What Kills Most Alcoholics? The Leading Causes of Death

Understanding the real dangers of chronic heavy drinking—and why treatment can be life-saving.

What You'll Learn:

• The leading causes of death in people with alcohol use disorder.

• How alcohol contributes to each major killer.

• Which conditions develop over time versus acute risks.

• How stopping drinking changes these outcomes.

• When intervention becomes urgent.

This isn't comfortable reading. But understanding what alcohol actually does to the body—and how it kills—can motivate change and inform decisions. If you or someone you love struggles with drinking, this information matters.

The Statistics Are Sobering

According to the Centers for Disease Control and Prevention, alcohol is responsible for approximately 140,000 deaths per year in the United States. It's the third-leading preventable cause of death.

People with alcohol use disorder have a life expectancy roughly 24-28 years shorter than the general population, according to research in Alcohol and Alcoholism. This shortened lifespan results from multiple causes, some developing slowly over years and others striking suddenly.

Liver Disease: The Classic Killer

When people think of alcoholism killing someone, they often think of liver disease. It's a leading cause of death, though not the only one.

How Alcohol Damages the Liver

According to the American Liver Foundation, alcohol damage progresses through stages. It begins with fatty liver, where fat accumulates in liver cells in a reversible process. This can progress to alcoholic hepatitis, involving inflammation and cell damage that is partially reversible. Continued drinking leads to fibrosis, where scar tissue forms, though early stages may still reverse. Finally, cirrhosis develops, where extensive scarring impairs function and becomes irreversible.

Cirrhosis Complications

Advanced cirrhosis leads to portal hypertension (high pressure in liver blood vessels), ascites (fluid accumulation in the abdomen), variceal bleeding (ruptured blood vessels in the esophagus or stomach), hepatic encephalopathy (brain dysfunction from toxin buildup), liver failure, and liver cancer. The liver performs over 500 functions. When it fails, toxins accumulate, blood clotting fails, infections become dangerous, and other organs fail in cascade.

Prevention and Reversal

Stopping drinking can halt progression and allow partial recovery at earlier stages. Even with cirrhosis, abstinence improves survival significantly. The body's ability to heal, given the chance, is remarkable.

Cardiovascular Disease: An Underrecognized Killer

Heart disease actually causes more deaths in people with alcohol use disorder than liver disease does.

How Alcohol Affects the Heart

Chronic heavy drinking causes cardiomyopathy (weakening of heart muscle), arrhythmias (irregular heartbeats, including potentially fatal ones), hypertension (high blood pressure that damages blood vessels), and stroke (blood vessel blockage or rupture in the brain).

The holiday heart syndrome describes how binge drinking can trigger acute arrhythmias, particularly atrial fibrillation. These can cause stroke or death even in people without chronic heart disease.

Why It's So Dangerous

Unlike liver disease, which typically takes years to develop, cardiovascular events can be sudden. A heart attack or stroke can kill without warning.

Improvement With Abstinence

Blood pressure often normalizes within weeks of stopping drinking. Heart function can improve significantly with abstinence and medical care. Even one week without alcohol begins positive changes in your body.

Cancer: The Slow Accumulator

Alcohol causes several types of cancer. These may develop over years or decades.

According to the National Cancer Institute, alcohol increases risk for mouth and throat cancer, esophageal cancer, liver cancer, breast cancer, and colorectal cancer. Alcohol damages DNA and impairs the body's ability to repair it. The metabolite acetaldehyde is directly carcinogenic. Alcohol also affects hormone levels that influence cancer risk.

Unlike some alcohol-related conditions, cancer risk may persist even after quitting—though it does decrease over time. Earlier intervention means less accumulated DNA damage.

Accidents and Injuries: Acute Death

Not all alcohol deaths are from disease. Acute causes claim many lives.

Alcohol-related accidents include motor vehicle crashes (alcohol is involved in about 30% of traffic fatalities), falls, drowning, burns, poisoning, and violence including homicide and suicide. Alcohol impairs judgment, coordination, reaction time, risk assessment, and impulse control.

The CDC reports that about 10,000 people die annually in alcohol-impaired driving crashes in the United States alone. Thousands more die from other alcohol-related accidents. These deaths are immediate and often affect not just the drinker but innocent bystanders.

Alcohol Poisoning: Acute Overdose

Unlike slow-developing diseases, alcohol poisoning can kill within hours.

When blood alcohol concentration gets too high, breathing slows dangerously, heart rate becomes irregular, body temperature drops, gag reflex is suppressed (leading to choking on vomit), and brain functions controlling basic life functions fail.

