Poor inhibitory control and stress as risk-factors for alcohol (mis)use during the COVID-19 pandemic in the UK: a national cross-sectional study across four generations
Authors: Clay James M. , Stafford Lorenzo D. , Parker Matthew O. 
Published: September 2020

SummaryBackgroundThe impact COVID-19 on the UK population’s alcohol intake is unknown. We assessed change in alcohol-use and hazardous drinking during the first lockdown, and tested the hypothesis that variation would be predicted by stress and inhibitory-control.MethodsWe interrogated cross-sectional data from the first sweep of the COVID-19 longitudinal survey, comprising 4 national cohorts (13 453 respondents, 19-62 years). Respondents self-reported their alcohol use, stress, and inhibitory control. We regressed change in drinking and alcohol misuse on stress and inhibitory control, adjusting for covariates to account for demographics.Findings29·08% 30-year-olds increased alcohol use post-COVID-19. Stress was a major contributing factor to increased alcohol use in 30-year olds (adjusted OR 3·92, 95% CI 1·17 - 13·15), as was inhibitory control in 19-year-olds (adjusted OR 1·14, 95% CI 1·05 - 1·23), 30-year-olds (adjusted OR 1·18, 95% CI 1.05 - 1.33) and 50-year-olds (adjusted OR 1·06, 95% CI 1·01 - 1·12). We identified several interactions between stress and inhibitory control in all age groups, suggesting a complex age-specific relationship between the risk factors and alcohol use and misuse during the pandemic.InterpretationIn the UK, alcohol use increased in up to 30% of the population during COVID-19, resulting from a combination of factors including poor inhibitory control and stress. It is critical in future lockdowns that clinicians and public health officials are aware of the challenges faced by different age groups, and prioritise and personalise interventions and prevention measures appropriately.FundingESRC, Foundation for Liver Research.Putting research into contextEvidence before the studyWe searched PubMed, Web of Science, EBSCO Discovery, bioRxiv, medRxiv, and PsyArXiv for articles published between Jan 1, 2020 and Sep 1, 2020, with the following keywords: “covid-19”, “coronavirus”, and “alcohol”. We prioritised the selection of references based on relevance, importance, opportunity for further reading, and whether the work had been peer-reviewed. There have been several published articles that address the issue of alcohol use and misuse during COVID– 19, including a number of editorials and some limited empirical work. There were no nationally representative studies about alcohol use in the UK. In addition, all of the studies identified simply reported figures of those using alcohol during the pandemic, and to the best of our knowledge, none covered risk-factors for alcohol misuse.Added value of this studyUsing data from the COVID-19 national longitudinal survey (first sweep), comprising data from 18 000 people across five national cohorts (aged 19-74), we tested the hypothesis that people who reported higher levels of stress, and who self-reported low impulse-control, would show higher rates of alcohol use/misuse during the pandemic lockdown. First, we show the proportion of adults across the UK that are drinking more during the pandemic, and how this differs by age and gender. Second, we show that while higher levels of stress were associated with higher levels of alcohol intake in some (e.g., 30-year-olds), we found that the relationship was complex and multifaceted. Stress-induced alcohol use and misuse was dependent on age and personality characteristics, with low impulse-control predictive of higher levels of alcohol consumption in 19-, 30- and 50-year-olds, and several stress x personality interactions.Implications of all the available evidenceStress, as well as poor inhibitory control, were risk factors for the susceptibility to increased alcohol intake and hazardous drinking during the early stages of the COVID-19 pandemic and lockdown. The government, healthcare professionals, and the global media should consider the impact of change of lifestyle and stress that might impact on alcohol consumption among at-risk individuals during any future lockdowns. Similarly, additional support for those that may go on to develop an alcohol use disorder or relapse needs to be put in place.