References to high‐risk drinking persist during the pandemic despite restrictions on large social gatherings; more alcohol‐related blackout tweets were written between March 13th and April 24th in 2020 than 2019

Describing the impact of the COVID‐19 pandemic on alcohol‐induced blackout tweets. Rose Marie Ward  Benjamin C. Riordan  Jennifer E. Merrill  Jacques Raubenheimer. Drug and Alcohol Review, October 6 2020. https://doi.org/10.1111/dar.13186

Rolf Degen's take: https://twitter.com/DegenRolf/status/1313509611438309380

Abstract

Introduction and Aims: COVID‐19, considered a pandemic by the World Health Organization, overwhelmed hospitals in the USA. In parallel to the growing pandemic, alcohol sales grew in the USA, with people stockpiling alcohol. Alcohol‐induced blackouts are one particularly concerning consequence of heavy drinking, and the extent to which blackout prevalence may change in the context of a pandemic is unknown. The purpose of the current study is to describe the prevalence of publicly available tweets in the USA referencing alcohol‐induced blackouts prior to and during the COVID‐19 outbreak.

Design and Methods: We used Crimson Hexagon's ForSight tool to access all original English tweets written in the USA that referenced alcohol‐related blackouts in 2019 and 2020. Using infoveillance methods, we tracked changes in the number and proportion of tweets about blackouts.

Results: More alcohol‐related blackout tweets were written between 13 March and 24 April in 2020 than 2019. In addition, a greater proportion of all tweets referenced blackouts in 2020 than in 2019. In the period prior to the ‘stay at home’ orders (January to mid‐March), the proportion of blackout tweets were higher in 2020 than 2019.

Discussion and Conclusion: Our findings demonstrate that references to high‐risk drinking persist during the pandemic despite restrictions on large social gatherings. Given that the internet is a common source of information for COVID‐19, the frequent posting about blackouts during this period might normalise the behaviour. This is concerning because alcohol use increases susceptibility to COVID‐19, and alcohol‐related mortality can further tax hospital resources.

Discussion

Our findings demonstrate that references to high‐risk drinking (i.e. blackouts) persist during the pandemic despite lack of access to venues where alcohol is commonly consumed and restrictions on large social gatherings. The continued trend of blackout mentions on Twitter during the pandemic is disconcerting due to the additional strain risky drinking may place on the health‐care system. Furthermore, the consistent pattern of blackout tweets during the month of March to April 2020 is surprising given that traditional college spring break activities, the ability to drink in typical venues (e.g. bars, restaurants) and social interactions were limited. In short, we expected a dip in the rate of blackout tweets due to these restrictions. Drinking to the point of blackout appears to be continuing, though may be occurring in different contexts. Given that over 94% of people in the USA were instructed to observe ‘stay at home orders’ [18], there may be people consuming at risky levels with potentially fewer people around them that can help them in an alcohol‐related emergency.

Furthermore, infoveillance [12] information such as that used here has the potential to provide insight into future alcohol problems in the USA. For example, exposure to 9/11 was linked to binge drinking rates 5–6 years later [19]. This indicates that experiences of mass stress (similar to a pandemic) increase later drinking rates. Similarly, with the 2003 SARS outbreak, hospital employees in China reported alcohol abuse/dependence symptoms 3 years later [20]. Moreover, research suggests that alcohol‐induced blackouts are a potential screener for additional alcohol‐related negative consequences [3]. Additionally, posts about alcohol on Twitter are linked to self‐reported drinking behaviours [21]. Therefore, while our data cannot speak to whether alcohol problems will increase in the future, using Twitter to monitor the impact of the pandemic on alcohol‐induced blackouts informs potential immediate needs (e.g. extra hospital resources or points of intervention) and may forecast potential lasting impacts of the pandemic (e.g. increased rates of alcohol misuse).

The limitations of the current study must be considered. Because the sample is limited to English language tweets, it is possible it might not generalise to individuals who do not post in English. Furthermore, the tweets were limited to public tweets in the United States, which excludes tweets kept private or where no user information exists to locate the tweet. A further limitation is that the US States did not announce their ‘stay at home’ and ‘shelter in place’ orders on exactly the same date and the adherence to those orders is unknown. However, the total window across all states was only 23 days, and the trends observed here extend beyond that range. More detailed analyses examining data for each state relative to their specific announcement date are beyond the scope of this publication, but may be of value.

Whereas tweets about blackouts are not a perfect measure of the extent of risky drinking in a population, our methods can provide insight into the extent of extreme drinking that persisted despite pandemic conditions (e.g. stay at home conditions; lack of traditional college spring break celebrations) and the extent to which drinking behaviour is changing in tandem with the pandemic. In addition, tweets provide information beyond traditional self‐report surveys. For example, the timing of the tweet (date, time of day), location and wording could provide information not only about past drinking experiences, but also about context and anticipation concerning future drinking experiences. Moreover, while it is yet to be seen, our findings suggest that there might be lasting impacts on alcohol consumption multiple years after the pandemic similar to the SARS outbreak [20] and 9/11 [19]. Our findings indicate that public health officials should consider monitoring behaviours presenting risk health such as alcohol‐related blackouts as they might be intensifying the effects of the pandemic.