Trends in Alcohol Use After the COVID-19 Pandemic: A National Cross-Sectional StudyFREE
Submit a Comment
Contributors must reveal any conflict of interest. Comments are moderated. Please see our information for authorsregarding comments on an Annals publication.
Background: Alcohol is a leading cause of morbidity and mortality in the United States (1). The COVID-19 pandemic was associated with increases in stress-related drinking and alcohol-related deaths (1–3). Analyses of whether increased alcohol use has persisted since the pandemic and trends among subpopulations could inform public policy and health care initiatives to mitigate alcohol-related morbidity and mortality.
Objective: To determine whether increased alcohol use during the pandemic (2020 vs. 2018) was sustained after the pandemic (2022).
Methods: This was a population-based study using cross-sectional data from serial nationally representative surveys of adults aged 18 years or older who participated in the National Health Interview Survey (NHIS) from 2018 to 2022. The survey uses complex sampling to provide estimates that are representative of the entire U.S. population. Data were collected on demographic, health, and socioeconomic factors at the family and person levels. The survey was administered by trained interviewers in face-to-face or telephone interviews.
The primary outcomes of this study were prevalence of any alcohol use and heavy alcohol use. Adults were categorized as having any alcohol use or heavy alcohol use within 1 year of the survey per the National Institute on Alcohol Abuse and Alcoholism definition of heavy drinking (≥5 drinks on any day or ≥15 drinks per week for males, and ≥4 drinks on any day or ≥8 drinks per week for females) (4). Prevalence rates per 100 persons and associated 95% CIs were calculated. We tested for differences in national prevalence of any alcohol use and heavy alcohol use by year (vs. 2018) using logistic regression. The margins command was used to calculate pairwise differences in proportions by year with 95% CIs. NHIS weighting was used for all analyses, which were performed in SAS, version 9.4 (SAS Institute), and Stata MP 17.0 (StataCorp). All data are publicly available and were deemed to be exempt from review by the Institutional Review Board of the University of Southern California.
Findings: The study included 24 965 respondents from 2018, 30 829 from 2020, and 26 806 from 2022.
Compared with 2018, there were absolute increases in any alcohol use in 2020 (2.69% [95% CI, 1.28% to 4.10%]) and 2022 (2.96% [CI, 1.58% to 4.33%]). Numerical increases in any alcohol use occurred in 2020 and 2022 versus 2018 among all subgroups. Point estimates and 95% CIs are shown in Figure 1.
Figure 1. Prevalence of and absolute mean difference in any alcohol use.
The figure shows the absolute mean difference in national prevalence per 100 persons of any alcohol use within the past year among the overall population in 2020 and 2022 compared with 2018. Error bars represent 95% CIs. Alcohol data were missing for 2036 participants. All estimates are weighted.
* Maine, New Hampshire, Massachusetts, Vermont, Connecticut, Rhode Island, New York, New Jersey, and Pennsylvania.
† North Dakota, South Dakota, Minnesota, Nebraska, Iowa, Kansas, Missouri, Wisconsin, Michigan, Illinois, Indiana, and Ohio.
‡ Maryland, Delaware, District of Columbia, West Virginia, Virginia, North Carolina, South Carolina, Kentucky, Tennessee, Mississippi, Alabama, Georgia, Florida, Louisiana, Arkansas, Oklahoma, and Texas.
§ Washington, Montana, Idaho, Wyoming, Oregon, California, Nevada, Utah, Colorado, Arizona, and New Mexico.
‖ Data on rural/urban residence were available only for 2020 and 2022. Estimates for 2022 versus 2020 were calculated using logistic regression.
Compared with 2018, there were absolute increases in heavy alcohol use in 2020 (1.03% [CI, 0.55% to 1.51%]) and 2022 (1.18% [CI, 0.70% to 1.67%]). Numerical increases in heavy alcohol use occurred in 2020 and 2022 versus 2018 among all subgroups except among American Indians and Asians in 2022. Point estimates and 95% CIs are shown in Figure 2.
Figure 2. Prevalence of and absolute mean difference in heavy alcohol use.
The figure shows the absolute mean difference in national prevalence per 100 persons of heavy alcohol use within the past year among the overall population in 2020 and 2022 compared with 2018. Error bars represent 95% CIs. Alcohol data were missing for 2036 participants. All estimates are weighted.
