Alcohol use during the Great Recession

There have been many theories and contradictory findings about how alcohol use changes during economic downturns. Will people drink less because they can’t afford it—a common refrain in economics journals? Or will the depression associated with unemployment lead to more binging? A recent article looking at alcohol use during the Great Recession provides an interesting, if unexpected, result.

Since the start of the recession in December 2007, alcohol-related emergency room visits and hospitalizations increased in a few locales. Some health departments therefore anticipated that alcohol-related health problems would require increased medical and public health attention during this period. Binge drinking has been found to be correlated with economic downturns in the past, even among those who remain employed. Yet some other agencies have proposed reducing or eliminating substance abuse programs, especially in the context of budget deficits. Some studies suggest that economic downturns are associated with significant declines in overall alcohol use and other health risks, and have therefore been cited as justification for such cuts.

This conflicting evidence have led to a variety of hypotheses about what might be going on: an ‘uncovering’ hypothesis suggesting that potentially abusive drinkers will be “frightened out of drinking” by the threat of job loss if they continue to drink; an ‘income-effect’ hypothesis suggesting that less income with which to purchase alcohol will lead to less drinking during the recession; and a ‘provocation’ hypothesis reasoning that people will cope with insecurity and stress related to real or threatened job loss by drinking more. Depending on which hypothesis you subscribe to, you might expect decreased or increased drinking during the Great Recession, and therefore recommend a different policy response in terms of funding alcohol abuse programs.

A recent epidemiological analysis by Jacob Bor at Harvard (full disclosure: I’m a co-author on the study) newly informs the debate between these alternative hypotheses. The analysis uses data on drinking patterns during the Great Recession using a nationally representative sample of over 2 million U.S. adults who were subjected to a standardized alcohol drinking survey. The study assessed drinking behaviors along several dimensions: drinking participation, drinking frequency (number of drinking days), drinking intensity (number of drinks on drinking days, maximum number of drinks in a single episode), total alcohol consumption, and frequency of binge drinking. In contrast to industry reports that measure total consumption of different alcoholic beverages, this analysis was able to assess changes across the full distribution of drinking behaviors, ranging from abstinence to frequent binge drinking.

Here’s the surprising result: during the Great Recession, rates of abstinence from alcohol increased among U.S. adults, but total alcohol consumption also increased. What does that mean? It means the country was diverging: most people drank a little less Charles Shaw wine at dinner because of the pinch on their pocket-books, but there was a smaller population about the size of a small city—about  770,000 adults—who started binging (a statistically significant rise in the prevalence of frequent binge drinking of 7.2% relative to baseline levels). In other words, there was simultaneously a rise in the number of moderate and heavy drinkers and a decline in the number of light drinkers.

Who were these bingers? During the recession, frequent binge drinking was highest among non-Black, unmarried men under 30 years who were unemployed for less than one year. This finding is consistent with existing literature. Binging rose the most among people 25-34 and 55-59 years, age groups that are the most vulnerable to job scarcity and job insecurity (either not finding a job after college/in the early years of work or being forced into early retirement).

This polarization of drinking behaviors supports a few of the theories at the same time: an increase in abstinence from drinking (the “income-effect” hypothesis) among primarily young people with less than a college education (who may be more sensitive to changes in expected income), but a rise in frequent binging and total alcohol consumption (the “provocation” hypothesis) suggesting job insecurity, the threat of loss of a home or life savings, or other recession-linked exposures may have led to greater use of alcohol as a coping mechanism among a subpopulation. However this study found no evidence of an “uncovering” effect, in which higher-risk drinkers reduced consumption due to threat of job loss during the recession.

Although this analysis is descriptive, it allows us to document some of the potential human costs of The Great Recession, and provide evidence that can guide clinicians and policy makers to target resources towards populations at highest risk. It also suggests that common analyses of “counter-cyclical” phenomena during recessions–that is, looking at how average rates of substance abuse or mortality decline during recessions–is likely to be a bit foolish: the averages disguise a striking variation within the country. Vulnerable people appear to be hidden behind the average statistic.