Increased alcohol use to cope with COVID-19-related anxiety one year into the coronavirus pandemic

Abstract

Background: An increase in drinking to cope with anxiety provoked by the coronavirus was observed during the first few months of the COVID-19 pandemic. Objective: In the present study, we examined the role of drinking motives in the anxiety–alcohol link one year into the pandemic. Methods: Using a cross-sectional design, we collected data between April and May 2021: 678 participants located in Romania or the Netherlands completed an online survey on alcohol consumption in the past month (assessed using a simple quantity-frequency measure), change in drinking during the past year (assessed using a single item asking whether there had been an increase, decrease or no change), drinking motives (assessed using the Revised Drinking Motives Questionnaire), drinking-related problems (assessed using the Alcohol Use Disorder Identification Test), and COVID-19-related anxiety (assessed using the Coronavirus Anxiety Scale). Results: Compared to before the pandemic, while 42% of participants had decreased their alcohol consumption, 15% reported an increase. Participants with clinically relevant COVID-19-related anxiety (11%) were more likely to drink to cope with negative affect, enhance positive affect, and conform to others. The association between COVID-19-related anxiety and drinking-related problems was specifically moderated by drinking to cope, such that the anxiety–alcohol link was stronger in participants who endorsed this drinking motive more. Conclusion: Drinking is a maladaptive coping strategy for individuals with high levels of COVID-19-related anxiety. These individuals might benefit from interventions involving the learning of healthier skills to deal with the ongoing pandemic.

Keywords

alcohol consumption anxiety coping coronavirus COVID-19 drinking motives

COVID-19 was declared a pandemic in March 2020. Multiple cross-sectional studies conducted in various countries in the initial stage of the pandemic found the first lockdown to be associated with changes in alcohol consumption that varied between individuals (e.g., Avery et al., 2020; Capasso et al., 2021; Chodkiewicz et al., 2020; Garnett et al., 2021; Jacob et al., 2021; Stanton et al., 2020; Tran et al., 2020). While many individuals reported they did not change or decreased their drinking, across the cited studies 17%–31% reported to have increased their drinking. As this latter subgroup reported more drinking-associated problems (Chodkiewicz et al., 2020), it is considered at higher risk for alcohol use disorder (AUD).

Increased drinking after the start of the pandemic may have been due to increased anxiety. Several studies conducted in the first few months after the pandemic started have reported that adults who reported drinking more since the pandemic started also reported more general anxiety (Avery et al., 2020; Jacob et al., 2021; Lechner et al., 2020; Stanton et al., 2020; Tran et al., 2020). Wardell et al. (2020) reported a more specific link between health anxiety and increased alcohol consumption. Moreover, Capasso et al. (2021) found that adults drinking more since hearing about the COVID-19 outbreak were more anxious and unable to stop worrying about the outbreak. In general, these results fit well with past research showing that anxiety can cause people to drink more (see for example Anker & Kushner, 2019).

Among people experiencing COVID-19-related anxiety, alcohol consumption may have increased as a way to cope with this anxiety. In line with this idea, Anker and Kushner (2019) described alcohol consumption as being motivated by an effort to cope with anxiety. Indeed, several studies on drinking motives have found that drinking to cope increased after the start of the pandemic, whereas drinking to enhance positive affect, socialise with others, or conform to others decreased (Graupensperger et al., 2021; McPhee et al., 2020; Prestigiacomo et al., 2021). Moreover, both drinking to cope with negative affect (e.g., Irizar et al., 2021; McPhee et al., 2020; Prestigiacomo et al., 2021; Wardell et al., 2020) and, more specifically, drinking to cope with the pandemic (Fruehwirth et al., 2021) have been associated with drinking more during the first lockdown. In addition, drinking to cope with negative affect has been associated with drinking more during the second lockdown (Carbia et al., 2021).

Unlike all aforementioned studies, the present study was conducted one year after the pandemic started, after two lockdowns but with various public-health measures still in effect. Several studies conducted in the first few months of the pandemic (Avery et al., 2020; Capasso et al., 2021; Chodkiewicz et al., 2020; Garnett et al., 2021; Jacob et al., 2021; Stanton et al., 2020; Tran et al., 2020) found that while a majority of participants reported decreased or unchanged alcohol consumption compared to before the pandemic, a significant minority reported increased consumption. At least a proportion of this latter subgroup would likely continue their increased consumption beyond the acute phase of the pandemic. As also suggested by several studies conducted early in the pandemic (Capasso et al., 2021; Carbia et al., 2021; Wardell et al., 2020), this subgroup would be most likely to report anxiety. Specifically, we expected them be more likely to report clinically significant levels of COVID-19-related anxiety, assessed using the Coronavirus Anxiety Scale (CAS) (Lee, 2020). Other studies have generally used questionnaires that ask about general or health anxiety, which may have started before the onset of the pandemic.

