So, I posted an article in the @BostonGlobe last night suggesting we temporarily ban alcohol sales until home confinement is over. I have a two layer reason 1/n bostonglobe.com/2020/04/02/opi…
a) alcohol use exacerbates domestic violence; c) confinement is undermining our domestic violence safeguards such as in person surveillance by professionals and sobriety maintenance through AA. It spurred some intense negative responses. 2/n
Some stats - domestic violence is serious at steady state. > 1M ED visits per year coded for it, and all studies suggest this is a vast undercount. Heavy alcohol use perpetrator and not uncommonly the victim also is involved in more than half of these events. 3/n
When external events have reduced access to alcohol geographically or individually, rates of domestic violence fall, dramatically. This is strong evidence of causation. It suggests that limiting or stopping access would reduce violence during our current crisis too. 4/n
Banning sales would be extreme, secondary consequences would be serious. My argument focuses on the balance of aggregate benefits and harms when home confinement is prob making both problems worse. I anticipated my conclusion would be unpopular, but still worthy of surfacing 5/n
Nobody wants victims of violence or EtOH withdrawal.
I have seen both sometimes in the same patient. I think with our safeguards for violence victims down, the draconian step I propose makes sense. We should be discussing if there is an effective middle ground. 6/n
I have seen both sometimes in the same patient. I think with our safeguards for violence victims down, the draconian step I propose makes sense. We should be discussing if there is an effective middle ground. 6/n
At this point there is awfully clear evidence that domestic violence rates are rising. In France they have started to open up shelters for a rising tide of victims. US policy is moving meanwhile to broaden liquor access and loosen restrictions. thehill.com/business-a-lob… 7/n
Lot of back-of-envelope guesses on the burden EtOH withdrawal would place on the system. This is part of considering the ramifications of such a temporary ban of course. Here is my math 8/n
5M with AUD, 310K have withdrawal, 32K with DT's, 5700 would need ICU care for 24-72 hours, of which 800 would need ventilators. This would happen gradually over a month as home alcohol supplies dwindle. Some self tapering but probably would not ameliorate DT rates much 9/n
This would be an enormous burden on people and our health system. If we actually contemplated trying to limit alcohol sales the approach could be rolled out selectively based on where health care system burden is not currently swamped first. 10/n
But inaction is also a choice, in this case a choice to not hold down rates of domestic violence by limiting EtOH use. The status quo in normal times may be our equilibrium, but we are not there now, all elements have changed w/home isolation, we should pause and consider 11/n
I am not a psychologist. I don't know if there are data robust for forecasting. But my expectation is that the duration of confinement, continued job loss and financial insecurity, and all general insecurity are strong negative predictors of violence frequency 12/n
