When Gov. Charlie Baker ordered all non-essential businesses to close late last month to mitigate the spread of COVID-19, the announcement was met with confusion by some wondering why liquor stores remained open, while other businesses shuttered operations indefinitely.
Addiction experts say there’s a legitimate medical reason behind the decision.
“It’s an essential business to individuals who are still actively using alcohol and aren’t ready for treatment,” said Dr. Heidi Ginter, chief medical officer at Recovery Centers of America. “If they continue their use rather than enter treatment, that use is going to keep them alive and keep them from having deadly symptoms associated with alcohol withdrawal.”
Ginter explained that alcohol addiction differs from other addictions, including opioids, because the withdrawal process itself can be fatal.
“It can lead to seizures and really significant complications,” she said. “With alcohol, you can have delirium tremens (DTs), which people often think means you’re shaking a lot, but delirium tremens is potentially lethal. It affects your brain and how you think and how you process (information), and it affects your whole metabolism. People end up in the intensive care unit and can certainly die.
“Being able to maintain an alcohol habit in the absence of treatment is really vital to keep people with substance use disorders alive.”
Not everyone supports keeping liquor stores open, however.
Peter B. Bach, a physician at Memorial Sloan Kettering in New York City, wrote an opinion piece for the Boston Globe April 2 detailing his concern that the number of domestic violence incidents would rise if liquor stores remain open, especially while the vast majority of the country’s population isolates at home.
“(There’s) no question that confinement of families, sudden demands to oversee home schooling, precipitous job loss, and worry over an invisible viral predator are the ingredients of a toxic domestic brew,” he said. “But alcohol is what turns it into a second invisible public health crisis.”
Bach said that excessive alcohol consumption impairs judgment and can lead to violent behavior. He noted that the sheriff’s department in Fresno, Calif., saw a 77 percent increase in domestic violence reports, and the Seattle Police Department reported 22 percent more calls on average since stay-at-home orders were implemented in those areas.
He called for liquor stores to halt operations, arguing that reducing access to alcohol would in turn reduce the frequency of domestic violence incidents during the coronavirus pandemic.
In a response to Bach published April 6, Tufts Medical Center physician Dr. Franklin Friedman argued that closing liquor stores would result in more harm than good by adding to the number of people needing emergency treatment during these unprecedented times.
“For people with alcohol dependency, abrupt cessation generally results in symptoms of acute withdrawal, which … may result in death,” he wrote. “These people often require hospitalization for several days during the worst of the withdrawal, and when hospitalized, they usually require a bed in the intensive care unit.
“Needless to say, that is a luxury we cannot afford during a pandemic.”
Friedman later explained in an interview with the Item that alcohol withdrawal is often much more serious than people realize, and the resources used to care for those suffering from its symptoms may be more than hospitals can provide.
Because stopping alcohol consumption cold-turkey often leads to acute withdrawal, he said, many of those people wind up in intensive care units that will likely be filled to capacity in many parts of the U.S. with COVID-19 patients.
“You can ask any emergency physician if we have opinions about the harms to society that alcohol produces, which it certainly does, between car accidents, domestic violence, and (bodily) harm,” he said. “But banning it in a prohibition-type manner during this pandemic — it just doesn’t seem like the right time and place to be doing that.”
