Women, alcohol, and COVID-19

Women, alcohol, and COVID-19

Finally, the COVID-19 public health emergency will end in May 2023, which may at least partially unravel steps taken toward delivering mental health services via telehealth and improving access to substance use disorder services. Excessive alcohol consumption may not only influence COVID-19 susceptibility and severity, but the broad effects of the pandemic are also likely to lead to excessive alcohol consumption. We know from previous disasters, such as 9/11 and Hurricane Katrina, that the stress of the events and anxiety about the future can increase drinking and exacerbate symptoms of alcohol use disorder.

1. On July 16, 2022, the federally mandated crisis number, 988, became available to all landline and cell phone users, providing a single three-digit number to access a network of over 200 local and state funded crisis centers where those in need may receive crisis counseling, resources and referrals.
2. We are committed to supporting our patients and their families who struggle with and are impacted by alcohol use disorder.
3. The immediate benefit of alcohol consumption can mask the long-term harmful effect [30,31].
4. Leading up to the pandemic, many people faced barriers accessing mental health and substance use disorder services for reasons including costs, not knowing where to obtain care, limited provider options, and low rates of insurance acceptance.
5. There was a significant association between increased alcohol consumption and poor overall mental health, depressive symptoms, and lower mental wellbeing [38].
6. Studies that investigated emergency department patient admissions related to drug use demonstrated that they increased during lockdown (Glober et al., 2020, Leichtle et al., 2020, Marais et al., 2020, Ochalek et al., 2020, Slavova et al., 2020, Wainwright et al., 2020).

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Poor mental health has been more pronounced among adolescent females in particular. As shown in Figure 3, the gap in the share of adolescent females and males reporting feelings of hopelessness and sadness – symptoms indicative of depressive disorder – widened from 2019 (47% vs. 27%, respectively) to 2021 (57% vs. 29%, respectively). Many female adolescents also reported adverse experiences in 2021, which can negatively impact mental health. Symptoms of anxiety and/or depression were also elevated among women (36%) compared to men (28%) in February 2023 (Figure 2). Even before the pandemic, women were more likely than men to report mental health disorders, including serious mental illness.

For clinicians: helping patients access treatment during the pandemic

FASD is both predictable and largely preventable but has been consistently ignored” [81]. Alcohol consumed for long time acts as a stressor on the body and makes it difficult to maintain homeostasis [28,29]. The immediate benefit of alcohol consumption can mask the long-term harmful effect [30,31]. Most often, adults who drink alcohol constantly justify consumption by claiming reducing mental stress, maintaining a state of physical and mental relaxation, but also improving their social behavior [32]. However, due to the action of ethanol on the central nervous system, at high doses of alcohol, there is an inhibitory effect that involves reduced discernment and weakened attention and memory [33]. The danger is even greater for those diagnosed with psychological or psychiatric pathologies, as often the concomitant administration of psychotropic medication and alcohol is contraindicated [34].

Drinking alcohol does not prevent or treat coronavirus infection and may impair immune function

The increase in problematic use during the pandemic suggests that increasing targeted and evidence-based interventions will be important in the period which follows, both to improve the lives of individuals and families, and prevent additional costs to societies and health systems. Two studies reported a statistically significant association between educational status and increasing drug use. The factor related to an increase in cannabis use was intermediate or low level of education, in a study by Rolland et al. (2020) whereas those starting medications/substances had a higher level of education in study by Boehnke et al., (2020).

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As we emerge from the COVID-19 pandemic and the federal public health emergency draws to an end, it will be important to consider how the increased need for mental health and substance use services may persist long term, even as new cases and deaths due to COVID-19 hopefully subside. In response to growing mental health concerns among youth, integration of mental health services in school-based settings became a priority. Recent legislation aims to expand mental health care in schools – a setting that is easily accessible by children and adolescents. Specifically, legislation provides funding to expand and train mental health providers in schools; implement suicide, drug, and violence prevention programs; and provide trauma support services, among others.

