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Patterns of Alcohol Consumption Among Individuals With Alcohol Use Disorder During the COVID-19 Pandemic and Lockdowns in Germany

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To identify the key insights or developments described in this article
1 Credit CME
Key Points

Question  Are COVID-19 lockdown measures associated with alcohol consumption (AC) and temporal patterns of AC?

Findings  In this cohort study of 189 participants who met the criteria for alcohol use disorder (AUD), high-frequency AC tracking comprising 14 694 smartphone ratings revealed no immediate negative association of lockdown measures with overall AC. Independent of the lockdown, intention to control AC was associated with less AC; however, a difference between AC on weekends vs weekdays decreased during lockdown measures and in individuals with severe AUD.

Meaning  Both holidays and weekly patterns were associated with drinking intention and lockdown measures, reflecting losing and regaining control over AC; these patterns may serve as targets for prevention and intervention of AUD.


Importance  Alcohol consumption (AC) leads to death and disability worldwide. Ongoing discussions on potential negative effects of the COVID-19 pandemic on AC need to be informed by real-world evidence.

Objective  To examine whether lockdown measures are associated with AC and consumption-related temporal and psychological within-person mechanisms.

Design, Setting, and Participants  This quantitative, intensive, longitudinal cohort study recruited 1743 participants from 3 sites from February 20, 2020, to February 28, 2021. Data were provided before and within the second lockdown of the COVID-19 pandemic in Germany: before lockdown (October 2 to November 1, 2020); light lockdown (November 2 to December 15, 2020); and hard lockdown (December 16, 2020, to February 28, 2021).

Main Outcomes and Measures  Daily ratings of AC (main outcome) captured during 3 lockdown phases (main variable) and temporal (weekends and holidays) and psychological (social isolation and drinking intention) correlates.

Results  Of the 1743 screened participants, 189 (119 [63.0%] male; median [IQR] age, 37 [27.5-52.0] years) with at least 2 alcohol use disorder (AUD) criteria according to the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) yet without the need for medically supervised alcohol withdrawal were included. These individuals provided 14 694 smartphone ratings from October 2020 through February 2021. Multilevel modeling revealed significantly higher AC (grams of alcohol per day) on weekend days vs weekdays (β = 11.39; 95% CI, 10.00-12.77; P < .001). Alcohol consumption was above the overall average on Christmas (β = 26.82; 95% CI, 21.87-31.77; P < .001) and New Year’s Eve (β = 66.88; 95% CI, 59.22-74.54; P < .001). During the hard lockdown, perceived social isolation was significantly higher (β = 0.12; 95% CI, 0.06-0.15; P < .001), but AC was significantly lower (β = −5.45; 95% CI, −8.00 to −2.90; P = .001). Independent of lockdown, intention to drink less alcohol was associated with lower AC (β = −11.10; 95% CI, −13.63 to −8.58; P < .001). Notably, differences in AC between weekend and weekdays decreased both during the hard lockdown (β = −6.14; 95% CI, −9.96 to −2.31; P = .002) and in participants with severe AUD (β = −6.26; 95% CI, −10.18 to −2.34; P = .002).

Conclusions and Relevance  This 5-month cohort study found no immediate negative associations of lockdown measures with overall AC. Rather, weekend-weekday and holiday AC patterns exceeded lockdown effects. Differences in AC between weekend days and weekdays evinced that weekend drinking cycles decreased as a function of AUD severity and lockdown measures, indicating a potential mechanism of losing and regaining control. This finding suggests that temporal patterns and drinking intention constitute promising targets for prevention and intervention, even in high-risk individuals.

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Article Information

Accepted for Publication: June 2, 2022.

Published: August 1, 2022. doi:10.1001/jamanetworkopen.2022.24641

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2022 Deeken F et al. JAMA Network Open.

Corresponding Author: Michael A. Rapp, MD, PhD, Department of Social and Preventive Medicine, University of Potsdam, Am Neuen Palais 10, 14469 Potsdam, Germany (michael.rapp@uni-potsdam.de).

Author Contributions: Dr Rapp had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Drs Deeken and Reichert contributed equally to this work.

Study concept and design: Deeken, Reichert, Rapp, Heinz, Smolka, Walter, Lenz, Deserno, Ebner-Priemer.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Deeken, Reichert, Rapp.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Deeken, Reichert, Rapp, Zech.

Obtained funding: Rapp, Heinz, Ebner-Priemer, Smolka, Walter, Lenz, Deserno.

Administrative, technical, or material support: Rapp, Heinz, Ebner-Priemer, Smolka, Walter, Lenz, Deserno.

Study supervision: Rapp, Heinz, Ebner-Priemer, Smolka, Walter, Lenz, Deserno.

Conflict of Interest Disclosures: Dr Ebner-Priemer reported receiving consulting fees from Boehringer-Ingelheim outside the submitted work. No other disclosures were reported.

Funding/Support: This study was supported by project 402170461–TRR 265 from the German Research Foundation (Deutsche Forschungsgemeinschaft) and was supported in part by the German Research Foundation (Deutsche Forschungsgemeinschaft) under Germany’s Excellence Strategy–EXC-2049–390688087.

Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Group Information: The ReCoDe Consortium members appear in Supplement 2.

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