The effect of pandemic‐related alcohol marketing: No data yet – Wiley

Abstract

The National Institute on Alcohol Abuse and Alcoholism (NIAAA) has a page devoted to updates on state alcohol policies adopted in response to the pandemic, but it has no information on the effects of these policies, which include expanded home delivery, curbside pickup, to‐go cocktails and more. The policies were meant to limit virus exposure. Some states have extended these policies, with the enthusiastic support of and urging by restaurant and alcohol beverage lobbies, until 2023, which could be well after the pandemic emergency ends.

Bottom Line…

The NIAAA would love to have had data before to‐go cocktails, home deliveries of alcohol, and other pandemic‐related moves were made; there is still no research, even as states extend the new policies, probably beyond the emergency.

The National Institute on Alcohol Abuse and Alcoholism (NIAAA) has a page devoted to updates on state alcohol policies adopted in response to the pandemic, but it has no information on the effects of these policies, which include expanded home delivery, curbside pickup, to‐go cocktails and more. The policies were meant to limit virus exposure. Some states have extended these policies, with the enthusiastic support of and urging by restaurant and alcohol beverage lobbies, until 2023, which could be well after the pandemic emergency ends.

ADAW talked to NIAAA and alcohol marketing researcher David H. Jernigan, Ph.D., about the ramifications of these changes to alcohol policies, which for years have focused on server and host liability, drunk driving and, to a lesser extent, alcohol‐related health harms.

The NIAAA’s Alcohol Policy Information System (APIS) existed prior to the pandemic but has been expanded during the pandemic. It includes policy information on the recreational use of cannabis. For the APIS dataset, which is updated regularly and includes information on all 50 states and the District of Columbia, go to https://alcoholpolicy.niaaa.nih.gov/resource/covid‐19/98. Also see https://alcoholpolicy.niaaa.nih.gov/sites/default/files/file‐page/digest_state_alcohol_policies_in_response_to_covid‐19_201015.pdf.

Home delivery

One of the biggest problems is that home delivery of meals, now accompanied by alcohol, is being done by third parties who have not necessarily received any training at all in identification of consumers. The National Restaurant Association, which did not provide answers to our emailed questions, also has concerns about this.

“Until now, the relationship between restaurants and third‐party delivery companies lacked a national framework to protect restaurants,” said Mike Whatley, vice president of state and local affairs for the association, in a March 1 statement. “These new principles, which center around permission and transparency, add consistency and structure that will benefit all restaurants.” There are seven principles, one of which applies to alcohol and states: “Restaurants should be able to offer alcohol to customers through third‐party delivery in a safe and legal manner.” The statement from the association also says “restaurants with liquor licenses rely on beverage alcohol sales to improve their bottom line.”

“The big deal with home delivery is the fact that the delivery folks are not trained to check IDs,” said Jernigan, who is a professor of health law, policy and management at Boston University. Delivery services are “not licensed purveyors of alcohol,” he told ADAW last week. “And we’ve seen bars morphing into semi‐restaurants so that they can do home delivery of alcohol — it’s allowed if they sell you a bag of potato chips.”

In California, a compliance check by the beverage control commission a year ago found that four out of five times the ID was not checked at all in home delivery, upping the chance that the recipient was a minor. Bars, restaurants and liquor stores know how to check IDs properly; at least, they are trained to.

“Internally when we talk about this, what comes up repeatedly is ID‐ing by people who deliver,” said Aaron White, Ph.D., senior scientific advisor to the director at NIAAA. “We are hoping people will go to the APIS system to look at state policies.” Questions include how this is going to be enforced, he told ADAW. “Everything has moved so fast because of this very unique situation [the pandemic] we’re moving in,” he said.

“At NIAAA, being a research institution, the preference would be to start with data first,” said White. “Our position is, we do the science, and we measure the effects of policy change.” But it’s way too soon to know what those effects are, he said. “There have only been one or two studies at all about delivery,” he said. “We just don’t know.”

Although White did not comment on this, many agencies, including health‐related ones, have seen their budgets diverted from core functions to COVID‐19, often to the Centers for Disease Control and Prevention. That may well be happening here. We hear from researchers that the grant process is very slow now.

AUDs

Some people are drinking more — especially women, and especially women with children at home — said Jernigan, adding that “this is not a good coping behavior; this is a maladaptive coping behavior.”

At least with “on‐premises” drinking (in bars and restaurants), consumers are under the eye of servers, who have been trained. Off‐premises drinking (at home) has gone up, based on liquor store sales. “What we’re finding from the studies in the U.S. is that people are drinking more often,” said Jernigan. “People who wouldn’t be headed toward alcohol use disorder (AUD) are — for example, the couple that used to buy a bottle of wine on a Friday and have two or three good meals is now buying five bottles of wine because they only wanted to go to the store once.”

