A Hidden Pandemic Toll: The Rise in Alcohol-Related Deaths

From time to time, we like to highlight senior living-adjacent topics that are more serious in nature — including around mental and behavioral health — in the hopes of starting important conversations that are not always easy to initiate. The past two-plus years of the pandemic have tested people in countless ways. Concerns about staying physically healthy have converged with worries about finances, employment, child-rearing, and loved ones’ health, as well as feelings of isolation for some, creating challenges around mental health. These factors seem to have set the stage for a perfect storm leading to increased use of alcohol for many people in the U.S., as confirmed by recent research.

Experts at the National Institute on Alcohol Abuse and Alcoholism, a division of the National Institutes of Health (NIH), have published their findings around the increase in alcohol consumption and drinking-related deaths during the first year of the pandemic, and their findings are alarming.

Year over year, from 2019 to 2020, the researchers found a 25 percent increase in the number of alcohol-associated deaths — those where the death certificate showed alcohol as the underlying or a contributing cause of death. Perhaps most concerningly, this increase was found in all age groups, starting with people as young as 16 years old.

A startling increase in alcohol-related deaths

In the U.S., death certificates list an underlying cause of death, as well as up to 20 other contributing causes. The NIH researchers identified a death as “alcohol-related” if an alcohol-induced cause was listed as an underlying or contributing cause. This could be causes such as alcohol-associated liver diseases, alcohol-related mental and behavioral disorders, or even opioid overdose deaths where alcohol was a contributing factor.

Using this criterion to examine U.S. mortality data from the National Center for Health Statistics, the study found that, between 2019 and 2020, the number of deaths that involved alcohol increased from 78,927 to 99,017 — a relative change of 25.5 percent.

By comparison, deaths from all causes had a smaller relative increase in number — going up 18.8 percent, from 2,823,460 to 3,353,547 — and rate, which went from 938.3 to 1,094.3 per 100,000 — a 16.6 percent increase.

In short, deaths that were classified as alcohol-related accounted for 2.8 percent of all U.S. deaths in 2019 as compared to 3.0 percent in 2020. Additionally, the rate of increase for alcohol-related deaths in 2020 — 25.5 percent — was substantially higher than the increase in all-cause mortality, which was 16.6 percent.

It’s worth mentioning that in 2020, a total of 2,042 death certificates listed both alcohol and COVID-19 as causes — 1,475 listed COVID-19 as an underlying cause, and 323 listed alcohol as an underlying cause. Thus, the researchers concluded that only a small portion of the 25.5 percent rise in alcohol-related deaths also involved COVID-19.

Also, while rates of alcohol-related deaths had been trending up before the pandemic, it was at a much slower pace: just a 2.2 percent mean annual change between 1999 and 2017.

A growing problem for all age groups

As noted above, the analysis of death certificate data found an increase in alcohol-related deaths for all age groups. The largest increase occurred among those age 35 to 44, jumping from 22.9 to 32.0 per 100,000 — a staggering 39.7 percent increase. Close behind were those age 25 to 34, which rose 37 percent from 11.8 to 16.1 per 100,000.

However, older people also were impacted by the increase in alcohol-related deaths. Among those age 55 to 64, there was a 21.7 percent increase in deaths with alcohol as a contributing factor. For people age 64 to 74, the increase was 20.8 percent, and for those age 75 and older, the increase was 15.3 percent.

An unexpected toll of the pandemic

These findings from the NIH study are concerning, showcasing one of the unexpected and often-hidden tolls of the COVID-19 pandemic. Indeed, there are likely many pandemic-related factors that lead to the increase in drinking, which in turn created this increase in alcohol-related deaths.

It is common for people to increase their drinking as a coping mechanism during stressful times, and the pandemic certainly created much of that. Concerns around personal health and the health of loved ones, anxiety about jobs and money, parental stress dealing with childcare and virtual schooling all could contribute to increased alcohol consumption.

Other factors that may have led to the uptick in drinking and alcohol-related deaths include changes to states’ alcohol policies (to-go drinks, for example) and challenges with accessing treatment programs.

There is also a connection between dealing with isolation and/or grief and increased alcohol use, especially among older people. The pandemic left many people feeling lonely, perhaps especially seniors who live alone. Add to that the loss of loved ones from COVID or other causes, and it’s not difficult to see why more older people turned to drinking.

Good intentions, unhealthy drinking habits

It is also important to note that some of that increase in alcohol use among seniors was based on other behavioral changes — some of which may have been well-intentioned if misguided in retrospect.

For example, in the early months of the pandemic, outdoor happy hours became common at many senior living communities, giving residents something to look forward to each afternoon. These outdoor/open-air happy hours were considered an enjoyable and safe way to socialize with others. On the flipside, however, seniors may have begun drinking more or more often as a result of these gatherings.

In other senior living communities, management came up with different creative ways to keep residents safe and happy — some of which also involved alcohol. For instance, as part of their pandemic precautions, meals were delivered to residences in some senior living communities, and in some cases, those deliveries included bottles of wine. It was a nice gesture on the part of management, but having alcohol regularly delivered to their doorstep also may have set the stage for increased drinking among some residents.

Signs of a drinking problem

Whether used as a coping mechanism or simply for socializing, frequently drinking alcohol — especially in large quantities — is unhealthy for our bodies at any age. It can be especially dangerous for older people, however, as it can worsen any existing balance or vision issues and be a contraindication for many medications.

According to the National Institute on Alcohol Abuse and Alcoholism, if you answer “yes” to two or more of the following questions, you may have the medical condition referred to as “alcohol use disorder.” In the past year, have you:

Had times when you ended up drinking more, or longer than you intended?
More than once wanted to cut down or stop drinking, or tried to, but couldn’t?
Spent a lot of time drinking? Or being sick or getting over the aftereffects?
Experienced craving—a strong need, or urge, to drink?
Found that drinking—or being sick from drinking—often interfered with taking care of your home or family? Or caused job troubles? Or school problems?
Continued to drink even though it was causing trouble with your family or friends?
Given up or cut back on activities that were important or interesting to you, or gave you pleasure, in order to drink?
More than once gotten into situations while or after drinking that increased your chances of getting hurt (such as driving, swimming, using machinery, walking in a dangerous area, or having unsafe sex)?
Continued to drink even though it was making you feel depressed or anxious or adding to another health problem? Or after having had a memory blackout?
Had to drink much more than you once did to get the effect you want? Or found that your usual number of drinks had much less effect than before?
Found that when the effects of alcohol were wearing off, you had withdrawal symptoms, such as trouble sleeping, shakiness, irritability, anxiety, depression, restlessness, nausea, or sweating? Or sensed things that were not there?

Help is available!

If you feel that you have developed an unhealthy relationship with alcohol, help is available. And thanks to treatment advancements in recent years, the formula is no longer one-size-fits-all. Options range from behavioral health counseling to medications to support groups, or any combination of these.

The National Institute on Alcohol Abuse and Alcoholism recommends starting with a conversation with your primary care doctor to address your concerns and discuss the option or options that are right for you. To learn more about alcohol treatment options, visit the National Institute on Alcohol Abuse and Alcoholism website. You can do this!