In the present study, besides checking the aforementioned assumptions in a sample surveyed one year into the pandemic, we examined the role of drinking motives in the link between COVID-19-related anxiety and alcohol consumption. Given other results from studies conducted soon after the start of the pandemic (Carbia et al., 2021; Fruehwirth et al., 2021; McPhee et al., 2020; Prestigiacomo et al., 2021), we focused on drinking to cope, assessed using the Revised Drinking Motives Questionnaire (DMQ-R; Cooper, 1994). Taken together with the aforementioned anxiety-alcohol studies, these results led us to hypothesise that the association between COVID-19-related anxiety and increased alcohol use one year into the pandemic would be stronger among individuals who are relatively likely to drink to cope with negative affect. While this drinking motive has previously been found to moderate the link between anxiety and alcohol (e.g., Chinneck et al., 2018; Comeau et al., 2001; Hammarberg et al., 2017), none of these past studies were conducted during the COVID-19 coronavirus pandemic hence focused specifically on anxiety experienced in relation to the pandemic. If, in line with our hypothesis, alcohol use would indeed be higher in individuals with more COVID-19-related anxiety and a higher motivation to drink to cope with negative affect, then these individuals in particular would be at risk for drinking-related problems (assessed using the Alcohol Use Disorder Identification Test [AUDIT]) (Saunders et al., 1993). This could mean that these individuals might benefit from learning more adaptive coping strategies, which could possibly help prevent a long-term, pandemic-associated increase in both AUD and anxiety disorder.

Methods

Participants

This study was part of a larger project involving Alexandru Ioan Cuza University in Romania and the University of Groningen in the Netherlands. The project was approved by the Ethics Committee of Psychology of both universities and was carried out in accordance with their guidelines for human subject protection.

Advertisements on Facebook in April and May 2021 invited adults in Romania and the Netherlands to complete an online survey on why people drink (“to understand people's drinking motives”). Additional participants were recruited by sharing the link to the survey via the researchers’ personal networks. Informed consent was provided digitally by 868 of 1210 individuals who opened the survey (the other 28% did not answer the consent question).

The COVID-19 and alcohol questions were completed by 682 (79%) individuals. The preferred language was Romanian for 471 individuals, Dutch for 105 individuals, and English for 106 individuals (see Procedures). However, four individuals indicated that they understood their preferred language less than moderately well, leaving 678 individuals in the final sample.

Measures

COVID-19-related anxiety was assessed using the CAS (Lee, 2020), which had good internal consistency (Cronbach coefficient α: 0.81). Total scores ≥9 are thought to indicate clinically relevant anxiety in the past two weeks.

Alcohol consumption in the past month was assessed by asking about the number of drinks on an average Monday, Tuesday, etc. Data on the past year were collected by asking whether consumption decreased, stayed the same or increased, and using the AUDIT (Cronbach coefficient α: 0.83). The AUDIT assesses drinking-related problems and is used to screen for AUD (Saunders et al., 1993). Total scores ≥8 result in sufficient sensitivity and specificity when screening for a “strong likelihood of hazardous or harmful alcohol consumption”.

Motivations for consuming alcohol were assessed using the Revised Drinking Motives Questionnaire (DMQ-R) (Cooper, 1994), which contains four subscales: Coping with negative affect; Enhancing positive affect; Socializing with others; and Conforming to others (Cronbach coefficient α: 0.83–0.88).

Procedures

The survey was advertised in Romanian and English to Facebook users located in Romania and in Dutch and English to Facebook users located in the Netherlands. After interested individuals opened the survey and indicated their preferred language, the study proceeded in that language. A brief study overview was followed by more detailed information, which (unlike the advertisement) mentioned the pandemic as one factor of interest, and could be downloaded. Subsequently, consent to participate was obtained.

The survey contained several parts: demographics; COVID-19; alcohol; and empathy (not considered here). After completing these parts, participants were debriefed, encouraged to contact the researchers in case of questions and given the option to partake in a lottery for an online 25-RON / 10-EUR gift certificate.

Data analyses

Analyses were performed in SPSS version 25. Gender was originally coded male, female, non-binary, prefer not to say, but recoded to 0 = male, 1 = female, 2 = unknown, as only six individuals chose one of the other options. Age was originally coded <18, 18–25, 26–35, 36–45, 46–55, 56–65, >65 years but recoded to 0 = 18–25 years, 1 = 26 + years, as most participants were young adults (while none were aged <18 years). Language was considered a covariate in all analyses because the three language subgroups differed on several demographic and drinking variables (see Supplementary Table 1). Effect sizes were calculated from relevant F or t statistics and expressed as Cohen's d values.

Before testing our hypothesis on drinking to cope as a moderator of the association between COVID-19-related anxiety and alcohol consumption, we calculated the proportion of participants who reported increased consumption since the start of the pandemic, using their answer to the question of how their consumption changed in the past year. Besides, using three separate analyses of covariance (ANCOVAs), we compared this subgroup to the subgroups whose alcohol consumption decreased or did not change, in terms of AUDIT scores, number of weekly drinking days and number of weekly drinks. Post-hoc simple comparisons between the three subgroups were Bonferroni-corrected.

