We all know alcohol is not the healthiest of drinks, but I do not think we know the extent of the dangers alcohol has introduced into our lives in general, and over the pandemic. So here are the studies, and some suggestions in the end.
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Pre and Post Pandemic Alcohol Studies
Alcohol, a beverage that has pleased our species for millennia, is one of the “foods” the consumption of which, in the words of the immortal bard, should give us pause.
Quote from scientific study of two large epidemiological posts published nearly two decades apart
World Health Organization (WHO)
WHO wrote (2022) that alcohol is a psychoactive substance with dependence-producing properties that has been widely used in many cultures for centuries. The harmful use of alcohol causes a high burden of disease and has significant social and economic consequences. They go on to note that alcohol consumption is a causal factor in 200+ diseases, numerous injuries, mental and behavioral disorders, and major noncommunicable diseases. But these observations do not occur in a vacuum, so they also highlight:
- Societal factors: level of economic development, culture, social norms, availability of alcohol, and implementation + enforcement of laws or policies.
- Drinking context: has an important role in the occurrence of alcohol-related harm, particularly as a result of alcohol intoxication.
- Individual factors: age, family circumstances, and socio-economic status. Although there is no single risk factor that is dominant, the more vulnerabilities a person has, the more likely the person is to develop alcohol-related problems as a result of alcohol consumption.
- There are gender differences in alcohol-related mortality and morbidity, and athe levels and patterns of alcohol consumption. The percentage of alcohol-attributable deaths among men amounts to 7.7 % of all global deaths compared to 2.6 % of all deaths among women.
Older Studies (1990s-2000s)
A major review in the New England Journal of Medicine (1997) reported that the causes of death associated with drinking were cirrhosis and alcoholism; cancers of the mouth, esophagus, pharynx, larynx, and liver combined; breast cancer in women; and injuries and other external causes in men. They go on to write that the overall death rates were lowest among men and women reporting about one drink daily. Mortality from all causes increased with heavier drinking, particularly among adults < 60 years of age.
The Lancet (2015) cohort study considered global patterns, economic status, and the countries economies in their review. The result was that high-intake led to higher mortality, and over time among drinkers there were higher incidences of alcohol-related cancers. One of the conclusions was alcohol consumption was a global problem.
All the older studies, and the CDC, point to both short-term and long-term effects of excessive alcohol drinking.
- Short term alcohol risks
- Injuries, such as motor vehicle crashes, falls, drownings, and burns.
- Violence, including homicide, suicide, sexual assault, and intimate partner violence.
- Alcohol poisoning, a medical emergency that results from high blood alcohol levels.
- Risky sexual behaviors, including unprotected sex or sex with multiple partners. These behaviors can result in unintended pregnancy or sexually transmitted diseases, including HIV.
- Miscarriage and stillbirth or fetal alcohol spectrum disorders among pregnant women.
- Long term alcohol risks
- High blood pressure, heart disease, stroke, liver disease, and digestive problems.
- Cancer of the breast, mouth, throat, esophagus, voice box, liver, colon, and rectum.
- Weakening of the immune system, increasing the chances of getting sick.
- Learning and memory problems, including dementia and poor school performance.
- Mental health problems, including depression and anxiety.
- Social problems, including family problems, job-related problems, and unemployment.
- Alcohol use disorders, or alcohol dependence.
Looking at the numerous studies over the past couple of decades, specifically pre-pandemic, leads me to consider that deaths caused by alcohol had been steadily growing more-or-less by ~7% yearly in the USA. But a change, post-pandemic, has been noticed.
Recent Studies (2019-2022)
The two major studies I am referencing here do not overlap. The journal JAMA Network Open published a pre-pandemic cross sectional article regarding alcohol + alcohol related deaths from 2015 – 2019. While the CDC’s National Center for Health Statistics, released in November 2022, was a statistical review regarding USA’s alcohol consumption deaths from 2019-2020 as the pandemic started to grow globally.
The Recent 2019-2020 Statistical Facts
One study reports that in 2020, as stay-at-home orders began in some US states as a mitigation strategy for COVID-19 transmission, Nielsen reported a 54% increase in national sales of alcohol for the week ending March 21, 2020, compared with 1 year before; online sales increased 262% from 2019. Three weeks later WHO warned that alcohol use during the pandemic may potentially exacerbate health concerns and risk-taking behaviors.
