Alcohol consumption surged during the pandemic — and deaths followed

Rhode Island stand-up comedians Kirsten Logan and Frank Gazerro already drank plenty. The husband and wife were literally paid in drinks at nightclubs. Then came the pandemic.

Logan, 35, drank over the stress of continuing to report to work as an emergency veterinarian technician, even as the coronavirus spread. Stuck at home, Gazerro, 40, guzzled copious amounts of bourbon, or sometimes cheap grain alcohol, every day - until he was rushed to the emergency room with an inflamed liver in the fall of 2021.

Recently released federal data underscores their experience: U.S. consumption of alcohol, which had already been increasing for years, accelerated during the pandemic as Americans grappled with stress and isolation.

At the same time, the number of deaths caused by alcohol skyrocketed nationwide, rising more than 45%. In 2021, alcohol was the primary cause of death for more than 54,000 Americans, causing nearly 17,000 more deaths than just a few years before, in 2018, according to data from the Centers for Disease Control and Prevention.

Mississippi saw a 159% increase in alcohol-related deaths, the nation’s biggest leap, along with a 10% rise in apparent consumption. In Delaware, consumption increased the most, by 25%, while alcohol-related deaths rose 73%.

George F. Koob, director of the National Institute on Alcohol Abuse and Alcoholism (NIAAA), said the traumas of the pandemic - the fear of covid-19 infection, job losses, social isolation - added to the stresses that were already spurring people to drink. “The pandemic just made it worse,” Koob said.

The highest alcohol consumption since 1988

Experts point to a variety of factors for the increase, among them stagnant alcohol taxes that make drinking cheap relative to inflation, increased marketing to women and social despairs that have led to crises of mental health and addiction in the United States.

According to NIAAA data, apparent consumption of alcohol, measured as gallons of ethanol sold per capita, increased by 6.6% between 2018 and 2021 across the United States, reaching an average of about 2.8 gallons per person annually - roughly 597 drinks per year - for Americans over 21.

That’s the highest consumption level since 1988. The data from the agency’s annual report, published in late April, represents “apparent” consumption of alcohol because it is inferred from alcohol sales data by state, as opposed to traditional survey data.

The drinking patterns reported by the NIAAA varied significantly by state. In nine states - including Florida, Tennessee and New Jersey - alcohol consumption increased by at least 10%.

The NIAAA data suggests that increased alcohol consumption may be more pronounced than previously believed. The 2021 National Survey on Drug Use and Health indicated that nearly 9 in 10 U.S. adults of drinking age reported drinking the same or less than they did before the pandemic.

Researchers say this type of survey data can mask risky behavior or changes in drinking habits because respondents often underreport their alcohol use.

Alcohol-related deaths increased in every state

As alcohol use was surging, so were alcohol-related deaths. Between 2018 and 2021, deaths caused by alcohol increased in every state, according to CDC mortality data.

Some states that had some of the biggest increases in consumption also had some of the largest spikes in alcohol-related death rates. In Mississippi, the rate of deaths caused by alcohol more than doubled in a four-year span, rising from 7 deaths per 100,000 residents to about 18 deaths per 100,000 in 2021.

“The costs of alcohol abuse and dependence are phenomenal,” said Jefferson Parker, a professor of psychiatry who co-directs a new addiction treatment program at the University of Mississippi Medical Center, which last fall received a $6 million federal grant to help treat alcohol use disorder, along with opioid addiction.

New Mexico had more than 51 deaths per 100,000 residents, the highest rate of alcohol-related deaths in the country, and an increase of almost 50% from its rate in 2018. Death rates related to alcohol also nearly doubled in Montana, South Dakota and Delaware during that time.

Many different underlying diseases or conditions involving alcohol could cause death. Between 2018 and 2021, the rate of Americans dying from alcoholic cirrhosis of the liver, the leading alcohol-related cause of death, grew by 42%, while deaths stemming from alcohol dependence or harmful use disorders increased by 54%.

Younger drinkers saw the biggest increase in the rate of alcohol-related deaths, which spiked by nearly 80% among 25-to-44-year-olds, a Washington Post analysis of CDC data found. For every 100,000 people that age, 12 people died of alcohol-related issues in 2021, the analysis found.

Older age groups didn’t see rises that dramatic but already had high rates. People between the ages of 55 and 64 had the highest rate of alcohol-related deaths, at 42 per 100,000.

Those findings add to similarly grim statistics. A CDC study published last fall estimated that between 2015 and 2019, excessive alcohol use was to blame for 1 in 8 deaths of Americans between the ages of 20 and 64.

Driven by spirits sales and loosening of rules

The pandemic spike was notably driven by sales of spirits, which rose nearly 17% compared with less than 1% for both wine and beer.

