Alcohol use behavior, policy, and treatment in the age of COVID-19

A webinar and Facebook Live event from the PTTC Network Coordinating Office

September 22, 2020

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PTTC Network

Today’s Presenters

Julia Sherman

Wisconsin Alcohol Policy Project, University of

Wisconsin Law Schooljulia.sherman@wisc.edu

Dr. Denis M. McCarthy

Professor of Psychology and Associate Chair for Research, Department of Psychological

Sciences, University of Missourimccarthydm@missouri.edu

Kamilla L. Venner, Ph.D.

Assistant Professor Department of Psychology, University of New Mexico

kamilla@unm.edu

COVID and Drinking

Changes in Consumption• Alcohol is the most accessible impairing drug

(but…cannabis)

• In March, Neilsen reported a 55% increase in alcohol sales

• Overall 5% increase in sales in March and April

• Sales down 5% in May

Changes in Consumption

• BacTrack published data on BAC changes pre-and post-lockdown

• In March, there were significant changes in • Average BAC in most States• Drinking days of the week (shift from weekend to

weekday)• https://www.bactrack.com/pages/coronavirus-covid-19-causing-dramatic-shift-

alcohol-drinking-habits-americans-lockdown \

• Biased sample of drinkers

Changes in Consumption• Emerging U-shaped curve in drinking changes

• Small group showing large increases in drinking• Others decreased drinking• Unclear what distinguishes the groups

• Women & Black adults more likely to increase

COVID and Drinking• Curated database of COVID papers

• https://www.addictionjournal.org/index.php/newsroom/news

• Changes in locations and motives for drinking

• Increases in solitary and at-home consumption• Increases domestic violence, child neglect

COVID and Drinking Motives• Alcohol is both stimulating and sedating

• Drinking to celebrate or socialize (stimulation) • Drinking to cope with negative affect/stress (sedation)

• Motives can alter effects and consequences

• Increased drinking to cope with stress, negative affect, boredom

• Not effective, more likely to lead to negative consequences

How Drinking Alters COVID Risk

Drinking and COVID• Alcohol reduces immune response

• May increase risk or severity of infection

• Increases risk for lung problems from COVID

Drinking and COVID• Alcohol reduces vigilance & behavioral control

• Harder to maintain social distancing• Mask wearing and physical distancing are not

established behaviors• Require higher level of cognitive control

• Can lead to unintentional “risk taking”

Drinking and COVID• Alcohol alters judgment and risk perception

• COVID changes risk of some behaviors• Driving alternatives have different “costs”

• Strategies for safe drinking need to change

Cannabis and COVID

• Approaching alcohol in accessibility

• Less clear data on changes in cannabis use

• Like alcohol, can be used to cope

• Effect on depression/anxiety not clear

Policy Changes

Julia Sherman

Wisconsin Alcohol Policy Project

Availability of Alcohol

When alcohol becomes more available, problems follow:

Immediate problems: disorderly conduct, noise, property damage, neighborhood disruption.

Long term problems:alcohol is a causal factor in 7 different cancers, number of outlets increases the number of ACES recorded for area youth.

Changing Alcohol Policies Make the temporary permanent • Mixed drinks to go• Home delivery of alcohol

Changes in law or rule• Expanded footprints “licensed premises” or

“licensed area”• Home delivery of alcohol authorized• Reinterpretation of existing law/rules

• Growlers in Wisconsin

Issues with Home Delivery

• Drafts assign all liability for underage/intoxicated person sales to delivery service, not retailer.

• Limit to on-premises licensees or allow off-premises.

• Limit days and times for delivery.• Community opt-in/opt out? Delivery

radius?• Limited to sealed containers?• Enforcement protocols are

developing, untested.

Concerns with Click & Collect Alcohol

• May impact licensed footprint• How to ID intoxicated

customers.• Underage purchasers• Lack of enforcement protocols

or meaningful sanctions for:• Online ordering• Home delivery• Curbside/Click & Collect

Mixed drinks to go

• Before the pandemic only Florida & Mississippi allowed.

• During the pandemic – 33 states and D.C. allowed, some sunset.