* Maine, New Hampshire, Massachusetts, Vermont, Connecticut, Rhode Island, New York, New Jersey, and Pennsylvania.
† North Dakota, South Dakota, Minnesota, Nebraska, Iowa, Kansas, Missouri, Wisconsin, Michigan, Illinois, Indiana, and Ohio.
‡ Maryland, Delaware, District of Columbia, West Virginia, Virginia, North Carolina, South Carolina, Kentucky, Tennessee, Mississippi, Alabama, Georgia, Florida, Louisiana, Arkansas, Oklahoma, and Texas.
§ Washington, Montana, Idaho, Wyoming, Oregon, California, Nevada, Utah, Colorado, Arizona, and New Mexico.
‖ Data on rural/urban residence were available only for 2020 and 2022. Estimates for 2022 versus 2020 were calculated using logistic regression.
Discussion: This nationally representative study suggests that the prevalence of any alcohol use and heavy alcohol use during the COVID-19 pandemic (2020 vs. 2018) showed absolute increases of 2.7% (relative increase, 4.0%) and 1.0% (relative increase, 20.2%) and that the increases were sustained in 2022.
Our results provide national data to draw further attention to the potential alcohol-related public health effects that may remain from the pandemic. A previous study reported increases in alcohol use via breathalyzer measurements from 2020 to 2021, but that study was limited by potential selection bias and was done while the pandemic was ongoing (2). Our study suggests that these increases persisted in 2022 and that certain subgroups may have had greater increases in heavy alcohol use. Potential causes of this sustained increase include normalization of and adaptation to increased drinking due to stress from the pandemic and disrupted access to medical services (1). Close follow-up is needed to determine whether increases in heavy alcohol use persist.
This study had limitations. The NHIS includes only nonmilitary noninstitutionalized adults and thus excludes certain populations that may be more vulnerable to harmful alcohol use. Self-reported alcohol use may be underreported, although quantity and frequency self-report measures are standard for reliable and valid assessment of alcohol consumption in population surveys (5). The variables are also at risk for misclassification and response bias. Nevertheless, this is a national survey administered over 50 years with careful selection of questions from validated instruments, and it uses complex sampling to provide accurate population estimates.
In conclusion, our results highlight an alarming public health issue that may require a combination of policy changes. Increased screening efforts for harmful drinking with systematic integration and rapid linkage to behavioral health treatments by health care professionals, in tandem with community-based interventions for at-risk populations, should be considered to mitigate the public health consequences of the pandemic-related increase in alcohol use.
References
1.
White AM, Castle IP, Powell PA, et al. Alcohol-related deaths during the COVID-19 pandemic. JAMA. 2022;327:1704-1706. [PMID: 35302593] doi: 10.1001/jama.2022.4308
2.
Houston PD, Vittinghoff E, Marcus GM. Changes in alcohol consumption during the COVID-19 pandemic: a longitudinal cohort study using smart-breathalyzer data. Sci Rep. 2024;14:3304. [PMID: 38332308] doi: 10.1038/s41598-024-53757-y
3.
Substance Abuse and Mental Health Services Administration. 2022 National Survey on Drug Use and Health (NSDUH) Releases. Accessed at www.samhsa.gov/data/release/2022-national-survey-drug-use-and-health-nsduh-releases on 18 October 2024.
4.
National Institute on Alcohol Abuse and Alcoholism. Drinking Levels and Patterns Defined. Accessed at www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/moderate-binge-drinking on 18 October 2024.
5.
McKenna H, Treanor C, O'Reilly D, et al. Evaluation of the psychometric properties of self-reported measures of alcohol consumption: a COSMIN systematic review. Subst Abuse Treat Prev Policy. 2018;13:6. [PMID: 29394950] doi: 10.1186/s13011-018-0143-8
Comments
Sign In to Submit A CommentInformation & Authors
Information
Published In
Annals of Internal Medicine
Volume 178 • Number 1 • January 2025
Pages: 139 - 142
History
Published online: 12 November 2024
Published in issue: January 2025
Keywords
Copyright
© 2024 American College of Physicians.
Authors
Author Disclosures
Metrics & Citations
Metrics
Citations
If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. For an editable text file, please select Medlars format which will download as a .txt file. Simply select your manager software from the list below and click Download.
For more information or tips please see 'Downloading to a citation manager' in the Help menu.
