The number of adults who binge drink at least once a week could be as high as 30 million, greater than the population of every state save California, according to a study published today in JAMA Psychiatry. A similar number reported alcohol abuse or dependency.

Between the genders, women showed the larger increase in alcohol abuse, according to the report.

“This should be a big wake-up call,” says David Jernigan, director of the Center on Alcohol Marketing and Youth at the Johns Hopkins Bloomberg School of Public Health, who wasn’t involved with the research. “Alcohol is our number one drug problem, and it’s not just a problem among kids.”

While underage drinking has declined in recent years, adult consumption increased across all demographics. The jump was also especially large for older Americans, minorities, and people with lower levels of education and income.

The rise is “startling,” says Bridget Grant, a researcher at the National Institute on Alcohol Abuse and Alcoholism and lead author of the paper. “We haven’t seen these increases for three or four decades.”

The share of adults who reported any alcohol use, high-risk drinking, or alcohol dependence or abuse increased significantly between surveys conducted in 2001-02 and follow-up surveys in 2012-2013. Researchers interviewed tens of thousands of people in person with similar questions, offering a robust, nationally representative look at how American drinking habits have evolved in the 21st century.

About 12.6 percent of adults reported risky drinking during the previous year in 2012-13, compared with 9.7 percent in 2001-02. Behavior was considered high-risk if people exceeded the government’s daily limits for alcohol intake, set at four drinks in one day for women and five drinks for men, at least once a week.

That 3 percentage point increase may not seem like a huge jump, but given an adult U.S. population of about 250 million, it represents roughly 7 million more people binge drinking at least once a week.

The increase in alcohol abuse or dependence was even greater: Some 12.7 percent of respondents reported such behavior in the 2012-13 period, compared with 8.5 percent in 2001-02. That percentage increase is roughly equivalent to 10.5 million people at the current population. The surveys assessed abuse or dependence using standard diagnostic criteria, with questions like whether people had difficulty cutting down on drinking, or if they continued drinking even when it caused trouble with family and friends.

There’s no single explanation for the increase. Researchers point to economic stress in the aftermath of the Great Recession; more easily available alcohol at restaurants and retailers; and the diminished impact of alcohol taxes. As a percentage of average income, alcohol is cheaper today than at any point since at least 1950.

Pervasive marketing by the alcohol industry and new products such as flavored vodkas or hard lemonade and iced tea may also be driving some of the increases among women and other demographics, says Jernigan.

The consequences for health care, well-being, and mortality are severe. Excess drinking caused on average more than 88,000 deaths in the U.S. each year between 2006 and 2010, the Centers for Disease Control estimates—more than twice the number of deaths from prescription opioids and heroin last year. The total includes drunk-driving deaths and alcohol-linked violence, as well as liver disease, strokes, and other medical conditions. The CDC says drinking too much is responsible for one-in-ten deaths among working-age Americans.

The estimated cost of excess alcohol consumption is almost $250 billion a year in the U.S.

“We pay for all of it,” says Jürgen Rehm, senior director of the Institute for Mental Health Policy Research at the Centre for Addiction and Mental Health in Toronto. The costs show up in higher health care needs, lost productivity, and prosecuting alcohol-fueled crimes from drunk driving to homicide.

Rehm says alcohol doesn’t command the attention of policymakers the way tobacco, illicit drugs, or prescription opioids have. “The response of society should be commensurate to the level of the problem,” he says. Yet there is no national strategy in the U.S. that matches recent, high-profile efforts to combat opioids, smoking, or illegal drugs. “Alcohol,” Rehm says, “we just tend to overlook.”

What can be done? Making alcohol more costly through higher taxes or setting minimum prices could reduce consumption, says William Kerr, senior scientist at the Alcohol Research Group, a nonprofit research center primarily funded by the National Institute on Alcohol Abuse and Alcoholism. In Canada, putting a floor under prices was linked to reductions in alcohol-related hospital visits. Limiting availability—by restricting hours of sale or the number of liquor licenses, for example—would also reduce consumption, he adds.

More medical screening could also identify people with risky drinking habits. That, however, would require a significant cultural shift in the U.S.

Americans tend to consider excess drinking a character flaw rather than a medical problem. Only about one-fifth of people who have reported alcohol abuse or dependency have ever been treated, previous research by Grant found. That compares with a treatment rate of about 60 percent for depression, she says.

“I think that there’s a lot of stigma still associated with it and people don’t want to talk to their doctors about it,” she says. “We haven’t done the job for alcohol that we’ve done with depression.”