By Annette T. Meadows MS, LCMHC, LAC, Clinical Director, Recovery Works Merrillville
Increased Use During the Pandemic: Liver Disease and Alcohol Use Disorder Among Women
At the beginning of the coronavirus pandemic in early 2020, experts predicted an increase in mental health issues related to the various related pandemic stressors. Among mental health professionals, major sources of concern included stress related to:
- Shelter-in-place orders
- Persistent fear of the unknown
- Economic hardships
- Employment instability
- Decreased social contact
They warned that the cumulative effect of these stressors would lead to increased rates of:
To clarify, alcohol use disorder (AUD) and substance use disorder (SUD) are the clinical terms we now use instead of phrases like alcohol addiction, alcoholism, alcohol abuse, drug addiction, drug abuse, or substance abuse. We still use those terms – sometimes – because everyone recognizes them. However, terms like AUD and SUD align with the medical model of addiction, which serves to reduce stigma and increase participation in treatment for AUD and SUD.
Right now, we need to reduce the stigma against treatment – and AUD and SUD in general – as much as we can.
Because it turns out the experts were right: during the pandemic, rates of depression, anxiety, AUD, and SUD all increased.
In this article, we’ll focus on AUD and drinking among women. First, though, we’ll offer the latest big picture statistics on AUD in the U.S. The 2020 National Survey on Drug Use and Health (2020 NSDUH) indicates that:
- 712,000 adolescents (12-17) have AUD
- 5.2 million young adults (19-25) have AUD
- 22.3 million adults (26+) have AUD
- 24.6% of men
- 11.5% of women
That was before the pandemic. There’s another set of pre-pandemic data we want to share, too: data on the AUD treatment gap. The treatment gap is the difference between people who need treatment for AUD and people who got treatment for AUD.
The Treatment Gap: Age 26 +
- People with AUD: 10,994,000
- People who received treatment for AUD: 1,955,000
- That’s 18%
- People who received specialized treatment for AUD: 1,181,000
- That’s 10.7%
What those numbers mean is that 89% of people age 26 + diagnosed with AUD did not get specialized treatment: that’s far too many.
Those numbers did not improve during the pandemic. And there’s one group of people for whom alcohol use and associated health problems increased dramatically during 2020-2021: women.
Alcohol Consumption During 2020
Several studies examined the increase in alcohol sales use among all demographics during 2020. Here’s the top-line data from that research:
- Alcohol sales during the first month of the pandemic increased by 54%
- Online alcohol sales increased by 234%
- Alcohol consumption for all adults increased by 61% from 2019 to 2020
- Heavy drinking increased by 41% for adult women, compared to 7% for men, from 2019 to 2020
- Heavy drinking is defined as consuming more than 14 drinks a week or binge drinking on five or more days in a month
- Binge drinking, for women, is defined as consuming 4 drinks or more in 2 hours
- Self-reported problems related to alcohol increased by 39% for women, compared to 27% for men.
We understand why people may have consumed more alcohol during the pandemic: self-medication to alleviate the pandemic stress. However, although people often use alcohol to mitigate the uncomfortable emotions related to stress-related anxiety and depression, evidence shows that over the long term, alcohol consumption has the opposite effect: it increases frequency and intensity of anxiety and depression symptoms. In addition, studies show that people who use alcohol to cope with stress have a higher likelihood of developing both AUD and SUD.
Excess Alcohol Use: Harm to Women
The picture is clear: alcohol use increased during COVID, and heavy alcohol use increased most for women. That’s a significant problem, because recent research shows that the physical problems associated with alcohol use affect women more than they affect men. These problems, discussed in detail by our Chief Medical Officer, Dr. Chris Johnston in the article Alcohol and Women: Increased Use, Increased Harm, include:
- Brain damage
- Cancer of the liver, breast, throat, and mouth
- Cardiovascular complications and heart disease
- Increased risk of alcohol-related liver disease
- Elevated risk of mouth, throat, esophageal, liver, breast, and colon cancer
- Greater risk of heart disease and cardiovascular complications
In addition, research shows that women are at increased risk of memory loss, memory problems, and cognitive decline due to excess alcohol consumption.
That picture is clear, too: alcohol has a more powerful negative impact on women than it does on men. But that doesn’t explain why drinking among women increased during the pandemic.
Women and Alcohol During COVID: A Physician Weighs In
In an article published last year, Dr. David Streem, MD, chief of psychiatry at Cleveland Clinic Lutheran Hospital and medical director of the Alcohol and Drug Recovery Center at Cleveland Clinic, discusses the various reasons for the dramatic increase in alcohol use among women during the pandemic.
First, he indicates that social media and viral advertisers took advantage of a phenomenon known as “Mommy Wine Culture” that condoned – and even encouraged – the use of alcohol by women as a coping mechanism during COVID.
Next, he points out that co-occurring disorders are more common among women with AUD than with men. Co-occurring disorders is the phrase clinicians use when an individual has AUD or SUD and an additional mental health disorder. Dr. Streem believes that barriers to access mental health treatment during the pandemic meant fewer women received treatment for mental health issues during the pandemic, which could have led to relapse among women in recovery, and increased use for women with AUD or women balancing between typical use, heavy use, and disordered use of alcohol.
Finally, he points to the thing we all experienced during the pandemic: stress.
“In the pandemic we have also seen that the multiple roles and functions taking place in the home — childcare, education, household responsibilities, and wage-earning responsibilities — have fallen disproportionately to women, resulting in higher stress levels.”
He explains why these additional responsibilities may have created barriers to care:
“For women who are disproportionately the primary care providers for family (children, aging parents), it is difficult to access care from home when privacy and competing responsibilities make it challenging. Another challenge is finding childcare coverage to enable engagement in care; it is either unavailable or not affordable.”
Those reasons make sense to us. Although gender roles have changed significantly over the past several decades, it’s still safe to say that women, in most cases, are the glue that holds families together. Men contribute, of course, as they always have. In recent years, men have also begun to contribute more in areas that have traditionally been the realm of women. However, women still bear most of the responsibility for childcare, household management, and the education of their children. It’s entirely logical that these responsibilities – with the added stress and weight of the pandemic – go a long way to explaining increased alcohol use among women during the pandemic.
What We Can Do to Help
There’s no magical solution, here.
What we need to do to help women is straightforward:
- Recognize that right now, they’re more vulnerable to AUD and its negative effects than most other demographic groups
- Increase screening for AUD for women in the primary care setting and women’s health setting
- Continue our efforts to reduce stigma around AUD and treatment for AUD
- Continue removing barriers to care by enhancing access to telehealth, virtual care, and support for specific women’s issues, such as securing childcare and increasing employment opportunities for women
- Expand our efforts to offer gender-responsive and trauma-informed care not only in addiction treatment, but in mental health treatment and healthcare in general
We can do all those things. We have the knowledge. We have the appropriate treatment techniques, and we have therapy that works. What we need now is to create a critical mass of awareness that allows women to come forward and seek support. We know that when we help any member of our society, we help everyone. At this moment in time, with regards to alcohol, we need to apply that lesson to our mothers, daughters, sisters, and spouses. When we help the women in our lives with any problems they may have with drinking, we’ll improve society at large. But really, we don’t need a big picture reason to rally to the aid of women in their time of need. We should help them for one simple reason: they need us.