Behind Closed Doors

alcohol and the covid-19 pandemic

by Erin Deneke, Ph.D., Senior Director of Research, and Olapeju Simoyan, M.D., MPH, BDS, FAAFP, FASAM, Executive Director of Research, Caron Treatment Centers

COVID-19 has reshaped the United States over the last 2 years. To date the United States has over 43,289,203 cases of confirmed COVID-19 illness and 694,701 deaths (Center for Disease Control [CDC]). Pennsylvania alone has 1,429,940 cases and experienced 29,400 deaths (John Hopkins Coronavirus Resource Center, 2021). The ever-evolving nature of this virus has led to a constantly shifting approach in the management of this disease. While effective vaccines have been developed and are available for free, only 58% of Pennsylvanians are currently fully vaccinated (John Hopkins Coronavirus Resource Center, 2021). Public health measures have included social distancing, temporary closure of non-essential businesses, stay-at-home orders, mask mandates, and companies implementing vaccine mandates for employees. While the economy is in the process of recovering from the devastating economic blow that COVID dealt, the societal and emotional toll of the pandemic is still being felt. A study conducted by Verdery, Smith-Greenaway, Margolis and Daw (2020) explored kinship networks in the United States and found that one coronavirus death impacts nine surviving family members. This suggests that approximately 6.25 million individuals (to date) have been personally impacted by the death of a loved one due to the pandemic. This does not include impacts on social circles.

The impact on mental health was not unexpected. Previous research has demonstrated the impacts of disaster and epidemics on individuals (Bonanno & Gupta, 2012; Boscarino, Galea, Ahern, Resnick, & Vlahov 2002; Tracy, Norris, Galea, 2011; Vlahov, Galea, Ahern, Rudenstine, Resnick, Kilpatrick & Crum, 2006). The isolation, job losses, and economic stressors due to the pandemic impacted the mental health and well-being of Americans on a large scale. Treatment options were limited for individuals with already pre-existing conditions, both physical and mental, and for individuals with new conditions. Symptoms of anxiety increased from 8.1% in the second quarter of 2019 to 25.5% in June of 2020 and depressive disorders increased from 6.5% to 24.3% (Czeisler, Lane, Petrosky, et. al., 2020). According to a Kaiser Family Foundation poll (Panchal, Kamal, Orgera, Cox, & Garfield, 2020), 53% of respondents reported that their mental health has been impacted by the coronavirus pandemic. Specifically, they reported difficulty sleeping (36%) or eating (32%), and an increase in substance use (including alcohol) (12%). While a great deal of attention has focused on the increase in overdose deaths due to prescription opioid and heroin use over the pandemic, little attention has focused on a more hidden problem, alcohol.

So why use the term “hidden”? After all, news programs were showing people with shopping carts full of wine and liquor at the state stores the day before they were closed due to the pandemic and Zoom Happy Hours started appearing between friends and co-workers. According to the Nielsen Company, national sales of alcohol increased 54% during the week ending March 21, 2020, compared to 2019. Early March 2020, Governor Tom Wolf closed

all wine and spirit stores in the state of Pennsylvania due to the COVID-19 pandemic, while beer distributors were left open as essential businesses since some of the stores often carried additional food items and sundries.

This did not receive as much attention and much of the excessive drinking that occurred was behind doors. With the closing of bars and restaurants, those “social outlets” disappeared. Alcohol use increased during the pandemic. A survey conducted in June 2020 found that 13.3% of the respondents reported either having started or increased substance use to cope with the feelings brought on by the COVID-19 pandemic (Czeisler, Lane, Petrosky, et. al., 2020). Barbosa, Cowell, and Dowd (2021) found statistically significant increases in risky drinking behaviors, average drinks per day and binge drinking in April of 2020 after lockdown took effect as compared to February 2020. A poll by the American Psychological Association (2021) found that approximately 23% of adults reported drinking more alcohol to cope with stress and 48% of fathers and 29% of mothers with children under the age of 18 reported drinking more. In older adults (50 and older), 14% reported an increase in alcohol use (Malani, Kullgren, Solway, Fernandez, Singer, & Kirch, 2021). Of those who reported the increase, 49% reported they drank to handle pain, 48% to cope with stress, boredom (46%), and improve mood (38%) (University of Michigan, June/ July 2021). The good news is alcohol use has not increased over the course of the pandemic in adolescents (Miech, Patrick, Keyes, O’Malley, Johnston, 2021).

