Addiction, mental illness, a defacto requirement to drive to get around low-density towns where walking is often extremely dangerous due to lack of sidewalks and fast roads.

Alcohol abuse has been around about as long as we've been human. We've just constructed a society where Alcohol abuse is far more likely to pick up collateral damage.

We've also become a lot better at distilling high-proof alcohol, and at making it cheap enough that most people have the budget to get absolutely wasted on the regular.

Most people don't do that, but the option is there for anyone looking to make their life and the lives of people around them significantly worse.