Tackling Scotland's Alcohol Problem
Myths, Lockdowns, Curfews & Bans: Alcohol consumption & harms during COVID-19
By Yvette Mojica-Perez (PhD student, La Trobe University) and Dr. Claire Wilkinson (Senior Research Fellow, University of New South Wales)
Last month the International Confederation of ATOD Research Associations (ICARA), with the support of SHAAP and the Scottish Alcohol Research Network (SARN), held the last of a series of webinars on the impact of COVID-19 on alcohol, tobacco and other drug research and services. Attendees were treated to four fantastic presentations unpacking the impact of the pandemic on alcohol consumption and harms in South Africa (Professor Charles Parry), India (Dr. Abhijit Nadkarni), Australia (Dr. Sarah Callinan) and England and Scotland (Professor Niamh Fitzgerald). Here, we provide a summary of each presentation and then discuss some overarching themes.
Unnatural deaths, alcohol bans and curfews in South Africa: Evidence from a quasi-natural experiment during COVID-19 - Professor Charles Parry
South Africa was one of a limited number of countries to at times completely prohibit the sales of alcohol to help the hospital system cope with COVID-19. In contrast to many other places, the South African President acknowledged that alcohol was not an essential product. Alongside alcohol sale restrictions, there were curfews of varying lengths on leaving one’s home. This gave researchers a quasi-natural experiment to untangle the impacts of curfews, compared to alcohol restrictions, on alcohol-related harms.
Professor Parry presented results from his published study comparing unnatural deaths occurring during complete and partial restrictions on alcohol sales and curfews of varying lengths from January 2020 to April 2021. When there were complete restrictions on alcohol sales (off-premise and on-premise) and when a curfew was in place, there was a significant reduction in unnatural deaths. Whereas, during periods without any restrictions on the sale of alcohol and a curfew there was an increase in unnatural deaths.
Shifts in alcohol consumption during the COVID-19 pandemic in Australia - Dr. Sarah Callinan
Similarly, researchers in Australia were given an unexpected natural experiment when Victoria, the second most populous Australian jurisdiction, exclusively entered an extended second lockdown in 2020. Drawing on an existing survey, researchers were able to measure self-reported home drinking among Australians living under different restrictions. Home drinking increased in Victoria, while participants from the rest of Australia reported a reduction in home drinking. Their longitudinal data supports an argument that lockdown was causally associated with an increase in home drinking. Dr. Callinan spoke about results from two further studies drawing on self-report data from convenience samples with Australians. The first study found that participants consumed alcohol more often but reported drinking less per occasion under lockdown compared with 2019. The second study found that there was an increase in home drinking in April 2020 compared to 2019 but overall consumption decreased. The authors data also indicate how alcohol consumption among men and women and people of different age groups have been impacted differently, a key finding of international survey research on this topic.
“Alcohol kills Coronavirus, I drink alcohol, ergo I don’t need the vaccine” - Stories from India - Dr. Abhijit Nadkarni
Dr. Nadkarni talked about the inconsistency in alcohol policy responses to COVID-19 across India. In some states alcohol was considered an “essential good”, while other states closed all liquor stores and bars and some introduced permit and prescription systems to enable individuals to purchase alcohol. During the pandemic, access to formal care for alcohol-related issues was scarce. The use of technology such as tele-health and face-to-face support from non-specialised health workers for people with alcohol use disorders were existing modes of service delivery which became instrumental for those seeking support. Dr Nadkarni also pointed to early but positive results from using text-messaging-based Brief Interventions to treat alcohol use disorders.
Lockdown & Licensed Premises: COVID-19 Lessons for Alcohol Policy - Professor Niamh Fitzgerald
Professor Fitzgerald presented mixed-methods results from three studies. In the first study, licensing stakeholders were interviewed to evaluate how the pandemic had impacted on alcohol sales at licensed premises in England and Scotland. This study found that changes in alcohol licensing permitted the sale of takeaway alcohol which favoured some businesses more than others.
In a second study, a large reduction in alcohol-related ambulance callouts was evident during the first 2020 lockdown in Scotland. Results from the third, qualitative study complement this finding, with ambulance clinicians indicating that there was a “massive drop” in alcohol-related callouts. Ambulance clinicians expressed fear over the impact of home drinking habits in the future, should drinking patterns during COVID-19 persist. The large decrease in alcohol-related ambulance attendances raises questions about ‘the amount’ of alcohol-related harms we might wish to return to, once restrictions are lifted.