Approximately 7.2% who had an alcohol use disorder received treatment in 2019 (Substance Abuse & Mental Health Data Archive (SAMHDA), National Survey on Drug Use and Health (NSDUH) 2019). Moreover, most individuals with alcohol use disorders (AUDs) are more likely to present with a medical issue related to AUD to a primary health care provider (O’Connor, P. G., Nyquist, J. G., & McLellan, A. T., 2011) than to treatment.

Individuals seeking treatment for alcohol use disorders often have co-existing health conditions. Medical conditions in the alcohol use disorder population are higher than in the general population (85.3% vs. 55.3%; p<.001) (Bahorik, A. L., Satre, D. D., Kline-Simon, A. H., Weisner, C.M., and Campbell, C.I., 2017). Common medical conditions in individuals with alcohol use disorders found in this study to occur at higher rates were asthma, chronic obstructive pulmonary disorder (COPD), hypertension, ischemic heart disease, hepatitis C, obesity, diabetes mellitus, and pneumonia (3.3% vs. 1.3%)(Bahorik, A. L., Satre, D. D., Kline-Simon, A. H., Weisner, C.M., and Campbell, C.I., 2017). Individuals with these medical conditions have been shown to have a poorer prognosis when infected with COVID-19.

The COVID-19 pandemic led to delayed or unmet care in 32% of U.S. adults and 12% of adults seeking urgent or emergency care (CDC, 2020). In addition, emergency rooms and urgent care facilities experienced a burden not seen before and it was not uncommon for primary health care facilities to move to a telehealth format, limiting healthcare for many individuals. Lack of access to broadband highspeed internet was a huge health disparity during the pandemic, more significantly impacting people of color, older individuals, individuals with limited financial means and individuals in rural areas (Lai & Widmar, 2020; DiMaria-Ghalilim Foreshaw Rouse, Coates, et. al., 2021).

With all the stressors experienced by individuals and families during the pandemic, those in recovery were at high risk of relapse. Social distancing measures, limiting group sizes, and the closure of churches and other public spaces where meetings were generally held reduced the ability for healthy, supportive social connection which is essential for recovery. This created a perfect storm, increasing the risk of relapse for those in recovery. Twelve-Step support groups moved online which limited availability for individuals who did not have access to the necessary technology. In most cases, outpatient substance use treatment moved to telehealth for treatment with its before-stated limitations. Medication assisted treatment was available to the degree that the doctors’ offices were open. While one study looking at data from 10 disasters showed that problematic drinking increases during disasters, very few go on to develop a postdisaster AUD (North, Ringwalt, Downs, Derzon, & Galvin, 2011). However, in the same study 83% of the individuals either with an existing AUD or in recovery drank (North, Ringwalt, Downs, Derzon, & Galvin, 2011).

Unfortunately, we are only beginning to see the consequences of increased alcohol intake during the COVID-19 pandemic. There have been regional reports of increased referrals for severe alcohol-related liver disease in Baltimore (Chen, Ting, Almazan, Chander, Cameron, & Gurakar, 2021), as well as anecdotal information such as that from the University of Southern California (USC) which has experienced a 30% increase in alcohol-related liver disease hospital admissions since March of 2020. USC reported that included not only those who relapsed but those who had no history of AUD (MSNBC News, July 17, 2021). Caron Treatment Center’s inpatient treatment center in Wernersville, PA has seen the percentage of individuals admitted with alcohol as a drug of choice rise from 960 in 2019, to 1183 in 2020 (a 5.37% increase). As of the first week of October 2021, 72.4% of individuals entering treatment reporting alcohol as a drug of choice; a 7.90% increase since 2019 and another 2.4% since 2020. While early data suggests an increase in alcohol-related problems, it will most likely be two or more years before the full impact of the pandemic is known.

Sources:

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