Background:Alcohol use is a leading risk factor for global disease burden, and data on alcohol exposure are crucial to evaluate progress in achieving global non-communicable disease goals. We present estimates on the main indicators of alcohol exposure for 189 countries from 1990–2017, with forecasts up to 2030.

Methods: Adult alcohol per-capita consumption (the consumption in L of pure alcohol per adult [≥15 years]) in a given year was based on country-validated data up to 2016. Forecasts up to 2030 were obtained from multivariate log-normal mixture Poisson distribution models. Using survey data from 149 countries, prevalence of lifetime abstinence and current drinking was obtained from Dirichlet regressions. The prevalence of heavy episodic drinking (30-day prevalence of at least one occasion of 60 g of pure alcohol intake among current drinkers) was estimated with fractional response regressions using survey data from 118 countries.

Findings: Between 1990 and 2017, global adult per-capita consumption increased from 5·9 L (95% CI 5·8–6·1) to 6·5 L (6·0–6·9), and is forecasted to reach 7·6 L (6·5–10·2) by 2030. Globally, the prevalence of lifetime abstinence decreased from 46% (42–49) in 1990 to 43% (40–46) in 2017, albeit this was not a significant reduction, while the prevalence of current drinking increased from 45% (41–48) in 1990 to 47% (44–50) in 2017. We forecast both trends to continue, with abstinence decreasing to 40% (37–44) by 2030 (annualised 0·2% decrease) and the proportion of current drinkers increasing to 50% (46–53) by 2030 (annualised 0·2% increase). In 2017, 20% (17–24) of adults were heavy episodic drinkers (compared with 1990 when it was estimated at 18·5% [15·3–21·6%], and this prevalence is expected to increase to 23% (19–27) in 2030.

Interpretation: Based on these data, global goals for reducing the harmful use of alcohol are unlikely to be achieved, and known effective and cost-effective policy measures should be implemented to reduce alcohol exposure.