GPs can play a pivotal role in the identification and management of alcohol problems at any time, and their role is even more important during the COVID-19 pandemic as more and more patients are resorting to alcohol to manage the stress and anxiety created by the pandemic.
- For some people, alcohol consumption has increased during the COVID-19 pandemic.
- This is likely associated with the elevated stress, anxiety and depression experienced by many, as well as increased time spent at home during periods of lockdown.
- GPs should screen every patient for alcohol misuse, even if they do not suspect it. The Alcohol Use Disorders Identification Test for Consumption (AUDIT-C) and the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition checklist for alcohol use disorder (AUD) are ideal assessment tools.
- Mental health problems commonly co-occur with AUD; therefore, GPs should also be prepared to investigate these during consultation.
- Laboratory investigations and physical examination may also indicate AUD; however, they should not be used in isolation.
- Management options include pharmacological treatment, withdrawal management and supportive counselling.
Alcohol is the most widely used drug in Australia, with almost 85% of the population reporting at least occasional use and 20% exceeding recommended safe drinking levels.1 Of the risk factors contributing to the burden of disease in Australia, alcohol ranks sixth, with over 200 medical conditions attributed to alcohol use, including chronic liver disease (which covers liver cancer), injuries sustained through motor vehicle accidents, suicide and self-inflicted harm.1 In recent years, population-wide alcohol use has fallen but medical complications have not changed significantly. Fewer than 20% of those with problematic drinking seek treatment for their alcohol use.2 Given most people in Australia visit a GP at least once per year, GPs are ideally placed to identify those with problematic alcohol use, and to screen all patients routinely as recommended by the RACGP guidelines.3
Impact of COVID-19 on alcohol use
The impact of COVID-19 on the drinking patterns of people in Australia has resulted in either a marked reduction in alcohol use or, conversely, a marked increase in alcohol use. As a result of the pandemic, the Australian government introduced social distancing measures and ordered nonessential services including licensed venues such as pubs and clubs to temporarily close, which resulted in changes to the sale and consumption of alcohol.4
For some people, lockdown offered an opportunity to change previously problematic drinking behaviour by facilitating abstinence.5 Changes in financial security because of the pandemic may also have indirectly contributed to forced abstinence from alcohol, and may account for the increased rates of complicated alcohol withdrawal reported during the COVID-19 pandemic.6,7
Although some Australians reduced their drinking during COVID-19, others increased their alcohol intake. Alcohol sales and home delivery increased significantly during the pandemic. Spending more time at home and the increased stress associated with the pandemic has led many Australians to increase their alcohol intake, with women aged 35 to 44 years reporting the greatest increase in alcohol consumption.8 Using alcohol to cope with anxiety and stress was reported by one in three people in Australia during lockdown.9
Stressful life experiences such as pandemics and other natural disasters are associated with increased risk of alcohol use and alcohol-related problems.10,11 However, the COVID-19 pandemic is unique in that it has lasted for much longer than typical natural disasters such as floods or bushfires. Most workers in Australia worked from home during lockdown and many children were also spending more time at home, causing a disruption to many households’ usual routines. Connecting with family and friends has become difficult, if not impossible, for many since the pandemic. Rates of domestic violence during the COVID-19 pandemic increased dramatically.12