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Analysis

Has COVID-19 changed Australia’s alcohol consumption?


Shani Macaulay


11/01/2022 3:58:56 PM

Emerging studies are starting to reveal what impact the pandemic has had on alcohol use, writes Dr Shani Macaulay.

Woman in her 30s drinking wine at home.
Women over 30 in child caring roles have noticeably increased their alcohol use during the pandemic.

Australians have changed how they are consuming alcohol.
 
If you’ve read media reports on panic buying of alcohol with lockdown announcements, or memes circulating about the benefits of wine to support home schooling, then you might have an idea of who is drinking more, where and why.
 
Surprisingly it is younger Australians who have reduced their alcohol use, whereas those in childcaring roles, particularly middle-aged women, have increased their intake.
 
And this increased alcohol use is taking place more readily in the home. Stress has emerged as a key driver increasing alcohol intake during COVID-19, consistent with the ‘self-medication hypothesis’ for substance use.
 
What the emerging studies tell us
In the pandemic era the demographic of Australians drinking has changed.
 
By May 2020 almost half of all Australians were working from home. Families and individuals were experiencing increased stress, financial strain, and loneliness. Three quarters of households with children were home from school or childcare (ABS/AIFS), with women being three times as likely to be the primary carer.
 
One of Australia’s leading bank institutions has reported a sustained increase in spending on alcohol by both low- and higher-income households between May 2020 to February 2021 compared with the previous year.
 
Twenty per cent of respondents to a 2020 poll by Australian National University (ANU) also reported increased alcohol use, predominantly 30–40-year-old females and 20–30-year-old males. The most cited reasons for increased use for women was stress and childcaring, while for men it was reduced hours, job loss and boredom.
 
Meanwhile, the Australian Drug Foundation found that 29% of parents increased their drinking, with 14% reporting drinking daily. This study concluded that COVID-19 has adversely affected parents.
 
In contrast, younger Australians have reduced their drinking, potentially due to more parental supervision or reduced opportunities to socialise or frequent drinking establishments. As alcohol use in adolescents and young adults is the leading cause of non-fatal burden of disease, this reduction in alcohol use is significant.
 
Alcohol related harms and COVID-19
Of all substances, legal and illegal, alcohol is the leading cause for ambulance call outs (AIHW). A Victorian study of 43,003 ambulance call outs from September 2019 to September 2020 found alcohol intoxication call outs increased with the length of each lockdown.
 
Call outs increased for both low- and higher-income earning households, showing that alcohol use can potentially impact any Australian.
 
For males and females in their 30s, ambulance call outs for acute alcohol-related presentations increased by 18–45% from the previous year, with highest call outs for alcohol use occurring for more disadvantaged and older people.
 
Alcohol consumption by parents increases the potential risk of harm to children, such as reduced emotional responsiveness that can impact a child’s social and emotional development and resilience. Parental drinking also influences a child’s future pattern of drinking. Heavy drinking is associated with increased child protection involvement and family violence.
 
Prior to the pandemic, the cost of alcohol-related harms to Australia was estimated at $67 billion, but the current trends associated with COVID-19 suggest this cost is likely to be higher still.
 
Demand for community based AOD services increased
Demand for community and home-based Alcohol and Other Drug (AOD) services has increased substantially, as has the use of telehealth services. Regional, rural and remote Australia has suffered during COVID-19 due to the lack of specialist treatment services and other barriers to care.
 
For Aboriginal and Torres Strait Islander people, where being close to culture and country is directly related to social and emotional wellbeing, barriers to care are compounded. Telehealth has offered a promising option for increased and safe access to AOD services for patients in rural and remote areas.

COVID-AOD-article.jpg
Males aged 20–30 were among the cohorts most likely to have increased their drinking during the pandemic. 

What do the results tell us?
The relationship of stress and alcohol consumption – the ‘self-medication’ hypothesis – appears to have been confirmed by the emerging evidence about alcohol intake and COVID-19.
 
Alcohol related harms during COVID-19 have increased, and the growing demand for community-based services shows the important role of general practice in the treatment of alcohol and other drugs issues.
 
GPs can effectively support patients to contemplate change, minimise risk, manage their alcohol related issues and alcohol use disorders.
 
Telehealth is an important innovation that is improving access to alcohol treatment services. Furthermore, alcohol-related harms are expensive so supporting GPs to provide alcohol treatment services and maintaining Medicare item numbers for telehealth makes good financial sense.
 
Parents, women over 30 in child caring roles, and men who have reduced working hours, have all noticeably increased their alcohol use. They would benefit from opportunistic alcohol screening, screening for family violence, and for comorbidity such as stress, anxiety and depression.
 
Increased screening for mental health issues and psychological support should also be considered for children and their families.
 
As COVID restrictions ease and drinking establishments re-open, there is concern that more Australians will resume their drinking, while other Australians will continue to drink more in the home. This could result in an overall net increase in alcohol use compared with pre-pandemic drinking levels.
 
How GPs can help patients who are drinking
After gaining consent to discuss the person’s alcohol use, the AUDIT-C screening tool can be used to determine the level of alcohol consumption.
 
A brief intervention of 5–10 minutes may be all a person needs to reduce their alcohol use. This is most beneficial for patients drinking at mild-to-moderate levels.
 
Dependent or heavy drinkers would benefit from a referral to a specialist alcohol and other drugs service.
 
FRAMES (Feedback, Responsibility, Advice, Menu of options, Empathy, Self-efficacy) is a useful acronym to help GPs conduct a brief intervention. This aims to give information in a way that improves the therapeutic alliance, is patient centered, empathetic and uses the strength of general practice to provide care over the longer-term.
 
Strategies to reduce harm and/or alcohol consumption are most likely to succeed when developed with the patient, and are ‘SMART’ – Specific, Measurable, Attainable, Relevant and Time-based.
 
Strategies can include: 

  • alternating alcoholic beverages with water
  • limiting drinking to certain times of the day
  • swapping drinks to lower alcohol options
  • setting a daily limit
  • distraction with activities not involving alcohol.
Pharmacotherapy options can also be effective for some patients.
 
Training is available for GPs to support patients who use alcohol and other drugs. RACGP members can apply to the AOD GP Education Program to access training and receive a $1200 completion payment.
 
Places are limited and applications close on 31 March or when spaces are filled.
 
*The studies conducted thus far have not included data on Aboriginal and Torres Strait Islander people, people who identify as lesbian, gay, bisexual, transgender, queer, intersex, asexual +, as well as those people from culturally and linguistically diverse communities.

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Dr Christopher Charles Davis   12/01/2022 12:11:21 PM

Thanks for highlighting this hidden pandemic. People are consuming 26.7% more alcohol in the last year and alcohol related deaths have risen by 8.6% in the same period. As the problem worsens our FTF services have been hit by reduced capacity due to social distancing requirements in rehab units leading to fewer beds and staff shortages across the board.
This is why telehealth has become a lifesaver. I encourage all my GP colleagues to look at www.cleanslateclinic.com for any of their patients that need a home alcohol detox provided completely over telehealth and for some great free resources for HCP's and patients.