We also calculated the proportion of participants who reported clinically significant COVID-19-related anxiety, using their CAS score, both in the total sample and in the three aforementioned subgroups. Moreover, we tested the association between COVID-19-related anxiety and alcohol consumption in three ways. First, we examined CAS scores as a predictor of AUDIT scores, number of weekly drinking days and number of weekly drinks using three separate hierarchical linear regressions. Block 1 included the dummy-coded covariate and block 2 included the predictor variable. Second, ANCOVAs were used to examine the clinical relevance of the findings: dichotomised CAS scores were entered as the predictor variable and the three drinking variables were serially entered as outcomes. Third, using another ANCOVA, we compared the CAS scores of the subgroup whose alcohol consumption increased in the past year to the other two subgroups. Post-hoc simple comparisons between the three subgroups were again Bonferroni-corrected.

Finally, we tested our hypothesis on drinking to cope as a moderator of the association between COVID-19-related anxiety and alcohol consumption. In fact, we examined all four drinking motives identified by the DMQ-R as potential moderators. CAS scores and the four DMQ-R subscale scores were all standardised, and four CAS-by-subscale interaction terms were created. In separate regressions, block 1 included the covariate, block 2 the standardised CAS scores, block 3 one of the DMQ-R subscales and block 4 the relevant interaction term.

Of note, as most participants were Romanian (69%), we also conducted sensitivity analyses in the Romanian subsample only. Thus, we repeated all aforementioned analyses using Language as a selection variable rather than as a covariate.

Results

Descriptives

Our final sample was 56% male and 53% of participants were aged 18–25 years. The mean CAS score was 6.02 ± 2.1. The mean AUDIT score was 7.77 ± 5.9. The mean number of days that participants drank was 3.46 ± 2.1 days with a mean of 9.54 ± 10.9 drinks per week. AUDIT scores were strongly positively associated with the number of weekly drinking days (r = 0.55) and with the number of weekly drinks (r = 0.69). The number of weekly drinking days was strongly positively associated with the number of weekly drinks (r = 0.67).

Participants were most likely to drink to socialize with others (M = 13.20 ± 5.1) then to enhance positive affect (M = 11.32 ± 4.9), then to cope with negative affect (M = 9.15 ± 4.6) and then to conform to others (M = 6.62 ± 2.8). All four DMQ-R subscales were positively associated with AUDIT scores (moderately to strongly, r = 0.32–0.58) as well as with the weekly number of drinking days and with the weekly number of drinks (weakly to strongly, r = 0.16–0.58). The highest correlations were with the Coping subscale.

Changed alcohol consumption during the first year of the COVID-19 pandemic

While 42% of participants reported decreased alcohol consumption in the past year and 43% reported unchanged alcohol consumption, 15% reported an increase. Table 1 shows that this latter subgroup, compared to both other subgroups, had higher AUDIT scores and reported more weekly drinking days and more weekly drinks. The rate of clinical AUDIT scores in this subgroup was 52%, compared to 34% and 39% in the subgroups that reported decreased or unchanged alcohol consumption, respectively.

Table 1.

Change in drinking as a function of COVID-19-associated anxiety and drinking

	(a) Full sample					(b) Romanian subsample
	Decrease (n = 285)	Same (n = 292)	Increase (n = 100)	F	d	Decrease (n = 215)	Same (n = 225)	Increase (n = 58)	F	d
AUDIT score	7.23 (0.39)^a	8.13 (0.39)^a	10.35 (0.59)^b	10.34***	0.25	6.67 (0.41)^a	7.39 (0.40)^ab	9.37 (0.78)^b	4.73**	0.20
No. of weekly drinking days	2.83 (0.14)^a	3.71 (0.14)^b	4.68 (0.21)^c	32.79***	0.44	2.83 (0.14)^a	3.63 (0.14)^b	4.69 (0.28)^c	19.50***	0.40
No. of weekly drinks	7.47 (0.71)^a	11.00 (0.70)^b	15.20 (1.07)^c	21.55***	0.36	7.00 (0.70)^a	9.48 (0.69)^b	12.98 (1.38)^b	8.38***	0.26
DMQ-R Socializing	13.23 (0.33)^a	12.41 (0.33)^a	15.49 (0.50)^b	14.00***	0.29	13.17 (0.35)^a	12.58 (0.34)^a	15.19 (0.68)^b	5.84**	0.22
DMQ-R Enhancing	11.28 (0.32)^a	11.16 (0.32)^a	14.04 (0.48)^b	14.71***	0.30	10.59 (0.35)^a	10.72 (0.34)^a	13.60 (0.68)^b	8.28***	0.26
DMQ-R Coping	8.15 (0.30)^a	8.44 (0.29)^a	12.24 (0.45)^b	33.99***	0.45	8.76 (0.33)^a	8.88 (0.32)^a	12.87 (0.64)^b	17.76***	0.38
DMQ-R Conforming	6.43 (0.19)^a	6.39 (0.19)^a	7.10 (0.29)^a	2.52	0.12	6.53 (0.21)^a	6.61 (0.21)^a	7.60 (0.41)^a	2.83	0.15
CAS score	5.82 (0.14)^a	6.00 (0.14)^ab	6.54 (0.21)^b	4.39**	0.16	5.92 (0.14)^a	6.01 (0.14)^a	6.53 (0.28)^a	2.01	0.13

Note. Values are given as estimated marginal means (standard errors) unless indicated otherwise. Means with different superscripts were significantly different. AUDIT = Alcohol Use Disorder Identification Test; CAS = Coronavirus Anxiety Scale; DMQ-R = Revised Drinking Motives Questionnaire.

