The National Institute on Alcohol Abuse and Alcoholism (NIAAA) is the lead Federal agency for research on alcohol and health and the largest funder of alcohol research in the world. NIAAA’s mission is to generate and disseminate fundamental knowledge about the effects of alcohol on health and well-being, and apply that knowledge to improve the diagnosis, prevention, and treatment of alcohol-related problems, including alcohol use disorder (AUD), across the lifespan.

Alcohol misuse refers to drinking in a manner, situation, amount, or frequency that could cause harm to individuals or those around them. It contributes to poor performance at school and work; family trouble; unprotected sex and sexually transmitted diseases; violence; memory blackouts; unintentional injuries, accidents, and overdoses; and organ damage and disease. It can also lead to AUD, a serious condition that affects nearly 16 million people in the United States. The Centers for Disease Control and Prevention estimates that alcohol misuse costs the United States $249 billion per year due to health care expenses, lost workplace productivity, crime, property damage, and other adverse outcomes.

For nearly five decades, NIAAA has supported cutting-edge research to reduce the toll that alcohol misuse takes on human health and well-being. This work has significantly broadened our understanding of the factors that contribute to alcohol-related problems and the mechanisms by which they develop. Once viewed as a moral failing or character flaw, AUD is now widely regarded as a chronic disease of the brain with potential for recovery and recurrence. This shift in perspective, supported by advances in neurobiological research, has helped reduce the stigma associated with AUD, led to more effective interventions, and provided support for integrating prevention and treatment services into mainstream health care.

This strategic plan serves as a roadmap for optimizing the allocation of NIAAA’s resources to areas of alcohol research most likely to benefit from additional support, translating scientific discoveries for the benefit of the public, and continuing to build on NIAAA’s position as the nation’s key source of evidence-based information on alcohol and health. Over the next five years, NIAAA will prioritize the following goals:

Goal 1: Identify Mechanisms of Alcohol Action, Alcohol-Related Pathology, and Recovery. NIAAA will support preclinical and clinical research to generate a more thorough understanding of the fundamental mechanisms through which alcohol exerts its effects on human health and behavior, how patterns of alcohol use interact with genes and the environment in the development and progression of alcohol-related conditions, and the neurobiological mechanisms underlying recovery from alcohol-related pathology.

Goal 2: Improve Diagnosis and Tracking of Alcohol Misuse, Alcohol Use Disorder, and Alcohol-Related Consequences. NIAAA will support research to improve the diagnosis of alcohol-related diseases, including AUD, fetal alcohol spectrum disorders (FASD), and alcoholic liver disease (ALD). The Institute will also support epidemiological research to track the prevalence, patterns, and trends of alcohol misuse, AUD and co-occurring mental health conditions, and related consequences; elucidate the nature and scope of individual- and population-based differences in substance use and related outcomes; and identify the complex biopsychosocial factors that contribute to these outcomes. This information will be used to guide the development and implementation of interventions for preventing and treating alcohol misuse and its negative repercussions.

Goal 3: Develop and Improve Strategies To Prevent Alcohol Misuse, Alcohol Use Disorder, and Alcohol-Related Consequences. NIAAA will support research to adapt and evaluate adult alcohol screening for a broader range of settings and populations, evaluate the effectiveness of youth alcohol screening, and develop and evaluate methods for administering alcohol screening in combination with screening for tobacco, marijuana, and other drugs. NIAAA will also prioritize the development of culturally appropriate interventions for preventing alcohol misuse and its consequences, including human immunodeficiency virus (HIV), among individuals at all stages of life.

Goal 4: Develop and Improve Treatments for Alcohol Misuse, Alcohol Use Disorder, Co-Occurring Conditions, and Alcohol-Related Consequences. NIAAA will support research to develop new and improved treatments for AUD and co-occurring mental health conditions, FASD, ALD, and other alcohol-related diseases. The Institute will also support studies to identify factors that facilitate or inhibit recovery from AUD and improve the implementation, accessibility, and use of alcohol treatment and recovery services tailored to the needs of individuals.

Goal 5: Enhance the Public Health Impact of NIAAA-Supported Research. NIAAA will continue to develop initiatives to raise public awareness about the effects of alcohol on health and well-being and about options for preventing and treating alcohol-related problems. The Institute will strengthen collaborations with other Federal agencies; with scientific, professional, and advocacy organizations; and with patient and community groups to develop, disseminate, and encourage the adoption of evidence-based and culturally appropriate resources and strategies to reduce the public health burden of alcohol misuse.

There has never been a better time to accelerate progress toward these goals. The Collaborative Research on Addiction at NIH (CRAN) initiative is fostering synergy among NIAAA, the National Institute on Drug Abuse, and the National Cancer Institute to develop a comprehensive, well-integrated understanding of polysubstance use and addiction that considers common and distinctive features among substances and substance use disorders. The Human Connectome Project and the Brain Research through Advancing Innovative Neurotechnologies (BRAIN) Initiative, in which NIAAA is an active participant, are expected to spur an explosion of knowledge about the structure and function of brain circuits and how the brain affects behavior. New technologies for measuring and modulating brain activity are being developed to translate our understanding of the neurobiology of AUD into new diagnostic and treatment methods. Advances are also being made in the behavioral and social sciences toward understanding the mechanisms of behavior change, and opportunities are ripe for applying this knowledge to the development of interventions for preventing and treating AUD.

Although alcohol-related injury and disease may never be eliminated completely, research has opened new avenues for reducing the adverse consequences of alcohol misuse and AUD. For example, three-dimensional facial imaging technologies hold promise for early identification and treatment of children affected by FASD. Significant progress has also been made in identifying the biological mechanisms by which ALD develops and progresses, and NIAAA is supporting a major initiative to translate these findings into new and improved treatments for alcoholic hepatitis.

Alcohol researchers are beginning to unravel the mysteries of why some people are more likely than others to develop alcohol-related diseases or to respond to behavioral and pharmacological interventions. Continued advances in genomics, along with the Precision Medicine Initiative, a national effort to elucidate how individual variability in genes, environment, and lifestyle contribute to disease, are expected to bring us closer to developing individually tailored interventions for preventing and treating these conditions. Moreover, rapid advances in electronic health technologies are providing opportunities to help individuals monitor their alcohol use and to provide them with personalized resources and support where and when they need it most. Such devices also have the potential to facilitate alcohol research and clinical care.

NIAAA looks forward to working with its partners to capitalize on these and the many other advances being made across the spectrum of alcohol research to reduce the public health burden of alcohol misuse on individuals, families, communities, and society.