Alcohol Use Before and During Pandemics and Quarantine Restrictions in Iceland. COVID-19, 2020 –2021

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Introduction
The aim of this study was to investigate whether alcohol consumption patterns among Icelanders had changed during the time of the pandemic and quarantine restrictions of Coronavirus disease 2019 . In order to achieve that goal, the first group of the participants were asked about their alcohol consumption during the last two months compared to the last twelve months in May 2020 and the second group of the participants in March 2021.
In November 2019, COVID-19 first emerged in China. Governments around the word mostly responded to the pandemic by imposing a lockdown. Situations like isolation due to lockdown can lead to more alcohol consumption and people recovering from alcohol use disorder (AUD) are in danger of starting to drink again and relapse (Sugarman & Greenfield (2021;Testino et al., 2021). In general, much like the world over, the normal lives of Icelanders changed in the beginning of the year 2020 due to COVID-19, which led to, for example, more individuals experiencing isolation, family units remaining more alone and isolated from daily activity, and limitations on people going out and gathering in restaurants or bars. In Iceland, though not uniquely, COVID-19 resulted in many people in the tourism sector losing their jobs at the start of the pandemic, while those who had the opportunity to work from home were urged to do so and formal education in high school and universities was provided online (Bernharðsdóttir et al., 2022). However, people working in the healthcare sector did not have the option of changing their work conditions. They needed to go to their workplace at the hospital units, taking care of their patients with different kinds of illness as well the patients who were hospitalised in the course of COVID-19 (Bernharðsdóttir et al., 2022).
Globally, in the first half of the year of 2020, more than 77 million people were infected with COVID-19 and 1.7 million people lost their lives (Rodriguesa et al., 2022). During the worldwide COVID-19 crisis, not only was the physical and mental health of populations impacted, but also national economies (OECD, n.d.). Families faced challenges following financial losses, for example due to job losses. This period of time has also been very challenging for parents with children who cannot work from home, with day care and schools closed and maybe no right for paid leave (Karpman et al., 2020). Study by Thorisdottir et al. (2021) in Iceland showed that during period of COVID-19 increased depression and impact on mental health among 15 to 18 years old but did not increase substance use among the adolescents. The researchers pointed out in the study that the restrictions and the quarantines could have been a protective factor against substance use disorder and prevention for these group of age (Thorisdottir et al., 2021). According to Gonç alves et al. (2020) disasters like pandemics and quarantine restrictions can lead to or increase the intensity of mental illness. Fear and worries regarding COVID-19 and financial insecurity can induce anxiety, mood disturbance and depression in individuals, which could led to increasing alcohol consumption as a self-medication. In their study, Sugarman and Greenfield (2021) show evidence for more alcohol consumption among people with AUD and relapsing among people in recovering in social isolation during the pandemic lockdown in London. According to a study by Rehm et al. (2020) which focused on a group of men, there is evidence of increased alcohol consumption in response to distress due to the situation related to the pandemic. They also point out that this should be considered in the future. Furthermore, in their study it also emerged that a lower level of alcohol consumption depended on a decreased physical and financial availability of alcohol. Rodrigues et al. (2020) explored alcohol consumption during COVID-19 lockdown, related to the social culture in the countries of Spain and the United Kingdom. Using questionnaires, 179 individuals were interviewed from each country. Results show that the Spanish participants consumed alcoholic beverages less frequently during lockdown, while British participants reported no change in their alcohol consumption habits. It may suggest that in Spanish culture alcohol consumption occurs more in social contexts and that British people consume alcohol more as part of their daily lives within their homes (Rodrigues et al., 2020). A cross-cultural study conducted in the United States showed that during COVID-19, compared to pre-COVID-19, 60% of the participants reported to have increased their alcohol consumption, while 13% reported a decrease. They addressed three main reasons for the increased alcohol consumption. Firstly, higher levels of stress; secondly, more availability of alcohol; and thirdly, individuals were bored and lonely (Grossman et.al. 2020). A study conducted in Finland and Norway with the aim of measuring whether alcohol use had increased or not showed that in Finland alcohol use had decreased by 9%. In Norway, the report showed that there was little or no difference in alcohol consumption from before COVID-19 and during the time of the pandemic (Mä kelä et al., 2021). In study by Kilian et al. (2021) alcohol consumption was investigated during the first months of COVID-19 pandemic in twenty-one European countries, Iceland was one of those countries in the study. The cross-sectional online survey was conducted between April and July 2020. The results showed that alcohol use among participants had decreased those first months of the pandemic which can be explained by less availability to access alcoholic beverages during the restriction be course of the pandemic.

