Alcohol in the pandemic: the perfect storm

Are people drinking more or less in the UK since the pandemic started? The answer is ‘both’. While overall sales of alcohol are down (sales receipts from HMRC show a 2.4% drop Apr-July 2020), it looks like those who were drinking in the most hazardous fashion previously, are now drinking more. The British Medical Journal identifies a particular subsection of at-risk drinkers:

…those on the brink of dependence during lockdown and beyond. For them, dependence will be triggered by bereavement, job insecurity, or troubled relationships. 

BMJ 2020 ; 369

This week, the journal Addiction published data on the impact of the Covid-19 lockdown on smoking, drinking and attempts to quit. What did they find?

Lockdown was associated with increases in high‐risk drinking but also alcohol reduction attempts by high‐risk drinkers. Among high‐risk drinkers who made a reduction attempt, use of evidence‐based support decreased and there was no significant change in use of remote support.

Addiction 21.10.20 (Open Access)

In other words, risky drinking got worse, people wanted to do something about it, but there was less treatment-seeking or treatment available. The authors also warn that increased consumption is likely to put people at risk of covid-19 and will put strain on already-stretched services. They call for increased public health messaging.

The Institute for Alcohol Studies (IAS) has also just published an excellent briefing which captures the most recent data from surveys and studies. 

It also makes comment on treatment: ‘Changes in referrals for and uptake of alcohol treatment are concerning but are typical of a wider pattern across healthcare. For alcohol, it is important to consider this in the context of future demand in an already stretched system, particularly given that one study found high risk drinkers were over twice as likely to make a serious attempt to reduce drinking during lockdown compared with before. 

The Royal College of Psychiatrists has estimated from PHE’s data that 8.4 million people are now drinking at higher risk levels. The College warned that addiction services are not equipped to cope with a post-pandemic surge in demand for alcohol treatment, following years of cuts.’ 

In Scotland, where there is a long history of negative consequences to communities, families and individuals from the nation’s heavy drinking, there are fears that the reduction in alcohol consumption associated with the hard-fought introduction of minimum unit pricing is being adversely affected by the pandemic. Concerns have also been raised about the impact on children of increased home drinking by parents during the pandemic’s restrictions and of increased domestic violence fuelled by alcohol.

Scotland on Sunday ran a feature last month which I recommend. Called ‘The coronavirus hangover and Scotland’s alcohol timebomb’, it captures some of the challenges and implications for the country. They summed up the situation:

It is, in short, a perfect storm; the kind feared by governments and public health experts. The signs are that in Scotland – a nation hardly revered throughout the world for its health outcomes – the crisis is exacerbating our long-standing problem relationship with alcohol.

Scotland on Sunday 27.9.20

What about treatment? Well, despite direction from the Public Health Minister that treatment services should remain open in the pandemic, closures did happen, and capacity continues to be affected. All of which adds to the ‘timebomb’.

Movendi, an international social movement for development through alcohol prevention published an alarming must-read policy report last month about the situation in Scotland which concluded:

Alcohol harm is rising across the country and the deficiency in alcohol services is adding fuel to the fire.

Movendi

We have a crisis, which seems likely to provoke yet further crises in terms of increased presentations of alcohol use disorders and all that means. The recurrent themes from multiple observers of increasing problems and a treatment system not prepared, need to be addressed.

A commendable amount of effort has gone into, and continues to go into, tackling Scotland’s drug deaths problem. While treatment resource has been increased, the focus has been on the opiate problem. It would be good to see similar elbow grease applied to tackling our almost-certain-to-grow alcohol morbidity and mortality – already higher than our drug deaths, but receiving only a fraction of the attention. 

Ian Gilmore and Ilora Finlay, in an BMJ editorial sum up nicely:

Presentations of alcoholic liver disease, already increasing before the covid-19 crisis, will rise further. A similar surge will occur in the need for alcohol treatment services, which are traditionally an easy target for cuts when finances are tight. We know that investing £1 in alcohol treatment services will save £3, as well as directly helping affected individuals, often the most vulnerable in society 

They conclude with an exhortation to look to national, and consequently personal, recovery:

This time, let’s be ready. Tackling alcohol harms is an integral part of the nation’s recovery.