Even before the pandemic began, some Americans were drinking significantly more alcohol than in previous decades – with harmful consequences. In 2020, researchers from the National Institute on Alcohol Abuse and Alcoholism (N.I.A.A.A.) found that per capita consumption increased 8 percent from 1999 to 2017 and the number of alcohol-related deaths doubled, many from liver disease. The trends are particularly worrying for women: while the number of men who reported drinking remained largely the same, the proportion of women who did so increased by 10 percent, and the number of women who reported excessive alcohol, or about four or more drinks consumed in about two hours increased 23 percent. (For men, excess alcohol is about five or more drinks during this period.) According to current dietary guidelines, moderate drinking is a maximum of one drink per day for women and two for men.
Researchers were understandably concerned when alcohol sales spiked at the beginning of the pandemic. They were particularly concerned about women because similar amounts of alcohol affect them more than men, making them more likely to be injured in accidents and developing chronic diseases such as liver and heart disease and cancer. However, it was unclear whether higher sales would lead to higher consumption. Perhaps Americans are hoarding alcohol like they are toilet paper.
However, a growing body of research has begun to confirm that Americans, and women in particular, are actually drinking more in response to the pandemic. In December, researchers from the Johns Hopkins Bloomberg School of Public Health and the University of Maryland, Baltimore County published the results of a survey they conducted last May in the International Journal of Environmental Research and Public Health. They found that of the more than 800 respondents – those who answered the online questionnaire were mostly white women – 60 percent drank more than before Covid-19 (13 percent drank less). More than 45 percent of participants said their reasons for drinking included increased stress. And those who said they felt “very” or “extremely” stressed by the pandemic said they drank more on more days than those who were less affected. Another poll conducted by the American Psychological Association in February found that nearly one in four adults said they drink more to cope with pandemic stress. While stress has long been a common reason people turn to alcohol, the extent to which it appeared to cause increased consumption in the past year has been astounding, says George Koob, director of the N.I.A.A.A. "It shouldn't have been a surprise, but it surprised us to handle this drinking."
This trend is particularly alarming as previous research suggests that people who drink to cope – as opposed to pleasure – are at higher risk of developing an alcohol use disorder, which is due to their being unable to use it to stop or control drinking even if it causes harm. Alcohol can be short-term calming: it slows down activity in the amygdala, the area of the brain that prepares the body's “fight or flight” response to real or imaginary stress by increasing heart rate and blood pressure and increasing our awareness of threatening stimuli . Over time, however, alcohol's depressant effects on the amygdala diminish as the region becomes "hyperactive," even between bouts of alcohol, according to Aaron White, a senior scientific advisor at N.I.A.A.A. In order to achieve the same level of relief, it is necessary to drink more and more frequently.
There is already evidence that groups most affected by the pandemic are seeing greater increases in alcohol consumption. For example, a survey of 12,000 doctors found that more than 40 percent had burnout, which was very likely exacerbated by the pandemic, and of whom more than a quarter drank to cope. And while pre-pandemic research has shown parents are less likely than people without children to be risky alcohol, parents now seem to be among those who drink more – especially if their children are in distance learning.
The most worrying pre-pandemic drinking behavior appears to be among women who have also carried a larger portion of the childcare burden caused by school closings. A study published in October in the Journal of Addiction Medicine found that women had a greater increase in excessive alcohol consumption than men between February and April 2020. Respondents who are black also reported larger increases. A November study in Addictive Behaviors magazine, based on an April survey asking about people's alcohol consumption in the previous month, found that women drank more than men in response to pandemic stress, to the point where their intake levels were roughly the same. "I left this study with more questions than answers," said Lindsey Rodriguez, the newspaper's lead author and psychologist at the University of South Florida. “Is it because of the home school? Uncertainty about the future? High pressure in more areas of life? Women were disproportionately affected by Covid-19. This is another way of showing the impact. "
Following previous disasters, including the September 11th terrorist attacks, the SARS outbreak in 2003 and Hurricane Katrina, alcohol abuse and its aftermath increased. However, researchers have never studied the impact on drinking behavior of a disaster that lasted as long and was as widespread as the current pandemic. These previous events have also not increased social isolation while triggering widespread changes in the availability of takeaway and delivery alcohol, as Covid-19 has done. There was more drinking at home, linked to domestic violence and child neglect, said Carolina Barbosa, behavioral scientist at RTI International, a nonprofit research organization. "So we're not just concerned with the health of the person who drinks," says Barbosa, lead author of the study on addiction medicine, "but also with the social impact on families and society in general."
These potential impacts – from individual health to poverty, crime and violence – previously linked to the density of alcohol sellers in a given area will take some time to unfold and evaluate. Currently, most of the data available on changes in drinking behavior is limited to small surveys. "All of this suggests that people are beginning to adopt patterns of drinking heavier," said Elyse Grossman, a Johns Hopkins political contributor and lead author of the article in the International Journal. She estimates that the effects will be visible in one to three years if alcohol abuse increases after other disasters. (Already now, cases of alcoholic liver disease in the University of Michigan health system have increased an estimated 30 percent over the past year, and many of those additional patients have been young women.)
Despite worrying circumstances, at least 20 states are considering making the relaxed drinking rules they put in place during the pandemic permanent. And alcohol manufacturers have used Covid-19 as a marketing tool to an extent that is "frustrating and surprising," says Grossman. “They used the pandemic to increase sales and defy regulation. “You need time for yourself; you should drink. You need alcohol to relax; You need it to survive this pandemic. "She adds," It's not an ordinary product like coffee or pencils. It is the third leading cause of preventable death in the United States. "
At the population level, drinking has already set in motion a cascade of consequences in the past year that would be difficult to reverse without major political changes. However, individuals can take steps themselves to avoid negative outcomes. Koob says the emergence of telemedicine during the pandemic could be a "silver lining" allowing doctors and support groups to reach people with more difficulty. Treatments exist in "a spectrum," he notes. "Not everyone needs to go on a 28-day detox." Doctors and health officials should respond now with initiatives such as screening for people's drinking habits and "better news" about excessive drinking, says Barbosa. "There are more people who will need help."
Kim Tingley is a contributing writer for the magazine.