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Lower alcohol consumption in the Netherlands’ general population during pandemic lockdown than previous years

Research on alcohol use during the COVID-19 pandemic provides insights into how common, but potentially harmful behaviors are impacted by public health crises. This study examined the impact of “lockdowns” on alcohol use at multiple times throughout the pandemic with a specific look at differences based on living arrangements and feelings of isolation.

WHAT PROBLEM DOES THIS STUDY ADDRESS?

Some studies have reported that the measures taken to control the spread of COVID-19, referred to hereafter as “lockdown”, have resulted in increased stress, loneliness, and mental health problems, as well as changes in alcohol consumption. Because excessive alcohol consumption is associated with many negative medical, mental, and social consequences it is therefore important to examine the impact of the potential stress caused by the lockdowns on alcohol use.

The studies that have examined changes in alcohol consumption during lockdown have shown conflicting results, with some showing increases in consumption and others showing decreases. These mixed results may be the result of different motivations for drinking. Some individuals may have increased how much they drink as a coping mechanism to deal with the stress and isolation caused by lockdown. Others, however, may have decreased their alcohol use because of closed bars and restaurants as well as limited opportunities for socializing, where alcohol consumption is more likely to occur for some.

Existing studies also have several limitations. First, many of them have only assessed alcohol consumption at one time point, rather than multiple time points, which would allow researchers to identify changes over time. Because lockdown has been occurring for more than two years and because the strictness of the measures taken has varied, examining changes across time may provide important insights. Second, many studies have not assessed differences between groups, such as between individuals with different living arrangements or how may experience different levels of feelings of social isolation. Both of these factors can influence alcohol use and are thus important to include in analyses of alcohol consumption during lockdown.

Researchers in this study aimed to overcome the limitations from these previous studies by examining the impact of lockdown on alcohol consumption across multiple timepoints throughout the pandemic and by examining whether there are any differences based on living arrangements (living alone vs. with others) and experiencing different levels of feelings of isolation. This research can provide insights on alcohol use patterns during the current pandemic that may also apply to future public health crises, which can help inform harm reduction and treatment services.

HOW WAS THIS STUDY CONDUCTED?

The researchers in this study examined the impact lockdown had on alcohol consumption among individuals living in the northern Netherlands across 13 months and whether their living arrangements and feelings of isolation further affected consumption.

The research team drew data from the Lifelines COVID-19 cohort, which was developed from the Lifelines Cohort Study. The Lifelines Cohort Study is a large population-based study of 167,729 individuals living in three northern provinces of the Netherlands that examined the factors contributing to their health.

Population-based studies draw participants from the general population that are from the same demographic or have certain characteristics in common, which should not be confused with nationally representative studies that draw participants in a way that ensures the sample reflects the demographics and characteristics of the entire population (e.g., the percentage of women in the sample match the percentage of women in the population).

The Lifelines COVID-19 cohort was developed to investigate how the pandemic affected these individuals, their health-related behaviors, and their attitudes towards the regulations imposed to control the spread of the virus since the start of the pandemic until July 2021. Between March and June 2020, participants were asked to complete questionnaires online every other week. Then, from July 2020 until July 2021, questionnaires were completed every month. This study used data from the questionnaires that included questions about alcohol use, which resulted in 13 waves of data from 63,194 participants and covered the months between April 2020 and July 2021. Data from the same participants collected in previous years of the study was also analyzed so the researchers could compare their alcohol use during the pandemic to their use previously.

Participants were 61.2% women and had a mean age of 57.2. The majority of participants had a mid-level education (i.e., “secondary vocational education or higher general and pre-university education”; 38.1%) and were employed (59.6%). Most reported living with others (86.2%) and experiencing low levels of isolation (81.6%).

