Changes in Adult Alcohol Use and Consequences During the COVID-19 Pandemic in the US | Infectious Diseases | JAMA Network Open | JAMA Network
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Table 1.  Demographic Characteristics of Analytic Sample at 2019 Baseline, Unweighted (N = 1540)
Demographic Characteristics of Analytic Sample at 2019 Baseline, Unweighted (N = 1540)
Table 2.  Estimates of Change in Alcohol Use and Associated Consequences From 2019 to 2020a
Estimates of Change in Alcohol Use and Associated Consequences From 2019 to 2020a
1.
The Nielsen Company. Rebalancing the ‘COVID-19 Effect’ on alcohol sales. Published May 7, 2020. Accessed August 27, 2020. https://www.nielsen.com/us/en/insights/article/2020/rebalancing-the-covid-19-effect-on-alcohol-sales/
2.
World Health Organization. Alcohol does not protect against COVID-19; access should be restricted during lockdown. Published April 14, 2020. Accessed August 27, 2020. https://www.euro.who.int/en/health-topics/disease-prevention/alcohol-use/news/news/2020/04/alcohol-does-not-protect-against-covid-19-access-should-be-restricted-during-lockdown
3.
Pollard  M, Baird  M. The RAND American Life Panel: technical description. 2017. RAND Corporation website. Accessed June 6, 2020. https://www.rand.org/pubs/research_reports/RR1651.html
4.
Gutsche  T, Kapteyn  A, Meijer  E, Weerman  A.  The RAND Continuous 2012 Presidential Election Poll.   Public Opin Q. 2014;78:233-254. doi:10.1093/poq/nfu009Google ScholarCrossref
5.
Miller  WR, Tonigan  JS, Longabaugh  R.  The Drinker Inventory of Consequences (DrInC): An Instrument for Assessing Adverse Consequences of Alcohol Abuse. US Dept Health and Human Services, Public Health Service, National Institutes of Health; 1995. doi:10.1037/e563232012-001
6.
Foulds  JA, Adamson  SJ, Boden  JM, Williman  JA, Mulder  RT.  Depression in patients with alcohol use disorders: systematic review and meta-analysis of outcomes for independent and substance-induced disorders.   J Affect Disord. 2015;185:47-59. doi:10.1016/j.jad.2015.06.024 PubMedGoogle ScholarCrossref
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    1 Comment for this article
    EXPAND ALL
    Awareness is a start, action comes next
    Eileen Barrett, MD, MPH | University of New Mexico
    I read this article with interest, including the recommendation that health systems may need to provide education about increased alcohol use. I agree that education of patients, clinicians, and communities is indicated, but would also recommend strongly health systems strengthen the mental health care infrastructure and work with elected officials on public health strategies, and that individual clinicians become familiar with treatment for excess alcohol use.

    The Centers for Disease Control and Prevention recommends enforcing existing laws to curtail the sale of alcohol to underage individuals; building coalitions between schools, public health agencies, health care and others to reduce
    excessive alcohol use; increasing taxes on alcohol; limiting the hours when alcohol can be purchased; and limiting quantities of purchases in the same day. These steps are effective in many states and municipalities to reduce unhealthy alcohol use, and should be adopted widely. These steps, in partnership with expanding access to mental health care, can help reduce harm to individuals during COVID and beyond.

    Additionally, all clinicians should understand alcohol and other substance use disorders as chronic illnesses rather than personal failings and should seek to treat these patients just as we treat others with chronic illnesses: with evidence-based medicine. A meta-analysis by Kranzler and Soyka published August 28, 2018 in JAMA Psychiatry evaluated all drugs studied for alcohol use disorder used on- or off-label (including disulfiram, naltrexone, acamprosate, topiramate, gabapentin, baclofen, and others). This paper concluded that acamprosate and naltrexone are the very effective albeit underutilized in reducing excess alcohol use. These medications are generic, safe, and effective, and all clinicians with a longitudinal relationship with patients should become more familiar with their use and prescribe them to patients with alcohol misuse.
    CONFLICT OF INTEREST: None Reported
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    Research Letter
    Substance Use and Addiction
    September 29, 2020

