Gabby completed a screening form to come to the Coleman Institute for Addiction Medicine looking for a safe way to stop drinking alcohol. Reviewing it before I called her back, I noted that Gabby was 35, a data analyst, married for ten years and had two children. Neither of her parents had any history of any sort of Substance Use Disorder (SUD), and Gabby noted that she had never attended any form of treatment in the past for her alcohol use.

According to her form, she was currently drinking the equivalent of at least two bottles of wine daily, some days with additional cocktail drinks, and had been doing so for about ten months.

Back to the Office After COVID-19 Quarantine

When I spoke to her on the phone, Gabby sounded frightened. Tearfully, she told me she had learned at a recent meeting, employees would be expected to return to work in person. This was going to be very difficult given the habit of daily drinking she’d fallen into.

Gabby told me she partied in college, sometimes to excess, but as the years went on and she got married, had children, and a demanding job, her drinking became more just part of a routine of having a couple drinks a night.

“I kind of equated it with being a grown-up. My husband, Tim and I would have a drink or two after work and exercising, or after the kids’ soccer games or practice, or while we hustled around fixing dinner, checking backpacks for assignments, checking homework…it was just a part of the fabric of our lives and it helped me relax. A reward after a busy day of hard work.”

COVID-19 Normalized Heavy Day Drinking

On weekend days it was easy to drink a couple bottles of wine, because they often started earlier. Theirs is a very social neighborhood, and Gabby never felt like she was drinking much more than most of her friends.

When COVID-19 hit in the spring of 2020, Gabby’s life—like lives all over the world—was turned upside down. Suddenly she found herself working from home while her husband, whose position as distribution warehouse supervisor deemed essential, was out of the house. This also left her responsible for managing the bulk of the educational and social challenges for their six and eight-year old daughters.

Gabby started uncorking her bottle earlier and earlier, eventually ordering cases at a time from the ever-efficient delivery modalities that had multiplied during COVID-19. Boxed wine was always on her grocery list.

She and her friends joked about the drinking; she assumed they were drinking just as much. They shared dozens of memes with each other, normalizing and justifying their drinking to cope.

"Putting a drink today in every room of my house and calling it a pub crawl.”
“Mommy celebrates every moment with you, darling; that’s why she drinks so much.”
“Once upon a time some kids did as they were told and mommy didn’t have to lose her sh*t and drink out of a box before noon.”
“If you combine wine and dinner the new word is winner.”
“I need a drink, just kidding, I need ten.”
“I could really use a hug from something alcohol-based right now.”
“S.L.I.F.= Sorry liver, it’s Friday.”

Impact of Alcohol Industry Growth During COVID-19

I was curious about how this year had looked from the perspective of the alcohol industry and asked a guy who’s been a sales representative for every major alcohol brand for over thirty years. He requested to be anonymous.

“I have never seen a year like the one that we have had. When it comes to sales at the retail level, typically two days before Christmas is the busiest day of the year, both dollar wise and volume of sales. During the pandemic, many of the busiest retail outlets had their largest dollar volume day in their history in late March 2020. But the pandemic continued, and when December 23rd came, it was-per historical data—again, the busiest day ever, but it eclipsed the previous numbers by upwards of 30%.”

“So, financially, for the retail industry, it was an absolute boom. Another interesting phenomena happened when the stimulus money was distributed. Higher priced ticket items such as bourbons from $75 to $2000 per bottle were going out the door regularly. Sales of the larger bottles of liquor, known as ‘handles’ were trending up in the double digits. The most amazing category was the consumption of any wine that was packaged in a box. The three-liter category has increased by nearly 80% during these pandemic times.”


Signs Drinking is More Than Just a Habit

Gabby had started to lose her appetite. She put this down to stress and not having enough time anymore to focus on a healthy diet. She frequently felt sick after eating, but drinking calmed that down, and it also took care of the very mild tremors she was starting to have a couple hours after waking up. Her husband persuaded her to see her primary care provider.

Gabby told her doctor that she was drinking pretty regularly but didn’t give all the details. Her doctor did some bloodwork, and Gabby learned that her liver enzymes were elevated. Suddenly the “S.L.I.F.” meme wasn’t so funny.

Alcohol Consumption and Liver Disease

A study done in 2018 shows the highest ever increase in cirrhosis-related mortality—driven by alcohol-related disease— among people aged 25-34 between the years of 2009-2016. This increase in the amount of liver related disease caused by alcohol use is not so surprising when the results of an earlier study reported in JAMA Psychiatry showed the significant increase in heavy drinking, especially by women from 2001-2002 to 2012-2013. We don’t yet have data on what has happened during COVID-19, when drinking rates have skyrocketed.

Increased Health Risk Among Women Drinkers

Women are at much higher risk than men for alcohol related liver problems. On average, women weigh less than men and have less water in their bodies than men. Because alcohol is mostly in body water, if a man and woman of the same weight drink the same amount of alcohol, the woman’s blood alcohol concentration will likely be higher, increasing her risk of harm.

I checked in with April Ashworth, AGPCNP-BC, a nurse practitioner who works at Bon Secours Liver Institute in Richmond, Virginia.

“There has been a significant increase in alcohol use, especially among those who typically have a few drinks in the evening and are now working from home. They tend to start drinking earlier and consume more. 'Day Drinking' now becomes the norm. It’s just more accessible. This is definitely the trend I am seeing.”

This is consistent with a recent article published by NPR. They interviewed liver specialist Dr. Jessica Mellinger at the University of Michigan, who stated she has seen a 30% increase in cases of alcoholic liver disease which includes “milder fatty liver and permanent scarring of cirrhosis, as well as alcoholic hepatitis.

Accelerated Alcohol Detox at the Coleman Institute

Gabby signed on for a medical detox at the Coleman Institute. Not everyone needs a medical detox, but it’s important you talk to your doctor before stopping abruptly, because of the possibility of an alcohol withdrawal seizure. I have heard from many people over the years who have gone to the emergency room with the hopes of getting a safe detox, but they are simply prescribed a small amount of anti-seizure medication and sent off.

Particularly during COVID-19, hospitals have been triaging what they consider to be the most urgent cases. Doing a safe, confidential, out-patient detox at a Coleman Institute office gives you more than just a safe detox. Our case managers and clinical staff help connect you with other resources like counseling and medication to help you reach your goals around sobriety.

If your drinking has escalated during COVID-19, you are not alone. Schedule a call below if you have questions about how to get help and hopefully prevent further damage to your liver.

Joan R. Shepherd, FNP