In Rhode Island, where Logan and Gazerro live in the town of Warwick, the state ranked third in terms of relative increases in spirits sales since 2018.

For Gazerro, a podcaster and consultant, his drinking escalated in his 30s and got worse during the boredom of pandemic shutdowns. There was a liquor store a few blocks from his apartment. The pandemic also spurred lawmakers in Rhode Island, among other states, to allow restaurants to sell takeout alcohol. Rhode Island has since made the measure permanent.

The growth of the spirits industry has been pronounced, helped by the popularity of luxury brands and ones backed by celebrities - think tequila brands launched by actors such as Dwayne Johnson or Mark Wahlberg. The Distilled Spirits Council of the United States reports that in 2022, the spirits revenue market share (42.9%) eclipsed that of beer (41.9%) for the first time. The council’s president recently called it a “great American success story,” according to CNBC.

The council cites changing consumer tastes toward high-end products, plus ready-to-drink beverages such as hard seltzers, and the proliferation of craft distilleries, which number more than 2,600 today.

During the pandemic, consumers who weren’t spending on vacations or restaurants instead spent on luxury spirits they could stock at home, said Amanda Berger, the council’s vice president of science and health.

“The majority of adults who choose to drink do so responsibly, and we have seen decreases in harmful drinking (including binge drinking and underage drinking) for more than a decade,” she said.

While the share of Americans under 35 that report binge drinking decreased by about 20% between 2011 and 2021, binge drinking has remained at about 18% among 35-to-54-year-olds over the decade and increased by about 13% for those over 55, according to survey data from the CDC’s Behavioral Risk Factor Surveillance System.

Alcohol has become more affordable

Critics have long pointed to the affordability of alcohol as a driving force behind increases in consumption.

Congress last raised the federal alcohol tax in 1991. State taxes vary widely but have generally been stagnant, said Philip J. Cook, an economist and professor emeritus at Duke University, who has studied alcohol taxes and consumption. Congress helped the industry more recently, slashing federal taxes on certain alcohol producers in 2017, changes made permanent three years later.

“Alcoholic beverages are cheaper today than they were in the 1980s, relative to the value of the dollar,” Cook said.

Public health officials say the cost to society is dire.

In Massachusetts, for example, a Boston University School of Public Health report in December found that the state’s excise taxes have lost 72% of their value since 1980, when they were last raised, amounting to less than a nickel per drink.

“This is the cheapest and most available drug to American adults,” said David H. Jernigan, a Boston University professor of health law and a critic of alcohol industry marketing.

In 2020, Massachusetts state alcohol tax revenue was just $78.6 million, according to the report. Meanwhile, researchers estimated that in 2010, the last year for which data was available, excessive alcohol use cost the state $5.6 billion in lost productivity, health care, criminal justice and other areas.

Berger, on the spirits council, disputed the criticism, saying that the spirits industry is one of the country’s most “heavily taxed and regulated industries” in the United States and that those who abuse alcohol aren’t deterred by higher prices. She said in a statement that tax hikes unfairly raise the cost on “responsible consumers” and hurt hospitality businesses still reeling from the pandemic.

Increasing taxes remains a tough sell. An effort to increase taxes on beer and wine in Oregon earlier this year fizzled, and last month, its governor dropped a request to the state’s alcohol commission to impose a 50-cent surcharge on bottles of liquor.

In Massachusetts, liberal Democrats have introduced legislation that would double the excise tax on alcohol products, which could raise up to an additional $89.5 million to be used for substance use education and treatment. But chances of the bill passing are not good - Rep. Kay Khan (D) has introduced a similar bill for years to no avail.

“It’s sort of a sacred cow,” Khan said. “It’s hard to get people to pay attention.”

Some are rethinking their relationship with alcohol

Koob, the director of the NIAAA, is hopeful about the future. He points out that many Americans are nevertheless rethinking their relationship with alcohol, as new research has also punctured the myth that drinking alcohol in moderate amounts is good for one’s health.

There’s been a noted decrease in alcohol consumption by underage drinkers, as well as the recognition of dry Januarys and the rising popularity of nonalcoholic alternatives, he said.

For Logan and Gazerro, they’ve been sober for more than a year, although it hasn’t been easy. “I loved everything about alcohol. It’s like an old friend I haven’t gotten to hang out with in a while,” Gazerro said.

Logan quit alcohol for her health - and to support her husband. But the cultural allure was strong. They felt awkward being out at nightclubs without a drink. So they started the Rhode Island Non-Alcoholic Beer Society, a networking group.

Said Logan, “I wanted people to be able to find restaurants that serve nonalcoholic beer, and stores that carried different varieties within the state.”