The Covid-19 pandemic has led to a worrying trend in the United States: an increase in alcohol consumption and related deaths that has not subsided as expected. Dr. Brian Lee, a transplant hepatologist at Keck Medicine of the University of Southern California, had anticipated a decrease in alcohol use but has instead witnessed a rise in patients suffering from liver failure due to excessive alcohol intake. "I had hoped for a decline in alcohol consumption, but as a liver specialist, I've seen an actual increase in patients with liver failure, a severe clinical outcome of overdrinking," Dr. Lee stated. "This surge has continued through the pandemic, and my clinical and hospital experiences reflect this trend, with no signs of reduction."

New research, spearheaded by Dr. Lee and published in the Annals of Internal Medicine on November 12, reveals that the upward trend in alcohol consumption in the U.S. in 2020 persisted, showing a slight increase in 2021 and 2022. The study utilized data from the National Health Interview Survey, conducted by the U.S. Census Bureau, and compared it with data from 2018 as a baseline. The research encompassed nearly 25,000 respondents from 2018, approximately 31,000 from 2020, and almost 27,000 from 2022. The increase in alcohol consumption was observed across both genders and all racial and ethnic groups. In 2022, 69.3% of Americans reported consuming alcohol in the past year, a slight increase from 69% in 2020 and 66.34% in 2018. Furthermore, the percentage of heavy drinkers rose to nearly 6.3% of those surveyed in 2022, up from 6.13% in 2020 and 5.1% in 2018.

"Although these results are concerning, they are not unexpected," remarked Dr. Jagpreet Chhatwal, director of the Institute for Technology Assessment at Massachusetts General Hospital, who was not part of the study. "Alcohol consumption has been on the rise over the past few years." Among White Americans, the increase in heavy drinking was the most significant, with about 7.3% identifying as heavy drinkers, an increase from approximately 5.7% in 2018 and 7.1% in 2020. Women were also more likely to be heavy drinkers, with 6.45% reporting as such, compared to 6.1% of men. Dr. Lee cautions that even a small increase in alcohol consumption can pose health risks: "For women, drinking more than one drink per day can put you at risk for liver disease."

The National Institute on Alcohol Abuse and Alcoholism defines heavy drinking for women as consuming four or more drinks in a single day or eight or more per week. For men, it is defined as five or more drinks a day or 15 or more per week. The institute considers a drink to be about 14 grams of pure alcohol, which is equivalent to approximately 12 ounces of regular beer, 5 ounces of wine, or 1.5 ounces of distilled spirits.

While the study's authors could not pinpoint the exact reasons for the high alcohol consumption among the surveyed U.S. adults, Dr. Lee offers several hypotheses. "Many people experienced significant pandemic-related disruptions to their careers, such as job loss or the loss of routine. Some also have young children," he explained. "We know that alcohol is often used as a coping mechanism for stress. What begins as a habit can evolve into addiction or a substance use disorder." Dr. Chhatwal concurred, adding that life stressors like financial instability, work stress, or other mental health issues may contribute to the increase in alcohol consumption. "The increasing stress and burnout in society can exacerbate this tendency," he said. "The normalization of drinking culture also plays a role in increased and excessive consumption. Unfortunately, most people only recognize the damage caused by alcohol in the later stages of liver disease, when treatment options are limited."

Data from the U.S. Centers for Disease Control and Prevention show that alcohol-related deaths in the U.S. surged during the pandemic, with over 49,000 in 2020. The peak of the pandemic also saw an average of about 488 deaths per day due to excessive alcohol consumption, marking an increase of more than 29% from 2016-17 to 2020-21. Dr. Lee believes that research findings alone are insufficient to deter people from overconsumption. "We have shown in studies that liver transplants for alcohol-related conditions have increased fivefold in the last 20 years. We have also shown that alcohol-related deaths due to liver disease are on the rise," he said. "Now, it's about intervention. What interventions could actually work to save lives, and what policies can we enact to curb the surge?"

Dr. Chhatwal suggests measures such as heavier taxation and limiting sale hours within retailers to reduce alcohol accessibility. Both Dr. Lee and Dr. Chhatwal also recommend more and better messaging on the risks of overconsumption to counter these effects. "People need to understand what constitutes harmful alcohol use and its impact on your body," Dr. Lee said. "Medical professionals really need to discuss alcohol use with their patients openly and nonjudgmentally. Alcohol has been linked to more than 200 diseases, including heart disease, cancer, and pancreatic disease—it can truly affect your body, and both patients and doctors need to be aware of this."