Mad man Don Draper made the midday cocktail iconic in the seemingly real-life drama depicting 1960s ad agency life but in 2020 that midday cocktail is taking on a different meaning and pain for many Americans. Rising use of alcohol during the pandemic has reportedly increased incidence not just of ER visits but underlying medical conditions. In a straw poll of 100 adult males who said they are drinking more now than in March, irritable bowel symptoms such as constipation are a growing issue. Our poll is not scientific but 39% of 94 gastroenterologists and internists confirmed this week that the amount of time they spend on virtual visits talking about alcohol’s effects is higher than normal, and referrals to behavioral health counseling are roughly twice the typical rate. The effect of drinking 5x to 7x a week over a 4-month stretch is elevating dehydration, stomach pain and risk of bowel conditions.
“I already refer a lot to mental health since I see a lot of Crohn’s patients,” says Samantha Winston, a nurse practitioner in a GI practice, “but that’s related to depression or intimacy issues.” The alcohol prevalence, she says, is a new problem tied to societal trends like unemployment, anxiety and lack of social interaction.
Harry Aslanian, MD, a professor and endoscopy specialist at Yale New Haven, says he’s noticed an increase in complaints related to constipation due to alcohol, but has not yet diagnosed a patient with IBD due to alcohol use during Covid.
The impact varies by state and gender and even job. 80% of women in healthcare positions in Texas age 25-34 report increasing use vs. 89% of males and females here from education jobs combined. Montana and Missouri have the highest use based on some adult groups while workers in the hospitality industry generally report the highest use, particularly those 35-55 who are supporting families, but generally out of work, according to stats are from TPS Alert.
In April, addiction treatment company Eleanor Health reported an increase in alcohol-related patients but was tackling the issue through telehealth and data about its patients. At the time, chief medical officer Nzinga Harrison, MD, was worried about the stimulus. “We know that the [government’s] Covid stimulus represents additional relapse risk, so we have proactively approached everyone to execute a safety plan,” she said back in April. (story here)
That worry may resurface as the stimulus runs out and people remain out of work, furloughed or underinsured. Gastroenterologists and internists have been actively embracing telehealth to manage patients, according to Joel Brill, MD, board certified in internal medicine and gastroenterology and chief medical officer at Predictive Health. “Question is will we see people return to the ER when the stimulus runs out.” To counter this, Brill believes efforts by patients to report early and for the GI and internist community to collaborate with behavioral health will be important, both for diagnosis and early management of symptoms. 52% of the GIs say they have started to refer patients to telepsych therapists, others say they are contemplating “hiring” a counselor.
All of this further illustrates the connection between the physician and behavioral health, particularly for conditions typically treated by gastroenterologists. Insurers in states like Maryland and New Jersey in recent years have begun to incentivize GI doctors to do more depression screening and management of chronically ill Crohn’s patients. We would anticipate that the Covid pandemic likely accelerates interest in partnerships among GI practices, internists and behavioral health.