• Many required concurrent food sale.• Some states allowed 3rd party delivery

(DoorDash)• Michigan allows through 2025

Concerns About Mixed Drinks To-Go

Problem Solutions/Mitigation

• Require food purchase with alcohol sales

• Require a seal and define it• Define when and where drinks

may be consumed

• Strength• Amount of alcohol will vary• Not sealed by manufacturer

tampering is possible

• Public safety• Drinking in cars• Underage drinking

Options

• Add and enforce sunset dates• Create meaningful sanctions

including suspension or loss of license

• Fund the creation/testing of enforcement protocols

• Fund enforcement by the appropriate agencies

Framing the Issue:

This is about health &

safety, not business

• There is no “healthy” level of drinking –only low-risk drinking.

• Communities see small businesses closing –hospitality industry hard hit.

• Save the Bars Movement – license fees and tax abatement proposals

• We know that expanding the availability of alcohol increases alcohol consumption.

• Unintended consequence, avoid blame.• Expand sympathy to all hard-hit

businesses. • Change the commoditization

of alcohol.

An Opportunity to Reduce Density

• Some licensees will close permanently.

• Map & measure now to assess outlet density .

• Relicense carefully based on vision & mapping.

COVID and Treatment with American Indian/

Alaska Native clients

Kamilla L. Venner, Ph.D.

Assistant Professor of Psychology

University of New Mexico

FCOI Disclosure

I have a financial conflict of interest (FCOI) management plan at the University of New Mexico due to providing training and consultation in evidence-based treatments for fee

Overview

AI/AN health inequities in COVID-19 prevalence

Challenges to SUD Treatment Reservations severely restricted (on lock down)

Technological challenges

Increased social isolation and stress

Facilitators of SUD Treatment

Summary

Age-adjusted mortality by race

New Mexico AI/AN COVID-19 mortality

COVID-19 related increases mental health problems

Increase substance use

Increase in misuse of medications to treat opioid use disorder

Increase in overdose death

Increase in suicidal behaviors

Increase in anxiety and depression

Why COVID related health inequities?

Not because of race Social Determinants of Health

Historical Trauma and Colonization

Boarding Schools

Poverty, Unemployment

Quality of education

Housing – multigenerational, cannot isolate one person from others in home

Neighborhood factors (e.g., safety, safe roads, lighting, distance to hospitals)

Reservation- lack of clean water sources, lack of running water

Access to culturally safe medical care (IHS severely underfunded)

AI/AN Strengths

High rates of alcohol and drug abstinence

People have resolved substance use disorder

Cultural Identity

Spirituality

Traditional Ceremonies

Community connectedness

SUD Outpatient Treatment Programs:Challenges

Many outpatient and inpatient programs closed since March of 2020 No in-person sessions (intake, group or individual counseling)

Patients go in to quickly and safely sign consent to treat forms

Phone contact Often focused on basic level needs, food, utilities, services, COVID

testing

Technological Challenges Counselors and patients limited in access to broadband providers

Little familiarity with virtual telehealth options

Lack of client privacy at home

Counselor and staff fears of contracting COVID if offer in-person treatment

Traditional Healing

Community ceremonies can lead to spread of COVID-19

Recommendations

Self-prayer

Self-smudging

Healers use phone or video

Virtual dances

https://www.mprnews.org/story/2020/03/17/every-step-you-take-is-prayer-as-coronavirus-spreads-women-lead-virtual-dance-for-healing?utm_content=buffer81478&utm_medium=social&utm_source=twitter.com&utm_campaign=buffer

COVID-19 related SUD Treatment:Opportunities

Technology and virtual sessions Overcome stigma

Increase outreach and engagement

Overcome transportation problems

Free phone app https://www.addictionpolicy.org/post/free-app-to-

support-people-in-recovery-during-covid-19-outbreak

On-line recovery groupshttps://www.intherooms.com/home/covid-19-resources/

AA online meetings

Summary

AI/AN populations disproportionately impacted by COVID-19 morbidity and mortality

SUD treatment programs experiencing many challenges Shut down since March

Challenges with technology for virtual outpatient counseling

Many clients not getting treatment services

Opportunities Increase outreach and engagement with virtual services

Decrease burden on client

Use Traditional healing and practices safely

Tsin ‘aen (Thank you)

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