COVID-19 oral antiviral treatments

Regardless of the amount of alcohol a person consumes though, since alcohol consumption can weaken our immune systems over time, any person with problematic drinking behaviors can be amongst the most vulnerable populations for getting COVID-19. While flattening the curve is the nation’s priority right now, we understand that the unique needs of an individual battling alcoholism are equally as urgent—maybe even more so during this time of social distancing and home quarantines. In four studies, there was a higher proportion of individuals reporting using less alcohol during the pandemic compared to those reporting more alcohol use in relation to pre-pandemic levels (Chodkiewicz et al., 2020, Håkansson, 2020, Scarmozzino and Visioli, 2020, Sallie et al., 2020). The last but not the least is the reverse analysis – how alcohol use disorder may influence the way of dealing with the pandemic from the personal safety perspective.

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Severe illness, grief, isolation, disrupted schooling, job loss, economic hardship, shortages of food and supplies, mental health problems, and limited access to health care — these are just some of the sources of stress people faced during the COVID-19 pandemic. Three studies specifically reported a negative effect of the epidemic on the use of substances (Czeisler et al., 2020, Gritsenko et al., 2020, Rogers et al., 2020). In general population US samples, an additional 5.0% started using cannabis, 5.6% started using stimulants and 5.6% opioids since the COVID-19 outbreak (Rogers et al., 2020). Equally, in Russia, those who reported substance use in the last month before COVID 19 reported their use increased as a COVID-19 consequence. Among substance users, there were increases in specific drugs including 27.3% cannabis, 16.7% Ritalin or similar substance, 18.2% pain relievers, and 23.5% sedatives (Gritsenko et al., 2020). Time-series analyses comparing periods of lockdown, where individuals were restricted in their movement, to the previous year, showed that alcohol problems increased during lockdown (Grigoletto et al., 2020, Leichtle et al., 2020).

Recovery programs based on mutual peer support, and many different behavioral therapies, involve social support and are very helpful for people struggling with maintaining sobriety or regulating their alcohol consumption. People currently in recovery or those who need help may benefit from telehealth and online support group meetings. Increasing online social interaction can also improve moods and reduce the motivation to drink to cope.

Electronic searches of databases (MEDLINE, Embase, PsycINFO, CINAHL, Sociological Abstracts) were conducted using a combination of keywords relating to alcohol and other substance use during the Covid-19 pandemic. Our search was restricted to articles published in peer-reviewed journals, from December 1, 2019 to November 30, 2020. Although evidence suggests substance and alcohol use may change during the Covid-19 pandemic there has been no full review of the evidence around this. NIAAA Director, Dr. George Koob, discusses what we know about how alcohol affects our immune and stress systems, along with issues related to treatment access during the pandemic. The immune system is a complex set of organs, structures and molecules (such as humoral factors, signal molecules and immunoglobulins), lymphatic vessels and white blood cells are its most important components [49].

The World Health Organization (WHO) has particularly emphasized the vulnerability of smokers to COVID‐19 [4, 5]. Obesity, another modifiable risk factor, has also been investigated with emerging evidence of an association [6, 7]. Obesity is closely related to two behavioural risk factors—poor diet and lack of physical activity [5].

Most people with COVID-19 and other respiratory infections will have a relatively mild illness, especially if they have been vaccinated. Fear and misinformation have generated a dangerous myth that consuming high-strength alcohol can crack cocaine wikipedia kill the COVID-19 virus. Consuming any alcohol poses health risks, but consuming high-strength ethyl alcohol (ethanol), particularly if it has been adulterated with methanol, can result in severe health consequences, including death.

The COVID-19 pandemic is affecting every family across the country and will likely have a long-lasting impact on public health and well-being. Alcohol misuse is already a public health concern in the United States, with dramatic increases in emergency department visits and alcohol-related deaths observed in recent years. Alcohol has the potential to further complicate the COVID-19 pandemic in multiple ways. As Table 1 shows, the frequency of drinking is difficult to compare, and the measurement and results show wide variance across studies. During the pandemic, the proportion of individuals consuming alcohol varied across samples from 21.7% (Knell et al., 2020) to 81.4% (Romero-Blanco et al., 2020). Likewise, hazardous drinking ranged from 28.2% (Chodkiewicz at al., 2020) to 52.7% (Newby et al., 2020) with binge drinking from 7.1% (Gritsenko et al., 2020), to 20% (Silczuk, 2020).

