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      The impact of changes in COVID‐19 lockdown restrictions on alcohol consumption and drinking occasion characteristics in Scotland and England in 2020: an interrupted time‐series analysis

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          Abstract

          Background and Aims

          Early evidence suggests that COVID‐19 lockdown restrictions affect alcohol consumption. However, existing studies lack data on how drinking practices changed as restrictions disrupted people’s work, family life and socializing routines. We examined changes in consumption and drinking occasion characteristics during three periods of changing restrictions in Scotland/England.

          Design

          Interrupted time‐series analysis of repeat cross‐sectional market research data (assessing step‐level changes).

          Setting

          Scotland/England, January 2009–December 2020.

          Participants

          Scotland: 41 507 adult drinkers; England: 253 148 adult drinkers.

          Measurements

          Three intervention points: March 2020 lockdown, July 2020 easing of restrictions and October 2020 re‐introduction of some restrictions. Primary outcome: mean units consumed per week (total/off‐trade/on‐trade; 1 unit = 8 g ethanol). Secondary outcomes: drinking > 14 units per week, heavy drinking, drinking days per week, solitary drinking, drinking with family/partners, drinking with friends/colleagues, own‐home drinking, drinking in someone else’s home and drinking start times.

          Findings

          In Scotland, March 2020’s lockdown was associated with a 2.32 [95% confidence interval (CI) = 0.61, 4.02] increase in off‐trade (i.e. shop‐bought) units per week, a −2.84 (95% CI = −3.63, −2.06) decrease in on‐trade (i.e. licensed venues) units per week, but no statistically significant change in total units per week. July 2020’s easing of restrictions was associated with a 1.33 (95% CI = 0.05, 2.62) increase in on‐trade units per week, but no statistically significant total/off‐trade consumption changes. October 2020’s re‐introduction of some restrictions was not associated with statistically significant consumption changes. Results for England were broadly similar. Lockdown restrictions were also associated with later drinking start times, fewer occasions in someone else’s home and with friends/colleagues, more own‐home drinking and (in Scotland only) more solitary drinking.

          Conclusions

          Reductions in on‐trade alcohol consumption following COVID‐19 lockdown restrictions in Scotland/England in 2020 were mainly offset by increased own‐home drinking. This largely persisted in periods of greater/lesser restrictions. The shift towards off‐trade drinking involved significant changes in the characteristics of drinking occasions.

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          Most cited references37

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          COVID-19 pandemic and mental health consequences: systematic review of the current evidence

          Highlights • COVID-19 patients displayed high levels of PTSS and increased levels of depression. • Patients with preexisting psychiatric disorders reported worsening of psychiatric symptoms. • Higher levels of psychiatric symptoms were found among health care workers. • A decrease in psychological well-being was observed in the general public. • However, well conducted large-scale studies are highly needed.
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            Mental health and well-being during the COVID-19 pandemic: longitudinal analyses of adults in the UK COVID-19 Mental Health & Wellbeing study

            Background The effects of coronavirus disease 2019 (COVID-19) on the population's mental health and well-being are likely to be profound and long lasting. Aims To investigate the trajectory of mental health and well-being during the first 6 weeks of lockdown in adults in the UK. Method A quota survey design and a sampling frame that permitted recruitment of a national sample was employed. Findings for waves 1 (31 March to 9 April 2020), 2 (10 April to 27 April 2020) and 3 (28 April to 11 May 2020) are reported here. A range of mental health factors was assessed: pre-existing mental health problems, suicide attempts and self-harm, suicidal ideation, depression, anxiety, defeat, entrapment, mental well-being and loneliness. Results A total of 3077 adults in the UK completed the survey at wave 1. Suicidal ideation increased over time. Symptoms of anxiety, and levels of defeat and entrapment decreased across waves whereas levels of depressive symptoms did not change significantly. Positive well-being also increased. Levels of loneliness did not change significantly over waves. Subgroup analyses showed that women, young people (18–29 years), those from more socially disadvantaged backgrounds and those with pre-existing mental health problems have worse mental health outcomes during the pandemic across most factors. Conclusions The mental health and well-being of the UK adult population appears to have been affected in the initial phase of the COVID-19 pandemic. The increasing rates of suicidal thoughts across waves, especially among young adults, are concerning.
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              Alcohol use and misuse during the COVID-19 pandemic: a potential public health crisis?

