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Did alcohol use among adults increase during COVID-19?

COVID-19 has contributed to increased levels of stress and isolation that can lead to increases in alcohol and other drug use for some. This study examined whether alcohol use increased during COVID and for whom in particular.

WHAT PROBLEM DOES THIS STUDY ADDRESS?

The COVID-19 pandemic has altered day-to-day life for many people in ways that are likely to impact well-being and mental health. These include increases in psychosocial stressors—including increased unemployment, activity restrictions, occupational risk, substantial loss, and caregiving/relationship stress—as well as increased rates of isolation. The pandemic has likewise been linked to a global increase in emotional difficulties, such as anxiety and depression.

Because the presence of stress elevates risk for alcohol consumption, there is concern that rates of drinking have increased over the course of the pandemic. Some researchers have compared rates of drinking during the pandemic to rates observed prior to pandemic onset (i.e., mid-March 2020) and have found that overall alcohol consumption and rates of binge-drinking have increased in the U.S. and other nations during this time. Relatedly, some studies have highlighted associations between COVID-related stress and level of drinking, demonstrating that increased COVID-related threat and psychological distress are associated with heavier drinking. Research examining patterns of drinking within the same set of individuals over time (i.e., longitudinal research) can help determine if the increases observed in other studies are sustained over time and/or are specific to certain groups. This information can help inform the type of resources that would be helpful to address alcohol use for the population as a whole and where to target support and prevention efforts (e.g., toward certain groups of people, in certain areas, etc.).

In this study, the research team examined a nationally representative sample of U.S. adults to determine 1) if there were changes in the number of drinking days during the early stage of the COVID-19 pandemic (March-July 2020) in U.S. adults, and 2) whether different groups of adults (e.g., characterized by race/ethnicity, gender, age, etc.) reported different patterns of drinking over time.

HOW WAS THIS STUDY CONDUCTED?

This study used survey data from the Understanding America Study (UAS), a nationally representative internet panel of U.S. adults (18+ years of age) who were recruited by address-based sampling (i.e., their postal address was randomly selected from a listing of residential addresses).

Study participants completed all surveys online and were provided with a device and broadband internet connection if they did not already have access. Participants completed a baseline survey the week of March 10, 2020 and then were asked to complete follow-up survey assessments every 2 weeks for a total of 8 additional assessments—9 assessments including the baseline questionnaire—ending the week of July 21, 2020. At each assessment, participants reported on the number of days they had consumed alcohol in the 7 days prior to survey completion.

The researchers conducted three stages of analyses using statistical models that accounted for each individual participating in multiple surveys across time. The first set of analyses examined the effect of each sociodemographic factor on the average number of drinking days across the entire study period. The researchers then examined the effect of time on drinking days across all adults to see if the overall trajectory of drinking over time changed for the entire sample. Finally, a model was used to examine the interaction between time and sociodemographic characteristics to see if there were different trajectories of drinking for different groups of participants. All data were statistically weighted to account for differences between the surveyed population and the U.S. population.

There were 8,547 eligible participants identified in the full UAS sample. However, this study only examined data from participants who reported at least 1 day of alcohol use across the survey period, leading to a final subsample of 4,298 participants. Of these participants, about half (50.6%) were male; 64.5% were White, 29.8% were living with partner, and 12.8% were below the federal poverty line. Each of the U.S. census regions (i.e., South, Midwest, Northeast, and West) were about equally represented in these data.

WHAT DID THIS STUDY FIND?

The number of drinking days differed by sociodemographic group.

The number of drinking days across the study period was lower among females (compared to males), Black, Latino, and other race/ethnicity participants (compared to White participants), in participants living alone, with a partner and children, with children only, or in other living arrangements (compared to participants living with a partner alone), and in adults living below the federal poverty line (compared to above). The number of drinking days was higher in older age groups compared to participants aged 18-29. No differences were observed between census regions in number of drinking days.

Average number of drinking days was higher than baseline on all follow-up assessments.

When compared to the study baseline, the number of drinking days on all subsequent assessment points was higher for the sample as a whole. That being said, increases were generally less than 1 drinking day on average. Specifically, the average number of drinking days at baseline was 2.23 days per week, which increased on average by 0.36 (April), 0.55 (May), 0.41 (June), and 0.39 (July) at each survey period.

