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Alcohol use disorder has surged in Tennessee. Patients and doctors point to the pandemic.

Bottles of alcohol sit on shelves at a bar in Houston on June 23, 2020.
Associated Press
David J. Phillip (File)
Bottles of alcohol sit on shelves at a bar in Houston on June 23, 2020.

In 2020, as the COVID-19 pandemic began, Joe Singer and his wife had just bought a house.

“We’re about to go into debt for another 20 years amidst this pandemic, where they’re shutting everything down,” he said. “And I can only foresee the bank owning our property. And during all this, I was afraid that was going to shut the liquor stores down.”

Singer had already been struggling with alcohol use disorder. The stress, uncertainty and isolation all magnified a problem that had existed for years. Like many people who have experienced addiction, Singer remembers the exact date he was forced to reckon with it.

“I hit my bottom May the 27th of 2020,” he said. “I went and asked my wife for help. It was like two in the morning, and I woke her up. And with her being used to me, you know, she’s like, ‘well go back to bed, Bubba. We’ll talk about it in the morning.’ Then I was like, ‘No… this is this now or never.’”

Singer is far from alone.

By every metric, alcohol use began surging in the pandemic and hasn’t stopped. Federal data paint a dire picture across the country and in Tennessee. Local addiction providers say they’ve seen a massive demand increase, and they’re hearing from patients that the pandemic made their alcohol addiction worse.

Over that first year or so of the pandemic, 178,000 Americans died from alcohol-related causes, according to the Centers for Disease Control and Prevention. The agency reports that’s a 26% increase compared to 2016-17.

The same study found that about 5,000 Tennesseans died from alcohol-related causes in that time.

Getting help

Singer went to the Cumberland Heights treatment center to get help for his addiction.

At first, the pandemic caused a dip in admissions, according to the facility’s medical director, Dr. Chapman Sledge. People were afraid to go into medical facilities, especially ones with congregate care. But once medical providers adjusted, and people lost some of their fear, admissions started growing.

“Last year, Cumberland Heights treated more people at a residential level of care than we ever have before,” Sledge said. “And virtually every patient that I interview on the front end speaks to the impact of the pandemic in their drinking history.”

He told WPLN News that they’ve seen it all: People who never had an issue with alcohol developing an addiction. People who have been in recovery for years falling back. He points to COVID-era environmental shifts.

“UberEats brings you a cocktail, and with delivery from liquor stores, I mean … that just really wasn’t ever a thing until the pandemic,” he said. “People are cooped up. They’re stressed absolutely to the max. And it was a fertile ground for alcohol to enter.”

Spikes in addiction

He likened the current surge in alcohol use disorder to the recognizable waves in the opioid epidemic. Addiction rates spiked after OxyContin hit the market, for example. Heroin addiction spiked after prescription opioids became unattainable.

“But alcohol has been very steady in the background,” Sledge said. “Alcohol has never gone away. And even in the height of the opioid epidemic, about 60% of our inpatient admissions or, or for alcohol use disorders, about 30% are opioid use disorders.”

Other facilities, like Vanderbilt University Medical Center, are seeing similar trends in patient breakdown.

“We are, of course, extremely concerned about fentanyl and opioid overdoses,” Dr. David Marcovitz, the Director of the Division of Addiction Psychiatry at Vanderbilt University Medical Center, said. “But it’s true that in a lot of both the popular media, and in terms of federal funding, alcohol hasn’t been getting as much attention in recent years. And it remains a huge problem.”

The lack of awareness has a direct effect on access to care.

“When patients are uninsured, we have more ability to place them in treatment with opioid use disorder because a lot of the federal funding that’s come out,” he said. “Whereas with alcohol use disorder, there’s often this donut hole, so to speak.”

Accessing care

Marcovitz added that about a third of the patients who come in for opioid use treatment also have alcohol use disorder, which means they qualify for the financial help that comes with opioid services.

“But, you know, the other two thirds, it can be a real challenge,” he said. “And I think it creates an unmet need, in a way that it’s just it’s just imbalanced. It’s not the best approach to policy, I would say.”

That can be especially concerning early on in alcohol use recovery.

“Alcohol and benzodiazepines are associated with the withdrawal process that can be life threatening from seizures and what are called delirium tremens,” Marcovitz said.

Access to care after the withdrawal stage is also hampered by a lack of federal funding, he said. That’s generally provided on an outpatient basis, and it’s something that might be unfamiliar to people who aren’t familiar with recovery services.

“People associate detox with kind of a one-and done-phenomenon,” Marcovitz added. “When we know that, more and more, we think of these as chronic brain diseases. And if you just quote-unquote “detox” somebody and assume that they’re sort of fixed, then that’s why you get so much return to use and problems.”

A quicker sobriety

Singer said continued care and support — such as consistent Zoom meetings — have kept him on track, especially during hard times. He now works at Cumberland Heights, mentoring people who are newly in recovery.

He added that he has complicated feelings about the COVID-19 era, but ultimately he’s grateful.

“The pandemic forced me to a quicker bottom, and I’m thankful for that,” he said. “But it also forced me to a quicker sobriety. And I’m thankful for that too. So as much as I love to badmouth the pandemic … it got me sober. Saved my life. But it very well could have killed me just as quick.”

If you or a loved one is struggling with substance use, you can Google Tennessee Red Line or call 800-889-9789.

Catherine Sweeney is WPLN’s health reporter. Before joining the station, she covered health for Oklahoma’s NPR member stations. That was her first job in public radio. Until then, she wrote about state and local government for newspapers in Oklahoma and Colorado. In her free time, she likes to cycle through hobbies, which include crochet, embroidery, baking, cooking and weightlifting.
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