Shortly after the first cases of COVID-19 were reported in Canada in early 2020, provincial governments deemed liquor retailers an essential service. While addictions experts generally favoured this decision — which helps support individuals with alcohol addictions — it raised a new set of potential public health concerns.
Around eight Canadians die in hospital each day due to alcohol use, with rates of hospitalization comparable to those due to heart attacks[i]. According to the Canadian Mental Health Association, alcohol is by far the most commonly drug used by Canadians, and 15% of drinkers consume above Canada’s Low-risk Alcohol Drinking Guidelines.
Over a year into the pandemic, mental health experts are actively researching the impact of COVID-19 on mental health and substance use. Research indicates associations between exposure to mass traumatic events and increased alcohol consumption and related harms following the crises.[ii] However, the Canadian Journal of Public Health pointed out in a June 2020 report that “there is limited evidence available to guide governments’ response to manage public access to alcohol during such events.”
As mental healthcare professionals, we have a vested interest in the impact COVID-19 has had on alcoholism and substance use overall.
WHAT IS ALCOHOLISM?
Alcoholism, known clinically as alcohol use disorder (AUD), is a problematic pattern of use leading to clinically significant impairment or distress.[iii]
In the Diagnostic Statistical Manual for Mental Disorders (DSM-V), AUD can be diagnosed when at least 2 of the following occur within a 12-month period:
- Alcohol is often taken in larger amounts or over a longer period of time than intended.
- There is a persistent desire or unsuccessful efforts to to cut down or control alcohol use.
- A great deal of time is spent in activities necessary to obtain alcohol, use alcohol, or recovery from its effects.
- Craving, or a strong desire or urge to use alcohol.
- Recurrent alcohol use resulting in a failure to fulfill major role obligations at work, school or home.
- Continued alcohol use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of alcohol.
- Important social, occupational or recreational activities are given up or reduced because of alcohol use.
- Recurrent alcohol use in situations where it is physically dangerous.
- Alcohol use is continued despite knowledge of having a persistent or recurrent or psychological problem that is likely to have been caused or exacerbated or caused by alcohol.
- Tolerance: You need to drink more in order to feel the intoxicating effects of alcohol
- Withdrawal: Symptoms of acute alcohol withdrawal range from tremors, nausea, body aches, nightmares and high blood pressure, to more severe symptoms like seizures and hallucinations.
Drinking, even daily, in low doses and occasional intoxication does not qualify as alcoholism or AUD.
In a recent webinar on the pharmacology of alcohol use disorder, EHN Sandstone psychiatrist Dr. Tim Ayas pointed out that there is a genetic component to alcoholism. A person with a close relative that has AUD is three-to-four times more likely to develop the disorder themselves, a statistic which has been replicated in studies where children were adopted early in life and therefore not raised by their biological parents.10
“There’s quite a lot that we’re still studying, but one fairly predominant theory right now is that [AUD] might be due to over-active alcohol dehydrogenase enzymes in these families,” he said. This means that certain people’s bodies are more efficient at filtering out the toxic properties of alcohol, and can drink more without feeling negative side effects that typically deter overuse.
ALCOHOLISM AND COVID-19
Over a year into the pandemic, many people have already faced significant stressors, such as a death or illness in the family, job loss, increased parenting responsibilities, social isolation and fear of infection. A survey conducted by CAMH between May 2020 to March 2021 found one in five Canadian adults reported experiencing high levels of mental distress:
- Overall, 20.9 per cent of respondents indicated moderate to severe anxiety levels;
- 20.1 per cent reported feeling depressed, and 21.3 percent reported feelings of loneliness.
And, 25.7 per cent of survey participants reported binge drinking in the previous week, a number that has remained relatively consistent throughout the pandemic. Binge drinking means having many drinks on one occasion: five or more drinks for men, or four or more drinks for women[iv]. Most Canadians drink moderately, with about a quarter of these drinkers over age 15 drinking more than government recommended amounts.
COVID-19’S IMPACT ON SUBSTANCE USE
Researchers have cited concerns about the overall state of mental health in Canada due to decreased access to in-person services and safe supplies of substances, and increased risk of substance-related harms. Specifically, alcohol use and its associated harms are a huge burden on Canada’s healthcare system.
“The mental health system in Canada was already under extreme duress before the pandemic began,” said CAMH Psychiatrist Dr. David Gratzer in an April press release. “If this is the new normal in terms of the mental health of Canadians, providing adequate support is unsustainable without a significant increase in resources.”
Statistics Canada’s most recent survey of substance use, conducted in January 2021, found that close to one-in-four Canadians believed their consumption had increased, compared with the pre-pandemic period. The amount of Canadians who drank heavily (at least five drinks in one sitting) also increased. As to why they believe they drank more, people cited boredom, stress, easy access to alcohol, loneliness and insomnia.[v]
It’s also important to consider that private and public alcohol retailers bring in billions of dollars every year, and that there is a financial incentive for governments and businesses to keep sales up. Overall, $23.6 billion worth of alcoholic beverages were sold in Canada in the fiscal year ending March 31, 2019.[vi]
While COVID-19 has impacted alcoholism and alcohol use overall, not everyone is drinking more. Of Canadians who had consumed alcohol pre-COVID, 22 per cent said they’d decreased their alcohol intake this year.[vii] Global alcohol market analysts have found that consumer demand for no- and low alcohol beer, wine, spirits, products grew and continues to increase.[viii]
EHN CAN HELP
Whether you’re an individual who needs help with your mental health or substance use disorder, or you’re an employer who has employees who need help—we’re here for you.
References
[i] Canadian Institute for Health Information. (2020). Health indicators interactive tool: Hospitalizations entirely caused by alcohol. Your Health System. https://yourhealthsystem.cihi.ca/hsp/inbrief?lang=en#!/indicators/061/hospitalizations-entirely-caused-by-alcohol/;mapC1;mapLevel2;trend(C1);/
[ii] Hobin, E., & Smith, B. (2020). Is another public health crisis brewing beneath the COVID-19 pandemic? Canadian Journal of Public Health, 111(3), 392–396. https://doi.org/10.17269/s41997-020-00360-z
[iii] Understanding Alcohol Use Disorder | National Institute on Alcohol Abuse and Alcoholism (NIAAA). (2020). National Institute on Alcohol Abuse and Alcoholism. https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/understanding-alcohol-use-disorder
[iv] Canadian Centre on Substance Use and Addiction. (2018). Canadian Centre on Substance Use and Addiction. Canada’s Low-Risk Alcohol Drinking Guidelines. https://www.ccsa.ca/sites/default/files/2020-07/2012-Canada-Low-Risk-Alcohol-Drinking-Guidelines-Brochure-en_0.pdf
[v] Alcohol and cannabis use during the pandemic: Canadian Perspectives Survey Series 6. (2020). Statistics Canada. https://www150.statcan.gc.ca/n1/en/daily-quotidien/210304/dq210304a-eng.pdf?st=51WnuxaJ
[vi] Government of Canada. (2020). Alcohol use among Canadians. https://health-infobase.canada.ca/alcohol/ctads
[vii] Statistics Canada. (2021). The Daily — Alcohol and cannabis use during the pandemic: Canadian Perspectives Survey Series 6. https://www150.statcan.gc.ca/n1/daily-quotidien/210304/dq210304a-eng.htm
[viii] IWSR Drinks Market Analysis. (2021, February). No- and Low-Alcohol Products Gain Share Within Total Beverage Alcohol. https://www.theiwsr.com//www/wp-content/uploads/IWSR_No-and-Low-Alcohol-Gains-Share-Within-Total-Beverage-Alcohol-2021.pdf
