Alcohol use behavior, policy, and treatment in the age of COVID-19 A webinar and Facebook Live event from the PTTC Network Coordinating Office September 22, 2020
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PTTC Network
Today’s Presenters Dr. Denis M. McCarthy Julia Sherman Kamilla L. Venner, Ph.D. Professor of Psychology and Assistant Professor Wisconsin Alcohol Policy Associate Chair for Research, Department of Psychology, Project, University of Department of Psychological University of New Mexico Wisconsin Law School Sciences, University of Missouri kamilla@unm.edu julia.sherman@wisc.edu mccarthydm@missouri.edu
COVID and Drinking
Changes in Consumption • Alcohol is the most accessible impairing drug (but…cannabis) • In March, Neilsen reported a 55% increase in alcohol sales • Overall 5% increase in sales in March and April • Sales down 5% in May
Changes in Consumption • BacTrack published data on BAC changes pre- and post-lockdown • In March, there were significant changes in • Average BAC in most States • Drinking days of the week (shift from weekend to weekday) • https://www.bactrack.com/pages/coronavirus-covid-19-causing-dramatic-shift- alcohol-drinking-habits-americans-lockdown \ • Biased sample of drinkers
Changes in Consumption • Emerging U-shaped curve in drinking changes • Small group showing large increases in drinking • Others decreased drinking • Unclear what distinguishes the groups • Women & Black adults more likely to increase
COVID and Drinking • Curated database of COVID papers • https://www.addictionjournal.org/index.php/newsroo m/news • Changes in locations and motives for drinking • Increases in solitary and at-home consumption • Increases domestic violence, child neglect
COVID and Drinking Motives • Alcohol is both stimulating and sedating • Drinking to celebrate or socialize (stimulation) • Drinking to cope with negative affect/stress (sedation) • Motives can alter effects and consequences • Increased drinking to cope with stress, negative affect, boredom • Not effective, more likely to lead to negative consequences
How Drinking Alters COVID Risk
Drinking and COVID • Alcohol reduces immune response • May increase risk or severity of infection • Increases risk for lung problems from COVID
Drinking and COVID • Alcohol reduces vigilance & behavioral control • Harder to maintain social distancing • Mask wearing and physical distancing are not established behaviors • Require higher level of cognitive control • Can lead to unintentional “risk taking”
Drinking and COVID • Alcohol alters judgment and risk perception • COVID changes risk of some behaviors • Driving alternatives have different “costs” • Strategies for safe drinking need to change
Cannabis and COVID • Approaching alcohol in accessibility • Less clear data on changes in cannabis use • Like alcohol, can be used to cope • Effect on depression/anxiety not clear
Policy Changes Julia Sherman Wisconsin Alcohol Policy Project
When alcohol becomes more available, problems follow: Immediate problems: disorderly conduct, noise, property damage, neighborhood disruption. Long term problems: alcohol is a causal factor in 7 different cancers, number of outlets increases the number of Availability o of A Alcohol ACES recorded for area youth.
Changing A Alcohol Poli olicie ies Make the temporary permanent • Mixed drinks to go • Home delivery of alcohol Changes in law or rule • Expanded footprints “licensed premises” or “licensed area” • Home delivery of alcohol authorized • Reinterpretation of existing law/rules • Growlers in Wisconsin
Issues ues w with h Home e Del elivery • Drafts assign all liability for underage/intoxicated person sales to delivery service, not retailer. • Limit to on-premises licensees or allow off-premises. • Limit days and times for delivery. • Community opt-in/opt out? Delivery radius? • Limited to sealed containers? • Enforcement protocols are developing, untested.
Concer erns ns w with C h Click ck & Collect ct A Alco coho hol • May impact licensed footprint • How to ID intoxicated customers. • Underage purchasers • Lack of enforcement protocols or meaningful sanctions for: • Online ordering • Home delivery • Curbside/Click & Collect
Mixed drinks t to g go • Before the pandemic only Florida & Mississippi allowed. • During the pandemic – 33 states and D.C. allowed, some sunset. • Many required concurrent food sale. • Some states allowed 3 rd party delivery (DoorDash) • Michigan allows through 2025
Concerns A About M Mixed D Drinks T To-Go Problem Solutions/Mitigation • Strength • Require food purchase with • Amount of alcohol will vary alcohol sales • Not sealed by manufacturer • Require a seal and define it tampering is possible • Define when and where drinks may be consumed • Public safety • Drinking in cars • Underage drinking
Options • Add and enforce sunset dates • Create meaningful sanctions including suspension or loss of license • Fund the creation/testing of enforcement protocols • Fund enforcement by the appropriate agencies
• There is no “healthy” level of drinking – only low-risk drinking. Fram amin ing t the e • Communities see small businesses closing – Issue ue: hospitality industry hard hit. • Save the Bars Movement – license fees and tax abatement proposals Thi his s is a abo bout ut • We know that expanding the availability of healt ealth & & alcohol increases alcohol consumption. • Unintended consequence, avoid blame. saf afety, • Expand sympathy to all hard-hit not busi no business businesses. • Change the commoditization of alcohol.
An Opportu tunity to y to Red educe ce D Dens ensity • Some licensees will close permanently. • Map & measure now to assess outlet density . • Relicense carefully based on vision & mapping.
COVID and Treatment with American Indian/ Alaska Native clients Kamilla L. Venner, Ph.D. Assistant Professor of Psychology University of New Mexico
FCOI Disclosure I have a financial conflict of interest (FCOI) management plan at the University of New Mexico due to providing training and consultation in evidence-based treatments for fee
Overview AI/AN health inequities in COVID-19 prevalence Challenges to SUD Treatment Reservations severely restricted (on lock down) Technological challenges Increased social isolation and stress Facilitators of SUD Treatment Summary
Age-adjusted mortality by race
New Mexico AI/AN COVID-19 mortality
COVID-19 related increases mental health problems Increase substance use Increase in misuse of medications to treat opioid use disorder Increase in overdose death Increase in suicidal behaviors Increase in anxiety and depression
Why COVID related health inequities? Not because of race Social Determinants of Health Historical Trauma and Colonization Boarding Schools Poverty, Unemployment Quality of education Housing – multigenerational, cannot isolate one person from others in home Neighborhood factors (e.g., safety, safe roads, lighting, distance to hospitals) Reservation- lack of clean water sources, lack of running water Access to culturally safe medical care (IHS severely underfunded)
AI/AN Strengths High rates of alcohol and drug abstinence People have resolved substance use disorder Cultural Identity Spirituality Traditional Ceremonies Community connectedness
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