The coronavirus pandemic has changed our everyday lives and the way we think about our health. In this blog, Dr Kieran Bunn from the Institute of Alcohol Studies explains why tackling alcohol harm should remain a priority.
It is hard to overstate the sheer speed and scale of the current crisis – at the beginning of February, the name COVID-19 did not even exist, and yet, just six months later, it has led to more than 45,000 deaths across the UK.
Throughout this period, my colleagues and I have continued to advocate for policies to reduce and prevent alcohol-related harm. This begs the not unreasonable question: why? Is the midst of the biggest public health crisis we’ve seen in a century really the right time to be asking politicians to consider alcohol?
The answer is a clear yes. If we don’t, we could risk another health crisis further down the line. By tackling alcohol harm we could also free up essential resources for the NHS, speed our economic recovery, and build a healthier, more resilient society.
Why we must think about the effect of COVID-19 on alcohol harm
COVID-19 is a global challenge, and it has impacted all our lives, but its consequences have been far from even. For some groups, this crisis has been particularly acute, and one such group is those who have experienced alcohol-related harm.
Alcohol is associated with both hypertension and dementia, underlying conditions that appear to increase the severity of COVID-19. Moreover, alcohol harm contributes to health inequalities: the substantial unevenness of alcohol harm explains up to a quarter of the difference in mortality between socio-economic groups. COVID-19 has shone a grim light on these inequities, with those living in the most deprived areas twice as likely to die of the disease than those in the least.
The response to the virus itself has also had a particular impact on those who have experienced alcohol-related harm. For those in recovery, isolation can present a particular challenge. Despite the phenomenal adaptive response of the treatment and recovery community, for some this period has included a relapse or recurrence of their addictive behaviour. As with most alcohol harm, the effects are not limited to just one person: early surveys identified that, during lockdown, alcohol raised tensions at home. We also know alcohol is associated with domestic violence. Calls to the National Association for Children of Alcoholic illustrate just how difficult this period could be for some. We need to think about existing alcohol harm during this crisis, but there is also a risk that COVID-19 may magnify these harms.
Why the crisis could worsen alcohol harm
If we don’t act, we risk a lasting increase in alcohol harm forming part of the legacy of COVID-19. Survey data seems to indicate that lockdown may have led to a polarisation in drinking. While some, away from pubs and restaurants, drank less, others, perhaps due to stress and isolation, drank more. Alarmingly, there is emerging evidence that we may have already seen a rise in high risk drinking. Looking further ahead, there is more reason for concern. The stresses of bereavement, illness, job instability, and an uncertain future could all contribute to a surge in alcohol harm.
At the individual level, a rise in alcohol harm represents huge personal impacts: in England, alcohol is the leading risk factor for death, ill-health, and disability amongst 15-49-year-olds. On a national level, a rise in alcohol harm could put potentially unbearable pressure on a system already under enormous strain. Shockingly, prior to the crisis, just one in five dependent drinkers in England were believed to be in treatment. Services have seen their budgets fall by an average of 30% since 2012 due to substantial cuts in the Public Health Grant.
The treatment provider, We Are With You, found that during the crisis people were unlikely to access non-emergency health services. This was reflected in their own referrals for alcohol treatment, which were down 72%. Most of these problems will have been deferred, not resolved, and it is likely that the delay will have made them worse. Compounding this, a survey from Action on Addiction found that 24% of people who experienced addictive behaviour during lockdown thought they would need support or treatment to resolve it – across the UK this equates to over 690,000 people. For scale, less than half that number were in contact with alcohol and drug services in England in the 2018/19 financial year.
Why tackling alcohol harm should be a part of our recovery
Tackling alcohol harm could become a cornerstone of an effective national recovery from COVID-19. The best policies to tackle alcohol harm, such as increasing the price through taxes or minimum unit pricing and restricting advertising, are exceptionally cost effective. Importantly, this kind of population-level prevention can free up resources for the ongoing COVID-19 response: alcohol-related incidents are estimated to take up 25% of A&E doctors’ time, make up 37% of ambulance staff’s workload, and represent an enormous 53% of police time.
This has already been recognised by some during this crisis: a specialist alcohol unit in Greater Manchester increased their capacity in part to relieve pressure on local A&Es. As the Government looks for smart investments to drive our recovery, we’d urge them to consider alcohol treatment, which boasts an impressive social return of £3 for every £1 spent.
Prevention in the 2020s
In 2019, the Government published the Prevention Green Paper Advancing our health: prevention in the 2020s. Although the start of the 2020s looks very different to what many imagined, the argument for prevention is stronger than ever. A focus on prevention would not only avert a surge in alcohol harm, but also lay a path for a rapid, vigorous recovery that allows the UK to level up and unlock its potential.
Crises include a mix of immediate rapid action and opportunities for reflection. At the beginning of this decade, it is now time to think about how we want our society to look like at the end. The House of Lords is holding an inquiry into Life beyond COVID and we want your input. What should our relationship to alcohol look like after this crisis? What are you worried about for the future? What do you think the government could be doing to support you, your community, and our country?
All responses received by 19 August will feed into our response to the government’s consultation.
Written by Dr Kieran Bunn, Policy and Advocacy Officer, The Institute of Alcohol Studies
This blog was published with the permission of the author. The views expressed are solely the author’s own and do not necessarily represent the views of the Alcohol Health Alliance or its members.