Gyms, theaters and shopping malls have all shut their doors to the public amid the coronavirus epidemic. Yet liquor stores remain open in Massachusetts, as the state has deemed them essential businesses.
The Commonwealth is not alone in this judgment. Several U.S. states, including New York, New Jersey and California, have opted to keep alcohol purchases convenient.
Harvard Medical School assistant professor Brandon Bergman is the associate director of the Recovery Research Institute, where he researches addiction treatment and recovery. For him, the decision makes sense.
Individuals already suffering from severe alcohol addiction might be at risk if they suddenly ceased consumption, especially if they tend to have severe withdrawal symptoms.
“The consequences of that would be worse than the consequences of maintaining access to alcohol the next couple of months or what have,” Bergman said.
Only about 10 percent of those with substance use disorder experience severe withdrawal, Bergman said, but that minority could develop serious symptoms that lead to seizures or death.
Joe Kelleher, clinical director at the Gavin Foundation, a nonprofit substance abuse treatment and prevention agency, said another aspect to consider is the toll these cases would take on an already overwhelmed health care system.
“I think the last thing that the medical system needs right now is more people in their emergency rooms,” Kelleher said, “which is going to put more people at risk and divert resources that are needed for the COVID-19 treatments.”
Exacerbating this possibility are the closures of many in-person treatment services due to social distancing guidelines. While some treatments are still available virtually, Bergman said addicts seeking help now find it more difficult to build a relationship with a treater.
“It’s less about the access to alcohol as an essential business to prevent withdrawal so much as if we remove their access to alcohol,” Bergman said, “without providing some treatment that would help keep them alive in addition to helping them potentially make progress, we would really be doing harm.”
When beverage alcohol is restricted, Kelleher said addicts will occasionally seek the substance in other forms, such as hand sanitizer and grain alcohol, out of desperation.
“Usually, there are other toxic substances in any of those types of things,” Kelleher said. “But there is alcohol in a lot of those, so it’s like a last resort, but people have been known to do it.”
Bergman said the country has already seen this kind of consequence play out in recent history.
The current dilemma with liquor draws a parallel to the opioid epidemic in the U.S., during which the push to reduce pain medication prescriptions and lessen dosages generated an unforeseen consequence: people began turning to illicit opioids, heroin and other black market drugs.
Despite addicts needing opioid use disorder treatment or another method of pain relief, the federal government severed access to legal prescription opioids and provided neither treatment plans nor safer substitutes.
“So what you saw was the removal of one medical treatment without providing the necessary support for the disorder,” Bergman said. “I think that’s what they’re trying to avoid here with keeping liquor stores open as essential businesses during this time.”
But these stores are not just accessible to those who need them most. The drawback of having them open to the public, Kelleher said, is that current circumstances will also lead non-addicts to begin drinking more and more.
“You got to weigh the good with the bad,” Kelleher said. “But I think the more significant thing is to keep people out of emergency rooms and out of the medical system if it can be avoided.”
Finding the balance is tough, according to Bergman, because he and other substance abuse experts hope not to encourage increased alcohol dependence as a method of combating anxiety during this period. Aside from general drinkers, however, those in remission are among the most vulnerable.
Previous addicts who have made it far in their recovery process are liable to pick up the bottle again now that they might be experiencing increased stress, as well as reduced access to treatment services.
“We don’t want to promote people using alcohol as a way to cope with the stressors and certainly don’t want to promote relapse,” Bergman said. “At the same time, people with current alcohol use disorder, especially if it’s severe and they might be prone to withdrawal, do need access to alcohol during this time.”
Another set of concerns around access to consumable liquor is its potential relation to the spikes in domestic violence since mass self-isolation began. Though the use of alcohol itself can lower inhibitions and increase aggression, the agitation of withdrawal can also produce this type of result.
Jac Patrissi is the founder of Growing a New Heart, an association of addiction and domestic abuse professionals, and has been in the field for more than 30 years. She examined the link between alcohol use disorder and intimate partner violence in a year-and-a-half-long project with the Massachusetts Department of Public Health.
Alcohol itself, or the lack of it, is not truly the cause of domestic abuse, according to Patrissi. The roots of this behavior reach deeper than any influence a substance can impose on its own.
“The underlying reason that they’re being abusive rests on a key idea, which is that when they’re uncomfortable in any way,” Patrissi said, “they have a deeply-held belief or value that when they experience negative experiences or feelings that they can misuse their power over others.”
The same agony or trauma can manifest in vastly different ways depending on the individual, she said. One may undergo painful withdrawal without demonstrating any tendencies toward violence, while another will take a swing at their partner or child.
Patrissi said the difference stems from each person’s foundational values. For someone who has adopted an abusive mindset, which typically involves placing oneself’s needs above others’, substance addiction will either exacerbate these values or reveal them — it does not change them.
This means an abusive person would only behave that way if it was already natural for them, she said.
“As an only English-speaking person, you’re not going to start speaking Chinese unless you already spoke Chinese,” Patrissi said. “You’re not going to exhibit this whole new way of being.”
Patrissi said current apprehensions surrounding whether liquor should stay within easy reach are beneficial to think about, as it puts society at large into the shoes of domestic abuse victims who have been weighing this complex tradeoff long before a global pandemic pushed it to the public fore.
“That is the point of view that survivors of domestic violence are always managing, like which is worse?” Patrissi said. “To have my partner go without? Should I hide it? Is that going to be more violent for me or not? Or should I just do what my partner wants me to do and go buy some for them?”