Americans have always received extreme and divergent policies governing alcohol consumption. One minute they are encouraged to enjoy, and the next to abstain. George Washington's first election to public office was fueled by supplying roughly half a gallon of alcohol, including rum, to every voter who supported him.¹ This practice likely would have been discouraged by fellow founding father Dr. Benjamin Rush, who urged his fellow citizens to abstain from distilled spirits.² 

The U.S. again encountered mixed messaging in December 2024 when the National Academies of Sciences, Engineering, and Medicine issued a report tying moderate alcohol consumption with a lower risk of cardiovascular disease and mortality but higher risks of breast and colorectal cancer.³ Less than a month later, Dr. Vivek Murthy, the U.S. Surgeon General, released an advisory that recommended the health warning statement on alcohol containers⁴ sold in the U.S. be updated to note that alcohol consumption may cause cancer.⁵ 

Present campaigns mirror past efforts that highlighted the potential negative effects of alcohol consumption and resulted in the federal government mandating health warning statements on alcohol containers. However, the current campaign to require a cancer warning on alcohol containers will likely be hampered by the complex and thorny congressional action required to update the health warning statement. Nonetheless, alcohol industry members will need to carefully implement public relations, legislative, and litigation strategies to respond to this emphasis on the potential harms related to alcohol consumption.

Passage of the Alcohol Beverage Labeling Act of 1988

Enactment of the Alcohol Beverage Labeling Act of 1988⁶ ("Alcohol Beverage Labeling Act") was spurred by three factors. First, beginning in the 1970s, there was a growing public awareness of the potential negative effects associated with alcohol consumption.⁷ Additionally, in the 1980s in California, there was an advocacy campaign to mandate alcohol warning labels that noted the potential negative effects of alcohol consumption.⁸ Last, litigation in the 1980s alleged that alcohol producers should warn the public about the potential negative effects of alcohol consumption.⁹ 

As initially drafted, the Alcohol Beverage Labeling Act required beverages sold in the U.S. to rotate between bearing five different health warnings, one of which stated that alcohol consumption can increase the risk of cancer.¹⁰ At the time, former Senator Al Gore noted that, "liver disease, cancer, and hypertension are just some of the diseases that can be alcohol-related."¹¹ Removing these rotating warnings was a compromise that helped ensure the passage of the bill.¹² With this concession in place, the Alcohol Beverage Labeling Act was passed. It required beverages sold in the U.S. to be labeled with a warning that notes alcohol consumption may cause health problems and which highlights the risks of drinking while pregnant, driving a car, or operating heavy machinery.¹³ 

Feeling the Effects of Advocacy

Current efforts mirror past campaigns to require the federal government to mandate health warning statements on alcoholic beverages and to raise awareness of the potential negative effects of alcohol consumption. In 2020, several organizations, including the American Institute for Cancer Research and the Center for Science in the Public Interest (CSPI), petitioned the Alcohol and Tobacco Tax and Trade Bureau (TTB) to require a cancer warning on alcohol containers.¹⁴ In 2022, CSPI and other organizations sued TTB,¹⁵ prompting TTB to initiate health-related rulemakings governing nutritional, ingredient, and allergen labeling for alcohol beverages.¹⁶ 

Additionally, in 2023 and 2024, neo-prohibitionist efforts successfully promoted policies highlighting the potential harms related to alcohol.¹⁷ Over the past decade, there have been renewed efforts to use litigation to hold alcohol producers liable for the failure to warn of alleged negative effects of alcohol consumption.¹⁸ Robert F. Kennedy Jr., the U.S. Secretary of Health and Human Services, is a recovering alcoholic who has also "been outspoken about the dangers of alcohol."¹⁹

Congressional Bottleneck

However, addition of a cancer warning on the health warning statement may be hampered by the requisite congressional action necessary to update the health warning statement. Under the Alcohol Beverage Labeling Act, the U.S. Secretary of the Treasury may consult with the U.S. Surgeon General on labeling requirements for alcoholic beverages.²⁰ The Treasury Secretary may then issue a recommendation to Congress that available scientific evidence shows the health warning statement should be updated.²¹ However, the Alcohol Beverage Labeling Act does not empower either the Surgeon General or Treasury Secretary to make changes to the health warning statement.²² Instead, congressional action is required to add a cancer warning to the health warning statement.²³ Also, it is unclear if Robert F. Kennedy Jr.,²⁴ U.S. Surgeon General nominee Dr. Janette Nesheiwat,²⁵ or the 119th Congress²⁶ will overcome opposition²⁷ to changing the health warning statement.

Diluting Risks

The alcohol industry is attempting to counter the negative impacts of these efforts to mandate additional health-related statements on alcohol labels, implement neo-prohibitionist policies, and hold producers liable for the alleged negative effects of alcohol consumption. Such plans should include strategies on how to work with public relations professionals, law firms, and congressional allies to:

1. Engage on issues related to updating the health warning statement or adding other health related statements on alcohol labels
2. Avoid federal or state policies that overstate potential harms related to alcohol consumption
3. Counter litigation that aims to hold alcohol producers liable for the failure to warn of potential negative effects of alcohol consumption.