*p < .05. **p < .01. ***p < .001.

Table 1 also shows that, compared to the other subgroups, the subgroup that reported increased alcohol consumption scored higher on all drinking motives except drinking to conform to others. The largest effect was for drinking to cope with negative affect.

COVID-19-related anxiety and its link with alcohol use

Overall, clinical CAS scores were reported by 11% of participants. In the subgroup that reported increased alcohol consumption, the rate was 19%, compared to 8% and 12% in the subgroups who reported decreased or unchanged alcohol consumption, respectively.

As indicated, we tested the association between COVID-19-related anxiety and alcohol use in three ways. First, in separate regressions, higher CAS scores were associated with higher AUDIT scores (d = 0.50), a higher number of weekly drinking days (d = 0.29) and a higher number of weekly drinks (d = 0.27). See Table 2a for statistical details. Second, in separate ANCOVAs, clinical CAS scores were associated with higher AUDIT scores (F(1,674) = 27.96, p < .0001, d = 0.41), a higher number of weekly drinking days (F(1,668) = 10.55, p < .002, d = 0.25) and a higher number of weekly drinks (F(1,668) = 5.99, p < .02, d = 0.19), indicating that participants with clinically relevant COVID-19-related anxiety consumed more alcohol and reported more drinking-related problems (Figure 1a). Third, the subgroup that reported increased alcohol consumption in the past year had higher CAS scores than the subgroup that reported decreased consumption (p < .01) (Table 1a). The difference with the other subgroup was not significant after Bonferroni correction (p = .06).

Figure 1.

Alcohol use as a function of clinically relevant levels of COVID-19-related anxiety. Note. AUDIT = Alcohol Use Disorder Identification Test; CAS = Coronavirus Anxiety Scale. Results in full sample derived from ANCOVAs that included language (Romanian, Dutch, English) as the covariate. ANCOVAs that also included gender and age as covariates showed comparable results.

Table 2.

Regressions of the various drinking variables onto COVID-19-related anxiety.

	(a) Full sample					(b) Romanian subsample
Outcome variables	Predictors	ΔF	ΔR²	β	t	Predictors	ΔF	ΔR²	β	t
AUDIT score	Block 1	2.77	0.01
	English			0.07	1.82
	Dutch			0.07	1.80
	Block 2	41.20***	0.07			Block 1	45.04***	0.08
	English			0.06	1.59
	Dutch			0.08	2.13*
	CAS score			0.24	6.42***	CAS score			0.29	6.71***
No. of weekly drinking days	Block 1	3.03*	0.01
	English			−0.02	−0.49
	Dutch			0.09	2.29*
	Block 2	13.81***	0.03			Block 1	12.15*	0.03
	English			−0.03	−0.67
	Dutch			0.10	2.46*
	CAS score			0.14	3.72***	CAS score			0.16	3.49**
No. of weekly drinks	Block 1	9.30***	0.03
	English			−0.01	−0.18
	Dutch			0.17	4.20***
	Block 2	12.53***	0.05			Block 1	12.29***	0.03
	English			−0.01	−0.35
	Dutch			0.17	4.38***
	CAS score			0.13	3.54***	CAS score			0.16	3.51***
DMQ-R Socializing	Block 1	2.70	0.01
	English			0.08	1.98*
	Dutch			−0.03	−0.84
	Block 2	0.27	0.01			Block 1	0.13	0.00
	English			0.08	1.95
	Dutch			−0.03	−0.81
	CAS score			0.02	0.52	CAS score			0.02	0.36
DMQ-R Enhancing	Block 1	6.20**	0.02
	English			0.14	3.50***
	Dutch			0.04	1.00
	Block 2	6.93**	0.03			Block 1	6.59*	0.01
	English			0.13	3.40**
	Dutch			0.04	1.12
	CAS score			0.10	2.63**	CAS score			0.12	2.57*
DMQ-R Coping	Block 1	7.97***	0.02
	English			0.07	1.77
	Dutch			−0.12	−3.20**
	Block 2	47.41***	0.09			Block 1	34.34***	0.07
	English			0.06	1.53
	Dutch			−0.11	−3.00**
	CAS score			0.25	6.89***	CAS score			0.26	5.86***
DMQ-R Conforming	Block 1	3.02	0.01
	English			0.03	0.65
	Dutch			−0.09	−2.21*
	Block 2	25.72***	0.05			Block 1	21.92***	0.05
	English			0.02	0.44
	Dutch			−0.08	−2.03*
	CAS score			0.19	5.07***	CAS score			0.21	4.68***

Note. When analysing the full sample, regression models included language (Romanian, Dutch, English) as a covariate, dummy-coded with Romanian as the reference category. Models that also included gender (male, female) and age (18–25, >26) as covariates showed comparable results for the effects of CAS scores; participants whose gender was “unknown” were excluded from these analyses. AUDIT = Alcohol Use Disorder Identification Test; CAS = Coronavirus Anxiety Scale; DMQ-R = Revised Drinking Motives Questionnaire.

