Millennium Health Signals Alert™
Pandemic-Era Increases in Alcohol Use Persist Among At-Risk Patients
Published May 2024
Urine drug testing (UDT) data reveal alarming, sustained increases in alcohol use among those with alcohol use disorder, may push higher as summer peak approaches
The number of Americans who die from alcohol-related causes each year is NEARLY DOUBLE the total number who die from fentanyl and ALL other drug-related overdoses COMBINED.1,2
- Consistent with other reports1, we show that drinking increased in those with and without an alcohol use disorder (AUD) following the onset of the COVID-19 pandemic but most dramatically among those with AUD (▬). Alcohol positivity rates remain elevated in those with AUD (▬), up more than 20% nationally since 2019.
- Alcohol use rates are twice as high in patients with AUD (▬) compared to those without AUD (▬) and alcohol use increases approximately 4% from winter to summer regardless of AUD diagnosis status (■■■;■■■).
- Patients with AUD who had recently consumed alcohol were significantly more likely to be positive for cocaine (difference of 75%), methamphetamine (52%), cannabis/THC (41%), and benzodiazepines (38%) compared to those with AUD with no recent alcohol use.
- These findings should serve as a call to action for patients, clinicians, communities, advocacy groups, and policy makers to implement strategies to increase awareness of the dangers and consequences of excessive alcohol use, reduce excessive drinking, promote screening for problematic alcohol use and AUD, reduce stigma, and increase utilization of evidence-based treatments for AUD.1,3,4
National Alcohol UDT Positivity Rates in Patients by AUD Diagnosis Status (left) and U.S. Census Division5 (right)
LEFT: Monthly, National Alcohol UDT Positivity Rates (%), stratified by the presence or absence of an alcohol use disorder (AUD) diagnosis (ICD-10 code F10), for January 1, 2018 through March 15, 2024 are shown (points). STL decomposition was used to estimate the seasonally-adjusted trend (smoothed solid lines) and unadjusted seasonal trend (smoothed dashed lines). All patient specimens (N = 434,641) were associated with a SUD diagnosis code (ICD-10 code F10-F19) and had clinician-ordered testing for alcohol (i.e., ethyl sulfate [EtS] and/or ethyl glucuronide [EtG]).
RIGHT: Alcohol UDT Positivity Rates for 2019, 2021, and 2023 and Percent Change from 2019 to 2023 are shown for the nation (i.e., National Total) and each U.S. Census Division.5 Statistically significant (p<0.05, 2-sample proportion test) Percent Change values are shown in bold font; red or green shading represents increases or decreases, respectively. NS = Not statistically significant.
References:
- Esser MB, Sherk A, Liu Y, Naimi TS. Deaths from Excessive Alcohol Use — United States, 2016–2021. MMWR Morb Mortal Wkly Rep 2024;73:154–161. DOI: http://dx.doi.org/10.15585/mmwr.mm7308a1
- Spencer MR, Garnett MF, Miniño AM. Drug overdose deaths in the United States, 2002–2022. NCHS Data Brief, no 491. Hyattsville, MD: National Center for Health Statistics. 2024. DOI: https://dx.doi.org/10.15620/cdc:135849
- Patel AK, Balasanova AA. Treatment of Alcohol Use Disorder. JAMA. 2021;325(6):596. doi:10.1001/jama.2020.2012
- Bernstein EY, Baggett TP, Trivedi S, Herzig SJ, Anderson TS. Outcomes After Initiation of Medications for Alcohol Use Disorder at Hospital Discharge. JAMA Netw Open. 2024;7(3):e243387. Published 2024 Mar 4. doi:10.1001/jamanetworkopen.2024.3387
- Census Regions and Divisions of the United States. U.S. Census Bureau. Accessed April 18, 2024. https://www2.census.gov/geo/pdfs/maps-data/maps/reference/us_regdiv.pdf
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