With millions of cases of a new and relentless virus, hundreds of thousands of deaths and the wait for a vaccine, for many, the first year of the coronavirus pandemic in the United States brought unimaginable pain, fear and frustration.
The study, published last week in the Journal of the American Medical Association, found that more than 99,000 people died in 2020 of alcohol-related causes ranging from alcohol-associated liver diseases to mental and behavioral disorders to drug overdoses involving alcohol.
Public health experts have seen increases in anxiety, depression and social isolation during the pandemic, said Aaron White, lead author of the study and senior scientific adviser to the director of the National Institute on Alcohol Abuse and Alcoholism. “And we know from previous crises that when people are faced with uncertainty, they tend to reach for things to try to cope with that and they’re not always the healthiest things,” he said.
He said the study’s findings reflect “a general increase in difficulty coping during the pandemic.”
Before the pandemic, White said, researchers with the NIAAA had been seeing an increase of about 3 percent per year in alcohol-related fatalities. In 2020 — when the coronavirus spread around the globe — that increase jumped to nearly 26 percent, he said.
“The most significant finding is just the sheer size of the increase and how abruptly it happened,” he said.
The researchers analyzed death certificates for people 16 and older and found that from 2019 to 2020, the largest increase in the number of deaths involving alcohol — about 38 percent — occurred among people ages 25 to 44, the data shows.
An estimated 29,500 deaths in 2020 were linked to alcohol-associated liver diseases, such as cirrhosis; more than 15,000 to alcohol-related mental and behavioral disorders; and nearly 12,000 to opioid overdose deaths involving alcohol — a more than 40 percent increase from the previous year, according to the research.
White said these deaths are underestimated because it is common for alcohol to be left off death certificates, oftentimes because the person filling them out may not know alcohol was involved in the deaths.
One example of this, he said, is alcohol-related traffic fatalities. Data from the U.S. Department of Transportation shows there were more than 11,000 traffic crash fatalities in 2020 that involved an illegal amount of alcohol, but 1,355 death certificates indicated alcohol played a role in the crash fatalities, he said.
Public health experts say drug overdose deaths, which are often tangled up in alcohol fatalities, also skyrocketed the first year of the pandemic.
Provisional data from the Centers for Disease Control and Prevention shows that more than 100,000 people died of drug overdoses in the United States during the 12-month period ending in April 2021 — nearly 29 percent more than the previous year. Opioids accounted for the largest number of overdose deaths.
Michael Barnett, assistant professor of health policy and management at Harvard T.H. Chan School of Public Health, said the coronavirus pandemic did not create many new social problems. It magnified the ones some people were struggling with — social isolation, financial uncertainty, the burden of mental illness with not enough available treatment, he said.
“It’s all kind of a perfect storm for addiction to get worse, if not prevent it from getting better,” he said.
Barnett, who was not involved in the study on alcohol-related deaths, said the United States went into the pandemic with an addiction treatment infrastructure that was inadequate for drugs, alcohol and multi-substance-use disorders. In addition, he said, addiction remains stigmatized, and “that gets in the way of people accessing treatment.”
For alcohol-use disorders specifically, White said most people struggling with alcohol-related issues do not get help, even during a good year. “And we know that it has been harder during the pandemic for people to figure out where to turn,” he said.
But, White said, it’s important for people to know that there are sources of support. The NIAAA, for instance, has a list of resources for those seeking alcohol treatment.
“Generally it’s becoming very clear that what we need to do in public health is put more energy into helping build resilient people who have healthy, sustainable coping strategies,” he said. “And that’s how we protect ourselves from increases in alcohol and other drug use during a crisis like this is to be better equipped to cope with the stress and the strain.”