Alcohol, COVID-19 and Lockdown

Data from the Office for National Statistics has shown that sales in alcohol stores during March increased on a month-on-month volume by 31.4%.

Alcohol consumption patterns also altered.  According to a survey by the charity Alcohol Change UK, one third of the 1,555 people surveyed who reported drinking alcohol before lockdown stated that they had stopped drinking or reduced how often they drank in the two weeks after lockdown commenced.  However, around one fifth indicated that they had been drinking more frequently in this same period. 

Whilst about half of drinkers said they were consuming about the same amount on a typical drinking day, 15% said they had been drinking more per session since lockdown began. 

Particularly concerning was that almost one in five of those who drank alcohol on a daily basis had further increased the amount that they drink since lockdown.  This research hints at the emergence of a subgroup of drinkers at risk of establishing a potentially dangerous pattern of alcohol consumption during lockdown.

Although isolation at home and social distancing undoubtedly has an immediate and important role in controlling the COVID-19 pandemic, the effects of long-term isolation on the health of the general population are particularly unclear.  Specifically, stress, boredom and the isolation of physical distancing, how it might affect the drinking patterns in at-risk individuals is unknown. 

For individuals with alcohol use disorder, this lack of structure and familial and social support may lead to relapse.  Indeed, a recent story in the New York Times reported on individuals with alcohol use disorder who were struggling to remain sober due to the cancellation of in-person support meetings. 

Thus, the disruption of COVID-19 not only has the effect of putting individuals under stress but also increases the risk of relapse while also experiencing disruption of the social networks that might have helped them to remain sober. 

Preliminary signs reveal that increased alcohol misuse during this COVID-19 pandemic is manifesting as alcohol-related liver disease.  While firm data is scarce, anecdotal reports are emerging of an increased number of people admitted to hospital with alcohol-related liver injury. 

This situation is further complicated by the fact that hospitalisation for cirrhosis in patients with pre-existing chronic liver disease is being delayed relative to the pre-COVID-19 period.  These delays may be due to services setting a higher threshold for access to urgent care as they attempt to shield vulnerable patients from the risk of COVID-19.

Concerns about hospitals having insufficient capacity and posing a risk of infection might also lead to patients delaying presentation.

This editorial in The Lancet Gastroenterology and Hepatology due to be published in July 2020 suggests that as with many challenges faced by healthcare in the wake of the COVID-19 pandemic, there is unlikely to be a single, simple fix.  However, telemedicine, which has been rapidly adopted since the onset of the pandemic, offers one route by which alcohol counselling and addiction treatment could be accessed by those in need.

The Lancet editorial suggests there should be close integration of clinical and alcohol services to help deal with the probable increase in new diagnoses of alcohol use disorder and alcohol-related liver disease.  It goes on to suggest that governments must incorporate warnings about the harms of excessive alcohol consumption into the public health messaging about COVID-19 to reduce the collateral damage of the effects of alcohol excess.

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