The COVID-19 pandemic has been one of the biggest threats to public health in living memory. Governments have been uncertain how to respond. The media has flooded us with constant updates. Scientists have been searching for treatments, vaccines and cures. And our insatiable appetite for COVID-19 information has led to all of us expanding our vocabulary, to include new words likes ‘hydroxycholoquine’ and ‘angiotensin-converting enzyme 2’.
Governments around the world have imposed lockdown restrictions, meaning most of us have been isolated, at least to some degree, over the past few months.
The rationale for the lockdown is to reduce disease transmission, and is pretty clear: if we stay away from people, we can’t catch the virus or pass it on! And, the success of the lockdown in this regard has been tangible. However, the impacts of the lockdown on non-virus-related health problems have also been tangible, with reports of many people ‘suffering in silence’ in fear of burdening the health service with their ‘less pressing’ health problems, and the lines of empty beds in hospital wards raising concerns about increased rates of health problems (heart attacks, stroke, cancer) becoming a reality as we move out of lockdown.
Some of us may have enjoyed, at least to some extent, the break from work the furlough scheme has offered. However, there is another side to this. An issue that has been concerning public health officials and researchers in the field. And that issue is our nation’s mental health.
In my particular field of research, which is alcohol use and misuse, there is a particular problem. The evidence is overwhelmingly clear that social isolation and lack of access to health services are among the most significant risk factors for mental health problems, including drug and alcohol misuse and dependence. At the beginning of the lockdown, I wrote an Op Ed in The Lancet: Public Health, in which I raised my concerns about this:
- Lockdown may be stressful, and we know that stress increases cravings for alcohol
- Lockdown might increase boredom, and we know that those at risk of alcohol misuse show high rates of impulsivity, and that impulsive people are much more prone to boredom
- Lockdown reduces social support and access to face-to-face services. For those in recovery or treatment for alcohol-related problems, continued support from those around them, including clinicians but also wider social support networks, is a critical part of their success.
Now that we are moving out of lockdown, what are we seeing? Have my
concerns been realised? Well, so far, it is not clear. Let’s start with
the good news: generally, people are drinking less. A survey of 2000 people
by Alcohol Change UK showed that 72% of people surveyed think they have
been consuming either the same or less than prior to lockdown. This was
somewhat unexpected, given the meteoric rise in supermarket and online
alcohol sales that were reported early in the lockdown by consumer data
analytics organisations such as Neilson. However, with the closure of
bars and restaurants, it seems likely that many people simply changed
their moderate drinking habits from outside to inside the home (either
that, or there are store cupboards throughout the UK that are stacked
six-feet high with Andrex, self-raising flour and Gordon’s Gin!).
However, those statistics still leave 28% drinking more, and some of
those have been drinking a lot more. Personal communications I’ve had
from staff on the frontline of alcohol services (such as hepatology and
specialist nursing teams) have indicated a sharp spike in cases of
alcohol-related illness, including relapse of some people who were in
recovery. In addition, there have been reports from the USA of increases
in alcohol use amongst people to tend to drink to cope,
raising concerns of similar problems in the UK. This could lead to a
rise in the number of people developing alcohol use disorders in the
coming months, or in any future lockdowns.
So, where do we go from here? We may see a second wave of COVID-19
infections (and maybe a third or fourth) and further social distancing
measures may follow. It is critical that health professionals focus on
those at risk of alcohol harm during any future restrictions, and devise
strategies for supporting them during lockdown. It may be that at-risk
people are encouraged, even during lockdown, to access face-to-face
services. It may be, dare I say it, that the Government introduces some
limitations in alcohol sales during lockdown? This seems to have worked
well in South Africa, albeit with a large spike of hospital admissions
after the ban was lifted. Whatever route we take, it’s important to
learn the lessons from this crisis before the next one hits us!
Follow Matt Parker on Twitter @psych_genes.