*p < .05. **p < .01. ***p < .001.

Table 2a also shows that, in separate regressions, higher CAS scores were associated with higher scores on the DMQ-R Enhancing (d = 0.20), Coping (d = 0.53) and Conforming subscales (d = 0.39), whereas the association with scores on the DMQ-R Socializing subscale was not significant (d = 0.04). Similarly, in separate ANCOVAs, clinical CAS scores were associated with scores on Enhancing (F(1,674) = 3.90, p < .05, d = 0.15), Coping (F(1,674) = 38.89, p < .0001, d = 0.48) and Conforming (F(1,674) = 11.44, p < .002, d = 0.26), while there was no significant association with scores on Socializing (F(1,674) = 0.08, p = .78, d = 0.02). The largest effects were again for drinking to cope with negative affect.

Drinking motives as moderators of the anxiety–alcohol link

All four DMQ-R subscales were positively intercorrelated (r = 0.31–0.72). The highest correlation was between the Socializing and Enhancing subscales; the lowest correlation was between the Conforming and Enhancing subscales.

When examining the four subscales as a moderator of the association between CAS scores and AUDIT scores, the interaction term was not significant for three subscales, namely Socializing (β = −0.02, t(672) = −0.63, p = .53), Enhancing (β = 0.01, t(672) = 0.21, p = .84) and Conforming (β = −0.01, t(672) = −0.11, p = .91). Indeed, Coping was the only drinking motive to moderate the association between CAS scores and AUDIT scores, as indicated by a significant Coping by CAS interaction (β = 0.08, t(672) = 2.02, p < .05). This interaction is visualized in Figure 2a and shows a link between COVID-19-related anxiety and drinking-related problems among participants who were more likely to drink to cope with negative affect but not among participants were less likely to drink to cope with negative affect.

Figure 2.

Drinking to cope as a moderator of the anxiety-drinking association. Note. AUDIT = Alcohol Use Disorder Identification Test; CAS = Coronavirus Anxiety Scale. Lower versus higher CAS scores were visualized by taking 1 standard deviation below or above the CAS mean, respectively. Similarly, less versus more drinking to cope was visualized by taking 1 standard deviation below or above the DMQ-R Coping subscale mean. The regression model for the full sample included language as the covariate, dummy-coded with Romanian as the reference category. Models that also included gender (male, female) and age (18–25 years, >26 years) as covariates showed comparable results; participants whose gender was “unknown” were excluded from this model. * p < .05.

Sensitivity analyses

While 43% of Romanian participants reported decreased alcohol consumption in the past year and 45% reported unchanged alcohol consumption, 12% reported an increase. This subgroup included 45% with clinical AUDIT scores, had higher mean AUDIT scores, reported more weekly drinking days and more weekly drinks, and scored higher on all drinking motives except drinking to conform to others (see Table 1b). This is similar to the full sample.

Clinical CAS scores were reported by 13% of Romanian participants. In the subgroup that reported increased alcohol consumption, the rate was 24%. Clinical CAS scores were associated with higher AUDIT scores (F(1,497) = 32.47, p < .0001, d = 0.51), a higher number of weekly drinking days (F(1,477) = 8.02, p < .006, d = 0.26) and a higher number of weekly drinks (F(1,477) = 6.90, p < .01, d = 0.24) (Figure 1b), and also with higher scores on Enhancing (F(1,470) = 5.21, p < .03, d = 0.21), Coping (F(1,470) = 26.98, p < .0001, d = 0.48) and Conforming (F(1,470) = 9.91, p < .003, d = 0.29). Similarly, higher CAS scores were associated with higher AUDIT scores (d = 0.61), a higher number of weekly drinking days (d = 0.32), a higher number of weekly drinks (d = 0.32) and higher scores on the DMQ-R Enhancing (d = 0.24), Coping (d = 0.54) and Conforming subscales (d = 0.43) (Table 2b). Thus, even when only Romanian participants were considered, we found that COVID-19-related anxiety was positively associated with alcohol consumption, drinking-related problems, and a higher motivation to drink to enhance positive affect, cope with negative affect, or conform to others.

When examining the four subscales as a moderator of the association between CAS scores and AUDIT scores in the Romanian participants only, the interaction term was again only significant for the Coping subscale (β = 0.12, t(464) = 2.76, p < .007). There was a link between COVID-19-related anxiety and drinking-related problems among Romanian participants who were more likely to drink to cope with negative affect but not among Romanian participants were less likely to drink to cope with negative affect (Figure 2b). Overall, results obtained in the full sample were replicated in the Romanian subsample.