Why were liquor stores made essential services that needed to stay open during lockdown? Unclear, except that early on, the most frequent supposition was that if liquor stores closed, people would go into withdrawal (although that was debunked by experts; see Alcohol store closure in Pennsylvania: Withdrawals in future?, ADAW, March 23, 2020; https://onlinelibrary.wiley.com/doi/10.1002/adaw.32665), said Jernigan. “That’s just supposition, though,” he said.

“The bottom line is we have a lot of people who are drinking more,” said Jernigan. And this follows the pattern of disasters. “If you look a year or two out from 9/11, from Hurricanes Rita and Katrina, from the SARS epidemic in Hong Kong, you get an uptick in AUDs.”

“The main point is you don’t have to have an increase in alcohol use in the country for there to be an increase in alcohol‐related harm.”

Aaron White, Ph.D.

Already in the United States there are reports from hospitals of an increase in alcohol‐related liver disease (see “Pandemic linked to rise in alcoholic hepatitis and liver failure,” ADAW, March 1; https://onlinelibrary.wiley.com/doi/10.1002/adaw.32988). Women and young people are drinking earlier. And it takes a long time to develop alcohol‐related liver disease, so when there are stories about people in their 50s having it, it’s clear that this is a pattern that was set already and can only get worse.

People over 65

Typically, around 20% of people report drinking more, 50% report drinking less and the rest report drinking at the same levels, said White. People over 65 are drinking more, and this is a serious concern, he said.

Older people are more likely to fall and injure themselves, he said. In addition, the over‐65 population is growing in size, and “we’re worried about the burden [excessive drinking] will place on the health care system,” he said.

People are more likely to be drinking alone, with “levels of anxiety and depression gone through the roof,” said White. Isolation and addiction go together anyway.

“The main point is you don’t have to have an increase in alcohol use in the country for there to be an increase in alcohol‐related harm,” White said. He explains that for a given individual, the more you drink, the greater your risk of harm. The risk of harm is not zero at one drink a day. If you have more people drinking one drink a day, if they’re 65, for example, the harm comes from health effects. One in 10 people 65 or older gets hurt in a fall. The one drink could increase the likelihood of this fall. And older people tend to have less water in their bodies, so they reach a higher blood alcohol content earlier. Finally, many take other medications that interact with alcohol.

There’s a good biomedical reason for alcohol being used as a stress reliever, even if it’s not healthy to do so. “One of the things that alcohol does very well is slow down brain areas, especially the amygdala,” said White. “The amygdala is the brain’s canary in the coal mine, warning you of danger,” he said. “In the modern world, the amygdala can be chirping all day long.” Alcohol quiets it. That makes you less worried about getting sick, money, life stress — all pandemic‐related concerns.

But because of the way the brain works, it doesn’t like you to pull it away from its balance. “When the alcohol wears off, the amygdala goes up to a higher volume,” said White. “Then you need more alcohol.”

Research has shown that female college students who say they drink to cope with anxiety are drinking even more and have even worse anxiety after a year. So the self‐medication for stress with alcohol backfires.

Driving

There are no studies on the relationship between liberalized alcohol policies and drunk driving per se. There are indications that driving itself went way down when lockdown began more than a year ago, especially in the early weeks, but that the number of crashes and fatalities went up. But whether this was due to alcohol, reckless driving, lack of police enforcement or something else is not known. “We don’t know; we’re so slow with research like this,” said Jernigan.

Figures from Massachusetts show that in April 2020, traffic dropped by about 50%, but the number of fatalities remained the same, said Jernigan.

Omnipresence of alcohol

“Largely because of the industry’s marketing being everywhere, alcohol has become the wallpaper of our lives,” said Jernigan. It’s hard to fight against both the pandemic and marketing. Add to that “societal amnesia,” in which cycle after cycle, “people can’t remember the damage that alcohol causes.”

And again, there are no studies that presaged the balancing of risks of COVID‐19 and AUDs. Into this research gap comes new policy, made by politicians, possibly lowering the risk of COVID‐19 transmission (by keeping people out of bars) but probably increasing the risk of drunk driving and AUDs. Extending the new policy beyond the pandemic serves the industry well, noted Jernigan. And it’s already doing well. Restaurants, which are not, are eager to use alcohol to improve sales.

Source: https://onlinelibrary.wiley.com/doi/10.1002/adaw.33049