    Changes in Adult Alcohol Use and Consequences During the COVID-19 Pandemic in the US

    Author Affiliations
    • 1RAND Corporation, Santa Monica, California
    • 2Indiana University School of Public Health, Bloomington, Indiana
    JAMA Netw Open. 2020;3(9):e2022942. doi:10.1001/jamanetworkopen.2020.22942
    Introduction

    As stay-at-home orders began in some US states as a mitigation strategy for coronavirus disease 2019 (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 2019.1 Three weeks later, the World Health Organization warned that alcohol use during the pandemic may potentially exacerbate health concerns and risk-taking behaviors.2 This study examines individual-level changes in alcohol use and consequences associated with alcohol use in US adults, as well as demographic disparities, from before to during the COVID-19 pandemic.

    Methods

    In this survey study, data were collected using the RAND Corporation American Life Panel (ALP), a nationally representative, probability-sampled panel of 6000 participants age 18 years or more who speak English or Spanish; data are weighted to match a range of national demographic characteristics.3 Panel members provide informed consent annually online. All procedures were approved by the RAND Corporation Human Subjects Protection Committee. A sample of 2615 ALP members ages 30 to 80 years was invited to participate in the baseline survey (wave 1), which was closed after 6 weeks (April 29-June 9, 2019) with 1771 completions. Wave 2 data were collected from May 28 to June 16, 2020, several months after widespread implementation of COVID-19–associated social distancing. This study followed the American Association for Public Opinion Research (AAPOR) reporting guideline for survey studies.

    The completion rate for the wave 2 survey was 58.9% of all wave 1 invitations. The ALP is composed of individuals recruited from multiple sources over more than 10 years, and a precise standardized response rate is difficult to compute. Based on survey completion rates of 56.6%, a prior estimate of the average ALP cumulative response rate is 9%.4

    Comparisons before and during the COVID-19 pandemic were made on number of days of any alcohol use and heavy drinking (defined as 5 or more drinks for men and 4 or more drinks for women within a couple of hours), and average number of drinks consumed over the past 30 days. The 15-item Short Inventory of Problems5 assessed adverse consequences associated with alcohol use in the past 3 months (eg, “I have taken foolish risks when I have been drinking”). Comparisons were made overall, and across self-reported sex, age, and race/ethnicity. Significant changes were assessed based on whether the 95% CI around change from wave 1 to wave 2 included 0. Analyses include weights.

    Results

    The current analytic sample includes 1540 adults (87.0%; mean [SD] age, 56.6 [13.5] years; 825 [53.6%] were in the age range of 30-59 years; and 883 [57.3%] were female) from the baseline survey who, approximately 1 year later, completed the wave 2 survey (Table 1). Frequency of alcohol consumption increased (1) overall, 0.74 days (95% CI, 0.33-1.15 days), representing an increase of 14% over the baseline of 5.48 days in 2019; (2) for women, 0.78 days (95% CI, 0.41-1.15 days), representing an increase of 17% over the 2019 baseline of 4.58 days; (3) for adults age 30 to 59 years, 0.93 days (95% CI, 0.36-1.51 days), an increase of 19%; and (4) for non-Hispanic White individuals, 0.66 days (95% CI, 0.14 to 1.17 days), an increase of 10% over the 2019 baseline of 6.46 days (Table 2). On average, alcohol was consumed 1 day more per month by 3 of 4 adults. For women, there was also a significant increase of 0.18 days of heavy drinking (95% CI, 0.04-0.32 days), from a 2019 baseline of 0.44 days, which represents an increase of 41% over baseline. This equates to an increase of 1 day for 1 in 5 women. For women there was an average increase in the Short Inventory of Problems scale of 0.09 (95% CI, 0.01-0.17 items), over the 2019 average baseline of 0.23, representing a 39% increase, which is indicative of increased alcohol-related problems independent of consumption level for nearly 1 in 10 women.

