With retail stores, restaurants, schools, and more shuttering their doors nationwide because of COVID-19 restrictions, the list of business that can remain open has been short — and confusing. Liquor stores are among those that can keep the open sign on, and it's for a very important reason.

By Stacey Ballis
April 23, 2020
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It is a strange time we are all living through. As a society, we are faced with making all sorts of decisions that we never expected to have to make. The engines of economic creation have fallen on a very small group of professionals. The country's well-being is literally borne on the backs of medical workers who are racing against time with limited resources to keep us alive, first responders who are putting themselves in harm's way even more than usual, and the hourly/gig workers who are keeping us fed. That includes delivery drivers, shoppers, grocery store owners, chefs and restaurant owners, farmers, and truck drivers. They're all bearing the burden of our collective needs, while facing down unprecedented risks to their own health.

With increasing closures and even some re-openings, communities of all sizes are having to decide what should be considered an "essential" business and what shouldn't. Medical offices, pharmacies, grocery stores, and restaurants make the list understandably. But in most areas, so do liquor stores, and where legal, marijuana dispensaries do, too.

Our collective approach to alcohol use seems to have shifted during lock-down. Ina Garten went viral for making a giant Cosmopolitan and touting that during lockdown, cocktail hour is any hour you drink a cocktail. Isolation memes abound with jokes about day drinking — everyone's having "coffee with a margarita in it, and also no coffee."

But among the jokes and memes is an important concern: What happens if people with a new-found fondness for drinking more than usual during quarantine develop a dependency issue? And what if people who have been sober find the allure of an open liquor store in these difficult times too tempting to ignore? Which then brings us back to the question so many have: Why exactly are liquor stores "essential" businesses?

Open Liquor Stores Can Prevent Another Health Crisis

People who rely on medical marijuana to treat everything from pain to nausea, or to help manage stomach ailments during chemotherapy, need these spaces to be open just as any pharmacy would be. In some states where recreational marijuana is legal, many dispensaries are choosing to only fulfill prescriptions for these patients.

Some liquor stores sell other beverages, as well as food and packaged goods, and in some communities, that may be the only option for food.

But chief among considerations for many governors and healthcare officers in each state are the dangers associated with detoxing from regular alcohol use without medical supervision. What's more, there is strong evidence that alcohol-related domestic violence can worsen if access to alcohol is denied or limited.

In short, liquor stores are often considered essential businesses because they prevent additional healthcare emergencies.

Ways to Cope With Stress and Anxiety Without Substance Use

To better understand this important need, we reached out to Shane Krause, PhD, an assistant professor of psychology at the University of Nevada, Las Vegas, and George Koob, PhD, the director of the National Institute on Alcohol Abuse and Alcoholism, to help us understand some of the issues at play and why states and cities have determined liquor stores are essential businesses.

AR: What are the dangers to people with an alcohol dependency who stop drinking without medical support?

Dr. Krause: For most regular drinkers, stopping alcohol consumption will not result in any issues. However, for those who drink heavily (5+ drinks a day), supervised medical attention (detox) may be necessary. Anyone who is drinking heavily should consult a medical provider before stopping. There is a chance, though small, of seizure occurring when the person begins to experience withdrawal between three to five days of abstinence. I would strongly encourage individuals to seek out medical help if they have an alcohol problem and wish to discontinue.

Dr. Koob:  For chronic heavy drinkers, the abrupt cessation of alcohol use can precipitate dangerous, even deadly, withdrawal. Depending on how much and how often a person drank, withdrawal symptoms could include insomnia, restlessness, sweating, rapid heart rate, anxiety, nausea, seizures and even death. Severe alcohol withdrawal contributes to roughly 850 deaths and 250,000 emergency department visits each year in the United States. If someone has been drinking heavily for a long period of time, it is best to stop under the supervision of a medical professional. Medications can be used to help treat the symptoms and improve the outcome.

AR: What does the general public need to understand about both alcohol use and clinical approaches to marijuana use during a time of crisis?

Dr. Krause: We can expect alcohol/drug use and other behaviors to increase during periods of stress. For example, results suggest that under difficult times, alcohol use can increase. There is some evidence that alcohol use disorders (those who meet DSM-5 criteria) decline during economic crisis. However, at the same time, heavy or excessive drinking can increase, which is not good for a variety of reasons. I think it would be prudent to promote safe/healthy alcohol consumption among the general public right now. Obviously, people turning to alcohol or drugs (including cannabis) to cope with stress will not be helpful to them in the long run. There are a number of healthier behaviors (exercise, cooking, knitting, etc.) that may be a better stress reducer for folks.

Dr. Koob: It can be tempting to turn to alcohol to help cope with the stress and uncertainty of the current pandemic, but it is a risky and unsustainable option. We learned from previous disasters, including 9/11 and Hurricane Katrina, that alcohol consumption tends to increase during such events. More people drink and those who drink often do so more heavily. Unfortunately, the relief alcohol provides for boredom and discomfort is short-lived. Feelings of lethargy, anxiety, low mood, and irritability tend to increase when the buzz wears off, even after a single night of excessive consumption. For people who regularly drink to excess, changes in the brain lead to increases in emotional misery between episodes of intoxication, motivating the drinker to drink again. In essence, using alcohol to medicate emotional misery causes more emotional misery and leads people to drink again in an effort to fix a problem caused by alcohol itself.

AR: What are people in the medical recovery industry promoting at this time?

Dr. Koob: Many people rely on in-person visits with clinicians and/or mutual support groups to support their recovery. Such in-person meetings might not be possible for a while. For some, the sudden absence of in-person support and added stress due to social isolation and uncertainty during the pandemic could be a recipe for relapse. Fortunately, there are several options available for people currently in recovery or those looking for help. The NIAAA Treatment Navigator provides an overview of treatment options for alcohol use disorder. It includes links to online mutual support groups and allows users to search for addiction counselors who offer remote sessions via phone or computer.

AR: If someone is sheltering in place with an active alcoholic, especially one who might have been secretive about amount of consumption, what do they need to know?

Dr. Krause: I would try open a dialogue with the person who you have concerns about their drinking. They should also assess their safety and determine if staying there is right for them. In addition, I would also encourage them to call SAMHSA's National Helpline at 1-800-662-HELP (4357) for support and to identify services in their area.

Dr. Koob: If you do not know how much they are drinking, do not ask them to stop their drinking abruptly. Keep in mind that alcohol withdrawal can be a medical emergency. Try to have an honest discussion about their alcohol use and with the tools in our websites help them seek treatment options tailored to their needs. Remember that alcohol use disorder is a medical disorder rooted in the brain, and there are several effective treatment strategies available. If the person is willing, they could visit the NIAAA Rethinking Drinking website and do an online assessment using DSM-5 criteria to see if the relationship with alcohol qualifies as a clinical disorder. If they are willing to get help, plenty of options remain despite the pandemic, including online mutual support groups and counseling via telehealth. Please visit the NIAAA Treatment Navigator for examples.

Dr. Koob also says that social isolation can be a trigger for patients with an alcohol use disorder, and that alcohol use can be a poor coping strategy at times of stress. He encourages everyone to "Please stay in contact with your loved ones. We need to make this a time of physical distancing but not one of isolation."

If you believe that you might have a problem with drinking, NIAAA's Rethinking Drinking can help people evaluate whether drinking that may be problematic. If you determine you may need help, the NIAAA Treatment Navigator provides information about treatment options.