Alcohol use sent nearly twice as many women to the hospital during pandemic, study finds

Editor’s note: If you or someone you know is struggling with suicidal thoughts or mental health matters, please call the 988 Suicide & Crisis Lifeline by dialing 988 to connect with a trained counselor, or visit the 988 Lifeline website.

The number of women ages 40 to 64 seen at a hospital because of alcohol misuse nearly doubled during the pandemic, according to a new study.

During 10 months between April 2020 and September 2021, complications of alcohol-related disease rose by 33% to 56% among middle-aged women compared with pre-pandemic times, said first author Dr. Bryant Shuey, an assistant professor of medicine at the University of Pittsburgh.

“Drinking has increased in the last decade among women, particularly during the pandemic, in comparison to men,” Shuey said. “That uptick in drinking is likely contributing to the really serious alcohol-related liver disease, mood disorders, alcohol withdrawal problems and heart and gastric concerns we found in our study.”

Research shows the rate of women ages 35 to 50 having five or more drinks in a row rose twice as fast as men over the last decade. That trend appeared to worsen during the pandemic, with a 41% increase in heavy drinking days among women.

“The study was very well conducted,” said addiction specialist Dr. Scott Hadland, associate professor of pediatrics at Mass General for Children and Harvard Medical School.

“I was surprised to see that the rates of alcohol-related complications that usually take years to build up suddenly increased so rapidly in the wake of Covid-19,” said Hadland, who was not involved in the study.

Dangerous complications

The study, published Friday in the journal JAMA Health Forum, analyzed claims from an insurance database of people ages 15 and older to determine the number of emergency room visits and hospitalizations due to alcohol abuse during the pandemic.

Among the diagnoses, between 54% and 66% were due to complications from alcohol-related liver disease, such as cirrhosis. Alcohol withdrawal and alcohol-related mood disorders accounted for 29% to 39% of the visits.

“Withdrawal can be deadly. For people who drink large amounts daily, withdrawal can lead to something called alcohol withdrawal delirium, which can cause seizures and even cardiac arrest,” Shuey said.

“As far as mood disorders, we know alcohol reduces inhibition and is a risk factor for suicide. And if someone has alcohol-related psychosis, or even a manic episode, those are really high-risk conditions that require urgent medical evaluation,” he added.

A much smaller percentage of hospitalizations related to alcohol, 3% to 5%, were due to cardiomyopathy, or a disruption in heart rhythm, while 1% to 3% were due to gastric bleeding from alcohol misuse, according to the study.

While the study could not determine cause and effect, one explanation for the uptick could be that women already had a problem with alcohol before the pandemic, said Dr. Ibraheem Karaye, assistant professor of population health at Hofstra University in Hempstead, New York, via email. He was not involved in the new study.

“The pandemic then served as a tipping point, exacerbating their condition,” said Karaye, who published a 2023 study on mortality and drinking.

One reason for the deterioration could be the lack of access to health care during the pandemic, Shuey said.

“Women who were developing alcohol-related conditions prior to the pandemic may have lost contact with their outpatient provider, alcohol addiction treatment center or Alcoholics Anonymous support group, which then tipped them over and into trouble with their alcohol use,” Shuey said.

Women are more susceptible to the ill effects of alcohol for a number of reasons, Hadland said. Their bodies have lower amounts of alcohol dehydrogenases, an enzyme needed to break down alcohol. In addition, women’s bodies have slightly more fat and less water than men’s bodies

“Because alcohol is dissolved in water in the body, it becomes more highly concentrated in women,” Hadland said. “And then there’s the size difference. Men are often a little bit taller and a little bit heavier, which means that the same amount of alcohol in the body is also more concentrated in women and may do more damage at lower doses.”

The risk for liver damage and cirrhosis due to alcohol misuse is higher for women than men, and heart disease can occur at lower levels of consumption and over fewer years of drinking than men, according to the US Centers for Disease Control and Prevention.

In addition, cognitive decline and shrinkage of the brain due to alcohol develop more quickly for women than for men, the CDC noted. Another key difference between the sexes: Drinking is also associated with breast cancer in women, even at low levels of consumption.

Have you crossed the line?

How do you know if your alcohol use has crossed to the dark side? One telltale sign is when drinking has negative consequences, Karaye said.

“Recognizing alcohol-related issues can involve observing changes in behavior, such as increased consumption, mood swings or neglecting responsibilities,” he said.

Another sign: You continue drinking despite the negative impact on your physical or mental health. And it doesn’t have to be calling in sick or working with a hangover — it can be as simple as having a hard time getting up in the morning or having more disagreements with coworkers and loved ones.

Here’s another red flag: You’re pouring big drinks without realizing it. Current dietary guidelines call for no more than two standard drinks a day for men and one for women and anyone 65 and older.

But many people pour much more than a standard drink, which is 12 ounces of a regular beer, 4 ounces of regular wine or 1 ½ ounces of liquor.

“I recommend utilizing the Alcohol Use Screening Tool provided by the Centers for Disease Control and Prevention,” Karaye said. “It’s a reliable resource designed to help individuals assess their alcohol consumption.”

If you (or a loved one) are struggling with alcohol, don’t hesitate to reach out to your doctor, Hadland said.

“There are available medications, probably the most common and effective one that we use as a medication called naltrexone, and there are others that can offer some degree of help as well,” he said.

Many behavioral support groups can assist, such as 12-step programs and individual therapy.

The Substance Abuse and Mental Health Services Administration has a free, confidential national helpline open at all times to provide referrals to local treatment facilities, support groups and community-based organizations: 800-662-HELP (4357) and 800-487-4889 (TTY option).

The National Institute on Alcohol Abuse and Alcoholism has a tool called the NIAAA Alcohol Treatment Navigator for adults. For teens, the institute recommends these resources.

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