Alcohol-related deaths and hospitalizations spiked during the pandemic. Could policy have made a difference?

The COVID-19 pandemic threw a wrench in Dr. Peter Butt's retirement plans. Not because of an influx in patients infected with the new virus — but because he pivoted to an inpatient addiction medicine consulting service, and so many more people needed his help with alcohol use. 

"What we saw was ... potentially a doubling of the number of people coming in needing alcohol withdrawal management or other services directly attributable to their alcohol use," said Butt, a family physician who also co-chaired Canada's Guidance on Alcohol and Health.

Now, a new study from the Canadian Medical Association Journal suggests not only were more people consuming more alcohol — there were more hospitalizations and deaths because of it.

Between April 2020 and December 2022, deaths fully attributable to alcohol were up about 18 per cent, while hospitalizations were up about eight per cent. The increases were highest in the first two years of the pandemic, with deaths up about 24 per cent, and hospitalizations about 14 per cent. That's 1,596 more deaths and 7,142 more hospitalizations that may not have happened if not for alcohol consumption.

Preliminary data, published by Statistics Canada in 2023, already suggested that alcohol-related deaths increased during the pandemic. This new study is a much more complete look at the data, looking at long-term trends, as well as alcohol-related harm by income quintile, region and specific condition type. 

It even controlled for different waves of the pandemic, said lead author Dr. Yipu Shi, a senior epidemiologist at the Public Health Agency of Canada. She said pandemic-related stressors, health restrictions and health-care capacity all varied across waves — in addition to people's access to and willingness to seek care. 

That may have had "varying effects on alcohol consumption and related harm," she said.

Younger adults were most vulnerable to alcohol-related harms. Excess deaths were highest among adults aged between 25 and 44, while excess hospitalizations were more pronounced among young women between 15 and 44, suggest researchers. 

Alcoholic liver disease — which includes fatty liver disease, alcoholic hepatitis and cirrhosis — was the leading cause of both hospitalizations and deaths, the authors say. 

Some of the factors that drove the increase: "Stress, boredom, worsening mental health, disrupted health care and easier access to alcohol," say the authors. 

The trend did decline significantly by 2022, returning to pre-pandemic levels, said Shi, though excess mortality remained slightly higher. The decrease in alcohol-related harm came hand-in-hand with a decline in alcohol sales in 2022, said Shi. 

The results are consistent with findings from other countries. In the United States, there was a 29 per cent increase in alcohol-related deaths. Another study looking at 19 European countries found an 18 per cent increase in such deaths. 

A 'self-inflicted wound' 

"The magnitude of the increase to me was a bit surprising," said Dr. Tim Naimi, the director of the Canadian Institute for Substance Use Research at the University of Victoria, who was not involved in the study. 

Naimi says it's still not clear what the long-term effects of increased alcohol consumption during the pandemic will be — like rates of some cancers that are caused by alcohol.

"Even for things like liver disease," he said "There's almost like a conveyor belt of people with different degrees of liver disease, for example, some of whom may have a damaged liver but they haven't come to medical attention yet."

Naimi calls some policy decisions during the pandemic a "self-inflicted wound."

"Alcohol was declared an essential commodity at the beginning in all 13 provinces and territories," said Naimi.

Adam Sherk, a senior scientist also with the Canadian Centre on Substance Use and Addiction, says he understands why liquor stores were deemed an essential service: It was a time of extreme stress, and taking away alcohol would have been difficult.

At the time, some provinces also justified the move by saying for those who have severe alcohol abuse disorder, withdrawal symptoms could be severe and dangerous without medical supervision. Some praised this rationale — but others criticized it. 

But it did cause serious harm, for individuals, as well as the health-care system writ large, says Sherk.

"It increased the draws on our health-care system, because alcohol is responsible for a lot of those draws:" resources that were very precious, as hospitals were overwhelmed due to the spread of COVID-19, said Sherk.

If there are future pandemics or national emergencies, Sherk says, this could serve as a lesson for policymakers — to take a more tempered approach to alcohol sales, like reducing opening hours at alcohol outlets. 

"I'm not saying close all the alcohol outlets," he said. "We could possibly do it in a way that was a bit more balanced and protective of our health."

Another important way to address factors that drive increased alcohol consumption? Expanding services that help people cope with difficult emotions and build resilience, says Butt. 

"Instead of thinking about increased access to alcohol as being an essential service during times of national emergency," he said, "we should be thinking of the importance of increased access to mental health services."