A surge of stress-related drinking and alcohol-related deaths brought on by the Covid-19 pandemic in the US has not tapered off the way Dr. Brian Lee, a transplant hepatologist at the University of Southern California’s Keck School of Medicine, had hoped.
“I was hopeful that we would see declines in alcohol use, but I’m a practicing liver specialist, and the reality is, we had definitely seen a rise in patients with liver failure, which is really an extreme, I think, clinical condition from excessive alcohol use,” Lee said. “So we had definitely seen a surge with the pandemic. And if you look at my clinic and in the hospital, at least from my experience, it hasn’t gone down.”
New research, led by Lee and published November 12 in the Annals of Internal Medicine, found that a spike in alcohol consumption among people in the US in 2020 continued to rise slightly in 2021 and 2022.
The study used data from the National Health Interview Survey, administered by the US Census Bureau, and compared the data with 2018 as the baseline. The study included almost 25,000 respondents from 2018, about 31,000 from 2020 and almost 27,000 from 2022.
The increase in drinking was seen among both men and women and across all race and ethnic groups. In 2022, 69.3% of Americans reported some alcohol consumption in the previous year, a slight increase from 69% in 2020 and 66.34% in 2018.
Additionally, the percentage of heavy drinkers rose to almost 6.3% of those surveyed in 2022, up from 6.13% in 2020 and 5.1% in 2018.
“While the findings are troubling, they are not surprising,” said Dr. Jagpreet Chhatwal, director of the Institute for Technology Assessment at Massachusetts General Hospital, who was not involved in the study. “Alcohol consumption has been steadily increasing over the past several years.”
White Americans had the highest change in being heavy drinkers, with roughly 7.3% claiming to be heavy drinkers, an increase from about 5.7% in 2018 and 7.1% in 2020.
Women also were more likely to be heavy drinkers, with 6.45% reporting as such, compared with 6.1% of men.
It doesn’t take much alcohol to increase health dangers, Lee says: “If you’re drinking more than one drink per day as a woman, you can be at risk for having liver disease.”
The National Institute on Alcohol Abuse and Alcoholism defines heavy drinking for women as four or more drinks on any day or eight or more per week. For men, it is defined as five or more drinks a day or 15 or more per week.
The institute considers a drink to be about 14 grams of pure alcohol, which equates to about 12 ounces of regular beer, 5 ounces of wine or 1.5 ounces of distilled spirits.
Though the researchers couldn’t answer exactly why alcohol consumption was so high among the US adults surveyed, Lee has a few hypotheses.
“They had really disruptive pandemic-related effects to their careers, losing jobs or losing their routine. Some of them have young children, too,” he said. “We know that alcohol is used as a coping mechanism for stress. What starts as a habit can become addictive or a substance disorder.”
Chhatwal agreed, adding that life stressors like financial insecurity, work pressure or other mental health struggles may contribute to the rise in alcohol consumption.
“Increasing stress and burnout in society exacerbate this tendency,” he said. “The normalization of drinking culture also contributes to increased and excessive consumption. Unfortunately, most people recognize the damage caused by alcohol only in the later stages of liver disease, when treatment options are limited.”
According to data from the US Centers for Disease Control and Prevention, deaths caused by alcohol use in the US spiked during the pandemic, with over 49,000 in 2020. The height of the pandemic also saw an average of about 488 deaths per day due to excessive alcohol consumption; there was an increase of more than 29% from 2016-17 to 2020-21.
Lee believes that research findings alone are no longer enough to deter people from overconsuming.
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“We’ve shown in studies that liver transplants for alcohol have increased fivefold in the last 20 years. We’ve also shown that alcohol deaths due to liver disease are surging,” he said. “Now, it’s about intervention. What interventions could actually work to save lives and what policies can we enact to stem the surge?”
Chhatwal recommends heavier taxation and limiting sale hours within retailers to decrease alcohol accessibility.
Lee and Chhatwal also suggest that more and better messaging on the risks of overconsumption could help counter these effects.
“People need to know what is harmful alcohol use and what it does to your body,” Lee said. “Medical professionals really need to speak to their patients about alcohol use openly and nonjudgmentally. Alcohol has been implicated in more than 200 diseases, whether it’s heart disease, cancer, pancreatic disease – it really can affect your body, and both patients and doctors really need to be aware of this.”
