People who don’t drink a drop can still be harmed by alcohol, according to a new study. 

The study, published in BMC Medicine, looked at the health consequences of alcohol, even for people who don’t drink. The researchers found that through car accidents, physical assaults, and the effects of alcohol on pregnancy, thousands of people who do not drink are hurt or killed by alcohol each year in Germany.

Although researchers looked at only one country, they say the study proves that alcohol can cause third-party harm or loss of life. 

“These study’s estimates indicate there is a substantial degree of health harm to third parties caused by alcohol in Germany. While more research on harms to others caused by alcohol is needed to provide comprehensive estimates, the results indicate a need for effective prevention,” the study authors wrote.

The authors took a fairly conservative approach to estimating the number of car accidents, violence and birth defects where alcohol was a contributing factor. They found that alcohol was involved in 45.1% of third-party traffic fatalities (this did not include drunk drivers who killed themselves).

In addition, alcohol was estimated to be a factor in 14.9% of deaths caused by interpersonal violence. It also contributed to birth defects in nearly 3,000 babies born in 2014 alone. 

“The harmful effects of alcohol on others need to be recognized as a public health problem in the same way as are the harmful effects on the drinker or the costs to society,” the study authors wrote. “The present findings of harms to others related to alcohol use during pregnancy, drunk driving, and interpersonal violence using the best available data reveal that alcohol may not only cause harm to the drinker but may also harm a substantial number of third parties.”

The study authors pointed out that most research has focused on alcohol’s harms to drinkers, while other studies have focused on the financial cost to society. However, interpersonal harm from alcohol hasn’t been studied in depth because it can be hard to measure. 

Although the authors focused on harms from three conditions that are relatively easy to measure, they pointed out that alcohol can also cause social harms that are more difficult to study. 

“Sober people walking home at night may be harassed and injured by drunken pedestrians or may be attacked while attempting to separate intoxicated young people who are fighting,” they write. “Children may suffer problems caused by a drinking father or mother, and continued heavy drinking during pregnancy may severely harm the health of the newborn.”