Bringing things together
With the closure of licensed premises, there was an increase in home drinking which was found in Dr. Callinan’s research and was also mentioned as an area of concern for ambulance clinicians in Professor Fitzgerald’s study. Both presenters noted home drinking habits during lockdown may persist as restrictions lift. A policy implication from all four presenters was addressing the current light regulation of online availability of alcohol. As Professor Fitzgerald noted restricting online/ home deliveries may dually support a reduction in alcohol-related harms while helping the recovery of the on-premise/on-trade sector.
Another similarity among presenters was the ability of researchers to make strategic use of existing survey studies to provide insights into the impacts of COVID-19 on alcohol consumption and alcohol-related harms. As policy goal posts change and restrictions were introduced researchers responded with new survey questions, while others drew on administrative data to assess impacts in the health system.
There were also several differences. One was the extent alcohol sales were restricted. So, while full prohibitions existed for a period in South Africa and in some Indian states, alcohol was always available from off-trade outlets in Australia, England, and Scotland. Dr Nadkarni noted that trade in illegal liquor had reportedly increased during COVID-19. Dr Nadkarni’s presentation also highlighted how restrictions on alcohol were implemented in the context of varying alcohol control baselines. That is, alcohol controls and enforcement vary greatly internationally. A government’s ability to limit alcohol availability depends on the strength of their alcohol control system and their existing enforcement capabilities.
Professor Parry’s presentation was unique in being able to readily untangle the impacts of curfews, compared to alcohol restrictions, on patterns of unnatural deaths. Thus, refuting the argument put by the alcohol industry that it was the curfews that were responsible for a reduction in unnatural deaths.
Dr. Nadkarni explained the inconsistent responses in alcohol policy during the pandemic in India. The closure of all liquor stores and bars led to issues with alcohol withdrawals, suicides suspected to be due to restrictions on alcohol sales, accidental deaths (e.g. consumption of hand sanitiser), illicit alcohol and alcohol sold on the black market. However, the presentation did not examine the scale of these impacts. Dr Nadkarni’s work was also unique in highlighting the acceleration of changes already underway in parts of India in responding to individuals seeking support with alcohol-use disorders.
Conclusion
COVID-19 has provided a rare natural quasi-experiment on the impacts of huge societal change on alcohol consumption and alcohol-related harms. The four presentations here are illustrative of the range of study design and topics that are occurring internationally, and how researchers are making strategic use of existing studies to provide insight into the impacts of COVID-19 on alcohol consumption and alcohol-related harms.
The four presenters explored the impacts of restrictions and lockdowns on alcohol consumption and harm during COVID-19. There were many similarities and differences in the experience across the four continents, all of which will be imperative as we continue explore and understand the impacts of COVID-19 on alcohol consumption and harms in the years to come. Future research will inform policy and can provide valuable information for providers of alcohol-related services.
Contributors
Yvette Mojica-Perez is a PhD student at the Centre for Alcohol Policy Research (CAPR) at La Trobe University. Her PhD will investigate the short- and long-term impacts of COVID-19 on alcohol consumption. Her first paper will explore how people’s alcohol consumption and drinking patterns changed during the COVID-19 pandemic, with a focus on participants from Victoria who experienced a second lockdown in 2020 compared to participants from the rest of Australia who were not subject to the same lockdown restrictions. Yvette’s PhD will also examine the relationship between mental health and alcohol consumption during the pandemic.
Dr. Claire Wilkinson is a Senior Research Fellow specialising in alcohol policy. She works at the Drug Policy Modelling Program at the University of New South Wales. She has been working on a study exploring the impact of COVID-19 on alcohol consumption and purchasing behaviour in New South Wales, as well as being part of an international team mapping and classifying alcohol policy changes occurring during the first wave of COVID-19 in five countries and/or subnational jurisdictions.
All SHAAP Blogposts are published with the permission of the authors. The views expressed are solely the authors' own and do not necessarily represent the views of Scottish Health Action on Alcohol Problems.
You can watch the recording of this webinar below:
The ICARA webinar series on the impact of COVID-19 on alcohol, tobacco and other drug research and services was sponsored by the Society for the Study of Addiction (SSA).