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I recently hit my five-year mark without a drop of alcohol. Given how stressful the past year has been, I often pat myself on the back for getting through without a drink. Sadly, drinking has increased at alarming rates during the pandemic. Countries like Canada, the U.K., Australia, and the United States have all seen significant increases in alcohol use and abuse. Indeed, as stress increases, coping mechanisms proliferate — both the healthy and unhealthy ones
It’s understandable why people often turn to alcohol in times of stress. The first few drinks feel like a warm blanket pulled over our weary shoulders. But along with this false sense of relaxation comes the stark reality that alcohol is a toxin that can do a lot of damage to bodies, minds, and relationships.
Research has shown that increased alcohol use can put people at risk for worse outcomes from Covid-19. However, most Westernized countries chose to keep stores that sell alcohol open as essential services, prompting many social media debates. As a recovering alcoholic and a former nurse, I often write on this topic and can shed some light on why alcohol sales were deemed essential. These insights come from both research and personal experience.
As it turns out, limiting access to alcohol may do more harm than good.
Alcohol withdrawal has a higher fatality rate than withdrawing from opiates, benzodiazepines, cocaine, and amphetamines. Alcohol withdrawal can evoke severe symptoms, such as prolonged seizures, internal trauma from seizure activity, infection, and metabolic or cardiovascular complications. The severity of alcohol withdrawal depends on several factors, including genetics, daily alcohol amounts, length of addiction, and how often the person has been through withdrawal before.
Although not everyone has a severe response to alcohol withdrawal, research shows that about 25% of heavy drinkersexperience dangerous withdrawal symptoms. The CDC defines heavy drinking as more than 15 drinks for men and more than 8 drinks for women per week. Heavy drinking is likely to be underestimated due to denial, stigma, and a declining nervous system.
Also, an issue rarely discussed about alcohol withdrawal is the kindling effect, which refers to how often a person has been through alcohol withdrawal before. Research shows that repeated withdrawal incidences make someone more likely to develop severe alcohol withdrawal symptoms over time. The kindling effect applies not only to daily drinkers but also to binge drinkers. According to the CDC, binge drinking is characterized by drinking more than five drinks for men and four drinks for women on one occasion. A defining feature of binge drinking is that once the binge is over, the person stops drinking for a period of time. This is when a binge drinker may be affected by the kindling effect, which may lead to severe alcohol withdrawal symptoms.
Binge drinking is dramatically increasing worldwide, especially with the pandemic. However, binge drinkers likely have no idea how this activity is affecting their brains and nervous systems. Most binge drinkers typically think they don’t have a problem because they don’t drink every day. It seems the sickly, daily drinking “alcoholic” stereotype is masking most of the problem drinking in the modern world.
When I look back at my drinking habits, I would say I cycled between daily use and binge drinking. I prided myself for being so “functional,” yet I most certainly had a problem. But I can say with confidence that the worst withdrawal symptoms happened when I binged. These symptoms definitely got worse over time, likely because I was amping up the kindling effect. Like many people with addictions, shame and denial stopped me from admitting my problem and accessing information about severe withdrawal symptoms and how to prevent them.
Withdrawal symptoms can be mild, medium, or severe. They range from mild tremors, headaches, and fatigue to extreme shaking, hallucinations, vomiting, racing heart rate, and seizures. The worst withdrawal symptom is delirium tremens, or DTs. I never experienced DTs, thankfully, but many heavy drinkers are at high risk of them the longer they drink, withdraw, and drink again. DTs can produce severe psychosis, prolonged seizures, and cardiac or metabolic consequences with a high probability of death.
The gold star for alcohol withdrawal care is usually an inpatient stay with medications and monitoring to ensure a safe detox process. However, most alcoholics don’t want to go through this process due to shame, stigma, lack of money, and other socioeconomic issues. And in a pandemic, when hospitals are already taxed, there isn’t enough space and resources to safely see people through the alcohol withdrawal process.
Medical professional provide few recommendations to help people withdraw from alcohol at home. This is because alcohol withdrawal is unique to each person and carries such a risk that health care officials usually advocate for inpatient care. Lastly, the medications used for withdrawal are Schedule 4 drugs that only medical professionals can administer.
However, this doesn’t mean many people aren’t withdrawing at home alone. I never accessed health care for my alcohol withdrawal process, and likely there are many others who have coped — or are coping — as I did. And for all who try the DIY withdrawal process, no doubt some are ending up needing emergency care.
Nonetheless, we are in the midst of a highly stressful time, and the conditions are ripe for addictions to take hold or worsen. Health and policy officials are likely aware of the dangers of alcohol withdrawal, which is why they continue to allow alcohol sales during a pandemic.
Though research shows that alcohol abuse may worsen individual Covid-19 symptoms and other issues like depression, suicidality, and domestic abuse, even those adverse outcomes may not outweigh the pressure that a vast wave of alcohol withdrawal would have on the health care system. Unfortunately, the truth is that limiting alcohol use would provoke more visits to the ER — something most hospitals can’t cope with in a pandemic atmosphere.
And so, what can be done?
As a nurse, I frequently look to education, harm reduction, and personal empowerment as the best strategies for prevention and promotion of health. Most nurses understand that the best way to stop a serious issue from happening is to prevent it in the first place. Education is key, but it needs to be simple yet deep enough for people to know exactly how the issue affects them.
Lastly, even though most people have heard the widely familiar safe drinking limits — one drink a day for women and two drinks a day for men — it doesn’t stop many from overimbibing. Having guidelines around alcohol withdrawal, where to get help, and how to prevent severe withdrawal could be protective for both the person with the addiction and the health care system.
Until these guidelines are widely available, it may be safer to keep stores that sell alcohol categorized as an essential service — even if it means heavy drinking goes unchecked.