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Before You Try to Heal: Alcohol, Freedom, and the Consequences We Cannot Undo

Writer: Galen Cole
Galen Cole
7 days ago
7 min read

Updated: 3 days ago

“Before you try to heal someone, ask them if they are willing to give up the thing that is making them sick.”


That line, often attributed to Hippocrates, has stayed with me across decades of public health work and clinical practice. It is not a threat. It is a reality check. Healing requires willingness. Without it, the best interventions become temporary detours around a problem the person still wants to keep.


It may look as though I am picking on alcohol. In one sense, I have reason to be grateful for it. The damage it produces has kept my schedule full and helped pay the bills for years. On the other hand, the consequences I see and hear about are overwhelming—far beyond what I imagined as a young therapist. Occasional use of a beer, a glass of wine, or a single drink is not, in my view, the central problem. The American cultural script that says “if it feels good, do it, and keep doing it until it hurts” or “the more the merrier” is the opposite of what serves individuals, families, and the broader society.


I grew up watching adult men drink on occasion. None of them had a drinking problem. The photograph that accompanies this post shows my grandfather holding me as a small child. Those men drank, then they stopped. What concerns me most now is the pattern among people in their twenties, thirties, and forties who drink heavily and often nearly every day. This is especially alarming among young women. Data show that alcohol-related harms, including liver disease and deaths, have risen faster among women in recent decades, and in some recent surveys young adult women have reported higher past-month binge drinking rates than young men in the same age group. Women are biologically more vulnerable to certain alcohol-related injuries, including liver disease and breast cancer risk, even at lower levels of consumption.


You can do whatever you want. You do not get to choose the consequences. Many of those consequences cannot be taken back or undone.


I learned that early. In my early thirties, while serving as associate director of public health in Maricopa County, Arizona, I heard about a young man returning home after a long night of drinking. He went up over a curb, into a front yard, and ran over and killed two young boys. When the news reached me, I wept. Those children were gone. Their families would carry that loss forever. The driver would carry the knowledge of what he had done. No amount of remorse or treatment could reverse the facts of that morning.


The list of irreversible or long-lasting harms is long and well documented. Excessive alcohol use is linked to roughly 178,000 deaths each year in the United States—an increase of nearly 30 percent from earlier estimates—and shortens the lives of those who die by an average of about 24 years. About one-third of those deaths involve acute events; the rest involve chronic conditions. Alcohol is among the leading risk factors for death and disability in early and middle adulthood. Below are major categories of harm, drawn primarily from CDC and NIAAA data:


Deaths, injuries, and acute harm


  • Roughly 178,000 deaths annually from excessive alcohol use (about 488 per day).

  • Alcohol is a factor in about 30–32 percent of motor vehicle traffic fatalities (approximately 11,900–13,500 deaths in recent years, or one every 39–44 minutes).

  • Alcohol contributes to a substantial share of other fatal injuries: about 25 percent of suicides, 40 percent of fatal burn injuries, 50 percent of fatal drownings and homicides, and 65 percent of fatal falls.

  • About one-third of injuries treated at trauma centers are alcohol-related.

  • Alcohol-related emergency department visits have risen substantially over time.

  • Acute alcohol poisoning, falls, drownings, and violence can produce permanent disability or death in a single episode.


Liver and other chronic disease


  • Roughly half of liver disease deaths in the United States involve alcohol. Of cirrhosis deaths, about half are alcohol-related; the percentage is especially high among adults ages 25–34 (around 80 percent in recent data) and 35–44.

  • Alcohol-associated liver disease has been rising, particularly among younger adults and women. Women who drink heavily progress to alcohol-associated hepatitis and cirrhosis more readily than men at comparable levels.

  • Alcohol increases the risk of high blood pressure, cardiomyopathy, atrial fibrillation, stroke, and pancreatitis.

  • It worsens management of conditions such as diabetes, hypertension, and sleep disorders.


Cancer


  • Alcohol is a Group 1 known human carcinogen. Recent estimates indicate it accounts for roughly 5–6 percent of cancer cases and about 4 percent of cancer deaths in the United States.

  • It is associated with cancers of the oral cavity, pharynx, larynx, esophagus, liver, colon, rectum, and breast.

  • Even one drink per day is linked to a 5–15 percent higher risk of breast cancer in women compared with nondrinkers. The risk rises with the amount consumed.

