSD, and chronic illness. When alcohol use goes undetected or untreated, it undermines outcomes across the entire care continuum. Patients don’t improve, comorbidities compound, and readmission rates climb.
For states, the economic burden is staggering. Lost workplace productivity, increased criminal justice involvement, child welfare costs, and mortality in working-age adults represent compounding losses that no state can afford to ignore. Unlike the opioid crisis, where overdose deaths create visible, acute emergencies, the harms of AUD often accumulate quietly over years, which makes them easier to defer and harder to reverse.
The urgency is real. The tools exist. What is needed now is the will to prioritize it.
Drivers Behind the Rise
The reasons for rising AUD prevalence are multifaceted. Mental health challenges including stress, anxiety, depression, and PTSD often drive individuals to use alcohol as a coping mechanism. The COVID-19 pandemic intensified these pressures, accelerating drinking in response to uncertainty, boredom, and social disruption.
Central to that disruption was isolation. As CHESS Health explored in The Loneliness Epidemic: Why Human Connection Can’t Be Automated Away, loneliness is not just an emotional experience. It is a documented driver of substance use disorder. The relationship between isolation and substance use is causal and cyclical: people experiencing deep loneliness are significantly more likely to turn to alcohol as a means of numbing emotional pain. Once alcohol use takes hold, it typically deepens isolation further, as relationships erode, trust breaks down, and individuals retreat from the community they need most.
The U.S. Surgeon General’s 2023 advisory identified loneliness as one of the most significant preventable risk factors for depression, addiction, and suicide, and the forces driving that loneliness have not receded.
Alcohol use has also become more normalized and integrated into social life, with access expanding significantly during the pandemic through to-go drink policies and online sales. Genetics plays a role as well. Individuals with a family history of AUD face elevated risk, and routine heavy or binge drinking significantly increases the likelihood of developing the disorder.
For those seeking recovery, traditional treatment methods can be effective but are not always accessible. Geographic isolation, lack of transportation, work schedules, and stigma can prevent individuals from seeking or sustaining in-person care, leaving many without the ongoing support necessary to maintain recovery.
The Promise of Scalable Recovery Support
Addressing AUD at scale requires solutions that can reach people where they are, not just in clinical settings, but in the moments between appointments, during late-night cravings, and in communities where in-person care is miles away. Technology-enabled recovery support has emerged as a critical complement to traditional treatment.
Sustained Recovery Engagement
Ongoing support throughout recovery is essential. CHESS Health’s Connections app offers consistent, peer-backed engagement across the recovery journey. In a randomized controlled trial, participants who used an app to support their recovery experienced a greater reduction in heavy drinking days over 12 months compared to those who received standard treatment alone. The app performed as well as telephone counseling, which is a more intensive and expensive option, demonstrating its value as a low-cost, accessible alternative.
Self-Monitoring and Accountability
Tracking abstinence, cravings, and mood increases self-awareness and keeps individuals accountable to their recovery goals. Real-time data enables timely clinical interventions and allows providers to identify potential issues before they become crises.
Real-Time Support
Cravings and triggers don’t respect office hours. Recovery support tools that offer 24/7 access to peer support teams, coping strategies, and on-demand resources create a safety net during high-risk moments. Direct messaging with counselors or peer groups provides human connection when it matters most, directly addressing the isolation that so often underlies AUD.
Lowering Barriers to Treatment
For individuals in rural areas, those with limited mobility, or those concerned about stigma, technology-enabled tools provide private, convenient access to help. Anonymity lowers the fear of judgment and makes it easier to take a first step.
Implications for Organizations
The case for action is not just humanitarian. It is financial and strategic.
Integrating AUD screening and recovery support into member and community engagement campaigns reduces costly emergency utilization, lowers inpatient admissions for AUD-related medical complications, and improves outcomes for one of the highest-cost, highest-utilization populations in any plan or care system. When alcohol use goes undetected, comorbidities compound, readmission rates climb, and patients across the care continuum fail to improve, driving up costs that no health plan, provider, or state agency can afford to absorb indefinitely.
Sustainable, scalable recovery support extends the reach of traditional care into the moments that matter most: between appointments, during high-risk situations, and in communities where in-person services are hard to access. It enables providers to demonstrate the quality metrics that define value-based contracts, gives states a proven lever against workforce productivity losses and child welfare burdens, and helps health plans close the gap on a member population that has historically been underleveraged for intervention.
Technology-enabled recovery support is not a replacement for traditional care. It is how traditional care reaches the people it has not been reaching.
The Future of AUD Recovery
As the AUD rate continues to rise, innovative approaches are needed to address the issue and support those in need. Digital health tools represent a critical component of the solution, offering flexibility, scalability, and evidence-based support that can meet patients where they are. For organizations committed to improving outcomes for individuals with alcohol use disorder, investing in digital tools provides an opportunity to make a meaningful impact on public health.
By embracing technology and integrating digital solutions into care pathways, organizations can help more people achieve lasting recovery and build healthier, more resilient communities.
