Alcohol use behavior, policy, and treatment in the age of COVID-19
A webinar and Facebook Live event from the PTTC Network Coordinating Office
September 22, 2020
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PTTC Network
Today’s Presenters
Julia Sherman
Wisconsin Alcohol Policy Project, University of
Wisconsin Law [email protected]
Dr. Denis M. McCarthy
Professor of Psychology and Associate Chair for Research, Department of Psychological
Sciences, University of [email protected]
Kamilla L. Venner, Ph.D.
Assistant Professor Department of Psychology, University of New Mexico
COVID and Drinking
Changes in Consumption• Alcohol is the most accessible impairing drug
(but…cannabis)
• In March, Neilsen reported a 55% increase in alcohol sales
• Overall 5% increase in sales in March and April
• Sales down 5% in May
Changes in Consumption
• BacTrack published data on BAC changes pre-and post-lockdown
• In March, there were significant changes in • Average BAC in most States• Drinking days of the week (shift from weekend to
weekday)• https://www.bactrack.com/pages/coronavirus-covid-19-causing-dramatic-shift-
alcohol-drinking-habits-americans-lockdown \
• Biased sample of drinkers
Changes in Consumption• Emerging U-shaped curve in drinking changes
• Small group showing large increases in drinking• Others decreased drinking• Unclear what distinguishes the groups
• Women & Black adults more likely to increase
COVID and Drinking• Curated database of COVID papers
• https://www.addictionjournal.org/index.php/newsroom/news
• Changes in locations and motives for drinking
• Increases in solitary and at-home consumption• Increases domestic violence, child neglect
COVID and Drinking Motives• Alcohol is both stimulating and sedating
• Drinking to celebrate or socialize (stimulation) • Drinking to cope with negative affect/stress (sedation)
• Motives can alter effects and consequences
• Increased drinking to cope with stress, negative affect, boredom
• Not effective, more likely to lead to negative consequences
How Drinking Alters COVID Risk
Drinking and COVID• Alcohol reduces immune response
• May increase risk or severity of infection
• Increases risk for lung problems from COVID
Drinking and COVID• Alcohol reduces vigilance & behavioral control
• Harder to maintain social distancing• Mask wearing and physical distancing are not
established behaviors• Require higher level of cognitive control
• Can lead to unintentional “risk taking”
Drinking and COVID• Alcohol alters judgment and risk perception
• COVID changes risk of some behaviors• Driving alternatives have different “costs”
• Strategies for safe drinking need to change
Cannabis and COVID
• Approaching alcohol in accessibility
• Less clear data on changes in cannabis use
• Like alcohol, can be used to cope
• Effect on depression/anxiety not clear
Policy Changes
Julia Sherman
Wisconsin Alcohol Policy Project
Availability of Alcohol
When alcohol becomes more available, problems follow:
Immediate problems: disorderly conduct, noise, property damage, neighborhood disruption.
Long term problems:alcohol is a causal factor in 7 different cancers, number of outlets increases the number of ACES recorded for area youth.
Changing Alcohol Policies Make the temporary permanent • Mixed drinks to go• Home delivery of alcohol
Changes in law or rule• Expanded footprints “licensed premises” or
“licensed area”• Home delivery of alcohol authorized• Reinterpretation of existing law/rules
• Growlers in Wisconsin
Issues with Home Delivery
• Drafts assign all liability for underage/intoxicated person sales to delivery service, not retailer.
• Limit to on-premises licensees or allow off-premises.
• Limit days and times for delivery.• Community opt-in/opt out? Delivery
radius?• Limited to sealed containers?• Enforcement protocols are
developing, untested.
Concerns with Click & Collect Alcohol
• May impact licensed footprint• How to ID intoxicated
customers.• Underage purchasers• Lack of enforcement protocols
or meaningful sanctions for:• Online ordering• Home delivery• Curbside/Click & Collect
Mixed drinks to go
• Before the pandemic only Florida & Mississippi allowed.
• During the pandemic – 33 states and D.C. allowed, some sunset.