Drinking change over time differed by sociodemographic group.

Both male and female participants reported a greater number of drinking days over time; however, these increases were sustained only for male participants. Similarly, all age groups initially reported more drinking days, but these increases were sustained only for older adults, particularly those over the age of 65. In terms of race/ethnicity, increases in drinking days were largest and most sustained for White participants compared to participants from other race/ethnicity groups (i.e., Black, Latino, other race/ethnicity). In terms of household structure, sustained increases were seen in participants who lived with partners only, lived with partners and children, or who lived alone, compared with those living with children only or having another household structure. With respect to poverty level, sustained increases were only seen in those who lived above the federal poverty line. Increases in drinking were seen across all census regions.

WHAT ARE THE IMPLICATIONS OF THE STUDY FINDINGS?

Using a large, longitudinal survey study of a representative sample of U.S. adults, researchers found some evidence that adults consumed alcohol on more days during the early stages of the COVID-19 pandemic and that these increases were more likely to be observed and sustained in particular sociodemographic groups. Specifically, sustained increases were more commonly seen in participants who were male, White, in older age groups (particularly 65+ years), who had household structures characterized by living alone, with a partner alone, or with a partner and children, and/or who lived above the federal poverty level.

These findings highlight an association of certain sociodemographic factors with elevated risk of drinking at baseline and likewise reflect how different groups have been differentially impacted by the COVID-19 pandemic itself. For instance, other researchers have found that males have higher levels of alcohol consumption in general, which may reflect other gender differences underlying alcohol use. Specifically, men, particularly those in traditional gender roles, may have greater access to alcohol, whereas women are more likely to present to treatment for alcohol use earlier in the course of use. Similarly, existing research has suggested that older adults in general may already be at an increased risk of drinking. However, this group was also disproportionately impacted by the pandemic with respect to increased isolation and increased risk of COVID-19 infection, among other factors, which could be accounting for their sustained increases in drinking over time (e.g., potentially to mitigate increased anxiety surrounding those risks).

Interestingly, the finding that increases in drinking days were not sustained for younger adults has been echoed in similar longitudinal surveys of emerging adults (aged 18-25) and may partially be attributable to restrictions on access to social settings where alcohol use predominantly may occur for this age-group. Finally, the authors suggest that some of the groups for whom sustained drinking increases were not observed (i.e., non-White participants, those living below the federal poverty line, and those who were living with children alone) may have been more burdened by the pandemic in terms of financial and other stress, and therefore had less access to alcohol during this period. Interestingly, around a half of the entire UAS sample reported no drinking days, suggesting that a large portion of the population remained entirely abstinent from alcohol despite the challenges associated with the pandemic. Overall, these findings suggest a complex interplay of sociodemographic factors, cultural changes during COVID-19, and stress on drinking behavior across the population.

In the future, it will be helpful to better characterize the observed increases in drinking, particularly since the current study did not assess the number of standard drinks consumed per day, which is important in determining the negative impacts from alcohol consumption. For example, it would be important to know if individuals were drinking within the U.S. Department of Health and Human Service’s dietary guidelines of 2 drinks per drinking day or less for men and 1 or less for women. Additionally, it is possible that there are important interactions between sociodemographic factors (i.e., intersectionality) that may be missed by examining each factor independently. The research team did not assess certain demographics, such as gender identity and sexual minority status, so it is unclear how alcohol use changed in these vulnerable groups. Similarly, the effects of pre-existing mental health disorder and alcohol and other drug use disorders were not examined in this analysis. It could be that the pandemic stress and restrictions led to relapse for some and greater help-seeking to stave off relapse risk for others. Furthermore, it will be important to see if similar trends persist over the course of the pandemic and the degree to which these changes in drinking are moderated by changes in mental health symptomatology, economic status (e.g., employment), or other factors.

