Survey shows increase in alcohol use during COVID-19 pandemic
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Alcohol use increased in the United States during the first few months of the COVID-19 pandemic, according to a study published in JAMA Network Open.
“Alcohol consumption is often used as a way to cope with mental distress,” Michael S. Pollard, PhD, a sociologist at the RAND Corporation and a professor at the Pardee RAND Graduate School, told Healio Primary Care. “Depression, anxiety, loneliness and physical isolation have all likely increased during the COVID-19 pandemic, and increased alcohol use may reflect and be a result of these increases. At the same time, we also know that alcohol use can contribute to depression and anxiety, which may create a vicious circle of increased mental distress, increased drinking and further increased distress.”
Previously, a Nielsen report found that alcohol sales had increased compared with previous years in the early days of the COVID-19 pandemic.
For the current analysis, Pollard and colleagues conducted a survey study using data from the RAND Corporation American Life Panel, a nationally representative probability-sampled panel of adults.
They included information from the wave 1 baseline survey, which was conducted from April 29, 2019, through June 9, 2019, and from the wave 2 survey, conducted this year from May 28 through June 16.
Researchers compared the number of days of any alcohol use and heavy drinking — defined as consuming five or more drinks for men and four or more drinks for women within a few hours — and the average number of drinks consumed in the last month before and during the COVID-19 pandemic.
A total of 1,540 adults with a mean age of 56.6 years were included in the study.
Pollard and colleagues found that the frequency of alcohol consumption increased by 0.74 days overall (95% CI, 0.33-1.15 days), a 14% increase from 2019 to 2020.
In women, the frequency of alcohol consumption increased by 0.78 days (95% CI, 0.41-1.15 days), or by 17% from baseline. In adults aged 30 to 59 years, the frequency of alcohol consumption increased by 0.93 days (95% CI, 0.36-1.51 days), or by 19%, from baseline.
According to Pollard and colleagues, three out of four adults consumed alcohol an average of 1 day more per month compared with baseline.
Researchers also found that women experienced a significant 0.18-day (95% CI, 0.04-0.32 days) increase in heavy drinking, representing a 41% increase from baseline.
The results further showed that women experienced an average increase in Short Inventory of Problems scale of 0.09 (95% CI, 0.01-0.17 items), representing a 39% increase from baseline. Nearly one in 10 women had increased alcohol-related problems regardless of how much they consumed.
“Our study shows that people drank more frequently, and for women in particular, more heavily, and with more negative consequences, during the initial stages of COVID-19 compared to their own behaviors from a year earlier,” Pollard said.
He added that alcohol consumption is associated with a variety of negative physical health outcomes —including high BP, heart disease, liver disease, lung disease and acute respiratory distress syndrome — and mental health outcomes such as depression and anxiety.
“Health care providers, the public and their families should all be mindful of changes in alcohol use during this stressful time and aware of the risks they involve,” Pollard said.
Perspective
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Kenneth J. Mukamal, MD, MPH
The results generally concord with our own clinical impression, namely that the early part of the pandemic represented a severe and acute stress that precipitated increased drinking in specific patients. I would note a couple of particularly noteworthy findings: first, although it goes mostly ignored in the paper, the results in men are entirely null (although the magnitudes were similar to women). That’s somewhat surprising and suggests that the survey probably lacks sensitivity and power. Second, total drinks in women went down slightly but days drinking went up slightly. That’s reassuring insofar as it means that average intake PER DAY did not go up overall. Third, that reassurance must be balanced by recognition that heavy drinking episodes went up slightly — about one episode in a 30-day period for every five women. And the problem scale concords with that. Fourth, the dates end fairly early in the pandemic, when the large initial spike was just beginning to ebb. It will be important to see how all this changes as time goes on.
In general, the adverse health effects of alcohol come not from drinking frequency but from amount consumed on any given day. That increase in heavy drinking days among women is exactly the kind of signal we don’t want to see. Obviously, it can lead to inebriation and injury — both for the drinker and people around them — but those kinds of episodes can also lead to irritation of the stomach lining (causing bleeding), heart rhythm disturbances, acute liver damage, increased susceptibility to infection — not necessarily COVID-19, but possibly — and many other effects. So, we very much hope it has already begun to taper from its peak much as the pandemic did.
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