The findings from our co-relative design suggesting a direct causal effect of AUD on mortality is consistent with several prior lines of evidence. First, naturalistic studies show declines in mortality with reduced alcohol consumption at a population level (eg, Prohibition in the United States26 and the Gorbachev reforms in the Soviet Union27). Second, a previous meta-analysis showed that alcohol-dependent individuals who continued to drink heavily had significantly greater mortality than alcohol-dependent individuals who reduced their alcohol intake.2 Third, 6 randomized clinical trials have shown that interventions leading to reduced drinking also reduced mortality rates.28