Time experiencing a COVID lockdown was measured in number of days since first lockdown (March 15, 2020) and transformed into categories that corresponded with the month of the questionnaire. Living arrangements were determined by asking participants the yes or no question, “Do you have one or more housemates?” They also asked whether participants had children under the age of 18 living with them and whether they had no children with them to see if this factor affected their findings. Feelings of social isolation were categorized as low or high based on how socially isolated they reported feeling in the last 14 days on a 10-point scale (1-6 = low; 7-10 = high). Alcohol consumption was the main outcome of interest and was assessed by asking participants, “How many glasses of alcohol did you drink in the past 7 [14] days?” A standard glass of alcohol (i.e., standard drink) in the Netherlands is defined as approximately 10 grams of alcohol (in contrast, a standard drink in the U.S. contains 14 grams of alcohol). To standardize the amount of alcohol consumed for each participant, the researchers created an average weekly consumption score. Scores ranged from 0 to 70.

WHAT DID THIS STUDY FIND?

Alcohol consumption was lower throughout the study period than in previous years.

Overall, alcohol consumption was lower during the lockdown period than in previous years, but the difference was small and may not be very meaningful in real-world terms. The differences ranged between approximately 5 – 5.5 glasses of alcohol per week in the years prior to the lockdown compared to roughly 4 – 4.5 glasses of alcohol per week during the lockdown.

The seasonal patterns of alcohol consumption during the lockdown were similar to the years prior, but there were some notable differences. Before the lockdown, alcohol consumption steadily increased during the spring until it peaked in mid-summer. However, in the spring of 2020 during lockdown, drinking levels decreased, which may have resulted in the summer peak occurring sooner. Then, after the summer, the decline in alcohol consumption was steeper and steadier during lockdown than in the years prior. Finally, there was no holiday peak in January 2021 that was seen in previous years, and, in fact, the lowest levels of alcohol use through the entire study were reported.

Although individuals living alone and those living with other people had similar alcohol consumption, overall, during the study period, they reported somewhat different courses over time. Individuals living alone increased their use during the strictest lockdown period, while those living with others increased their use during the summers.

Overall alcohol consumption was similar between those who lived alone and those who lived with others. However, their patterns differed somewhat across time. Those who lived alone showed a steady increase in alcohol consumption during the strictest lockdown period (Nov. 2020 – May 2021), while those living with others showed a decrease into this strict lockdown period, until Feb. 2021. Another difference between the two groups’ drinking patterns was that those who lived with others, particularly those who lived with children, showed a steeper increase during both summers (2020 and 2021) than those who lived alone. The effects of living arrangements remained even adding in the effects of social isolation, which suggests that they were independent of each other.

Individuals who felt isolated increased their drinking to a lesser degree during periods when most increased their drinking.

Overall alcohol consumption was slightly lower among those who reported feeling extremely isolated compared to those who reported no feelings of isolation, but the differences were very small (approximately a half of a drink difference per week). Further, the differences in alcohol consumption between those reporting low feelings of isolation compared to those reporting high feelings of isolation primarily only reached statistical significance during both of the summer periods (2020 and 2021), whereby those with high feelings of isolation reported less alcohol use compared to those reporting feeling more isolated.

WHAT ARE THE IMPLICATIONS OF THE STUDY FINDINGS?

Among the general population in the Netherlands, researchers examined the impact of COVID lockdown on alcohol consumption from the beginning of the pandemic (March 2020) until July 2021. They also examined whether participants’ living arrangements and feelings of social isolation further impacted the effects of lockdown on alcohol use. While differences were small, researchers found that alcohol consumption was lower during the lockdown than it was in prior years and that drinking patterns slightly differed from typical seasonal patterns (such as no peak during the holiday season). Even small effects when considered across an entire population can have noteworthy public health impacts, as was the case in this study. Living arrangements and feelings of social isolation further impacted alcohol consumption somewhat. Specifically, individuals living alone increased their use during the strictest lockdown period, while those living with others, especially children, increased their use during the summers, and those who felt isolated increased their drinking to a lesser degree during periods when most increased their drinking. It may be that those who felt most isolated were not participating as much in typical summer activities, such as vacations, where alcohol is more likely to be consumed.