Signs of alcohol poisoning include confusion or stupor, vomiting, seizures, slow or irregular breathing, blue-tinged skin, low body temperature, and unconsciousness. This is a medical emergency. Sleeping it off can be fatal.

Withdrawal: The Paradox of Quitting

Ironically, stopping drinking can be dangerous for people with severe alcohol dependence.

Severe withdrawal can include seizures, hallucinations, severe confusion, rapid heartbeat, high blood pressure, and fever. This condition, known as delirium tremens, has an untreated mortality rate of 15-40%. With medical treatment, this drops to 1-5%.

This is why severe alcohol dependence may require medical supervision to quit safely. It's not an excuse to keep drinking—it's a reason to get proper help. If you've been a heavy drinker, your first week without alcohol may need medical monitoring.

Suicide: The Mental Health Connection

Alcohol use disorder dramatically increases suicide risk. People with alcohol use disorder have a suicide rate 5-10 times higher than the general population.

Alcohol is a depressant that worsens mood over time. It lowers inhibitions that might prevent acting on suicidal thoughts. It impairs judgment about consequences. It often co-occurs with depression and other mental health conditions. It creates life circumstances such as relationship loss, job loss, and health problems that contribute to hopelessness.

Many suicides occur during or immediately after drinking episodes. Alcohol can push someone from ideation to action.

Infections: Compromised Immunity

Alcohol weakens the immune system, making infections more dangerous.

Heavy drinkers are more susceptible to pneumonia, tuberculosis, hepatitis, HIV (partly through risk behavior, partly through immune effects), and post-surgical infections.

According to research in Alcohol Research: Current Reviews, alcohol reduces white blood cell function, impairs the gut barrier, creates chronic inflammation, and decreases the body's ability to mount effective immune responses. During the pandemic, heavy drinking was associated with worse outcomes from COVID-19, highlighting this immune connection.

Pancreatitis: Excruciating and Deadly

Alcohol is the leading cause of chronic pancreatitis. The pancreas becomes inflamed, which can cause severe abdominal pain, digestive enzyme leakage, infection, pancreatic necrosis (tissue death), and multi-organ failure.

Acute pancreatitis can be a medical emergency. Chronic pancreatitis leads to permanent damage, diabetes, and digestive problems. Severe acute pancreatitis has a mortality rate of 10-30%.

Nutritional Deficiencies: The Hidden Killer

Alcoholism often leads to severe nutritional deficiencies that can be fatal.

Common deficiencies include thiamine (B1), which leads to Wernicke-Korsakoff syndrome (brain damage); folate, which causes anemia and cognitive problems; B12, which leads to nerve damage; magnesium, which affects heart rhythm; and zinc, which impairs immune function.

Alcohol reduces nutrient absorption, increases nutrient loss, replaces nutritious calories with empty ones, and damages organs that store and process nutrients.

Why Early Intervention Matters

Many of these conditions are preventable or reversible with early intervention.

With abstinence, the body can often reverse fatty liver, early fibrosis, high blood pressure, cardiomyopathy (sometimes), immune dysfunction, and nutritional deficiencies. Stopping drinking reduces risk of accidents and injuries immediately, cancer development over time, cardiovascular events, and liver disease progression. Every year matters. Continuing to drink accumulates damage. Each year of sobriety allows healing and prevents further harm.

Getting Help

If you're concerned about your drinking, help is available.

Naltrexone and other medications can help reduce cravings and support abstinence. Medical supervision ensures safe withdrawal.

Don't wait for liver disease symptoms, a health crisis, or hitting "rock bottom." The best time to address problematic drinking is before serious damage occurs. But it's never too late to benefit from stopping.

Alcohol use disorder is a medical condition with effective treatments. The majority of people who receive appropriate treatment improve significantly.

Summary

The leading causes of death in people with alcohol use disorder include liver disease (cirrhosis and its complications that develop over years but are partially reversible if caught early), cardiovascular disease (heart attacks, strokes, and cardiomyopathy that can be sudden but often improve with abstinence), cancer (multiple types linked to alcohol that develop over years with risk decreasing after quitting), accidents (motor vehicle crashes, falls, and drowning that are immediate, unpredictable, and eliminated by abstinence), alcohol poisoning (acute overdose that is a medical emergency but immediately preventable), withdrawal (paradoxically dangerous for heavy drinkers requiring medical supervision for severe dependence), and suicide (dramatically elevated risk where treatment helps).

Many of these deaths are preventable. Early intervention saves lives. Treatment works. It's never too late to benefit.

If your drinking concerns you, don't wait for a health crisis. Take an Alcohol Use Assessment to explore how treatment could help you avoid these outcomes.