To Governors Cuomo, Lamont, and Murphy:

We commend the leadership you have taken to lessen the devastation from the COVID-19 pandemic thus far.

As doctors and other health professionals contending with the COVID-19 crisis, we are seeing excessive alcohol consumption add fuel to an already raging fire.

Because of this, we plead with you to limit the harm from this global pandemic by: (1) deeming liquor stores non-essential; (2) maintaining pre-pandemic alcohol delivery regulations for bars and restaurants; and, (3) providing emergency “surge” funding for detoxification, treatment, and recovery support services for those addicted to alcohol and other drugs. This additional funding is critical. At this time there is increased demand for treatment services is running up against pandemic-driven barriers to those services, including staff shortages. [1]

These requests reflect new World Health Organization recommendations to maintain and reinforce restrictions on alcohol availability during the pandemic and to strengthen alcohol and drug services. [2]

Even before this emergency erupted, alcohol-related deaths had reached crisis levels in the U.S., doubling over the last two decades [3], with women especially hard hit [4]. Now, with the stress and anxiety associated with this pandemic and need for social distancing, there are widespread reports of people turning to excessive alcohol use to manage their emotions [5].

There are several reasons why this spike will only worsen the COVID-19 crisis and its effects:

- Alcohol use is a major risk factor for family violence [6]. Households are already facing increased stress during stay-at-home and restrictive orders [7]. Higher levels of alcohol use under these circumstances threaten to make a bad situation worse. Already, New York City is reporting that its website for survivors of domestic violence has seen traffic double [8], reflecting a disturbing global trend [9].

- Excessive alcohol use impairs judgement. Research shows, for example, HIV patients report that adherence to their medication protocol is affected by too much drinking [10]. This is a time when our states need their residents to exercise “best judgement.”

- Alcohol weakens the immune system. This point has been emphasized by Dr. George Koob, Director of the National Institute on Alcohol Abuse and Alcoholism (NIAAA) [11]. Just one bout of excessive drinking can have measurable negative effects on immune system response [12]. The elderly are especially vulnerable. [13]

- Excessive alcohol use has detrimental effects on lung function, including the worsening of acute respiratory distress syndrome (ARDS) and other pulmonary conditions [14].

We are familiar with the argument that liquor stores need to be open to prevent life-threatening withdrawal symptoms for alcohol dependent people. A healthier strategy is to fund more available and targeted detoxification, treatment, and recovery support services, rather than letting people fend for themselves. Additionally, other arguments for keeping liquor stores open, advocated by some (including wine and spirits industry interests), supposedly for the benefits for public health and safety, lack any basis in research. We would also note that alcoholic beverages remain available at many grocery stores.

We sympathize with businesses impacted by this pandemic. Public health must take precedence over economic concerns, but in this case, we hope that businesses will recognize that it’s just plain good business to NOT increase their customers’ risk of illness or death.

Respectfully submitted,

Jeffrey A. Berman, M.D., DFASAM
   Diplomate in Addiction Medicine, American Board of Preventive Medicine
   Diplomate in Addiction Psychiatry, American Board of Psychiatry and Neurology
   Medical Director, SOBA New Jersey, New Brunswick, NJ
   Medical Director, Discovery Institute, Marlboro, NJ
   Secretary, New Jersey Society of Addiction Medicine

Council on Addictions of New York State (NYS)
https://canys.net/

Cheikhou Ann
Immigrant Health Consultant
Bronx, NY

James M. Bassage, MSED
Prevention Director, Steuben Council on Addictions
Bath, NY

Rachel Berman, MD, MPH, FAAP
Attending Pediatrician
Assistant Professor of Pediatrics
Bronx, NY

William Bowman, CASAC, CPP
Executive Director, Pivot
Watertown, NY

James E. Conklin, CASAC, CPP
Executive Director, Alcoholism & Drug Abuse Council of Orange County
Goshen, NY

Jennifer Faringer, M.S.Ed., CPPg
Director, NCADD-RA
Rochester, NY

Andrew Goldstein, MD, MPH
Assistant Professor, NYU

Beth E. Hurny, LMSW, CASAC
Executive Director, Prevention Network/OCAA
Syracuse, NY

Prof. Faroque Ahmad Khan M.B (Kmr), Master American College of Physicians
Retired Chairman of Medicine, Nassau University Medical Center, Long Island, New York, USA

Eileen Leonard, LMSW
Social Worker - Primary Care
NYC Health + Hospitals

Maria E. Luisi, MSW, LSW
Clinician at SOBA New Jersey

Robin Mann, LMSW
Executive Director - Erie County Council for the Prevention of Alcohol and Substance Abuse, Inc
Buffalo, NY

Ellen Morehouse, LCSW, CASAC, CPP
Exec. Director, Student Assistance Services Corp.
Tarrytown, NY

Sanjivan Patel, MD, FAAP
Chairman of Department of Pediatrics, Wyckoff Hospital , Brooklyn, NY 11237

Harold Stein, MD, FACP, FASN
Nephrologist

Patricia Wallace, LCSW, LCADC, CCS, ICCS
Clinical Director and Administrator, SOBA New Jersey

Robert B. Whitney, MD
Certified ASAM, American Board of Internal Medicine
Erie County Council for the Prevention of Alcohol and Substance Abuse (Board Member)
Member, American Society of Addiction Medicine

Michael Zingman, MD, MPH
Resident Physician, NYU Langone Medical Center

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[1] cf. also, Vestal, C. (2020, April 3). “Addiction treatment pivots for coronavirus.” Retrieved on April 3, 2020 from https://www.pewtrusts.org/en/research-and-analysis/blogs/stateline/2020/04/03/addiction-treatment-pivots-for-coronavirus

[2]  World Health Organization (2020, April 14). “Alcohol does not protect against COVID-19; access should be restricted during lockdown.’ Retrieved on April 16, 2020 from http://www.euro.who.int/en/health-topics/disease-prevention/alcohol-use/news/news/2020/04/alcohol-does-not-protect-against-covid-19-access-should-be-restricted-during-lockdown/_recache?fbclid=IwAR2lkIQcxfDdziOa7esAbXO-caLv66wvhmP4JxoDwXQd5z14X02jAmHZulg.