• Many required concurrent food sale.• Some states allowed 3rd party delivery
(DoorDash)• Michigan allows through 2025
Concerns About Mixed Drinks To-Go
Problem Solutions/Mitigation
• Require food purchase with alcohol sales
• Require a seal and define it• Define when and where drinks
may be consumed
• Strength• Amount of alcohol will vary• Not sealed by manufacturer
tampering is possible
• Public safety• Drinking in cars• Underage drinking
Options
• Add and enforce sunset dates• Create meaningful sanctions
including suspension or loss of license
• Fund the creation/testing of enforcement protocols
• Fund enforcement by the appropriate agencies
Framing the Issue:
This is about health &
safety, not business
• There is no “healthy” level of drinking –only low-risk drinking.
• Communities see small businesses closing –hospitality industry hard hit.
• Save the Bars Movement – license fees and tax abatement proposals
• We know that expanding the availability of alcohol increases alcohol consumption.
• Unintended consequence, avoid blame.• Expand sympathy to all hard-hit
businesses. • Change the commoditization
of alcohol.
An Opportunity to Reduce Density
• Some licensees will close permanently.
• Map & measure now to assess outlet density .
• Relicense carefully based on vision & mapping.
COVID and Treatment with American Indian/
Alaska Native clients
Kamilla L. Venner, Ph.D.
Assistant Professor of Psychology
University of New Mexico
FCOI Disclosure
I have a financial conflict of interest (FCOI) management plan at the University of New Mexico due to providing training and consultation in evidence-based treatments for fee
Overview
AI/AN health inequities in COVID-19 prevalence
Challenges to SUD Treatment Reservations severely restricted (on lock down)
Technological challenges
Increased social isolation and stress
Facilitators of SUD Treatment
Summary
Age-adjusted mortality by race
New Mexico AI/AN COVID-19 mortality
COVID-19 related increases mental health problems
Increase substance use
Increase in misuse of medications to treat opioid use disorder
Increase in overdose death
Increase in suicidal behaviors
Increase in anxiety and depression
Why COVID related health inequities?
Not because of race Social Determinants of Health
Historical Trauma and Colonization
Boarding Schools
Poverty, Unemployment
Quality of education
Housing – multigenerational, cannot isolate one person from others in home
Neighborhood factors (e.g., safety, safe roads, lighting, distance to hospitals)
Reservation- lack of clean water sources, lack of running water
Access to culturally safe medical care (IHS severely underfunded)
AI/AN Strengths
High rates of alcohol and drug abstinence
People have resolved substance use disorder
Cultural Identity
Spirituality
Traditional Ceremonies
Community connectedness
SUD Outpatient Treatment Programs:Challenges
Many outpatient and inpatient programs closed since March of 2020 No in-person sessions (intake, group or individual counseling)
Patients go in to quickly and safely sign consent to treat forms
Phone contact Often focused on basic level needs, food, utilities, services, COVID
testing
Technological Challenges Counselors and patients limited in access to broadband providers
Little familiarity with virtual telehealth options
Lack of client privacy at home
Counselor and staff fears of contracting COVID if offer in-person treatment
Traditional Healing
Community ceremonies can lead to spread of COVID-19
Recommendations
Self-prayer
Self-smudging
Healers use phone or video
Virtual dances
https://www.mprnews.org/story/2020/03/17/every-step-you-take-is-prayer-as-coronavirus-spreads-women-lead-virtual-dance-for-healing?utm_content=buffer81478&utm_medium=social&utm_source=twitter.com&utm_campaign=buffer
COVID-19 related SUD Treatment:Opportunities
Technology and virtual sessions Overcome stigma
Increase outreach and engagement
Overcome transportation problems
Free phone app https://www.addictionpolicy.org/post/free-app-to-
support-people-in-recovery-during-covid-19-outbreak
On-line recovery groupshttps://www.intherooms.com/home/covid-19-resources/
AA online meetings
Summary
AI/AN populations disproportionately impacted by COVID-19 morbidity and mortality
SUD treatment programs experiencing many challenges Shut down since March
Challenges with technology for virtual outpatient counseling
Many clients not getting treatment services
Opportunities Increase outreach and engagement with virtual services
Decrease burden on client
Use Traditional healing and practices safely
Tsin ‘aen (Thank you)
Questions?
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