President’s message: alcohol use during the COVID-19 pandemic

In March 2020 life changed when cases of COVID-19 rose in the United States and 44 states and Washington DC implemented stay at home orders. As our country faced the new reality of living through a pandemic, alcohol sales increased 54% in the third week of March, and online sales of alcohol were increased by 477% toward the end of April, compared to the year prior. People bought larger sizes of alcoholic beverages, with an increase in box wine sales up by 44% and increase in 1.75 mL bottles of liquor up by 47%.¹ The rise in alcohol purchases for at home consumption is not surprising because bars closed and restaurants closed to dine-in service, as these were deemed nonessential businesses. As sales of alcohol for use at home increased, online memes seemingly celebrated or made light of day drinking. Recipes for “quarantinis” were widely shared as a means to escape or entertain ourselves. As an addiction psychiatrist, I have to ask how has COVID-19 and the changes surrounding alcohol use affected drinking behavior and those with alcohol use disorder?

In Pennsylvania, Fine Wine and Spirits stores (i.e., state run stores which sell wine and liquor) were closed as nonessential businesses. I recall there were many concerns raised in Pennsylvania about what will happen when the state stores close? There were worries that there would be escalating numbers of people seeking treatment for alcohol withdrawal or people going through alcohol withdrawal on their own, resulting in serious complications, like withdrawal seizures and/or delirium. I prepared myself for an influx of people seeking treatment for alcohol withdrawal and possibly people reporting drinking nonbeverage alcohol. Our program decreased barriers to starting treatment and switched to telemedicine visits. Despite the changes, anecdotally, very few people sought ambulatory withdrawal management in late March and April but the number has grown in recent months. People seeking treatment told me about how loss of employment, increased time at home, boredom, stress and isolation, and loss of social support from in-person mutual support meetings, resulted in a return to drinking or increased drinking during the pandemic.

In addition to sharing my experience thus far, I would like to review some survey data regarding how people’s drinking has changed during COVID-19. First is a cross-sectional phone survey of people previously in treatment for alcohol use disorder which was performed in May 2020 in the United Kingdom. Of the 182 participants, a majority were male (73%) and White (78%). Forty-three (24%) indicated an increase in alcohol intake and mean consumption was 82.5 units of alcohol per week, while 34 people (19%) had a decrease in their alcohol intake. Survey participants who were abstinent before lockdown (n = 69, 38%) had a mean period of abstinence of 19.5 months, and of this group, 17% returned to drinking during the lockdown. There were 113 survey participants who were drinking prior to lockdown and 14 of them (12%) stopped drinking during lockdown.² Second, in May 2020, Research Triangle Institute (RTI)³ conducted a survey of 993 individuals asking about alcohol consumption, mental health, employment, and lifetime alcohol experiences in both February and April 2020. Out of the 993 individuals queried, 555 reported drinking alcohol in February. The study found the amount people reporting drinking increased from February to April by 27%, with average number of drinks per day increasing from 0.74 to 0.94. Furthermore, respondents reported exceeding drinking guidelines in April (36%) compared to February (29%), a 21% increase. With regard to binge drinking, a higher percentage engaged in binge drinking in April (27%) compared to February (21%), a 26% increase. When asked about frequency of drinking, 31% increased their drinking frequency by an average of more than 7 days, 48% had no change in the frequency, and 21% of respondents decreased their frequency of drinking. Looking at demographic characteristics, a higher percentage of Black respondents reported exceeding drinking guidelines (17%) compared to White respondents (3%; p = 0.028) and a higher percentage of women reported exceeding drinking guidelines (10%) compared to men (2%; p = 0.026).

As the addiction treatment and research communities speculated, COVID-19 appears to have impacted those struggling with alcohol use and alcohol use disorder. Loss of employment and social support, economic hardship, and stress and boredom may contribute to alcohol use as a means to escape or entertain. We are now learning about how the pandemic affects drinking behavior in those previously in treatment for alcohol use disorder and those who may not have a prior alcohol use disorder diagnosis. To improve outcomes, we need continued research focusing on how those who use alcohol are affected by the pandemic, effective messaging regarding prevention, screening, brief interventions and referral to treatment, and sustained efforts to facilitate participation and continued engagement in substance use disorder treatment.

Julie Kmiec, DO
President, American Osteopathic Academy of Addiction Medicine
[email protected]