[3] White, A. M., Castle, I. J. P., Hingson, R. W., & Powell, P. A. (2020). Using death certificates to explore changes in alcohol‐related mortality in the United States, 1999 to 2017. Alcoholism: Clinical and Experimental Research.

[4] Spillane, S., Shiels, M. S., Best, A. F., Haozous, E. A., Withrow, D. R., Chen, Y., et al. (2020). Trends in alcohol-induced deaths in the United States, 2000-2016. JAMA Network Open, 3(2), e1921451-e1921451.

[5] Fischer, S. (2020, April 5). “Virus vices take a toll on Americans.” Axios. Retrieved on April 7, 2020 from https://www.axios.com/coronavirus-vices-alcohol-marijuana-food-23f02d5e-b82b-4944-8609-b4479af1070e.html
      Davis, C. (2020, March 30). “The trauma of the coronavirus pandemic could cause a nationwide spike in substance abuse, experts say.” Business Insider. Retrieved on March 30, 2020 from https://www.businessinsider.com/experts-say-coronavirus-may-cause-spike-in-alcohol-abuse-2020-3
Hoffman, J. (2020, March 26). “With meetings banned, millions struggle to stay sober on their own” New York Times. Retrieved on March 30, 2020 from https://www.nytimes.com/2020/03/26/health/coronavirus-alcoholics-drugs-online.html
      Gustafson, I. (2020, March 27). “Alcohol sales see significant growth amid COVID-19.” CStore Decisions. Retrieved on March 30, 2020 from https://cstoredecisions.com/2020/03/27/alcohol-sales-see-significant-growth-amid-covid-19/

[6]  Leonard, K. E., & Quigley, B. M. (2017). Thirty years of research show alcohol to be a cause of intimate partner violence: Future research needs to identify who to treat and how to treat them. Drug and Alcohol Review, 36(1), 7-9.
      Freisthler, B., & Holmes, M. R. (2012). Explicating the social mechanisms linking alcohol use behaviors and ecology to child maltreatment. Journal of Sociology and Social Welfare, 39(4), 25–48.

[7] Lang, M.J. (2020, March 27). “Domestic violence will increase during coronavirus quarantines and stay-at-home orders, experts warn.” Washington Post. Retrieved on March 30, 2020 from https://www.washingtonpost.com/local/domestic-violence-will-increase-during-coronavirus-quarantines-and-stay-at-home-orders-experts-warn/2020/03/26/04e63d6a-6d37-11ea-b148-e4ce3fbd85b5_story.html.

[8] Bocanegra, M. (2020, April 1). “City's domestic violence website sees surge in visitors.” Politico New York. Retrieved on April 2, 2020 from https://www.politico.com/states/new-york/albany/story/2020/04/01/citys-domestic-violence-website-sees-surge-in-visitors-1270105

[9]  Taub, A. (2020, April 6). “A new Covid-19 crisis: Domestic abuse rises worldwide.” New York Times. Retrieved on April 7, 2020 from https://www.nytimes.com/2020/04/06/world/coronavirus-domestic-violence.html.

[10] Azar, M. M., Springer, S. A., Meyer, J. P., & Altice, F. L. (2010). A systematic review of the impact of alcohol use disorders on HIV treatment outcomes, adherence to antiretroviral therapy and health care utilization. Drug and Alcohol Dependence, 112(3), 178-193.
       Samet, J. H., Horton, N. J., Meli, S., Freedberg, K. A., & Palepu, A. (2004). Alcohol consumption and antiretroviral adherence among HIV‐infected persons with alcohol problems. Alcoholism: Clinical and Experimental Research, 28(4), 572-577.

[11] Cassel, E. (2020, March 19). “What to do if you're drinking way more during self-isolation.” Vice. Retrieved on March 20 from https://www.vice.com/en_us/article/dygek7/drinking-alcohol-covid-19-self-isolation.

[12] Szabo, G., & Saha, B. (2015). Alcohol's effect on host defense. Alcohol Research: Current Reviews, 37(2), 159–170. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4590613/
       Afshar, M., Richards, S., Mann, D., Cross, A., Smith, G. B., Netzer, G., et al. (2015). Acute immunomodulatory effects of binge alcohol ingestion. Alcohol, 49(1), 57-64.

[13] Centers for Disease Control and Prevention (2020, ). “Coronavirus disease 2019 (COVID-19): Older adults” [webpage]. Retrieved on March 26, 2020 from https://www.cdc.gov/coronavirus/2019-ncov/specific-groups/high-risk-complications/older-adults.html
       National Institute of Health (n.d.).  “Older adults” [online fact sheet].  National Institute on Alcohol Abuse and Alcoholism. Retrieved from https://www.niaaa.nih.gov/older-adults on March 27, 2020.

[14] Moazed, F., & Calfee, C. S. (2014). Environmental risk factors for acute respiratory distress syndrome. Clinics in Chest Medicine, 35(4), 625–637.
       Yeligar, S. M., Chen, M. M., Kovacs, E. J., Sisson, J. H., Burnham, E. L., & Brown, L. A. (2016). Alcohol and lung injury and immunity. Alcohol, 55, 51–59.
       Simou, E., Britton, J., & Leonardi-Bee, J. (2018). Alcohol and the risk of pneumonia: A systematic review and meta-analysis. BMJ Open, 8(8), e022344.