HarvardNews (2022) reported on a National Institute on Alcohol Abuse and Alcoholism (NIAAA) study that showed that alcohol consumption in November 2020 was 39 percent higher than in February 2020, with a 30 percent rise in binge drinking. NIAAA also published reports showing that per capita consumption increased 2.9 percent in 2020, the fastest rate since 1968, and that alcohol-related deaths increased 25 percent between 2019 and 2020. In January 2020, Massachusetts General Hospital and Harvard Medical School researchers estimated that increases in drinking during the COVID crisis will result in 8,000 additional deaths from alcohol-related liver disease, 18,700 cases of liver failure, and 1,000 cases of liver cancer by 2040.
Other evidence is corroborated by the increase in on-line direct sales of delivered alcohol to homes during the pandemic. The increase in alcohol sales were directly supported by states trying to keep businesses alive, and people employed, during the trying first year of “stay at home” pandemic decisions by allowing alcohol delivery. The suggestions for why there was increased drinking includes:
- Reductions in commuting, travel, and social and recreational activities: allowed more time for drinking, reduced constraints to get alcohol, reduced peer pressure, etc.
- Changes in alcohol policy or laws: allowing delivery and pickup options.
- The ready-to-drink (pre-made drinks, canned alcohol) category is the only beverage alcohol sector expected to see growth in 2020, with volumes forecast to increase 43%, according to IWSR Drinks Market Analysis.
- Increased political and racial tensions, family dynamics, boredom, financial distress, psychological distress and virus‐related stress.
The evidence already shows that alcohol-induced deaths increased from 2000 to 2020 which support the projection above. We even know that, adjusting for age, alcohol-induced deaths from 2019 to 2020 were significantly higher.
- 2019 was 10.4/100k, 2020 was 13.1/100k, this is an amazing increase of 26% from 2019 to 2020.
For both males + females, the rates of alcohol-induced deaths in 2020 increased with age. They peaked for those aged 55–64, and then declined for age groups 65 and over.
- From 2019 to 2020, rates of alcohol-induced deaths for females increased across all age groups for those aged 25 and over.
- From 2019 to 2020, rates of alcohol-induced deaths for males increased across all age groups under 85.
Alcoholic liver disease was the frequent underlying cause for all alcoholic-related deaths. However, other causes of death also increased.
- From 2019 to 2020, deaths from alcohol-induced acute pancreatitis increased 50%.
- From 2019 to 2020, deaths increased 33% for mental and behavioral disorders due to use of alcohol.
- From 2019 to 2020, deaths from alcoholic liver disease increased 23%.
Some Data Footnotes
The CDC report does not include some counts I personally would have added, such as: Alcohol-induced causes exclude unintentional injuries, homicides, and other causes indirectly related to alcohol use, as well as newborn deaths associated with maternal alcohol use.
The CDC data focused only on deaths caused fully by alcohol. They did not include deaths for which it may have been partially responsible. This suggested to me, and plenty of others, that alcohol’s real death count during the pandemic was most likely even larger than the CDC reports.
These studies generally refer to an agreed upon alcohol consumption definition. One drink is considered as 12g of absolute alcohol (75° proof liquor). Here are the categories:
- None: is defined as less than daily, but at least 3x a week
- 1 drink per day
- 2–3 drinks per day
- 4 or more drinks per day
Many studies (2017) acknowledged that although high doses of alcohol are harmful to the heart and causes some cancers; mild to modest alcohol consumption is associated with reductions in coronary artery diseases, diabetes, and even all-cause mortality. The findings of some studies is that some very modest amount of drinking might be beneficial, but drinking more is not.
What Do Studies Show
Differences by State Exist
The journal JAMA Network Open published a cross sectional study that looked at estimated deaths that were attributable to excessive alcohol use among USA adults 20 to 64 years old, between 2015 to 2019. One of their major findings was that alcohol was at fault in one in five USA deaths for people between 20 to 49 years of age.
It is not yet clear why the amount of alcohol related deaths vary among the states, but clearly they do. More studies are going to have to occur for this phenomenon to become clearer.
Alcohol Increases Mortality Risk
Alcohol use is a known and much studied risk factor for mortality. The worry is that the rates of alcohol-induced deaths have risen over the past several years (1). In fact, now one out of every eight deaths in the USA, of working adults 20-64 years, is alcohol related (1a).
The CDC analysis points out that alcohol use in the USA increased during the first year of the COVID-19 pandemic (2). So the ideas that we have been drinking more during the pandemic is not surprising, nor is the idea consuming lots of alcohol is not healthy. What is surprising to me is how many people have taken to drink to deal with the feelings the pandemic stirred up, such as anxiety, stress, and loneliness.
