SALT LAKE CITY — More people have been drinking at home during the pandemic, raising fears among experts that the trend will result in more people becoming physically and emotionally dependent on alcohol.
Alcohol and COVID-19 bring out the worst in each other. COVID-19 appears to increase drinking, which raises risk for serious health consequences if someone compromised by alcohol contracts COVID-19.
“The data is showing that absolutely during pandemic, we do have more people drinking. Not everybody may be problem drinking, or drinking to excess every day, but definitely more people are drinking,” said Misty McIntyre Goodsell, director of research and development at Odyssey House, which operates treatment programs.
“People can become problem drinkers at any age,” she added.
A rise in drinking is difficult to quantify. Some are doing it quietly at home. And reports that treatment programs are seeing new people seeking treatment are countered by people who are staying away from any care settings to avoid the virus, experts say.
But Dr. George Koob, director of the National Institute on Alcohol Abuse and Alcoholism, said alcohol sales provide clues that more people are drinking at home right now. On-premise alcohol sales went down when bars closed and people started social distancing, but retail sales where people buy alcohol to consume elsewhere went up: Alcohol sales were up 5% in March and 10% in April. May and June figures aren’t out yet.
“Some people are clearly drinking more, some may be drinking less,” he told the Deseret News.
Koob sees cause to worry, starting with alcohol use patterns. Individuals who are “vulnerable, on the edge of alcohol misuse,” may be pushed over that edge by the pandemic-related stresses. Loneliness and separation might increase drinking and lead to what he calls a vicious cycle of using alcohol to fix a problem, then feeling lousy the next day and drinking to fix that. It has been trickier getting treatment during the pandemic, too.
With people more likely to be home, they also have more time to think about things they don’t like, the family support they don’t have or sometimes problems in the family they do have. Alcohol use may rise where people who don’t get along are together more or in homes with any form of domestic violence, said Goodsell.
People who never drink, including kids, may become alcoholic trying to cope with abuse. Adverse childhood events are a known risk for alcohol misuse.
“And alcohol is by far in our culture and our community the easiest drug to access,” she said.
Alcohol use is common in America. The 2018 National Survey of Drug Use and Health found 86.3% of those 18 and older drank alcohol at some point, while 70% said they drank in the past year. And 55.3% said they drank in the past month. More than a fourth reported binge drinking, defined as having multiple drinks in a sitting and getting drunk.
That survey showed 14.4 million adults with what’s now called “alcohol use disorder,” which the national institute called a disease characterized by “uncontrolled drinking and preoccupation with alcohol.” Not quite 8% with the disorder in the past year were treated for it.
Additionally, more than 400,000 youths 12-17 years old had alcohol use disorder; 5% of them were treated, which means 95% were not. Young females had a higher rate of the disorder than young males, bucking the trend in older drinkers, where males dominate, but women are catching up.
Each year, about 88,000 people die from alcohol-related causes, the institute says. Drunken-driving deaths are about a third of all motor vehicle fatalities.
Alcohol consumption, emergency room visits related to drinking and hospitalizations have all increased since 2012, according to a study published in the journal Alcoholism: Clinical and Experimental Research.
The institute says treatment may require behavioral therapy, medications, medical detoxification and long-term mutual support groups.
COVID-19 has complicated all of that. Many support meetings have moved online, which doesn’t help people who lack technology or don’t feel comfortable using it. Online therapy or support may feel less personal, as well. And seeking immediate, in-person help has been hampered by health care provider policies designed to limit COVID-19 spread.
Ages and stages
Though Koob calls alcohol use disorder an “equal opportunity employer” impacting people of all races and ages and regions, he notes some are more vulnerable. If both parents misused alcohol, there’s a higher likelihood their kids will do the same. That’s a risk with people who experienced childhood trauma — even years later. Any major stress can increase alcohol use that lingers even after the stress itself.
The stress-inducing pandemic could impact alcohol use patterns for a long time if people become both physically and emotionally dependent on alcohol.
How much people drink also increases the likelihood alcohol will become problematic. People who exceed dietary guidelines — up to seven drinks for females a week and 14 for males, none of it in binges — are at far greater risk.
The 2015-2020 Dietary Guidelines for Americans say to avoid alcohol entirely if medications or medical conditions could interact badly with alcohol; if you’re underage; if you plan to operate a vehicle or machinery; if you want to do anything requiring skill, coordination or alertness; if you are recovering from alcohol use disorder or can’t control how much you drink; or if you are pregnant or trying to become pregnant.
Goodsell said people can drink too much at any age. In late adolescence and young adulthood, brains aren’t completely formed, but life is opening up. Kids leave home; they also have more access to booze. The combination of being on their own, socializing with alcohol, and pressure from jobs or school or relationships can all lead to alcohol misuse.
In their 20s through 40s, Goodsell said people may become problem drinkers because they have emotional pain and challenges they don’t know how to manage. Connection to others, feeling good about one’s life and having responsibility and validation are protective against alcohol abuse, though they don’t guarantee alcohol never becomes a problem.
People can feel disconnected when the nest empties or overburdened by caring for aging, sick parents or spouses with health issues. Worry about things like money can also create a problem with alcohol consumption, said Goodsell. People in their 50s and 60s may tackle changes in their lives and relationships by drinking too much.
She said treatment programs see many in their 20s and 30s and fewer in their 40s, 50s and 60s. Maybe part of that, she said, is because heavy drinkers may die from their addiction and they die decades earlier than other people do.
Bars and COVID-19
Texas reclosed its bars recently after they were opened briefly as the state moved to jumpstart the economy. Other states have or are considering doing the same.
Koob said indoor bars are problematic when it comes to slowing COVID-19.
Drinking disinhibits people, he said, so they are less likely to social distance or to wear masks. They tend to speak louder — and if it’s noisy, louder still. That has been shown to increase the spread of respiratory droplets. Patrons are also less likely to worry about a virus when they’re drinking.
Folks need to take the risks seriously, Koob said. His director’s blog points out that “alcohol misuse both activates the immune system, causing inflammation, and interferes with the body’s immune response to viral and bacterial infections.” Too much alcohol damages cells lining the lungs and can lead to acute respiratory distress syndrome. An impaired immune system and any ensuing respiratory illness could make COVID-19 more severe or even deadly, he wrote.
Koob said he’s not saying the risk is the same at a restaurant or perhaps an outside table, where they’re socially distant from others. “But to go back to the regular bar scene is clearly problematic, and I think we’re seeing that across the United States right now.”
The institute’s Rethinking Drinking website has information on alcohol misuse disorder, COVID-19 and other topics. For people who want information on getting help, the institute offers an online Treatment Navigator.