    Discussion

    These data provide evidence of changes in alcohol use and associated consequences during the COVID-19 pandemic. In addition to a range of negative physical health associations, excessive alcohol use may lead to or worsen existing mental health problems, such as anxiety or depression,6 which may themselves be increasing during COVID-19. The population level changes for women, younger, and non-Hispanic White individuals highlight that health systems may need to educate consumers through print or online media about increased alcohol use during the pandemic and identify factors associated with susceptibility and resilience to the impacts of COVID-19.

    Study limitations include that measures are self-reports, which may be subject to social desirability bias. Additionally, not all baseline respondents completed wave 2, although nonrespondents did not significantly differ from completers on any of the outcome measures at baseline. Nonetheless, these results suggest that examination of whether increases in alcohol use persist as the pandemic continues and whether psychological and physical well-being are subsequently affected may be warranted.

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    Article Information

    Accepted for Publication: August 8, 2020.

    Published: September 29, 2020. doi:10.1001/jamanetworkopen.2020.22942

    Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2020 Pollard MS et al. JAMA Network Open.

    Corresponding Author: Michael S. Pollard, PhD, RAND Corporation, 1776 Main St, PO Box 2138, Santa Monica, CA 90407 (mpollard@rand.org).

    Author Contributions: Dr Pollard had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

    Concept and design: All authors.

    Acquisition, analysis, or interpretation of data: All authors.

    Drafting of the manuscript: Pollard.

    Critical revision of the manuscript for important intellectual content: All authors.

    Statistical analysis: Pollard, Green.

    Obtained funding: Pollard, Green.

    Administrative, technical, or material support: Pollard, Green.

    Supervision: Green.

    Conflict of Interest Disclosures: None reported.

    Funding/Support: This study was funded by grant R01AA025956 (PI: Dr Pollard) from the National Institute of Alcohol Abuse and Alcoholism.

    Role of the Funder/Sponsor: The funding source had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

    References
    1.
    The Nielsen Company. Rebalancing the ‘COVID-19 Effect’ on alcohol sales. Published May 7, 2020. Accessed August 27, 2020. https://www.nielsen.com/us/en/insights/article/2020/rebalancing-the-covid-19-effect-on-alcohol-sales/
    2.
    World Health Organization. Alcohol does not protect against COVID-19; access should be restricted during lockdown. Published April 14, 2020. Accessed August 27, 2020. https://www.euro.who.int/en/health-topics/disease-prevention/alcohol-use/news/news/2020/04/alcohol-does-not-protect-against-covid-19-access-should-be-restricted-during-lockdown
    3.
    Pollard  M, Baird  M. The RAND American Life Panel: technical description. 2017. RAND Corporation website. Accessed June 6, 2020. https://www.rand.org/pubs/research_reports/RR1651.html
    4.
    Gutsche  T, Kapteyn  A, Meijer  E, Weerman  A.  The RAND Continuous 2012 Presidential Election Poll.   Public Opin Q. 2014;78:233-254. doi:10.1093/poq/nfu009Google ScholarCrossref
    5.
    Miller  WR, Tonigan  JS, Longabaugh  R.  The Drinker Inventory of Consequences (DrInC): An Instrument for Assessing Adverse Consequences of Alcohol Abuse. US Dept Health and Human Services, Public Health Service, National Institutes of Health; 1995. doi:10.1037/e563232012-001
    6.
    Foulds  JA, Adamson  SJ, Boden  JM, Williman  JA, Mulder  RT.  Depression in patients with alcohol use disorders: systematic review and meta-analysis of outcomes for independent and substance-induced disorders.   J Affect Disord. 2015;185:47-59. doi:10.1016/j.jad.2015.06.024 PubMedGoogle ScholarCrossref
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