LIMITATIONS
  1. The main outcome of the study was number of drinking days. Therefore, no information is known regarding the number of standard alcoholic drinks consumed per day, missing important information that is vital in judging the negative behavioral and health effects of problematic drinking.
  2. The researchers examined the effect of each sociodemographic grouping as independent. Therefore, it is unclear whether there are meaningful interactions between subgroups (e.g., if older men are more likely to drink than older women, etc.) or if certain effects may be artifacts of other sociodemographic variables (e.g., household structure may be tied to age). Additionally, no time-varying factors (e.g., employment status) were studied, nor were indicators of mental health/well-being.
  3. The observed differences in drinking days over time are statistically significant but of unclear clinical and public health significance. Most of these differences are less than 0.50 days when compared with baseline., It is unclear how this small magnitude of change translates into actual increased risk of hazards and harms, particularly without information on number/type of drinks.
  4. The studied period is limited to the early stage of the COVID-19 pandemic; thus, it is not known if these changes were observed or if changes in drinking were associated with subsequent surges.
  5. This study uses a population-based, non-clinical sample. This provides helpful information about behavior across the population yet does not characterize changes in drinking behavior for those with alcohol use disorders specifically.
  6. The study did use statistical techniques that might have been able to identify which individuals in particular might be at the greatest risk for harmful increases in alcohol use due to COVID.

BOTTOM LINE

The number of drinking days increased among U.S. adults during the early stages of the COVID-19 pandemic. Increases in drinking days were more likely to be observed and sustained in particular sociodemographic groups, specifically in participants who were male, White, in older age groups (i.e., 65+ years), who had household structures characterized by living alone, with a partner alone, or with a partner and children, and who lived above the federal poverty level.

  • For individuals and families seeking recovery: Stress related to the COVID-19 pandemic may increase risk of drinking, particularly if you are older, White, male, have a particular household structure (i.e., living alone, alone with a partner, or with a partner or children), or live above the federal poverty line. Although these specific factors are not very malleable, it is important to monitor alcohol use and seek support and treatment if you notice any increased pandemic-related stress and/or increases in drinking—particularly if you are a member of one of these groups—in order to reduce vulnerability and risks related to increased alcohol use.
  • For treatment professionals and treatment systems: The COVID-19 pandemic has contributed to increased demand for mental health services and has placed additional stress on most members of the population. This study suggests that drinking behavior (particularly number of drinking days) has increased over the course of the pandemic for many people, and that these increases are sustained particularly for member of certain demographic groups. Although the magnitude of the increases observed is relatively small, for some these increases are sustained over time. Given the potential health impacts of increased alcohol use, it is important to include an assessment of amount and frequency of alcohol use and to track trends over time to determine if your patients are experiencing these increases in consumption. These changes may initially be subtle but have the potential to become more problematic over time.
  • For scientists: This study illustrates how the number of drinking days in U.S. adults increased during the early stages of the COVID-19 pandemic, with sustained increases seen for particular sociodemographic groups. This research highlights the importance of epidemiological research that involves multiple longitudinal assessments so that the trajectory of behaviors in the population can be examined over time. That being said, future research can further elucidate these findings by including assessment of standard drinks consumed to better characterize severity of drinking. Similarly, future research would benefit from examining interactions between sociodemographic variables and/or using person-centered methods to identify relevant profiles of these variables to better characterize those most at risk. Examination of time-varying variables, including those relevant to the individual (e.g., employment status) and the population (e.g., surge status of COVID-19) will likewise be important additions.
  • For policy makers: This study suggests that the number of drinking days in U.S. adults increased over the early stage of the COVID-19 pandemic, with increases sustained for members of particular sociodemographic groups. Given the pervasiveness of the pandemic’s impacts on areas of public health beyond infection risk itself, it will be important to fund easily accessible resources that can help address risky alcohol consumption, other drug use, and mental health more generally. Additionally, increased assessment of the frequency and severity of alcohol use over time will be an important public health surveillance tool.

CITATIONS

Nordeck, C. D., Riehm, K. E., Smail, E. J., Holingue, C., Kane, J. C., Johnson, R. M., Veldhuis, C. B., Kalb, L. G., Stuart, E. A., Kreuter, F., & Thrul, J. (2022). Changes in drinking days among United States adults during the COVID-19 pandemic. Addiction, 117(2), 331-340. doi: 10.1111/add.15622