Discussion

We found that 15% of our participants reported increased alcohol consumption in the first year of the COVID-19 pandemic. In the Introduction, we cited several studies that reported rates of 17%–31% when only considering the first months of the pandemic. Moreover, a study in 21 European countries found an average (substantial) increase in alcohol consumption in 22% of participants during the first months (Kilian et al., 2021). Together, these findings could mean that for many people, drinking more might not have been a temporary reaction to the pandemic. Recent longitudinal data also suggest that a substantial proportion of adults may have continued drinking more as the pandemic continued after the initial lockdown (Riehm et al., 2022).

This might be due to increased anxiety levels. Indeed, we found that participants who reported drinking more during the first year of the pandemic reported more COVID-19-related anxiety and were more likely to report clinical levels of COVID-19-related anxiety than participants who reported drinking less (Table 1). Further, we found that participants with more COVID-19-related anxiety reported more weekly drinking days and more weekly drinks (Table 2). Furthermore, although the proportion of explained variance was small, we found that the subsample with clinical levels of COVID-19-related anxiety reported more problematic alcohol consumption (Figure 1), indicating an increased risk of AUD (Allen et al., 1997). All in all, these findings correspond with those of Capasso et al. (2021), who reported that adults drinking more during the first lockdown were more anxious and unable to stop worrying about the COVID-19 outbreak; with another recent study in young adults in which COVID-19-related worry was cross-sectionally associated with alcohol-related problems (Haag et al., 2022); and with a recent longitudinal study in which COVID-19-related worry during the initial lockdown positively predicted drinking-related problems in young adults three months later (Venanzi et al., 2022). Moreover, the findings are in line with the high co-morbidity of anxiety disorder and AUD (Anker & Kushner, 2019): as participants who increased their drinking after the pandemic started were most likely to report both COVID-19-related anxiety and alcohol problems, they in particular may be at risk for both disorders.

The main and most novel finding of our study was that drinking to cope strengthened the link between COVID-19-related anxiety and drinking-related problems (Figure 2). This drinking motive was previously found to be strongly associated with problematic alcohol use in individuals with an anxiety disorder (Anker & Kushner, 2019). Our present finding is more specific and also timely, as it could be taken to mean that individuals who tend to drink to cope and who develop clinical levels of COVID-19-related anxiety during the pandemic are most likely to drink more during the pandemic and develop alcohol problems. If (and only if) this finding were replicated in a longitudinal study, it could have clinical implications. Interventions that promote more adaptive coping strategies, such as positive reframing (Chodkiewicz et al., 2020), might help reduce both COVID-19-related anxiety and problematic alcohol use.

One limitation of our study, but also of most cited studies, was its cross-sectional nature. This means we could not infer any causal relations from the established anxiety–alcohol link. In one longitudinal study (Graupensperger et al., 2021), the number of drinking days increased but the number of weekly drinks did not change significantly from before to after the start of the first lockdown, which could mean that our retrospective measure of increased drinking (and that of most other cross-sectional studies) was imprecise. Moreover, several factors potentially contributing to increased drinking during the pandemic were not considered, such as having a child at home, social isolation, or depression (Wardell et al., 2020). In addition, as Garnett et al. (2021) found that adults with an anxiety disorder were more likely to report increased drinking soon after social distancing started, increased drinking more may not only be due to the emergence of COVID-19-related anxiety.

We note that we used a convenience sample in which over 50% of participants were young adults who originated from different cultural backgrounds, but who were primarily Romanian. Although a sensitivity analysis showed comparable results in the Romanian subsample, our findings may not generalise to older (Romanian) adults. For example, it is possible that young adults were more likely to increase their alcohol consumption even after the first few months of the COVID-19 pandemic compared to older adults, putting them at higher risk for drinking-related problems.

Another limitation concerns the exclusive use of self-report measures of drinking and anxiety, which are considered relatively sensitive to social desirability bias (Latkin et al., 2017). However, participants could complete the online survey anonymously, which may have promoted accurate disclosure of drinking and anxiety. Besides, the timeliness of the research topic may have reduced social desirability bias.

Overall, our study extends previous anxiety–alcohol research conducted during the first few months of the COVID-19 coronavirus pandemic (Avery et al., 2020; Chodkiewicz et al., 2020; Jacob et al., 2021). Moreover, although we acknowledge its cross-sectional nature, the study provides indirect support for the idea that drinking to cope with COVID-19-related anxiety could explain why a substantial proportion of (young) adults reported increased drinking during the first year of the pandemic.

