Longitudinal Assessment of Drinking Changes During the Pandemic: The 2021 COVID-19 Follow-Up Study to the 2019 to 2020 National Alcohol Survey
Abstract
Background
Surveys of changes in alcohol use during the COVID-19 pandemic have primarily relied on retrospective self-report. Further, most such surveys have not included detailed measures of alcohol use patterns, such as beverage-specific consumption, nor measures of alcohol use disorder (AUD) symptoms that would allow a comprehensive understanding of changes in alcohol use.
Methods
Data from 1819 completed interviews from the N14C follow-up survey to the 2019 to 2020 National Alcohol Survey (N14) were conducted between January 30 and March 28, 2021. Questions on alcohol use from the Graduated Frequency series, beverage-specific quantity and frequency, and DSM-5 AUD items were asked in both surveys and used to estimate changes from pre-pandemic alcohol use to alcohol use during the pandemic. Analyses focus on changes in these measures over time and comparisons between key subgroups defined by gender, race/ethnicity, and age.
Results
Key findings include particularly large increases in alcohol use and AUD for African Americans and women, reduced alcohol use and heavy alcohol use prevalence among men and White respondents, and a concentration of increased alcohol use and AUD among respondents aged 35 to 49. Increases in alcohol use were found to be driven particularly by increases in alcohol use frequency and the consumption of spirits.
Conclusions
Results confirm prior findings of overall increases and subgroup-specific changes, and importantly, provide detailed information on the patterns of change across major socio-demographic subgroups. Substantial increases in the prevalence of DSM-5 moderate to severe AUDs are a novel finding that is of particular concern.
Research Interpretation
This study found that alcohol use patterns changed drastically during the first year of the COVID-19 pandemic (April 2020 – March 2021) in the United States (U.S.) compared to pre-pandemic patterns.
- The proportions of people using alcohol and using alcohol in a risky pattern declined during the pandemic, specifically for men.
- However, there was a significant increase in the proportions of people who used alcohol every day and reported symptoms of moderate to severe alcohol use disorder.
The study further found the following sub-group changes in alcohol use patterns:
- In age group comparisons the largest changes were experienced by people aged 35-49.
- This group has an 82% increase in the volume of alcohol consumed. This was largely due to having more days where five or more units of alcohol were used.
- They had a 62% increase in the rate of self-reported moderate or severe alcohol use disorder.
- In racial and gender subgroups, African Americans and women reported particularly large increases in the total amount of alcohol they consumed, compared to pre-pandemic reports.
The research shows that the average number of alcohol units a person was consuming increased during the first year of the pandemic compared to before the pandemic. This included more frequent alcohol use, increased use of spirits and hard liquor, and increased use of wine by women.
The overall increase in alcohol volume was driven by people drinking more often than previously, which could be because of increased stress and anxiety due to the pandemic and people having more free time, with less time spent commuting, traveling, and attending social events. The higher rates of consumption in the population, and particularly among African Americans, women and those in the age group 35-49, is concerning,” said William Kerr, lead author of the study from the Alcohol Research Group, Public Health Institute, California, as per their website.
William Kerr, The Alcohol Research Group, Public Health Institute, California
The researchers suggest that the specific rise in alcohol use among African Americans was possibly due to added stressors caused by the years of racism that have not been addressed by communities and systems. This racial group has experienced more health and social consequences from COVID-19 than other racial and ethnic groups.
In terms of the rise in alcohol use among women it was possibly due to increased vulnerability to COVID-19 effects such as job loss and facing more responsibilities at home than men during the pandemic.
The increase in alcohol use among 35 to 49 years olds could have been due to changes in work situations, stress related to familial responsibilities and reduction in at-home support.
The COVID-19 crisis seems to have accelerated recent behavioral trends of people consuming more spirits and slowly rising alcohol sales. This should be a concern for public health as studies have already shown much higher rates of alcohol-related morbidity and mortality in 2020 which will continue if we don’t take action by strengthening alcohol polices, looking at how systemic racism impacts a person’s physical health as well as addressing mental health needs,” said William Kerr, lead author of the study from the Alcohol Research Group, Public Health Institute, California, as per their website.
William Kerr, The Alcohol Research Group, Public Health Institute, California
The researchers of the study call for improved alcohol policy solutions including increasing alcohol taxes and reducing the availability of alcohol to reduce alcohol use and tackle the health and social harms caused by alcohol which has been exacerbated by the pandemic.
Sources:
Wiley Online Library: “Longitudinal assessment of drinking changes during the pandemic: The 2021 COVID-19 follow-up study to the 2019 to 2020 National Alcohol Survey“
Public Health Institute: “New COVID-19 Study Finds More Drinking, But Fewer Drinkers“