  • Alcohol-attributable cancer deaths have increased over time.


Reproductive, developmental, and prenatal harm


  • Prenatal alcohol exposure is a leading preventable cause of birth defects and neurodevelopmental disorders. Fetal alcohol spectrum disorders (FASDs) can produce lifelong physical, cognitive, and behavioral problems.

  • Community studies estimate that 1–5 percent of U.S. school-aged children (up to 1 in 20) may have FASDs.

  • There is no known safe level of alcohol during pregnancy. Recent surveys show that a meaningful percentage of pregnant women report past-month drinking or binge drinking.


Brain, mental health, and alcohol use disorder


  • Heavy use alters brain structure and function, including reductions in neuron size, changes in reward and executive-control circuits, and neuroinflammation. These changes make continued drinking more likely and recovery more difficult.

  • Alcohol can cause blackouts (gaps in memory) by disrupting memory consolidation in the hippocampus.

  • Progressive changes in the brain contribute to the development of alcohol use disorder (AUD). Among young adults ages 18–25, past-year AUD rates are elevated (around 14 percent in recent data).

  • Alcohol is linked to higher rates of depression, anxiety, and suicide. It is a factor in a substantial share of suicide deaths and attempts.

  • Some brain changes can improve with sustained abstinence, but the degree of recovery varies and is not guaranteed, especially with longer or heavier exposure.


Violence, family, and social harm


  • Alcohol is frequently involved in intimate partner violence; estimates from reviews and surveys often place it as a factor in 30–50 percent of cases (higher in some studies of severe incidents or homicides).

  • It contributes to child neglect, family disruption, and intergenerational patterns of harm. Children in households with heavy parental drinking face elevated risks of violence, neglect, emotional distress, and poorer outcomes.

  • Men’s heavy drinking, in particular, is linked to disproportionate harms to women and children through violence, economic strain, and relationship damage.


Economic costs


  • Excessive alcohol use cost the United States an estimated $249 billion in 2010 (the most widely cited comprehensive figure), or about $2.05 per drink. Roughly three-quarters of that cost is tied to binge drinking.

  • The largest share comes from lost workplace productivity (about 72 percent), followed by healthcare costs, criminal justice expenses, and motor vehicle crash costs.

  • Alcohol-associated liver disease alone has been estimated in the tens of billions annually in more recent analyses. Governments pay a substantial portion of the overall burden.


Young adults are not immune. Alcohol remains one of the leading risk factors for death and disability through early and middle adulthood. The sharpest relative increases in alcohol-induced deaths over the past 25 years have occurred among adults ages 25–34, with particularly steep rises among women in that age group (more than doubling, and in some analyses exceeding 250 percent from 1999 levels). Binge drinking rates among young women ages 18–25 have, in recent national survey periods, equaled or exceeded those of young men.


In clinical work I have also seen the quieter but equally durable damage: blackouts that erase memory, progressive isolation, relationships that erode under repeated broken promises, careers stalled or ended, and the slow accumulation of medical problems that appear only after years of daily or near-daily use. These are not abstract statistics. They show up in the people who sit across from me, and in the families who describe years of watching someone they love choose the drink over the consequences that follow.


The cultural message that more is better, or that feeling good in the moment justifies whatever comes later, collides with the simple fact that alcohol does not negotiate. Biology, physics, and other people’s safety do not care about intentions. Once the car leaves the road, once the liver is scarred, once a child is injured in utero or by neglect, the option to undo the outcome is gone.


This is why the opening question matters. Before anyone attempts to help another person change, it is useful to ask whether that person is willing to give up the thing that is keeping them sick. Willingness is not the same as perfection. It is the starting point. Without it, the most skilled therapy, the best medication, and the most loving family support will keep running into the same obstacle. With it, change becomes possible even when the road is difficult.


I do not write this as someone who believes all drinking is forbidden or that occasional use is the same as daily heavy use. I write it as someone who has spent a career in public health and clinical practice watching what happens when a culture treats “the more the merrier” as wisdom and then wonders why so many people, especially the young, are paying prices that cannot be refunded.


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© 2026 Galen E. Cole, PhD, MPH, LPC. All rights reserved. This essay is an original work first published at galencole.com. No part of this work may be reproduced, redistributed, scraped, or used to train commercial models without prior written permission, except for brief quotation with clear attribution to the author and a link to the original post.



 
 
 

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