Concern over lockdown drinking as doctors report spike in liver damage cases

Experts say the lack of structure and loss of social and therapeutic supports may have led problem drinkers to relapse and could also lead to a surge in new referrals.

Liver disease specialists said those with pre-existing disease may also have delayed going to hospital due to virus fears resulting in “grave” outcomes for their health. Treatment and support services for alcohol misuse run by the NHS or charities have been reduced, with staff deployed to the Covid effort, or services moved to phone or online help.

Alcohol Focus Scotland said it has real concerns about the impact of lockdown on drinking. Research by the charity found that one million Scots reported consuming more alcohol during lockdown.

Data from the Office for National Statistics (ONS) shows shop sales in March increased in month-on-month volume by 31·4%. Of particular concern, according to the new report – Drinking alone: Covid-19, lockdown and alcohol-related harm – is that almost one in five of those who said they drank alcohol daily were consuming even more.

It stated: “While firm data are scarce at present, anecdotal reports have emerged of an increased number of people admitted to hospital with alcohol-related liver injury.

“The situation is further complicated by the suggestion that, relative to the pre-Covid-19 period, hospitalisations for cirrhosis in patients with pre-existing chronic liver disease might be delayed.

“These delays may be due to services setting a higher threshold for access to urgent care as they attempt to shield vulnerable patients from the risk of the virus. Whatever the reasons, these reports raise grave concerns about clinical outcomes for such individuals.”

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The report, which is published in The Lancet, also warns of a new "subgroup" of drinkers at risk of establishing potentially dangerous patterns of alcohol consumption during lockdown and said there was an urgent need for more data to establish the scale of the problem.

It suggests that increased use of tele-medicine video consultations could allow more people to access alcohol counselling and addiction treatment, and help doctors monitor long-term patients.

Alcohol Focus Scotland said there is evidence that some people are struggling to access support due to service cuts and changes.

Alison Douglas, chief executive of the charity, said: “As with many other services, alcohol treatment and support has been reduced during the last few months, with staff having been redeployed to other Covid-related efforts, or having to shift to online or telephone support. A further concern is that alcohol services, which were already hard-pressed before this crisis, may experience even greater demand after it.

“The Scottish Government has now recognised alcohol and drug services as essential services but anecdotally we’ve been hearing of people who have still struggled to access support.

“If people can’t get access to help now the problems will only continue to build which leads to poorer health outcomes for individuals and more pressure on our health services. We need to be thinking now about how we ensure that services are able to offer people the help they need when they need it.”

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Dr Christopher Hand, a psychologist based at Glasgow Caledonian University, agrees that further research is needed to understand the impact of the pandemic on drinking habits. He said that for some, the slower pace of life may actually have removed some of the stressors that lead people to drink to excess.

He said: “We know that Scotland in particular has a difficult relationship with alcohol, which is perhaps why there has been a hesitance to reopen beer gardens and similar spaces.

“We know that problematic alcohol use goes hand in hand with other complications, such as domestic violence, poorer mental and physical health, and anti-social behaviour.

“It’s possible that Covid-19 may be adding fuel to a fire that was already burning. However, there is also evidence that it has allowed people the time and space to reset their relationship with alcohol, possibly by removing a number of stressors from daily life.

“The editorial in The Lancet is interesting for a number of reasons.

“The data from the ONS showed a seemingly large increase on month-on-month alcohol sales in off-licences, supermarkets, shops, etc, but this doesn’t factor in the almost-total cessation of on-sales in pubs, bars and restaurants. These sales statistics are also quite slippery, if we think about how people’s drinking may or may not have changed.

"For example, pre-Covid-19 lockdown someone may have gone to a pub once a week to drink three gin and soda waters, but then drank no alcohol elsewhere that week.

“When lockdown happened, that person might still have fancied their three gins a week, but suddenly had to buy a bottle to drink from at home – this superficially looks as if in that week that person has gone from buying three gins to buying 28 (based on 25ml measures).

Hand said his own research involving 400 Scottish participants found that 7% were drinking a lot more alcohol while 37% were drinking a little more. “Many other sources are reporting similar mixed findings," he said. "We have to be careful that we look at high-quality empirical research before planning any strategies or policies or interventions. If we go only by anecdotal evidence we are likely to be getting biased data – shaped by our own social and demographic bubbles.”

A spokesman for the Scottish Government said: “Despite the unprecedented circumstances that the Covid-19 pandemic presents, we expect alcohol and drug partnerships to do what they can to continue to provide services for the people who rely on them. We are aware that the current restrictions in place are having an impact on everyone’s lives and that is why we are committed to easing them as soon as it is deemed safe to do by experts.”