Alcohol and COVID-19: How Do We Respond to This Growing Public Health Crisis?
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Division of Alcohol, Drugs, and Addiction, McLean Hospital, Belmont, MA, USA; 2Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
J Gen Intern Med DOI: 10.1007/s11606-020-06321-z © Society of General Internal Medicine 2020
the onset of COVID-19, the USA was experiencing B efore rising rates of alcohol use, high-risk drinking, and alcohol use disorder (AUD) with negative consequences including increases in alcohol-related morbidity and mortality.1 As a result of the COVID-19 pandemic, it is likely that the USA will see further increases in alcohol consumption similar to those observed in the UK2 and Australia,3 raising significant public health concerns. In the USA, while effective screening, medication, and behavioral treatments are available, only 7.9% of adults with AUD received any alcohol treatment in 2018.4 This compounds the challenge of expanding treatment capacity for those who relapse to harmful drinking or have new onset of alcohol-related problems as a consequence of this pandemic. Excessive alcohol use is a common response to coping with stress3 and increased alcohol use following past traumatic events has been demonstrated in the USA with associated adverse health and social consequences.5 A meta-analysis of 31 population-based studies of mass terrorist attacks concluded that 7.3% of a population can be expected to report increased alcohol consumption in the first two years after the attack, with 20% probability that the prevalence will be as high as 14%.5 That said, COVID-19 is distinct from other catastrophic events because of the extensive population exposure to ongoing trauma. The mortality rate from COVID-19 has already resulted in large numbers of Americans experiencing loss and grief. There is also widespread social disruption and isolation, while at the same time, social support and access to medical care have been delayed or limited due to stay-at-home orders and COVID-19 restrictions. This pandemic comes with severe domestic and global negative economic impacts and the length and scope of the pandemic are greater than we have seen with natural disasters and terrorist attacks, leading to prolonged
Received June 1, 2020 Accepted October 15, 2020
stress and uncertainty. In addition to the psychological stress, stay-at-home orders that are recurring in some states based on increased case rates, uncertainties related to school re-openings, self-isolation, and quarantining can lead to additional stress, which can in turn lead to increased drinking. According to one study, social isolation during the pandemic lockdown in London was a risk factor for increased alcohol consumption among people with AUD as well as relapse among those previously abstinent.2 In an Australian study (N = 4462), 30.8% of participants endorsed drinking “a lot more than normal” during the pandemic.3 This study also identified certain pre-pandemic characteristics that were predictors of increased consumption during the pandemic including pre-pandemic heavy drinking; being a woman, aged 25– 64, or in a highe
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