Is America Drinking Its Way Through COVID-19?
Alicia Sparks is a senior associate at Abt who focuses on community-level interventions to prevent alcohol and other drug use. She recently talked to us about the intersection of alcohol misuse and COVID-19.
What is the effect of COVID-19 on alcohol use?
We’re really concerned about rising rates of alcohol consumption during quarantine. Data on how much people drink isn’t out yet, but we're looking at alcohol sales data and seeing 20+ percent increases in the sale of alcohol in stores and nearly 500 percent increases online compared with a year ago.
Did the pandemic cause consumption increase or could it be just correlated to it?
The best we can do is look at comparisons from this time this year versus previous years. We see that prior to March 20, alcohol sales were pretty consistent. And then you see spikes in March, April, and May. So you can track alcohol sales data from when states started shutting down and going to some form of quarantine compared to previous months, and the same time period in previous years. We aren’t seeing those big jumps in store and online sales in previous years – I think the trend is pretty clear that people are buying, and likely consuming, more alcohol duringthe quarantine.
These are big increases in consumption, but are they dangerous increases?
There's no safe level of alcohol consumption, so, in that sense I would say it's a dangerous increase. It can lead to long-term health problems like cancer and liver disease and a number of physical health issues, including injuries, falls, and drowning. Risky drinking at home can be associated with other concerns, including increased poly substance use, intimate partner violence, depression, and anxiety.
Let’s look at this in the other direction. Does more alcohol consumption increase risk factors for COVID-19?
The World Health Organization and the National Institute on Alcohol Abuse and Alcoholism both say that excessive alcohol use might be related to an increase in contracting and the severity of COVID-19. Alcohol use harms lungs and the immune system. It potentially puts people at higher risk, reducing the body’s ability to fight off infection and increasing inflamation.
Some states declared liquor stores essential services and didn't close them down during shelter-in-place orders. Was that a good idea or a bad idea?
I think that was a bad idea, made worse by suddenly making legal what had been prohibited, like drive-by cocktails and home delivery of alcohol. The research is clear that those who don't drink should not start drinking, and those who do drink should not drink more. So calling alcohol “essential” is not accurate. It is not central to anyone's daily wellbeing. In fact, the new U.S. proposed dietary guidelines recommend that if you have to drink, limit it to one drink a day on days when alcohol is consumed, for both men and women, which is a decrease from previous dietary guidelines. Yet we're seeing an increase in availability and access to alcohol at a time when we should be focusing on improving and maintaining our health as opposed to putting ourselves at greater risk.
Are there trends or findings from the broader substance misuse prevention field that those working on alcohol issues should keep in mind?
There are a few things. One is that there's concern around alcohol being used as a coping mechanism during this pretty fraught and uncertain time when there is less access to in-person treatment. So access to things like telehealth and other options for folks to engage in healthier coping mechanisms is valuable.
The other one is the marketing trends we’re seeing that are specific to the pandemic and are potentially dangerous. We’re seeing a lot of messaging and marketing specific to alcohol use at home, including an ad about “fewer coffee breaks, more beer breaks” and another that promotes a “zero-judgment venting hotline for moms” sponsored by a new wine spritzer. Aggravating stress levels, many women are shouldering additional burdens as they either lose their jobs or work at home and supervise their kids, including their schooling, on top of other household duties. This type of very targeted marketing is concerning and contributes to the increase in alcohol sales and related harms that we discussed above.
Do different things help different genders?
I think the research specific to how COVID is affecting alcohol use by genders is emerging, but historically there have been differences in the way genders consume alcohol. And men and women process it in the body differently. You think of men being heavy drinkers and women drinking a glass, but we're seeing that trend change, with women drinking at much higher levels, almost equivalent to men. And because women process alcohol differently, they are susceptible to greater harm if they're drinking the same amount as men. We need to make sure that message is there.
How can we reduce alcohol use?
We've seen from the evaluation of Hilton Foundation substance misuse efforts that primary care practitioners can be valuable in doing screening and brief intervention (SBI) for youth, and there is a substantial body of evidence for SBI for adults. We need to make sure that any healthcare touch point is a place where individuals can be screened for risky or harmful alcohol use. It’s important that we normalize converations around alcohol use, especially with health care professionals. This may help break down some of the stigma associated with alcohol misuse, leading to earlier intervention and treatment when needed.
In addition, there is a lot of research on prevention strategies at the local, state, and federal levels, include reducing the number of alcohol outlets in a community, increasing the price of alcohol, and making sure that the legal blood alcohol level stays at 0.08 or less. There’s very similar research in the tobacco field that we can look to as well. We talked about that quite a bit in our guide on preventing vaping among youth and young adults for the Substance Abuse and Mental Health Administration’s Evidence Based Practices Resource Center. So there's plenty of places that we can pull literature from to emphasize this.
And there's the 2016 Surgeon General’s Report On Alcohol, Drugs, and Health. It’s an excellent report that compiles these issues and talks about the different levels that we can address around alcohol prevention, treatment, and recovery.
So, I think there's a lot of good resources out there to think about so that we can start making inroads on preventing alcohol misuse, from interventions that focus on a single individual to policies that may help the population as a whole.