Method
In this study, a survey addressing traditional cultures of alcohol use, e.g. beer, wine and spirit consumption, asked two questions. Firstly, did you drink more or less alcoholic beverages than usual in the last two months than last twelve months before? Second, have you been drunk (5 or more drinks in the same sitting) more often or less in the last two months than last twelve months before? Participants were also asked about their background, such as gender, age, education, work, marital status, household and monthly income.
Samples were taken at two different time points during the epidemic, where participants were asked about their alcohol consumption in the last two months prior to when the survey was conduct during COVID-19, compared to last twelve months before. Data collection was conducted in May 2020 after COVID-19 had been measures in February the same year and quarantine and lockdown had been applied and March 2021 after more than a year of COVID-19 period of time by the Directorate of Health in Iceland. For both years the sample was randomly drawn from the National Registry of Icelanders from the Gallup Panel. Participants were recruited by telephone. The sample who answered questions in 2020 were not the same as those who answered in 2021. In 2020, a total of 850 participants completed the survey; in 2021, a total of 864 participants completed the survey. The participants answered the questions on a five-point Likert scale, in which 1 = Much more, 2 = More, 3 = No change, 4 = Less and 5 = Much less. For statistical analysis, three variables were used. After analysing the data, we decided to simplify the five answer categories into three categories because of the relatively small sample sizes in both 2020 and 2021, in order to make the statistical analyses more consist and reliable. The first two options on the Likert scale were combined, as were the last two; 1 = Much more/More, 2 = No change, 3 = Less/Much less.
All statistical results are based on three options (Much more/More, No change, Less/Much less) following three variables according to the participants' response: 1) drank more often compering to last twelve months, 2) no changes and 3) drank less than last twelve months before.
The widely used statistical programme SPSS (Statistical Package for Social Science), version 24, and descriptive statistics were used to identify all of the variables in the study, including background variables such as gender, age, income and relationship status.

Results
More than half of the participants in both samples did not experience any change in their alcohol consumption during the epidemic. It was more common for participants to experience less frequent drinking and fewer drinks during the pandemic (29.4% in 2020 and 37.2% in 2021). When participants were asked if they had drank more or fewer alcoholic drinks in the last two months than last twelve months before, 14.8% of participants reported drinking more often in 2020, while in 2021 only 12.5% participants reported that they had drank more alcohol beverages. These results may indicate that fewer alcohol beverages had been consumed as the pandemic progressed. It is interesting to note that when participants were asked if they had been intoxicated more often or more seldom in the last two months than last twelve months before, 3.7% of participants in 2020 answered that they had been drunk more often, but 6.0% participants in 2021 reported being drunk more often. For the same question, 34.5% of 2020 participants reported fewer times of intoxication, while 36.3% reported the same in 2021, which follows a similar pattern as the first two questions. See Table 1 below. When looking at the survey responses in terms of gender, there were no significant differences between men and women.
On the other hand, as can be seen in Table 2, there was a difference between age group regarding alcohol consumption during the pandemic.
The oldest group seems to be less likely to increase their alcohol consumption. In all cases, they are most likely to see no change in their consumption patterns, yet they are much more likely to reduce their consumption rather than increase it. The youngest group sees the largest change in their alcohol consumption. Compared to the other groups, there is a significant difference in that they are less likely to see any change in their alcohol consumption. They are usually both more likely to increase consumption and decrease consumption compared to the other two groups. They more often reduce their consumption rather than see no change. The younger group and the middle group are more likely to increase their consumption than the older group. The oldest group sees the smallest change in their alcohol consumption. The middle group is the least likely group to reduce their consumption. See Table 2 Table 3 shows that there was a difference in drinking patterns during the pandemic in 2020 and 2021 when participants' education is taken into account. Participants with a university degree experienced drinking more often than participants with a primary school diploma. Participants with a college degree are less likely to experience intoxication less often than the other two groups and are also more likely to experience no change regarding COVID-19. See Table 3 below. When groups with different incomes are compared, it can be seen that the highest-income group tends to see smaller changes and even increases in their consumption. Participants were classified into the following five groups regarding household income: 1) <400,000 ISK, 2) 400,000 to 549,000 ISK, 3) 550,000 to 799,000 ISK, 4) 800,000 to 999,000 ISK and 5) >1,000,000 ISK. The three questions are: Q1. Did you drink alcohol more often or less frequently in the last two months than last twelve months before?; Q2. Did you drink more or fewer alcoholic drinks in the last two months than last twelve months before?; and Q3. Were you more often or more seldom intoxicated in the last two months than last twelve months before?  Table 4 show that group 5 was less likely to drink less than groups 1, 2 and 4. Group 5 was also less likely to drink fewer drinks than groups 2 and 4 as well as less likely to drink less often than group 2; group 5 is also more likely to get drunk than group 4. See table 4 below. As in most variables, it was slightly more common for people to reduce their consumption of alcohol rather than increase it. However, there is a difference regarding between which groups it changed more, and how much it changed between groups in each direction, compared to previous consumption.
When people who live together are compared to people who do not, it can be seen that it was more common for people who do not live together to see a change in their consumption of alcohol. Significance will be seen in the groups regarding all three questions.
There was also a significant difference: people who do not cohabit were more likely to drink alcohol less often than people living together. There was no significant difference between the groups whether the other group was more likely to drink more often. Thus, the difference is rather explained by the fact that those in cohabitation may drink less often compared to res.ccsenet.org Vol. 15, No. 2;2023 those in cohabitation who saw no change. See Table 5 below. When the respondents were asked whether they had no children, one child or two or more children, a significant difference was found between those with two or more children and no child. No significant difference was found in those who had one child. See Table 6 below. Table 6. Alcohol consumption in terms of number of children in the household

