Alcohol and substance use in 2020

This spring, as stay-at-home orders took effect and life’s routines were disrupted, the threat COVID-19 posed to mental health was significant. Some individuals are now unemployed while others are exhausted from working in front-line service jobs. For everyone, anxiety and stress are on the rise.

Prior to the COVID-19 pandemic, research emerged on the state of loneliness and the negative impact anxiety and stress have on our physical well-being. In addition, the opioid epidemic has already had immense consequences for society. The current pandemic has amplified these underlying issues. Studies warned that increased anxiety and stress were likely to exacerbate existing mental health and substance use disorders (SUDs) or trigger new ones.

Now, more than six months into the pandemic, both alcohol and substance use remain elevated above already previously concerning norms. Meanwhile, uncertainty related to an end to the pandemic persists. A growing body of studies point to the risks and long-term effects associated with alcohol and drug misuse. Health plan sponsors must face these challenges for the sake of their participants and their ability to manage costs.

Negative health impacts of alcohol and substance use

Excessive alcohol use has negative impacts on both physical and mental health. The CDC defines excessive alcohol use as five or more drinks for men, and four or more drinks for women.

Consuming alcohol interferes with the communication pathways within the brain, causing disorientation and memory loss. More concerning during a global pandemic is the impact on the immune system.

According to the National Institute on Alcohol Abuse and Alcoholism, drinking excessively leads to malnutrition causing the immune system to weaken, slowing the body’s natural ability to prevent and fight infections.

Substance use also has many additional physical health impacts. They include increased risk of heart disease, cancer and inflammation in the liver.

Long-term chronic alcohol and substance use can cause serious and permanent damage to the brain including increased depression, anxiety and disease

Rise in alcohol and substance abuse during the pandemic

In the midst of COVID-19, overall alcohol sales in the U.S. increased by more than 23 percent, with the sale of spirits and wine rising by more than 33 percent and wine 25 percent, respectively, according to Neilsen, One-quarter of respondents to a recent survey said they were binge drinking, 20 percent reported prescription drug abuse, and approximately 10 percent are using illicit drugs as reported.

This comes on the heels of an 8 percent increase in alcohol consumption over the past 20 years, as reported in an article published in Alcoholism: Clinical and Experimental Research. Drug overdoses have also increased during the pandemic, according to the American Medical Association.

In the short term, because of the economic impacts of the pandemic, we may see decreased levels of substance use due to decreased availability and affordability, according to a July 2020 study published in the journal BMC Medicine. However, that study’s longer-range predictions indicate an overall increase in consumption as a consequence of increased emotional distress and psychiatric conditions.

The BMC Medicine study cited above affirms things we know. First, the emotions associated with the pandemic impact health negatively and increase alcohol and drug use. Second, people with SUDs are already more vulnerable and facing increased risks during COVID-19.

Results of another study demonstrate that individuals already experiencing high levels of stress (“characterized by low levels of sense of coherence”) may be at risk for developing clinically significant symptom changes from pre- to post-pandemic. We also know the mental and emotional toll will not end immediately. Distress can last up to three years, according to a study published in BMJ.

What plan sponsors can do

Plan sponsors can be leaders in the effort to prevent and combat alcohol abuse and substance use.

Strategies include:

1. Providing education about the risks associated with excessive alcohol use and drug abuse.
2. Demonstrating empathy through leadership to help facilitate open communication and reduce the stigma associated with needing help.
3. Encouraging healthy coping skills, like mindfulness practices and healthy eating habits, that can help mitigate abuse.
4. Supporting treatment of those with alcoholism or SUDs through thoughtfully designed benefits that may include telemedicine and digital support solutions.
5. Developing leave policies that support recovery.
6. Working with network administrators to ensure adequate access to care delivery.
7. Working with benefit administrators to ensure care aligns with clinical best practices and complies with applicable laws, such as the federal Mental Health Parity and Addiction Equity Act (MHPAEA).

Adopting these strategies will help minimize the effects of COVID-19 on alcohol and substance use and advance recovery from conditions triggered or exacerbated by the pandemic.

While completely abstaining from alcohol and substance use may not be viable for many, reducing alcohol consumption by as little as one-third can have many positive impacts on physical and mental health.

Treatment of substance use disorder is also critical and may help reduce physical health comorbidities and overall treatment costs, including premature death and disability.