Alcohol-related deaths increased significantly during the pandemic, according to a new study published in JAMA, and were likely exacerbated by accumulated stress, a lack of social support, and treatment delays.

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Study details and findings

For the study, researchers from the National Institute on Alcohol Abuse and Alcoholism (NIAAA) analyzed U.S. mortality data from the National Center for Health Statistics to compare the number and rates of alcohol-related deaths among individuals ages 16 and older in 2019 and 2020. Deaths were considered alcohol-related if alcohol was listed as an underlying or contributing cause.

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Overall, alcohol-related deaths made up 2.8% of all deaths in 2019 and 3% of all deaths in 2020. the number of alcohol-related deaths in the United States increased from 78,927 in 2019 to 99,017 in 2020—a 25.5% increase. In comparison, the average annual increase in alcohol-related deaths between 1999 and 2019 was only 3.6%. Previously, the highest increase in alcohol-related deaths was 5% from 2018 to 2019.

The rates for alcohol-related deaths increased across all age groups, with the largest increases occurring among people ages 35 to 44 (39.7%) and people ages 25 to 34 (37%). Both men and women saw similar increases in rates at 25.1% and 27.3%, respectively, although the absolute number of alcohol-related deaths was higher among men.

Notably, the number of alcohol-related deaths outnumbered Covid-19 deaths among adults under the age of 65. In 2020, 74,408 Americans ages 16 to 64 died of alcohol-related causes, while 74,075 individuals under 65 died of Covid-19.

The researchers also examined provisional data from CDC for the first half of 2021 and found that alcohol-related deaths remained elevated during that time. However, it is not yet clear if the elevated numbers are a continuation of the trend seen in 2020.

"Maybe they'll go back down," said Aaron White, a senior scientific advisor at NIAAA and the report's first author, "but this could be the new norm."

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According to the researchers, the increased rate of alcohol-related deaths is the related to a rise in alcohol consumption during the pandemic, which has largely been driven by increased stress. From 2019 to 2020, total alcohol sales in the United States by volume increased by 2.9%, the largest annual increase in sales since 1968.

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"It's not uncommon for people to drink more when they're under more duress, and obviously, the pandemic brought a lot of added stress to people's lives. In addition to that, it reduced a lot of the normal outlets people have for coping with stress, [like] social support and access to gyms," White said.

Katherine Keyes, a professor of epidemiology at Columbia University who was not involved in the study, said the findings reflect a crisis that has been growing for several years.

"As with many pandemic-related outcomes, this is an exacerbation of issues that were beginning before the pandemic for many people," Keyes said. "Drinking has been going up for 10 or 15 years among adults, and the trend accelerated in 2020, as some of the motivations to drink changed: Stress-related drinking increased, and drinking due to boredom increased."

This increased stress and lack of social support may have also contributed to people in recovery from alcohol abuse relapsing. "Stress is the primary factor in relapse, and there is no question there was a big increase in self-reported stress, and big increased in anxiety and depression, and planet-wide uncertainty about what was coming next," White said. "That's a lot of pressure on people who are trying to maintain recovery."

In addition, an inability or reluctance to access treatment during lockdowns or surges when health care systems were overwhelmed with Covid-19 patients may have discouraged some people from getting needed care, according to John Kelly, a professor of psychiatry at Harvard Medical School and the director of the Recovery Research Institute at Massachusetts General Hospital.

"Deaths involving alcohol reflect hidden tolls of the pandemic," the researchers wrote in the study.

Going forward, White said it's important for health care providers to address the potential underlying causes behind this increase in alcohol-related deaths by increasing screenings and openly asking patients about their alcohol use. He also called for new approaches to addiction that will teach people how to cope with stress more productively.

"We are entering an era in public health where we are talking more about promoting wellness and building resilient people," he added. "What we are doing now is not sufficient. We need to help people live meaningful purpose-filled lives." (Rabin, New York Times, 3/22; Ahmed, CNN, 3/18; White et al., JAMA, 3/18)