We are in denial about alcoholism in this country – and it's going to get worse after lockdown

One of the safest predictions you could have made about the way we’d try to cope with Covid-19 is that we’d drink more alcohol.

This drug is so embedded in our society and psyche that we don’t think of it as a drug at all. Of all the drugs available to us, including illicit ones such as heroin and cocaine, alcohol ranks as one of the most dangerous to us individually and as a society. We’d rather have the gratification of a drink today than go without in order to protect our long-term health. This short-term thinking was also reflected in government priorities when they classified off-licences as “essential services” so they could ensure the nation’s need for alcohol wasn’t threatened. Not a single government minister has talked about the risks alcohol poses to health during the coronavirus outbreak.

Alcohol is a sneaky drug; most of the health problems, such as liver disease, take time to develop. A physical or psychological dependence on the drug also takes time, unlike crack cocaine or opiates, where dependence can take hold in weeks rather than years.

Given this long gestation period it can be difficult for the individual or those around them to know that they have a problem. We tend to think of alcoholics as people who drink first thing in the morning or those who drink every day. These patterns of drinking represent only a fraction of those who have problems. Other behaviours and factors need to be considered. If you are concerned about someone’s drinking, look out for these tell-tale signs: a pre-occupation with alcohol; prioritising a drink over family or work; appearing tired and irritable; being secretive or dishonest about how much the person is drinking; unable to say no to alcohol; looking intoxicated more frequently.

On their own, these signs might not look convincing, but it is likely that there will be more than one that are evident in the case of someone who is struggling with alcohol.

The most telling signs of dependence is what happens when the person abstains from alcohol. Do they experience withdrawal symptoms such as sweating, nausea, tremors, poor sleep, restlessness and becoming argumentative? There are more extreme symptoms for those who are severely alcohol dependent: abrupt abstinence can be life threatening for this group, and that’s why Public Health England recommends that homeless hostels buy in alcohol for those at risk in these settings.

Beyond these immediate risks, the more insidious risks take time to emerge. Cases of alcohol-related liver damage were on the rise prior to coronavirus. Sales data and results from surveys of people’s drinking habits suggest that many people were teetering on the edge of alcohol dependence and will now qualify for that diagnosis.

The chances of them receiving the diagnosis are slim, however. Only one in five harmful drinkers received the professional support they needed before the pandemic. And this is a disease that fosters denial in the drinker even when the evidence is overwhelming that a problem has developed. Many dependent drinkers don’t perceive themselves to be in that group. Many will be functional, holding down jobs, so the impact of their drinking is limited, unlike those from lower socio-economic groups who are prioritising alcohol over food.

Problems with alcohol in society have been brewing for some time, enabled by the lukewarm approach of various governments. The science may be unequivocal on our nation’s unhealthy relationship with alcohol, but we are still left to self-regulate and often with not enough awareness. Add to that our collective attitude that any issue with alcohol is a self-inflicted choice rather than a serious health problem on a par with cancer.

Even if you feel no empathy for people who have problems with alcohol, you might be swayed by the economic case for providing support. For every pound invested in treatment, three pounds are saved – especially important when our NHS is so drained of resources.

The legacy of Covid-19 will include our collective denial as a nation about our affair with alcohol. We still don’t want to admit we have a problem, and nothing will change until we’re ready to take that first essential step on the road to recovery.

Ian Hamilton is associate professor of addiction at the University of York