In comparison to studies in the US, these findings are broadly consistent with those found among college students. Among the general college student population in the US, students showed initial decreases in their alcohol consumption, likely because of the reduced opportunities to socialize with peers and limited access to alcohol. However, when students who are higher risk (defined as already having used a substance in the past month) are specifically selected, and mental health symptoms such as anxiety and depression are also considered, mental health problems and alcohol/drug use have been shown to increase during the pandemic. Researchers in the present study did not examine those with heavy alcohol use histories, those with alcohol use disorder, or those with any other mental health symptoms. They also did not examine whether participants were distressed by their feelings of isolation. Those who are experiencing mental health symptoms or distress from isolation may consume more alcohol than those who do not. Further, the researchers also included individuals who were abstinent during the COVID-19 study period. Including abstinent individuals in a population-level study measuring alcohol consumption over time likely obscured any potential increases in higher-risk individuals, such as those with alcohol use disorder or other forms of hazardous drinking, or even simply among those who drink at lower levels.

Further, these findings are somewhat in contrast to studies of adults in the general US population. Compared to February 2020 (the month before the pandemic and stay-at-home orders began), US adults from a study designed to be representative of the US population consumed 29% more standard drinks per day in April 2020 (0.74 drinks per day in February vs. 0.95 drinks per day in April) and a greater proportion reported drinking more than the recommended limit (30.11% vs. 36.11%) and binge drinking (23.39% vs. 28.39%). Following this initial increase, men in the US showed declines in their alcohol use through March 2021, while women’s use remained stable, but alcohol problems for both groups increased and more so for men. Another large study of US adults, however, showed that women had fewer drinking days than men through July 2020. Further, results from that US study also showed that adults living alone or with children and partners had fewer drinking days than adults living with just their partner. Finally, the study showed other demographic differences, such as those identifying as Black, Hispanic/Latino, or Other races having fewer drinking days than White individuals, and older individuals having more drinking days than those aged 18-29.

Differences between studies may be due to the study period examined or the nature of the included study population samples, but collectively they demonstrate that the pandemic affected alcohol consumption differently for different groups of people and at different times. Clearly, there are many variables that could affect rises, decreases, or no changes in alcohol consumption across time among various subgroups who would have responded to the adaptations needed to accommodate the lockdown related changes in different regions and in different countries.

Additional research is needed to continue to examine the impact of the COVID-19 lockdown on alcohol use and related problems within different populations in different countries and across time. Research on drinking during the COVID-19 pandemic can provide insights that apply to future public health crises as well, informing strategies to reduce harms and enhance linkages to services for those who need it.

Because the present study did not examine feelings of distress, mental health problems, and alcohol problems, it is difficult to determine whether differences in alcohol consumption between the US and the Netherlands is due to these limitations or due to differences in such variables as well as differences in social safety net supports provided in the different countries, including access to healthcare and the quality of the healthcare available. For instance, the Netherlands has one of the best healthcare systems in the European Union, with 100% of people having a regular doctor and paying a low annual deductible (approximately $405 in 2022). Health insurance is also not linked to employment in the Netherlands as it is in the United States, which may have been a particularly salient stressor as many Americans lost their jobs during the pandemic. Accordingly, it is possible that individuals in the Netherlands were less stressed about their ability to obtain healthcare if they or their loved ones got sick than individuals in the US, resulting in lower alcohol consumption overall

Taken together, these results perhaps suggest that consuming alcohol plays a bigger part in socializing in the Netherlands, which was prevented during the lockdown, and that these individuals were not using alcohol to cope with the stress and isolation brought on by lockdown, as adults in the US may have been.

