Amid the global COVID-19 pandemic that overwhelmed hospitals, upended the economy, and sent much of the world into lockdown, researchers tracked a concerning uptick in alcohol use. An online Harris Poll commissioned by Alkermes1 surveying 6000 US adults found that 1 in 6 met the criteria for “heavy drinking.” Evidence has also emerged that there was a correlation between home-based isolation and binge drinking, especially for those with a history of depression or anxiety.2 Alcohol-related deaths also increased by 25% during the first full year of the pandemic.3
Fortunately, more people now have access to vaccines and COVID-19 restrictions are abating. Yet while the world is working to stabilize, concerning alcohol use has intensified. A survey fielded by the American Psychological Association found that nearly 1 in 4 adults reported drinking more to manage pandemic stress.4 There are complex physical, neurological and psychological challenges at the heart of this public health crisis, which is exacerbated by the fact that the vast majority of patients go untreated.
While there were more than 28 million Americans in 2020 living with alcohol use disorder in the US, less than 8% received any treatment,5 and only 1% received medication treatment.5 So what contributes to the chasm between patients who need help and the treatment(s) they may need?
- Assessment methods. There is room for increased screening for alcohol use disorder in many health care settings. Assessments that focus on the consequences of drinking, such as screening tools collated by the National Institutes of Health (NIH), may be effective in identifying a person who may need help with alcohol use.
- Awareness. People may not realize that alcohol use disorder is a medically recognized condition that insurers are required to cover, or that a range of treatments — including oral and injectable medications, psychological support and medications for alcohol-related health conditions — are available.
- Stigma. The NIH cites stigma as “a significant barrier in many peoples’ willingness to seek help for alcohol problems” and as something that “can affect how they are treated in all aspects of life, including availability and quality of care.”6 We can all strive to ensure that we speak from a place of compassion and knowledge. Words like “alcoholic” or “addict” fail to uncouple the person from their disease and using this type of stigmatizing language can hinder an individual’s willingness to seek help. Using person-first language, such as “person living with a substance use disorder,” can be a helpful approach.
Additional data from our Harris Poll reinforce current challenges:
- A total of 30% of heavy drinkers admitted they kept drinking even though it made them depressed or anxious, or added to other health problems.
- While 23% reported giving up or cutting back on pleasurable activities in order to drink alcohol.
- Only 36% were familiar with prescription medications as a treatment option for alcohol use disorder.
Ultimately, barriers to treatment must be addressed. By working to destigmatize the disease, we encourage more people to seek treatment. And as psychiatrists, we play a pivotal role in educating patients and their families and raising awareness that alcohol use disorder is a serious yet treatable disease.
“Heavy drinking” for purposes of the survey was defined as having had 2 heavy drinking days in a single week at least twice in the previous 30 days. A “heavy drinking day” was defined for women as 4 or more drinks containing alcohol, and for men as 5 or more drinks containing alcohol.
Sarah Akerman is executive medical director of medical affairs strategy at Alkermes and a board-certified addiction psychiatrist with experience in research and clinical care of patients with substance use disorders. She is also an adjunct assistant professor of psychiatry at the Dartmouth Geisel School of Medicine.
National Institutes of Health Screening for Alcohol Related Problems
1. Insights into drinking behaviors during the pandemic. The Harris Poll (Commissioned by Alkermes). Published September 22, 2021. Accessed May 17, 2022. https://tinyurl.com/yp4zt5ah
2. Weerakoon SM, Jetelina KK, Knell G. Longer time spent at home during COVID-19 pandemic is associated with binge drinking among US adults. Published online December 7, 2020. Am J Drug Alcohol Abuse. doi:10.1080/00952990.2020.1832508
3. White AM, Castle IP, Powell PA, Hingson RW, Koob GF. Alcohol-related deaths during the COVID-19 pandemic. JAMA. Published online March 18, 2022. doi:10.1001/jama.2022.4308
4. One year on: Unhealthy weight gains, increased drinking reported by Americans coping with pandemic stress. American Psychological Association. Published online March 11, 2021. Accessed May 17, 2022. https://www.apa.org/news/press/releases/2021/03/one-year-pandemic-stress
5. Key substance use and mental health indicators in the United States: Results from the 2020 National Survey on Drug Use and Health. Substance Abuse and Mental Health Services Administration (SAMHSA). 2021. HHS Publication No. PEP21-07-01-003, NSDUH Series H-56. Accessed May 17, 2022. https://www.samhsa.gov/data/sites/default/files/reports/rpt35325/NSDUHFFRPDFWHTMLFiles2020/2020NSDUHFFR1PDFW102121.pdf
6. When It Comes to Reducing Alcohol-Related Stigma, Words Matter. National Institute on Alcohol Abuse and Alcoholism (NIAAA). Accessed May 17, 2022. https://www.niaaa.nih.gov/alcohols-effects-health/reducing-alcohol-related-stigma