Prevalence, risk and protective factors of alcohol use disorder during the COVID-19 pandemic in U.S. military veterans

Drug Alcohol Depend. 2021 Aug 1:225:108818. doi: 10.1016/j.drugalcdep.2021.108818. Epub 2021 Jun 18.


Background: There have been reports of increased alcohol consumption during the COVID-19 pandemic in the general population. However, little is known about the impact of the pandemic on the prevalence of alcohol use disorder (AUD), especially in high-risk samples such as U.S. military veterans.

Methods: Data were analyzed from the 2019-2020 National Health and Resilience in Veterans Study, which surveyed a nationally representative, prospective cohort of 3078 U.S. veterans. Pre-pandemic and 1-year peri-pandemic risk and protective factors associated with incident and chronic probable AUD were examined.

Results: A total of 6.9 % (n = 183) of veterans were classified as chronic probable AUD, 3.2 % (n = 85) as remitted from AUD, and 2.7 % (n = 71) as incident probable AUD during the pandemic; the prevalence of probable AUD in the full sample remained stable -10.1 % pre-pandemic and 9.6 % peri-pandemic. Younger age, greater pre-pandemic alcohol use severity, and COVID-related stressors were associated with incident AUD during the pandemic, whereas higher pre-pandemic household income was associated with lower risk of this outcome. Younger age, combat experience, lifetime substance use disorder, greater drug use severity, lower dispositional optimism, and more COVID-related worries and social restriction stress were associated with higher risk of chronic AUD.

Conclusions: Nearly 1-in-10 US veterans screened positive for AUD 1-year into the pandemic; however, the pre- and 1-year peri-pandemic prevalence of probable AUD remained stable. Veterans who are younger, have served in combat roles, endorse more COVID-related stressors, and have fewer socioeconomic resources may be at higher risk for AUD during the pandemic.

Keywords: Alcohol; Alcohol use disorder; COVID-19; Veterans.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Alcoholism / epidemiology*
  • COVID-19 / epidemiology
  • COVID-19 / psychology*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Pandemics*
  • Prevalence
  • Prospective Studies
  • Protective Factors
  • Risk Factors
  • United States / epidemiology
  • Veterans / psychology*
  • Veterans / statistics & numerical data
  • Young Adult