Q&A: COVID-19 pandemic threatens to exacerbate alcohol use disorder, risky behaviors

History indicates that the COVID-19 pandemic will likely worsen the United States’ rising rates of alcohol use, high-risk drinking and alcohol use disorder, experts said.

Previous research has shown that excessive alcohol use is a common response to stress following traumatic events. A study published in Addiction concluded that alcohol consumption is expected to increase in a population the first 2 years after a large terrorist attack. More recently, an article in the Journal of General Internal Medicine reported that the United Kingdom and Australia have observed increases in alcohol consumption since the onset of COVID-19 in those countries.

Dawn E. Sugarman, PhD, and Shelly F. Greenfield, MD, MPH, both of the alcohol, drug and addiction clinical and health services research program at McLean Hospital in Massachusetts, wrote in the Journal of General Internal Medicine article that “alcohol-related health and social consequences are a substantial economic burden in the USA and globally, exacerbating the critical need for intervention in the context of COVID-19.”

With few adults in the U.S. with alcohol use disorder seeking treatment, Sugarman discussed how the COVID-19 pandemic compares with other events that have spurred an uptick in alcohol use, resources primary care physicians can use to recognize and treat alcohol use disorder and more.

Q: What does the evidence tell us about alcohol consumption following catastrophic events, such as terrorist attacks and natural disasters?

A: We know that there were immediate and sustained increases in alcohol use and problematic drinking in Manhattan residents following the September 11 terrorist attacks, and that similar patterns have been observed following large-scale natural disasters (such as Hurricanes Katrina and Rita).

Q: How does alcohol consumption during COVID-19 compare with other stressful events? What makes it different?

A: Like other catastrophic events, increases in alcohol use have been linked with stress and anxiety related to the pandemic. What is unique about COVID-19 is that we are also seeing increases in alcohol use due to social isolation. In addition, the COVID-19 pandemic is much longer lasting than other traumatic events we have experienced in the United States. Therefore, people are experiencing the associated stress and anxiety for longer periods of time. We do not yet know the full impact that this will have on population-wide rates of alcohol use and alcohol use disorders.

Q: What approaches can be implemented in the U.S. to moderate and reduce rising alcohol consumption during the pandemic?

A: Increasing identification of harmful alcohol use in patients and intervening early are key components of addressing this problem. Public health messages also need to be targeted to include managing stress and anxiety without using alcohol and drinking within safe limits during physical distancing and social isolation. This is important because public health messages have already lagged cultural messages promoting alcohol to cope with social distancing. In addition, recognition of the problem from policy makers could lead to changes in federal regulations (such as we have seen with telehealth) and improvements in access to health care.

Q: What are some resources PCPs can use to help screen and treat patients with alcohol use disorder?

A: The National Institute on Alcohol Abuse and Alcoholism recommends PCPs ask patients a single screening question: “How many times in the past year have you had five (four for women) or more drinks in a day?” If the patient's response is one or more, further assessment with the Alcohol Use Disorders Identification Test, or AUDIT, is recommended. The patients’ score on the AUDIT will help the physician determine if the patient is drinking at a harmful or hazardous level and whether referral to treatment is needed. The National Institute on Alcohol Abuse and Alcoholism has also recently launched an alcohol treatment navigator website to help connect individuals with evidence-based care.

References

DiMaggio C, et al. Addiction. 2009;doi.org/10.1111/j.1360-0443.2009.02526.x.

Sugarman DE, Greenfield SF. J Gen Intern Med. 2020;doi:10.1007/s11606-020-06321-z.