              In an attempt to control the 2019 coronavirus disease (COVID-19) pandemic, governments across the world have implemented distancing measures during the search for medical countermeasures, resulting in millions of people being isolated for long periods. Alcohol misuse is one of the leading causes of preventable mortality, contributing annually to about 3 million deaths worldwide. 1 In some individuals, long term, excessive alcohol misuse might escalate into an alcohol use disorder. The potential public health effects of long-term isolation on alcohol use and misuse are unknown. Stress is a prominent risk factor for the onset and maintenance of alcohol misuse. For example, chronic alcohol use results in neuroadaptations in stress and reward pathways, which lead to dysfunctional hypothalamic pituitary adrenocortical and sympathetic adrenomedullary axes, characterised by dysregulation of the cortisol response and deficits in emotional regulation. 2 In turn, these neuroadaptations lead to increased cravings for alcohol in response to stress. The effects of long-term social isolation on stress levels, including increased neuroendocrine responses and stress reactivity, have been described in non-human animals. 3 However, the ongoing lockdowns across many countries are unique and little is known of the effects on the general population of chronic isolation (with respect to health and wellbeing) in these circumstances A risk factor for the onset and maintenance of alcohol misuse and alcohol use disorder is trait impulsivity (ie, the tendency to take risks or act without adequate forethought or reflection). Impulsivity can moderate stress-induced consumption of alcohol 4 and is also associated with relapse in addicted individuals. 5 Thus, this period of isolation might lead to a spike in alcohol misuse, relapse, and potentially, development of alcohol use disorder in at-risk individuals, therefore placing further strain on addiction and drug and alcohol services, and the health service in general, during and after the pandemic. Most governments, including the UK Government, have responded to the COVID-19 pandemic by advising the public to remain indoors, avoid unnecessary social contact, to protect themselves and health-care systems, and to save lives. We suggest that, as well as this important public health advice, governments should give public health warnings about excessive alcohol consumption during isolation to protect vulnerable individuals.
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                Author and article information

                Contributors
                iain.hardie@glasgow.ac.uk
                Journal
                Addiction
                Addiction
                10.1111/(ISSN)1360-0443
                ADD
                Addiction (Abingdon, England)
                John Wiley and Sons Inc. (Hoboken )
                0965-2140
                1360-0443
                02 February 2022
                June 2022
                : 117
                : 6 ( doiID: 10.1111/add.v117.6 )
                : 1622-1639
                Affiliations
                [ 1 ] MRC/CSO Social and Public Health Sciences Unit University of Glasgow Glasgow UK
                [ 2 ] Sheffield Alcohol Research Group (SARG), School of Health and Related Research University of Sheffield Sheffield UK
                Author notes
                [*] [* ] Correspondence

                Iain Hardie MRC/CSO, Social and Public Health Sciences Unit, University of Glasgow Berkeley Square, 99 Berkeley Street, Glasgow G3 7HR, UK.

                Email: iain.hardie@ 123456glasgow.ac.uk

                Author information
                https://orcid.org/0000-0002-4694-3755
                https://orcid.org/0000-0002-5637-5245
                https://orcid.org/0000-0001-8909-926X
                https://orcid.org/0000-0001-5354-1933
                https://orcid.org/0000-0001-9283-2151
                Article
                ADD15794
                10.1111/add.15794
                9302640
                35108758
                bab34100-226f-4f7c-a8d5-893d4c7b7931
                © 2022 The Authors. Addiction published by John Wiley & Sons Ltd on behalf of Society for the Study of Addiction.

                This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                : 24 August 2021
                : 13 December 2021
                Page count
                Figures: 3, Tables: 6, Pages: 18, Words: 10097
                Funding
                Funded by: Economic and Social Research Council , doi 10.13039/501100000269;
                Award ID: ES/R005257/2
                Award ID: R005257
                Funded by: Scottish Government Chief Scientist Office , doi 10.13039/100014589;
                Award ID: SPHSU20
                Funded by: University of Sheffield , doi 10.13039/501100000858;
                Funded by: University of Glasgow , doi 10.13039/501100000853;
                Funded by: Chief Scientist Office , doi 10.13039/501100000589;
                Funded by: the Scottish Government , doi 10.13039/100012095;
                Funded by: Medical Research Council , doi 10.13039/501100000265;
                Award ID: MC_UU_00022/5
                Categories
                Research Report
                Research Reports
                Custom metadata
                2.0
                June 2022
                Converter:WILEY_ML3GV2_TO_JATSPMC version:6.1.7 mode:remove_FC converted:21.07.2022

                Clinical Psychology & Psychiatry
                alcohol consumption,covid‐19 pandemic,drinking occasion characteristics,interrupted time‐series analysis,lockdown restrictions,policy analysis

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