Changes in US drinking and alcohol use disorders associated with social, health, and economic impacts of COVID-19.

Aims: The COVID-19 pandemic increased alcohol consumption in the USA as a result of widespread individual changes in drinking patterns. Few studies have utilized longitudinal data allowing the prediction of increased or decreased drinking from COVID-19 economic, social, and health impacts.

Methods: Data are from 1819 respondents in the 2019-20 National Alcohol Survey and a one-year follow-up in early 2021. Changes in past-year alcohol volume, drinking days, days with 5+ drinks, and Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) alcohol use disorder (AUD) severity were measured as outcomes. Measures of COVID-19 economic, health, and social impacts were assessed for the individual and household. Economic impacts were combined into Self and Household scores. Analyses utilized multinomial logistic regression models to estimate meaningful increases or decreases in outcomes, while generalized estimating equation models estimated overall effects.

Results: Increases in alcohol use and AUD severity were larger and more prevalent than decreases, and differences between sociodemographic groups in the prevalence of meaningful increases and decreases were found. Models of meaningful changes found that higher self-economic impact scores predicted increases in 5+ days and AUD severity. Generalized estimating equation models also found that the self-economic impact score predicted increased AUD severity and additionally that being an essential worker was associated with reductions in alcohol volume and 5+ days.

Conclusions: Substantial changes in drinking and AUD severity were observed, with increases in these outcomes being more prevalent and larger than decreases. Results highlight the importance of the pandemic's economic impacts in predicting changes in drinking and AUD severity.