Supplemental Material

sj-docx-1-nad-10.1177_14550725221147111 - Supplemental material for Increased alcohol use to cope with COVID-19-related anxiety one year into the coronavirus pandemic

Supplemental material, sj-docx-1-nad-10.1177_14550725221147111 for Increased alcohol use to cope with COVID-19-related anxiety one year into the coronavirus pandemic by Marije aan het Rot, Isabelle C. Baltariu and Violeta Enea in Nordic Studies on Alcohol and Drugs

Footnotes

Acknowledgements

The authors thank Nidhi B. Chauhan and Sjoukje Sinnema for assistance in data collection.

Declaration of conflicting interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iDs

M. aan het Rot

Isabelle C. Baltariu

Supplemental material

Supplemental material for this article is available online.

References

Allen

J. P.

Litten

R. Z.

Fertig

J. B.

Babor

(1997). A review of research on the alcohol use disorders identification test (AUDIT). Alcoholism: Clinical and Experimental Research, 21(4), 613–619. https://www.ncbi.nlm.nih.gov/pubmed/9194913 . https://doi.org/10.1111/j.1530-0277.1997.tb03811.x

Anker

J. J.

Kushner

M. G.

(2019). Co-occurring alcohol use disorder and anxiety: Bridging psychiatric, psychological, and neurobiological perspectives. Alcohol Research: Current Reviews, 40(1), arcr.v40.41.03. https://doi.org/10.35946/arcr.v40.1.03

Avery

A. R.

Tsang

Seto

E. Y. W.

Duncan

G. E.

(2020). Stress, anxiety, and change in alcohol use during the COVID-19 pandemic: Findings among adult twin pairs. Frontiers in Psychiatry, 11, 571084. https://doi.org/10.3389/fpsyt.2020.571084

Capasso

Jones

A. M.

Ali

S. H.

Foreman

Tozan

DiClemente

R. J.

(2021). Increased alcohol use during the COVID-19 pandemic: The effect of mental health and age in a cross-sectional sample of social media users in the U.S. Preventive Medicine, 145, 106422. https://doi.org/10.1016/j.ypmed.2021.106422

Carbia

García-Cabrerizo

Cryan

J. F.

Dinan

T. G.

(2021). Associations between mental health, alcohol consumption and drinking motives during COVID-19 second lockdown in Ireland. Alcohol and Alcoholism, 57(2), 211–218. https://doi.org/10.1093/alcalc/agab067

Chinneck

Thompson

Dobson

K. S.

Stuart

Teehan

Stewart

S. H.

(2018). Neurotic personality traits and risk for adverse alcohol outcomes: Chained mediation through emotional disorder symptoms and drinking to Cope. Substance Use and Misuse, 53(10), 1730–1741. https://doi.org/10.1080/10826084.2018.1432647

Chodkiewicz

Talarowska

Miniszewska

Nawrocka

Bilinski

(2020). Alcohol consumption reported during the COVID-19 pandemic: The initial stage. International Journal of Environmental Research and Public Health, 17(13), 4677. https://doi.org/10.3390/ijerph17134677

Comeau

Stewart

S. H.

Loba

(2001). The relations of trait anxiety, anxiety sensitivity, and sensation seeking to adolescents’ motivations for alcohol, cigarette, and marijuana use. Addictive Behaviors, 26(6), 803–825. https://doi.org/10.1016/s0306-4603(01)00238-6

Cooper

M. L.

(1994). Motivations for alcohol use among adolescents: Development and validation of a four-factor model. Psychological Assessment, 6(2), 117–128. https://doi.org/10.1037/1040-3590.6.2.117

10.

Fruehwirth

J. C.

Gorman

B. L.

Perreira

K. M.

(2021). The effect of social and stress-related factors on alcohol use among college students during the COVID-19 pandemic. Journal of Adolescent Health, 69(4), 557–565. https://doi.org/10.1016/j.jadohealth.2021.06.016

11.

Garnett

Jackson

Oldham

Brown

Steptoe

Fancourt

(2021). Factors associated with drinking behaviour during COVID-19 social distancing and lockdown among adults in the UK. Drug and Alcohol Dependence, 219, 108461. https://doi.org/10.1016/j.drugalcdep.2020.108461

12.

Graupensperger

Fleming

C. B.

Jaffe

A. E.

Rhew

I. C.

Patrick

M. E.

Lee

C. M.

(2021). Changes in young adults’ alcohol and marijuana use, norms, and motives from before to during the COVID-19 pandemic. Journal of Adolescent Health, 68(4), 658–665. https://doi.org/10.1016/j.jadohealth.2021.01.008

13.

Haag

Du Toit

Skeen

Steventon Roberts

Chideya

Notholi

Sambudla

Gordon

Sherr

Tomlinson

(2022). Predictors of COVID-related changes in mental health in a South African sample of adolescents and young adults. Psychology, Health & Medicine, 27(Supp 1), 1–17. https://doi.org/10.1080/13548506.2022.2108087

14.

Hammarberg

Öster

Nehlin

(2017). Drinking motives of adult patients seeking treatment for problematic alcohol use. Journal of Addictive Diseases, 36(2), 127–135. https://doi.org/10.1080/10550887.2017.1291052

15.