LIMITATIONS
  1. Information on individual drinking patterns, such as drinking alone, was not available. Accordingly, the researchers used the “proxy” variables of living arrangements and feelings of isolation that were close enough to allow them to gain similar insights.
  2. Information on the nature, quality, and alcohol use status of the relationships of the people who lived with others was not available.
  3. The researchers did not examine any mental health symptoms, histories of alcohol use disorder/harmful alcohol use, or whether participants were distressed by their feelings of isolation, which may have affected the results. It is possible, for instance, that individuals who are experiencing mental health symptoms or distress from isolation may consume more alcohol than those who do not in an attempt to self-medicate. Just because there were few substantial changes in alcohol use found in this study, there are certain subgroups of individuals who would have definitely shown large increases in alcohol use that were not examined here. These individuals are the most at risk for negative outcomes and adverse events from heavier alcohol consumption and should be examined in future research.
  4. The researchers did not exclude individuals who never consumed alcohol or were not consuming alcohol currently. How drinking changed during the pandemic among those who do not typically consume alcohol cannot be determined from this study.

BOTTOM LINE

Among the general population in the Netherlands, researchers found that alcohol consumption was lower during the lockdown than it was in prior years and that drinking patterns slightly differed from typical seasonal patterns (such as no peak during the holiday season). Living arrangements and feelings of social isolation further impacted alcohol consumption somewhat, such that those living alone and those who felt isolated reported lower levels of alcohol consumption than those who lived with others or did not report feeling isolated. Taken together, these results perhaps suggest that consuming alcohol is part of socializing in the Netherlands, which was prevented during the lockdown, and that these individuals were not using alcohol to cope with the stress and isolation brought on by lockdown.

  • For individuals and families seeking recovery: The study findings show that among the general population in the Netherlands, lockdown was associated with a reduction in alcohol consumption. Further, individuals who lived alone, compared to those living with others, and those who felt isolated, compared to those who did not, reported lower levels of alcohol consumption. Importantly, participants in the study were from the general population and were not individuals at high risk for, currently have, or are in recovery from, alcohol use disorder. Results may have been different if these individuals were specifically examined. However, the study findings highlight the important role social interactions can have in alcohol use and suggest that some may be at higher risk for feeling isolated if they feel they cannot participate in social activities where alcohol is often involved. Accordingly, it might be helpful for individuals in recovery whose goal is abstinence to consider alternative ways of socializing without alcohol.
  • For treatment professionals and treatment systems: Treatment professionals can help support their clients in recovery who goal is abstinence to consider alternative ways of socializing without alcohol, as study findings highlight the important role alcohol can have in social interactions and suggest that they may be at higher risk for feeling isolated. Additionally, treatment professionals should assess the importance of alcohol in participating in familial and cultural traditions, such as holiday celebrations, with their clients who want to abstain and discuss strategies for dealing with these situations.
  • For scientists: Given the recency and novelty of the pandemic and associated restrictions, research on how it impacted alcohol consumption is its infancy and producing seemingly conflicting results. Additional research is needed to investigate the pandemic’s differential impacts on sociodemographic groups and across countries. Studies investigating whether different countries’ responses to the pandemic (i.e., strictness and promptness of lockdowns, communication with the public) differentially impacted alcohol consumption and other mental health indicators would also be useful. Finally, the role of trust the public has in their government and the extent to which social safety net programs and healthcare systems affected stress and drinking levels in different countries should be examined.
  • For policy makers: If alcohol consumption was, in fact, lower during lockdown in the Netherlands, rather than being an artifact of the study design, policymakers in the US should take note of country-level differences that may have resulted in reduced alcohol use, as opposed to the increased levels seen in the US. It may be that in countries where citizens are less stressed due to not worrying about the economic burdens of healthcare, for instance, individuals are more likely to consume alcohol as part of social activities rather than to cope with stress.

CITATIONS

Mangot-Sala, L., Tran, K. A., Smidt, N., & Liefbroer, A. C. (2022). The impact of the COVID lockdown on alcohol consumption in the Netherlands. The role of living arrangements and social isolation. Drug and Alcohol Dependence, 233, 109349. doi: 10.1016/j.drugalcdep.2022.109349