No Child
One Child Two or more Children i.e., 34.5% participants reported less often being intoxicated 2020 when the survey was carried out than last twelve months before and 39.9% answered less often being intoxicated 2021. These results support the study by Thorisdottir et al. (2021) which pointed out that strict rules and isolation regarding to the pandemic could be prevention factor for example adolescents eighteen years old and older.
When looking at the results according to background variables, there is no differences in alcohol consumption according to gender. This is an interesting result, especially when compared to a study by Rehm et al. (2020) wherein they indicate that men increased their alcohol consumption in response to distress due to the situation related to the pandemic.
When looking at alcohol consumption regarding participants' age, the group over 55 years of age seems to be the group most likely to see no change in their alcohol consumption but more likely to reduce their alcohol drinking than the other groups. The youngest group (18-34 years old) showed the most change in terms of alcohol consumption. The results show that, compared to the other groups, this group was most likely to see any change in their alcohol consumption. This group is usually both more likely to increase consumption and decrease consumption compared to the other two groups ( Table 2).
The results show that participants with a university degree and higher income experience drinking more often than participants who had only completed primary school. This can indicate that people with higher education have more financial income, are able to work from home and have a stable income to finance their alcohol consumption, compering to individuals who do not have this position, as pointed out by Karpman et al. (2020). A study by Gonç alves et al. (2020) states that a situation like a pandemic and its restrictions can increase anxiety and depression, which can increase alcohol consumption as a self-medication. Participants with a college degree are less likely to experience intoxication less often than the other two groups and are also more likely to experience no change in alcohol consumption due to COVID-19 (Tables 3 and 4).
The results show that individuals who live alone were more likely to consume alcohol less often than people in partnerships during the period of the pandemic and restrictions (Table 5). This finding supports those of a study by Rodrigues et al. (2020), where they report that the Spanish participants in their survey consumed alcoholic beverages less frequently during the time of the pandemic and lockdown and reflect that the alcohol drinking culture can be related to socialising with other people. When the respondents were asked whether they had no children, one child or two or more children, a significant difference was found between those with two or more children and no child. Results show that parents who have two or more children are more likely than those who have no children to drink alcohol both more often and have more drinks than last twelve months in both times when the survey was conduct. However, no difference was found regarding whether they drank more often to get drunk or intoxicated compared to the participants with no children (Table 6).

Conclusion
The most interesting result of this study is that alcohol consumption seems to have increased between the two years or as the epidemic progressed. Further, the participants who live with their families, i.e. spouses and children, reported the most change in their alcohol consumption last twelve months before the survey for both 2020 and 2021 during the pandemic restrictions. It would be interesting to compare the results of this study to child protection notifications at the Child Services to see whether reports of neglect and domestic violence increased or decreased during the period from 2020 to 2021.