Those potential repercussions — on everything from individual health to poverty, crime and violence, which have previously been associated with the density of alcohol sellers in a given area — will take time to unfold and assess. Right now, most of the data available on people's changes in drinking behavior are limited to small surveys. "This all suggests people are starting to put in place patterns of heavier drinking," says Elyse Grossman, a policy fellow at Johns Hopkins and lead author of the International Journal article. She expects to start seeing the effects one to three years from now, which is when alcohol abuse increased following other catastrophes. (Already cases of alcoholic liver disease are up an estimated 30 percent over the past year in the University of Michigan's health system, and many of those additional patients were young women.)

On a population level, this past year's drinking has already set in motion a cascade of consequences that would be difficult to reverse absent major policy changes. But individuals can take steps to avoid negative outcomes themselves. Koob says that the emergence of telehealth during the pandemic may be a "silver lining" that will allow physicians and support groups to reach more struggling people. Treatments exist on "a spectrum," he notes. "Not everyone has to go into a 28-day detox." Doctors and health officials should begin responding now, with initiatives like screening for people's drinking patterns and "better messaging" on what is excessive drinking, Barbosa says. "There are more people who are going to need help."

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