Americans started drinking more as the Covid-19 pandemic got underway. They were stressed, isolated, uncertain — the world as they had known it had changed overnight.
Two years into the disaster, the trend had not abated, researchers reported on Monday.
The percentage of Americans who consumed alcohol, which had already risen from 2018 to 2020, inched up further in 2021 and 2022. And more people reported heavy or binge drinking,
“Early on in the pandemic, we were seeing an enormous surge of people coming in to the clinic and the hospital with alcohol-related problems,” said Dr. Brian P. Lee, a hepatologist at the University of Southern California and the principal investigator of the study, published in Annals of Internal Medicine.
“People assumed this was caused by acute stress, like what we saw with 9/11 and Katrina, and typically it goes back to normal after these stressful events are over,” he added. “But that’s not what we’re seeing.”
Alcohol can be addictive, “and we know that addiction doesn’t go away, even if the initial trigger that started it has gone away,” Dr. Lee said.
Rates of heavy drinking and of alcohol-related liver disease had been rising steadily for decades before the pandemic struck. But alcohol-related deaths surged in 2020, with one study reporting a 25 percent increase in a single year, said Christian Hendershot, director of clinical research at U.S.C.’s Institute for Addiction Science.
“We think that what happened during the pandemic was that there were a large number of people who were already in a high-risk zone, so to speak, and the pandemic pushed them over the brink into severe illness and death,” Dr. Hendershot said.
The surge in alcohol consumption was one of several lingering legacies of the pandemic, along with school absenteeism, lags in educational attainment, a rise in overdose deaths and a surge in mental health problems, especially among young people.
The new study was based on data from the National Center for Health Statistics’ National Health Interview Survey, carried out from January 2022 through the end of the year. A total of 26,806 people ages 18 and over were asked about their drinking habits in the past year.
Because the survey was based on self-reports, and did not include members of the military or institutionalized adults, the results may underestimate the problem, Dr. Lee and his colleagues cautioned.
The increases in alcohol use were found in both sexes; in every age, racial and ethnic group; and in every geographic region. Overall, 69.3 percent of Americans said they had consumed alcohol at some level in the past year, up from 69.03 in 2020 and 66.34 in 2018.
More important, the number of Americans who reported consuming alcohol at levels defined as heavy drinking increased to 6.29 percent in 2022, up from 6.13 percent in 2020 and 5.1 percent in 2018, the study found.
(Heavy drinking for men is consuming at least five drinks in a day or at least 15 drinks per week, and for women at least four drinks a day and at least eight per week. Binge drinking is defined as having four to five drinks in a roughly two-hour period.)
The increases were found in every group except Native Americans and Asian Americans, where the percentages of people reporting heavy drinking declined.
White Americans were most likely to be heavy drinkers among racial and ethnic groups, with 7.34 percent reporting heavy drinking, up from 5.69 percent in 2018 and 7.11 percent in 2020.
The uptick in heavy drinking was especially notable in two groups. Adults in their 40s reported the highest levels. A total of 8.23 percent of Americans ages 40 to 49 said they had drunk heavily in 2022, up from 6.49 percent in 2020 and 5.14 percent in 2018.
Adults ages 50 to 64 were not far behind, with 7.15 percent reporting heavy drinking, up from 5.65 in 2018 and 6.95 in 2020.
And among women of all ages, 6.45 percent said they had drunk heavily — exceeding the rate among men, 6.12 percent.
More women than men reported binge drinking in 2018 as well: 5.01 percent of men, compared with 5.19 percent of women. Both sexes reported an uptick in heavy drinking in 2020: 6.19 percent of men and 6.08 percent of women.
The stresses of the pandemic may have been especially burdensome for women, said a co-author of the study, Dr. Divya Ayyala-Somayajula, of the division of gastrointestinal and liver diseases at the Sidney Kimmel Medical College at Thomas Jefferson University in Philadelphia.
“The pandemic was a really stressful event,” she said. “People were at home, there was no child care, and one of the acceptable coping mechanisms is drinking alcohol to deal with stress, anxiety and depression.”
While it may be seen as socially acceptable, drinking is a “maladaptive” and harmful way to deal with stress, Dr. Ayyala-Somayajula added.
Access to behavioral health services was also limited during the pandemic, which may have led to relapses for those recovering from alcohol use disorders, she added.
Women and older adults are particularly vulnerable to alcohol-related harms. Women are more susceptible than men to alcohol-related disease at lower levels of exposure, while alcohol-related harms can be magnified in older adults, experts said.
In addition to the social toll of excessive alcohol use, prolonged or heavy alcohol consumption damages the liver, leading to alcoholic hepatitis and to cirrhosis.
Excessive alcohol affects the heart muscle, leading to arrhythmias, strokes and high blood pressure, and can cause inflammation of the pancreas, or pancreatitis. It weakens the immune system and has been associated with an increased risk of certain cancers, such as cancers of the head and neck, the esophagus, the liver, the breast and the colorectum.
But many of these effects take years to emerge, according to Dr. Lee, who said he feared that heavy drinking had become normalized during the pandemic.
“We know that alcohol use begins as a silent disease and only rears its head years later in terms of chronic disease,” Dr. Lee warned. “What this will unveil for the future is what worries me.”
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