Effects of COVID‐19 economic impacts on alcohol use disorder symptoms are mediated by maximum and volume of alcohol intake: Data from the National Alcohol Survey's COVID Cohort

Background Drinking patterns underlying the effects of COVID‐19 economic impacts on alcohol use disorder (AUD) severity are poorly understood, yet critical for alcohol messaging during global crises. We examined whether the effects of COVID‐19 economic impacts (CEIs) on AUD severity were mediated by drinking volume and/or maximum drinks. Methods Data are from the National Alcohol Survey's COVID Cohort, collected prepandemic in 2019–early 2020 (Wave 1), 2021 (Wave 2), and 2022 (Wave 3) using probability sampling via an online survey ( n = 1062 across all waves). Past‐year drinking volume categories were abstention and 7 drinking categories ranging from ≤1 drink/month to >4 drinks/day. Past‐year drinking maximum categories were lifetime abstainers, former drinkers, <4/5 drinks (women/men), 4–7/5–7, 8–11, and 12+. AUD severity was classified as none (0–1 symptoms), mild (2–3), moderate (4–5), or severe (6+). CEIs were measured as the count of five economic hardship items (e.g., job loss and pay reduction). Path modeling examined direct and indirect effects of CEIs on AUD severity via drinking volume and maximum, separately, controlling for demographics and associations across key variables over time. Results CEIs predicted both drinking volume ( p < 0.05) and maximum at Wave 2 ( p < 0.01) and Wave 3 (each p < 0.05). In turn, both drinking variables at Wave 2 predicted AUD severity at Wave 2 (each p < 0.001), and at Wave 3 (each p < 0.001). Indirect effects via multiple pathways were statistically significant but precluded specifying lagged effects due to reduced model goodness of fit. Conclusions Findings suggest people drank more and with higher intensity when facing pandemic‐related economic hardships. Both maximum drinking and average volume increased concurrent AUD severity and mediated CEI effects. Health messages and policies targeting reductions in overall alcohol consumption and heavy episodic or high‐intensity drinking during economic crises may mitigate the development of AUD symptoms among people experiencing negative economic impacts.