At the same time, studies historically have also clearly shown that men and women, who consume alcohol regularly, have historically higher death rates from: accidental injury, violence, suicide, poisoning, cirrhosis of the liver, cancer, and hemorrhagic stroke. Most of the causes of death I listed above are understood, but some I wanted to explain a bit further because the were not as clear to me as the other reasons.
Mental and behavioral disorders due to use of alcohol: Deaths resulting from acute intoxication, harmful use, dependence syndrome, withdrawal (with and without delirium), psychotic disorder (including residual and late onset), amnesic syndrome, and other mental and behavioral disorders including those unspecified.
Sexual Violence: Several decades of research have demonstrated that alcohol increases the likelihood of intimate partner violence. Excessive alcohol use, particularly binge drinking, is a major contributing factor to sexual violence. The UN reports that globally ~47,000 women and girls were killed by their intimate partners or other family members in 2020. So on average, a woman or girl is killed by someone in her own family every 11 minutes.
Alcohol and Cancer Mortality: The risk of death due to breast cancer was 30% higher in women who consumed at least one drink a day, as compared with women who did not drink. How alcohol causes this cancer is explained by the CDC:
- When you drink alcohol, your body breaks it down into a chemical called acetaldehyde.Acetaldehyde damages your DNA and prevents your body from repairing the damage. DNA is the cell’s “instruction manual” that controls a cell’s normal growth and function. When DNA is damaged, a cell can begin growing out of control and create a cancer tumor.
What Actions Can I Choose
This list of choices below is for those who are not alcoholics, or problem drinkers. I am not an expert in any sense of the word regarding this disease. However, if you are worried about your alcohol consumption, and do not have the disease of alcoholism, then the options below may assist in changing your drinking habits.
Do not think me preachy here. I know that for many this is a very hard conversation to have. But clearly, the obvious first choice is to choose not to drink.
- Fortunately, I do not have the type of brain that lends itself to alcohol or drug addiction, and if I made this decision to no longer drink, it would not cause me any psychological harm. For others, this decision may be extremely difficult, and is one that rarely can occur in isolation. To stop drinking is a major step that requires the support of family, community, and maybe some sort of therapy, to help understand the why’s of your drinking.
The next choice is to limit the when, were, and how much one drinks.
- Again for me, it is rather easy to not think of drinking, so my deciding to drink on average <1 drink per week is no big or deciding to only have one drink every Friday after dinner would not be a big decision. But for others, limiting the consumption of alcohol takes support and compassion from family and friends, and from you for yourself. Learning to deal with issues (loneliness, depression, sadness, stress, etc) without the support of alcohol can be very challenging to some.
The third choice is to stop bingeing outright, learn to drink in moderation.
- Even as a youngster, I rarely binged, and when I did (those two times) I thoroughly embarrassed myself and got sick. After that last time, nearly 50 years ago, I can no longer drink gin. I chose then, not to drink to get drunk as there was clearly nothing good to gain by that activity.
The fourth choice is to decide to stop supporting drinking, especially underage drinking.
- At a family gathering, always stressful to me, I did not drink and did not allow my underaged son to have a drink. Despite overt, verbal pressure from siblings. In fact, I found their focus on drinking, and the implied allure of consuming an illicit drink, to be obnoxious and rather pissed me off. I do not have to serve alcohol at my house, do not have to have a drinks at a dinner party, or even have alcohol visible in my easy-to-access pantry.
My fifth choice is to change alcohol habits, and limit my exposure to when I mostly drink.
- To stick to limits I could stop drinking while watching TV, or drinking only when I am with someone. If drinking at night is used to pass time, I could just go to bed earlier and get up earlier. I could also replace my favorite alcoholic drink with another drink I really like. For me, I could replace wine with grape juice made from wine grapes which I really like and often prefer.
Sixth is to decide to drink intentionally.
- To me, this means making a decision before you drink, on how many. That may also mean making a decision not to drink before 5pm, so alcohol is not an active part of everyday life. If you think about drinking outside of your parameters, do something else that you like, perhaps walking or playing with your dogs. It really does take just a bit of time to stop obsessing about something and moving on.
Services
The CDC has a Check Your Drinking site that I visited for this post. It assesses your drinking pattern and makes suggestions.
Substance Abuse + Mental Health Services Administration (SAMHSA) national helpline is a free, confidential, 24/7, 365-day-a-year treatment referral and information service (in English and Spanish) for individuals and families facing mental and/or substance use disorders.
Various communities have more local services that are focused on that groups specific needs and trouble areas. Go to them for help and support.
Thank you for reading this post. I wish us all good health, and happy lives.
—Patty
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