Download article citation data for:
Trends in Alcohol Use After the COVID-19 Pandemic: A National Cross-Sectional Study. Ann Intern Med.2025;178:139-142. [Epub 12 November 2024]. doi:10.7326/ANNALS-24-02157
Trends in Alcohol Use After the COVID-19 Pandemic: A National Cross-Sectional Study. Ann Intern Med.2025;178:139-142. [Epub 12 November 2024]. doi:10.7326/ANNALS-24-02157
View More
Login Options:
Purchase
You will be redirected to acponline.org to sign-in to Annals to complete your purchase.
Access to EPUBs and PDFs for FREE Annals content requires users to be registered and logged in. A subscription is not required. You can create a free account below or from the following link. You will be redirected to acponline.org to create an account that will provide access to Annals. If you are accessing the Free Annals content via your institution's access, registration is not required.
Create your Free Account
You will be redirected to acponline.org to create an account that will provide access to Annals.
Pandemic-Related Alcohol Policy Shifts May Have Fueled Increases in Alcohol Consumption
I read the research report written by Ayyala-Somayajula et al. with great interest. Their study utilized data from the representative National Health Interview Survey and found that overall, the absolute increases in both any and heavy alcohol use between 2018 and 2020 persisted in 2022. The authors outline potential reasons for this sustained increase including normalization of stress-related drinking related to the pandemic and decreased access to medical services. However, there is an additional potential explanation for the sustained increase in population-level alcohol use that was not discussed by the authors: pandemic-related increases in alcohol availability. As a result of the COVID-19 pandemic, many jurisdictions adopted legislation expanding options for alcohol home delivery or obtaining to-go alcohol from establishments such as bars and restaurants. During the first year of the pandemic, for example, the number of individuals living in states permitting bars and restaurants to deliver alcohol increased by 284% and the number living in states permitting to-go alcohol sales increased by 627% (1). Although this legislation was enacted to provide businesses with economic relief from lockdowns and other measures, a recent analysis found that these policies have persisted, with no indication for future reversal (2). The use of on-demand alcohol delivery and to-go services during the pandemic has been associated with increased alcohol use and high-risk drinking, including binge drinking (1, 3). This is consistent with the authors' finding that heavy alcohol use increased during the pandemic and has since persisted. Evidence also suggests that many on-demand alcohol delivery services either have no requirements for age verification at delivery or have loopholes which can allow underage minors to access alcohol more easily (4, 5). This is consistent with the authors' finding of the age group 18-39 years having the greatest absolute mean increase in any alcohol use from 2018 to 2020. In conclusion, while normalization of stress-related drinking and decreased healthcare access can explain the persistently increased use of alcohol since the onset of the COVID-19 pandemic, so too can pandemic-related changes in alcohol availability. It is critical that states consider reversing pandemic-era policies that have increased access to on-demand alcohol, in addition to enacting other evidence-based alcohol policies, to protect public health and prevent alcohol-related harms.
References
1. Trangenstein PJ, Karriker-Jaffe KJ, Greenfield TK, Kerr WC. Characteristics associated with buying alcohol to-go and for delivery during the first year of the COVID-19 pandemic among a national sample of US adults. Drug and Alcohol Review. 2023;42(5):1252-63. [PMID: 37165791] doi: https://doi.org/10.1111/dar.13659.
2. Lemp JM, Kilian C, Probst C. Here to stay? Policy changes in alcohol home delivery and “to-go” sales during and after COVID-19 in the United States. Drug and Alcohol Review. 2024;43(2):434-9. [PMID: 38038182] doi: https://doi.org/10.1111/dar.13789.
3. Grossman ER, Benjamin-Neelon SE, Sonnenschein S. Alcohol consumption and alcohol home delivery laws during the COVID-19 pandemic. Subst Abus. 2022;43(1):1139-44. [PMID: 35471927] doi: 10.1080/08897077.2022.2060432.
4. Sneyd S, Richardson M. Online alcohol deliveries: age verification processes of online alcohol delivery companies in Auckland, New Zealand. N Z Med J. 2024;137(1606):13-21. Epub 20241129. [PMID: 39607960] doi: 10.26635/6965.6433.
5. Duthie C, Pocock T, Curl A, Clark E, Norriss D, Bidwell S, et al. Online on-demand delivery services of food and alcohol: A scoping review of public health impacts. SSM Popul Health. 2023;21:101349. Epub 20230124. [PMID: 36845670] doi: 10.1016/j.ssmph.2023.101349.