Thirty percent of adolescent females seriously considered attempting suicide in 2021 compared to 14% of their male peers (Figure 6). Other analyses found that as the pandemic progressed, emergency department visits for suicide attempts increased among adolescents, primarily driven by females. The NIAAA Alcohol Treatment Navigator can help you recognize and find high quality treatment for alcohol use disorder.

Black people also experienced significant increases in alcohol-induced deaths during COVID, with rates increasing more than 45% (Figure 5). Both rural and metropolitan areas experienced an increase in alcohol-induced deaths during the pandemic, but rural areas saw the largest increase (46% increase compared to 36%). Fifty percent of young adults (ages 18-24) reported anxiety and depression symptoms in 2023, making them more likely than older adults to experience mental health symptoms (Figure 2).

This pandemic comes with severe domestic and global negative economic impacts and the length and scope of the pandemic are greater than we have seen with natural disasters and terrorist attacks, leading to prolonged stress and uncertainty. In addition to the psychological stress, stay-at-home orders that are recurring in some states based on increased case rates, uncertainties related to school re-openings, self-isolation, alcohol poisoning symptoms and treatment and quarantining can lead to additional stress, which can in turn lead to increased drinking. Physical distancing (which can lead to “social distancing”) during the pandemic also has profound implications for access to treatment services for those with alcohol problems. Social support is a very powerful reinforcer for humans and is highly beneficial for helping people avoid relapse or an escalation in alcohol use.

Further, recognizing Medicaid’s importance in covering and financing behavioral health care for children, CMS is now required to provide updated guidance on how to support and expand school-based behavioral health services. The recently passed Consolidated Appropriations Act (CAA) continues to build on prior pandemic-era legislation that promotes access to behavioral health care for children. For example, to ensure more stable coverage for low-income children the CAA requires states to provide 12 months of continuous amphetamine sulfate oral eligibility for children in Medicaid and CHIP. To mitigate the spread of COVID-19, many treatment facilities limited their enrollment capacities, making it harder for some patients to access treatment.10 Temporary changes to federal regulations have increased access to telehealth services with potential to increase capacity for treatment. Evidence-based mobile and online programs for managing harmful drinking and AUD could expand the reach of services, especially if made available without cost to patients.

For example, in one study of data taken from hospitals in Italy, when compared to the same time period in 2019, despite a lower number of attendances to the Emergency Department, the absolute number of patients presenting with severe alcohol intoxication increased (25 vs. 15). This number increased further immediately after the easing of lockdown measures (11.3%) (Grigoletto et al., 2020). Likewise, a timepoint analysis from two psychiatric hospitals in Italy showed that admissions related to alcohol increased from 3.7% and 23.5–6.1% and 36.9% of the total when comparing the first two months of 2020 with March-May 2020 (Luca et al., 2020). Three studies exclusively reported a decrease in alcohol use because of the pandemic (López-Bueno et al., 2020, Đogaš et al., 2020, Wang et al., 2020).

History of alcohol use could be an important predictor for disease severity and ICU admission, and could contribute to treatment strategy for COVID‐19 patients with chronic alcohol consumption and alcohol use disorders (AUDs). Therefore, the role of alcohol consumption on severity of illness in patients with COVID‐19 should be explored, and a history of alcohol consumption should be included as a probable risk factor of disease severity in COVID‐19 studies. Six studies reported a statistically significant role of younger age in increasing drug use during lockdown. Ballivian et al., (2020) report that being younger predicted drug use during quarantine. Czeisler et al. (2020) reported that substance use increase was most reported in persons aged 18–24 years and that prevalence decreased progressively with age.