Irizar

Jones

Christiansen

Goodwin

Gage

S. H.

Roberts

Knibb

Cooke

Rose

A. K.

(2021). Longitudinal associations with alcohol consumption during the first COVID-19 lockdown: Associations with mood, drinking motives, context of drinking, and mental health. Drug and Alcohol Dependence, 226, 108913. https://doi.org/10.1016/j.drugalcdep.2021.108913

16.

Jacob

Smith

Armstrong

N. C.

Yakkundi

Barnett

Butler

McDermott

D. T.

Koyanagi

Shin

J. I.

Meyer

Firth

Remes

López-Sánchez

G. F.

Tully

M. A.

(2021). Alcohol use and mental health during COVID-19 lockdown: A cross-sectional study in a sample of UK adults. Drug and Alcohol Dependence, 219, 108488. https://doi.org/10.1016/j.drugalcdep.2020.108488

17.

Kilian

Rehm

Allebeck

Braddick

Gual

Barták

Bloomfield

Gil

Neufeld

O'Donnell

Petruželka

Rogalewicz

Schulte

Manthey

(2021). Alcohol consumption during the COVID-19 pandemic in Europe: A large-scale cross-sectional study in 21 countries. Addiction, 116(12), 3369–3380. https://doi.org/10.1111/add.15530

18.

Latkin

C. A.

Edwards

Davey-Rothwell

M. A.

Tobin

K. E.

(2017). The relationship between social desirability bias and self-reports of health, substance use, and social network factors among urban substance users in Baltimore, Maryland. Addictive Behaviors, 73, 133–136. https://doi.org/10.1016/j.addbeh.2017.05.005

19.

Lechner

W. V.

Laurene

K. R.

Patel

Anderson

Grega

Kenne

D. R.

(2020). Changes in alcohol use as a function of psychological distress and social support following COVID-19 related university closings. Addictive Behaviors, 110, 106527. https://doi.org/10.1016/j.addbeh.2020.106527

20.

Lee

S. A.

(2020). Coronavirus anxiety scale: A brief mental health screener for COVID-19 related anxiety. Death Studies, 44(7), 393–401. https://doi.org/10.1080/07481187.2020.1748481

21.

McPhee

M. D.

Keough

M. T.

Rundle

Heath

L. M.

Wardell

J. D.

Hendershot

C. S.

(2020). Depression, environmental reward, coping motives and alcohol consumption during the COVID-19 pandemic. Frontiers in Psychiatry, 11, 574676. https://doi.org/10.3389/fpsyt.2020.574676

22.

Prestigiacomo

C. J.

Liu

M. A.

Plawecki

M. H.

Cyders

M. A.

(2021). Early impact of the U.S. COVID-19 pandemic on drinking motives and alcohol use. Substance Use and Misuse, 56(9), 1383–1386. https://doi.org/10.1080/10826084.2021.1928210

23.

Riehm

K. E.

Cho

Smail

E. J.

Pedersen

Lee

J. O.

Davis

J. P.

Leventhal

A. M.

(2022). Drug use trajectories among U.S. adults during the first year of the COVID-19 pandemic. Journal of Psychiatric Research, 154, 145–150. https://doi.org/10.1016/j.jpsychires.2022.07.055

24.

Saunders

J. B.

Aasland

O. G.

Babor

T. F.

de la Fuente

J. R.

Grant

(1993). Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO collaborative project on early detection of persons with harmful alcohol consumption--II. Addiction, 88(6), 791–804. https://www.ncbi.nlm.nih.gov/pubmed/8329970

25.

Stanton

Q. G.

Khalesi

Williams

S. L.

Alley

S. J.

Thwaite

T. L.

Fenning

A. S.

Vandelanotte

(2020). Depression, anxiety and stress during COVID-19: Associations with changes in physical activity, sleep, tobacco and alcohol use in Australian adults. International Journal of Environmental Research and Public Health, 17(11), 4065. https://doi.org/10.3390/ijerph17114065

26.

Tran

T. D.

Hammarberg

Kirkman

Nguyen

H. T. M.

Fisher

(2020). Alcohol use and mental health status during the first months of COVID-19 pandemic in Australia. Journal of Affective Disorders, 277, 810–813. https://doi.org/10.1016/j.jad.2020.09.012

27.

Venanzi

Dickey

Green

Pegg

Benningfield

M. M.

Bettis

A. H.

Blackford

J. U.

Kujawa

(2022). Longitudinal predictors of depression, anxiety, and alcohol use following COVID-19-related stress. Stress and Health, 38(4), 679–691. https://doi.org/10.1002/smi.3125

28.

Wardell

J. D.

Kempe

Rapinda

K. K.

Single

Bilevicius

Frohlich

J. R.

Hendershot

C. S.

Keough

M. T.

(2020). Drinking to cope during COVID-19 pandemic: The role of external and internal factors in coping motive pathways to alcohol use, solitary drinking, and alcohol problems. Alcoholism, Clinical and Experimental Research, 44(10), 2073–2083. https://doi.org/10.1111/acer.14425

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.01 MB