The effect of resilience on alcohol use and alcohol-related outcomes: A systematic review and meta-analysis.

BACKGROUND: Resilience, defined as the capacity to recover from difficulties or to adapt well to stressors, challenges, and adversities in life, is increasingly studied, yet its role in a range of alcohol-related outcomes remains unclear, including alcohol consumption, risky drinking, and alcohol use disorder. This review synthesises available evidence while considering variability across populations, contexts, and measurement approaches. METHODS: We systematically searched MEDLINE, PsycINFO, CINAHL, and Web of Science for observational studies examining the relationship between individual-level resilience and alcohol-related outcomes. Two independent reviewers screened records and extracted data, with disagreements resolved by consensus. We included studies published on or after 1 January 2014 that reported an association or provided sufficient data to determine its direction. Random-effects meta-analysis was used to estimate pooled associations for studies reporting comparable effect sizes (odds ratios or correlation coefficients), and narrative synthesis was used for studies not amenable to meta-analysis. RESULTS: A total of 66 studies met the inclusion criteria and were included in the review. Approximately two-fifths (42.6%) were conducted in high school or college student populations, and 65.3% were conducted in high-income countries, primarily the United States. Meta-analysis of 24 studies showed that higher resilience was associated with lower odds of alcohol-related outcomes (pooled OR = 0.91, 95% CI = 0.87-0.95), although the observed heterogeneity was substantial (I2 = 99.9%, p < 0.001). Consistent with this, the narrative synthesis indicated that associations between resilience and alcohol outcomes varied by life stage, high-risk or clinically vulnerable populations, cultural context, and resilience dimensions, with emotion-regulation and coping-related components showing more consistent protective associations than competence- or achievement-oriented traits. CONCLUSION: While resilience shows a small protective association with alcohol use and related harms, but effects are highly context-dependent and specific by dimension. Given most evidence is cross-sectional with substantial heterogeneity, resilience should not be considered as a standalone target for prevention. Future research should prioritise longitudinal designs, standardised measurement and a clear differentiation between resilience components to clarify how specific dimensions of resilience influence alcohol outcomes across diverse populations. Prospero Registrationhttps://www.crd.york.ac.uk/PROSPERO/view/CRD42024520281.