When Drinking Alone Becomes A Problem

The pandemic has isolated people in their homes. For some, drinking has taken on the role of self-medication to manage negative emotions, like stress and anxiety.

Kasey Creswell, associate professor of psychology in the Dietrich College of Humanities and Social Sciences at Carnegie Mellon University, has focused her career on understanding the mechanisms that lead to addiction and which people may be vulnerable. She recently proposed a social-contextual framework for examining risk for alcohol use disorder (AUD) in the December issue of the journal Association for Psychological Science. According to Creswell, understanding the context in which drinking occurs has important implications for understanding who may be at risk for developing AUD and the underlying mechanisms explaining that increased risk.

“The vast majority of alcohol use by adolescents and young adults occurs in social settings with friends,” said Creswell. “There’s a substantial minority of young people, though, who are drinking alcohol alone, and they are telling us that the primary reason they drink alone is to cope with negative emotions. We are finding that such solitary alcohol consumption is an early warning sign for the development of alcohol problems.”

Over the past seven years, Creswell has been developing a new theoretical and empirical research area on solitary drinking. Using a large sample of adolescents followed over time, she found that solitary drinking in adolescence (ages 12-18) was associated with drinking to cope with negative affect and predicted AUD in young adulthood (age 25), even after controlling for teen drinking patterns and alcohol problems.

These initial findings indicated that adolescent solitary drinking represented an informative divergence from normative adolescent behavior and helped to predict who would go on to develop drinking problems years down the road. Since then, there have been a number of studies published by Creswell and others in the alcohol field showing that solitary drinking is linked to negative emotions, social discomfort, depression and anxiety. Along with one of her graduate students, Carillon Skrzynski, Creswell has recently published two meta-analyses summarizing the literature on solitary drinking in adolescents/young adults and adults, demonstrating that drinking alone is associated with alcohol problems and may serve as a coping mechanism to self-medicate and soothe distress.

The onset of the pandemic has only increased the levels of stress, anxiety and depression across society. As we sit in our homes alone, we are faced with stress and depression from potential job loss and anxiety for the health and safety of loved ones. The pandemic has been compounded by a year of social unrest and political instability. 

“An interesting thing about the pandemic is the remarkable shift in people’s typical drinking contexts that has resulted from social distancing and stay-at-home directives,” said Creswell. “It remains to be seen, but such restrictions could increase the prevalence of solitary drinking and, in the presence of increased stress/negative affect due to the pandemic, perhaps create opportunities to foster a different relationship with alcohol—one of self-medication, which has been consistently linked to increased alcohol problems.” 

Creswell is currently working on a study to determine the impact of the pandemic on alcohol consumption and alcohol problems and to test whether increases in solitary drinking, negative affect and coping-motivated drinking explain pandemic-related changes in alcohol use and problems. The vast majority of studies previously published on this topic have used cross-sectional designs that required participants to retrospectively recall changes in their alcohol consumption from pre- to post-pandemic.

For Creswell’s study, participants will be drawn from her ongoing 5-year longitudinal study funded by the National Institute on Alcohol Abuse and Alcoholism. As such, she will have the unique opportunity to prospectively examine within-person changes in alcohol consumption before and after the start of the pandemic in young adults. To her knowledge, it will be the first study to do so. 

“It’s important to keep in mind that social alcohol use is also associated with alcohol problems, but through different pathways,” said Creswell. “Individuals drink in social settings to enhance positive emotions and social experiences, and there’s a large body of work indicating that drinking in social settings is linked to negative outcomes like driving while intoxicated, sexual assault and aggression.”

Future studies will require rigorous research to understand the mechanisms and pathways that lead to negative outcomes for both social and solitary drinking. According to Creswell, focusing on the context of alcohol use will facilitate our understanding of the development of alcohol problems in adolescents and young adults.

“Knowing more about an individual’s drinking patterns will help us understand the purpose that drinking serves,” said Creswell. “This information can be used to create more targeted and effective treatments for alcohol use disorder.”

Creswell received funding from the National Institutes of Health for the article, titled “Drinking Together and Drinking Alone: A Social-Contextual Framework for Examining Risk for Alcohol Use Disorder,” published in the journal Association for Psychological Science.