These are important efforts given the headwinds, from competition from cannabis,²⁸ mocktails,²⁹ and non-alcohol products³⁰ by producing non-alcohol products, as well as products containing cannabis and hemp.³¹

References

1 Bramen, Lisa. "Swilling the Planters With Bumbo: When Booze Bought Elections." Smithsonian Magazine. October 20, 2010. https://www.smithsonianmag.com/arts-culture/swilling-the-planters-with-bumbo-when-booze-bought-elections-102758236/.

2 Katcher, Brian S. "Benjamin Rush's Educational Campaign against Hard Drinking—Public Health Then and Now." American Journal of Public Health 83, no. 2 (February 1993): 273, 275. https://pmc.ncbi.nlm.nih.gov/articles/instance/1694575/pdf/amjph00526-0115.pdf.

3 National Academies of Sciences, Engineering, and Medicine. "New Report Reviews Evidence on Moderate Alcohol Consumption and Health Impacts." December 17, 2024. https://www.nationalacademies.org/news/2024/12/new-report-reviews-evidence-on-moderate-alcohol-consumption-and-health-impacts.

4 See 27 U.S.C. § 215(a) (2025). 

5 U.S. Department of Health and Human Services. "U.S. Surgeon General Issues New Advisory on Link Between Alcohol and Cancer Risk." January 3, 2005. https://www.hhs.gov/about/news/2025/01/03/us-surgeon-general-issues-new-advisory-link-alcohol-cancer-risk.html.

6 Alcoholic Beverage Labeling Act of 1988. Pub. L. No. 100-690, 102 Stat. 4518 (1988) (to be codified at 27 U.S.C. § 201 et seq.).

7 Grove, Amanda. "Sobering News for the Alcohol Industry." Hastings Communication and Entertainment Law Journal 11 (1989): 643, 652. 

8 See id. at 645–647.  

9 See id. at 647–652. 

10 See S. 2047, 100th Cong., 2nd Sess., at 5–6 (1988). Summary: https://www.congress.gov/bill/100th-congress/senate-bill/2047?s=2&r=2&q=%7B%22search%22%3A%22S+2047%2C+1988%22%7D. 

11 See 134 Cong. Rec. 30752, 30754 (daily ed. Oct. 14, 1988) (Statement of Senator Gore, statement of Senator Thurmond) (emphasis added). 

12 See id.

13 See note 4.

14 Consumer Federation of America. "Consumer, Public Health Groups Petition for Cancer Warning on Alcohol." October 21, 2020. https://consumerfed.org/testimonial/consumer-public-health-groups-petition-for-cancer-warning-on-alcohol/.

15 Center for Science in the Public Interest." Alcohol Labeling: TTB." January 30, 2024. https://www.cspinet.org/case/alcohol-labeling-ttb.

16 Center for Science in the Public Interest. "Why we need more transparent alcohol labeling." June 11, 2024. https://www.cspinet.org/resource/why-we-need-more-transparent-alcohol-labeling.

17 Wehterall, Tyler. "What Do Neo-Prohibitionists Really Want?" Seven Fifty Daily. December 9, 2024. https://daily.sevenfifty.com/what-do-neo-prohibitionists-really-want/.

18 Joseph, Robert. "Will Lawyers Drive the Move Towards US Neo-Prohibitionism?" Meininger's International. May 26, 2024. https://www.meiningers-international.com/wine/insights/will-lawyers-drive-move-towards-us-neo-prohibitionism.

19 Oliphant, James and Nathan Layne. "Alcohol cancer risk warning may face tough road with Trump." Reuters. January 3, 2025. https://www.reuters.com/world/us/alcohol-cancer-risk-warning-may-face-tough-road-with-trump-2025-01-03/. 

20 See 27 U.S.C. § 217 (2025).

21 See id. at § 217.

22 See id. at § 217.

23 See id. at § 217.

24 See note 19.

25 Frazier, Kierra and Daniel Payne. "Trump chooses Fox News contributor Dr. Janette Nesheiwat for Surgeon General." Politico. November 22, 2024. https://www.politico.com/news/2024/11/22/trump-chooses-fox-news-contributor-dr-janette-nesheiwat-for-surgeon-general-00191379.

26 Cirruzzo, Chelsea. "Surgeon General's Call for Alcohol Warning Label Likely to Fall Flat in Congress." Politico. January 3, 2025. https://www.politico.com/news/2025/01/03/surgeon-general-alcohol-cancer-congress-00196399.

27 See id.

28 Jaeger, Kyle. "Analysts See 'Sudden Spike' in Use of Marijuana as an Alcohol Alternative." Marijuana Moment. December 27, 2024 https://www.marijuanamoment.net/analysts-see-sudden-spike-in-use-of-marijuana-as-an-alcohol-alternative/. Also see Newman, Kara and Ashlie D. Stevens. "As cannabis cuts into spirits spending, distillers release 'hempered' products." Salon. August 20, 2019. https://www.salon.com/2019/08/20/as-cannabis-cuts-into-spirits-spending-distillers-release-hemped-products/.

29 Wilson, Jason. "From Dry January to Fake Cocktails, Inside the New Temperance Movement." Washington Post Magazine. July 25, 2022. https://www.washingtonpost.com/magazine/2022/07/25/cocktails-sober-curious-drinking-alcohol/.

30 Valinsky, Jordan. "Americans have already been ditching spirits and beer. Alcohol companies are future proofing themselves." CNN. January 3, 2025. https://www.cnn.com/2025/01/03/food/beer-spirit-sales-non-alcoholic.

31 See notes 28 through 30.