For the past two years, life has been anything but normal. Isolation and social distancing we needed to protect ourselves from COVID-19 has impacted each of us in different ways. Some stayed connected by phone and virtual meetings, while others withdrew, and some experienced emotional isolation. You might wonder—did the pandemic impact alcohol consumption?
According to a Massachusetts General Hospital press release in December, scientists estimate that a one-year increase in alcohol consumption during the COVID-19 pandemic would 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.
Some states loosened restrictions on alcohol delivery and open containers, allowing people to get cocktail kits delivered to their doors or to sip wine on a café sidewalk. Easier access to alcohol results in increased drinking rates, particularly among women, African Americans, and parents.
What did people report as reasons for increased drinking?
- Increased stress—45.7 percent
- Increased alcohol availability—34.4 percent
- Boredom—30.1 percent
Though it is always difficult to assess specific impacts, a survey of 2,000 adults aged 50–80 in late January 2021 found an increase in excessive drinking (such as binge drinking, defined as about five alcoholic drinks for men or four for women in less than 2 hours). A drink is 12 ounces of beer, 5 ounces of wine, or 1.5 ounces of liquor. Alcohol consumption increased by 21 percent during the COVID-19 pandemic.
Information from the National Poll on Healthy Aging shows that 23 percent of adults over age 50 who drink alcohol routinely consume three or more drinks in one setting. Ten percent of adults who drink use other drugs while drinking, including marijuana or prescription medications, that can interact negatively with alcohol intake, and can result in alcohol-related blackouts. Combining alcohol with opioids or sedatives can cause dizziness in older adults, increase alcohol-related blackouts, and increase fall risk. Falls can cause significant injury and, in some cases, fatalities.
Survey participants who reported being stressed by the pandemic consumed more drinks over a greater number of days than those who did not report stress. This raises concerns from both an individual and public health perspective, and not only during the pandemic but beyond. It is imperative that we provide services and supports for all adults, particularly older adults, in addressing unhealthy drinking and/or other substances.
To help identify people who may be at risk of adverse health effects from their use of alcohol or other substances, many healthcare providers now use the Screening, Brief Intervention, and Referral to Treatment (SBIRT) model—an evidence-based process to identify and provide early intervention for patients engaged in unhealthy drinking and/or other substance use (from mild to severe):
- Screening—a healthcare professional assesses a patient for risky substance use behaviors and depression/anxiety using standardized screening tools. Screening can occur in any healthcare setting (e.g., hospital, primary care, dental office, behavioral health clinic).
- Brief Intervention—a medical professional, counselor, or healthcare professional engages in a short conversation about risky substance use behaviors and their consequences and/or depression/anxiety, providing feedback and advice.
- Referral to Treatment—a healthcare professional provides a referral to brief therapy or additional treatment to patients who screened as at-risk for adverse health effects due to the use of alcohol or other substances.
The Brief Intervention may include assistance in establishing a plan to reduce drinking and other substance use in the future. When indicated, patients are referred to specialty care for their substance use disorder, depression, or anxiety.
In addition to identifying and intervening with people who have mild substance use disorders (SUDs), SBIRT helps identify individuals with moderate to severe SUDs and works to connect them to substance use treatment or evaluation by a specialist (Referral to Treatment).
In cases where there is not a SUD but there is an indication of depression or anxiety, patients may be counseled by their primary care provider or referred to a behavioral health specialist. In cases where SUD and depression and/or anxiety are present, both can be treated at the same time.
The SBIRT can also be used by emergency department personnel.
A related concept—SBIRT-Plus, designed to improve the effectiveness and population reach of traditional, clinician-based programs—focuses on systems-level issues such as social marketing of SBIRT services through mass media and the Internet. It promotes enhanced delivery mechanisms using the electronic medical records, waiting room prompts, and self-assessment procedures for screening. This population approach would add a variety of support mechanisms designed to facilitate, extend, and reinforce the typical SBIRT patient encounter by providing environmental and population measures that complement clinical intervention.
Moving forward, it is vital that, as an age-friendly community, we address the public health impacts of alcohol consumption, particularly in older adults. It starts with meaningful and honest conversations with clients, family, and friends.
For more information, visit Screening, Brief Intervention, and Referral to Treatment (SBIRT) on the Addiction Technology Transfer Center Network Northwest (HHS Region 10) website.
Contributor Mary Pat O’Leary, RN, BSN, is a senior planner with Aging and Disability Services, Seattle Human Services Department.