Editorial: Preventing harmful alcohol consumption to promote healthier and stronger recovery after COVID-19

The COVID-19 pandemic has significantly changed the way we live. To contain the spread of the virus and avoid overwhelming our health services, following the two or even three waves of the virus, governments around the world implemented drastic measures to limit physical interaction and mobility. This led to the shutdown of most non-essential activities – from schools to factories; from shops to recreational activities – in the first wave and to repeated, albeit often less stringent, measures in the following waves. These measures have been effective in keeping people at home. For example, 39% of workers in OECD countries shifted to teleworking, and millions of children switched to online learning and home schooling. Leisure time was also affected with, for example, a sharp increase in time spent online.

Early evidence suggests that the “new normal” caused by the pandemic had a significant effect on our lifestyles, including drinking habits. Across 11 countries, 36% of individuals said that they had increased consumption of alcohol. An overall increase in consumption was also confirmed by government sources monitoring sales, at least in some countries for which data are available. For example, in the United Kingdom, total alcohol duty receipts showed a 4.5% increase in the period April to October 2020, compared to the same period in the previous year. Similarly, US data from 15 states suggest a 4% increase in the quantity of alcohol sold in the period January to August 2020, compared to the same period in the previous year. German data show an increase in alcohol tax revenues of 3.3% in 2020, compared to 2019.

People increased drinking frequency. Among individuals in the 11 countries, 43% increased their drinking frequency, compared to a quarter of adults who decreased their drinking. The probability of binge drinking – drinking more than 80% of a bottle of wine or 1.5 litres of beer per drinking occasion – did not change for nearly half of the population. About 29% of the respondents reported binge drinking less frequently, though 23% said they were binge drinking more frequently.

Predictably, people also changed the places where they drink alcohol. Restaurant reservations declined sharply, falling to practically zero when lockdowns were enforced. Alcohol sales in bars and restaurants therefore plummeted, but alcohol consumption increased at home. Sales in retail stores, and in particular online sales, also grew significantly. Stockpiling in the early phases of the pandemic may have been a key driver of these trends.

Lockdown and stay at home orders exacerbated some of the negative behaviours associated with harmful alcohol consumption, such as domestic violence. One in four women experience intimate partner violence in their lifetime, and one in three children experience some form of violence by parents or other family members. During the pandemic, there was an increase in the number of emergency calls to hotlines to report domestic violence in countries including Austria, Italy, Mexico, Spain and the United Kingdom, to name a few. Across EU countries there was a 60% rise in emergency calls about domestic violence.

It is difficult to know whether these changes will continue when living conditions go back to normality, but the experience of previous crises suggests that we may see an increase in problematic drinking in the medium term. Excessive alcohol consumption can be a response to high stress levels. Increased alcohol use is also common after traumatic events. Undoubtedly, COVID-19 has disrupted people and communities across the world, creating the conditions for long-term physical and mental distress. The associated economic crisis caused unemployment to rise by almost 60% (from 5.3% to 8.4%) across OECD countries in 2020. The reopening of the economy will also be associated with the removal of support measures for distressed companies and workers, possibly leading to bankruptcies and further unemployment, which will take time to reabsorb. The path to recovery therefore remains long and difficult, increasing the risk that individuals will engage in harmful patterns of drinking to cope with stress.

These factors make the findings of this report even more relevant and timely. Preventing Harmful Alcohol Use highlights the fact that harmful patterns of alcohol consumption such as underage drinking, heavy drinking or binge drinking are highly prevalent in some population groups. Monthly binge drinking is a habit for one in three adults in OECD countries, and women with higher education and people with the lowest and the highest incomes are particularly at risk. Among adolescents, one in five has been drunk at least twice in their lifetime. During confinement, women, parents of young children, middle-aged people, people with higher incomes and individuals with depressive and anxiety symptoms reported the highest increases in alcohol consumption.

Preventing alcohol-related diseases and injuries reduces the burden on health care services, which are already under heavy pressure from COVID-19, and will foster a stronger economic and social recovery in the aftermath of the pandemic. For many people, alcohol consumption is an enjoyable part of their social life. But harmful patterns of alcohol consumption are dangerous for health and costly for societies. Preventing harmful alcohol use has a triple dividend. First, during the pandemic it helps individuals cope with infections by protecting against the effects of harmful alcohol use on the immune system. Second, it reduces pressure on health care services. Hospitals and health care workers are already under enormous strain to provide care to patients with COVID-19. Reducing health system utilisation from harmful alcohol use helps doctors focus both on patients with COVID-19 and on patients requiring urgent care for other conditions. For example, South Africa – one of the countries implementing an alcohol sales ban – experienced a 65% drop in access to emergency rooms for trauma-related cases linked with alcohol use during the pandemic. Third, a healthier and more productive population will be better able to help restart economic activities and social life in the aftermath of the pandemic.

The OECD analyses conclude that a comprehensive “PPPP approach” – including actions to protect children from alcohol promotion; policing to limit alcohol-related injuries and violence; primary care to help patients with harmful patterns of alcohol consumption; and pricing to limit the affordability of cheap alcohol – is both effective and cost-effective to tackle harmful alcohol consumption. Investing in a policy package built around the PPPP approach saves millions of lives and generates savings that are greater than the implementation costs.

Investing in protecting children and people with problematic drinking is particularly important. During the pandemic, children increased screen time by 50%, including TV and social media, on-demand and online video, and online entertainment. This is likely to have increased their exposure to alcohol advertising, which is correlated to the probability of experimenting with drinking for the first time. Only a handful of countries have strong legislation to protect children from online alcohol advertising on social media, however. In addition, there is a need for further support for people with harmful drinking patterns and alcohol use disorders. It is estimated that less than 10% of them receive support from health care services in Europe and the United States. If, as seems conceivable, the number of individuals with harmful patterns of alcohol consumption and alcohol use disorders increases in the aftermath of the pandemic, health services need to be ready to meet the challenge.

COVID-19 has caused huge suffering. But, as with any crisis, it also brings opportunities. It has put a spotlight on the effects of stress, anxiety and depression on individuals. Part of the response must be to help people deal with the problems they have with alcohol consumption. This report shows that tackling harmful alcohol drinking and preventing chronic diseases can support efforts to “build back better”.

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Stefano Scarpetta

Director for Employment, Labour and Social Affairs

OECD

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