Millions are beaten and injured annually in the United States by drunken domestic partners and parents, and that is when times are good. With the economy tanking and families locked together because of stay-at-home orders to combat the spread of the coronavirus pandemic, domestic violence rates appear to be soaring. This requires an urgent response: States should immediately order the closures of liquor stores. They can reopen when home isolation is no longer needed.
The Fresno sheriff’s department filed 77 percent more domestic violence reports two weeks ago than three weeks ago. The Seattle Police Department received 614 calls in the last two weeks — 22 percent more than average rate. Domestic violence prevention organizations in Boston warn of an increase in cases.
No question that confinement of families, sudden demands to oversee home schooling, precipitous job loss, and worry over an invisible viral predator are the ingredients of a toxic domestic brew. But alcohol is what turns it into a second invisible public health crisis.
Most adults drink rarely or not at all. Just 10 percent of adults account for 75 percent of all alcohol sold, consuming 10 or more drinks per day. That kind of excessive use impairs judgment, engenders anger agitation and dysphoria, and can lead to violent behavior.
Reducing access to alcohol during the crisis will reduce the frequency of home violence. Finland’s liquor store employee strike in the 1970s as well as Sweden’s curtailment of liquor store sales on certain days in the 1980s, both had that effect. South Dakota imposed twice daily sobriety breathalyzer checks for individuals with multiple arrests for drunk driving last decade. That worked too. Not only did drunk driving rates fall, but so did calls for domestic violence — both by about 10 percent.
These data could support curtailing liquor sales at any time, and reducing domestic violence was one of the motivations for the temperance movement a century ago. But our response to the coronavirus pandemic itself is what makes this move appropriate now and for the duration of home isolation, as the isolation frustrates an array of safeguards we have in place to identify domestic abuse in the first place.
Victims are often identified through contact with professionals outside the home. I learned this firsthand as a third-year medical student in the 1990s. I evaluated a two-year-old boy with leg pain, which an X-ray revealed as a spiral fracture of the femur. This fracture rarely occurs other than as a consequence of a beating, and the boy’s belligerent and intoxicated father was arrested three hours later. This all took place in a hospital nestled in a tony enclave of Minneapolis.
Health care workers of all stripes and in most states are required to report suspected domestic abuse of both children and adults. In schools, teachers, counselors, social workers, and nurses are often trained to identify abused children, and most states require them to report what they uncover.
Telemedicine visits are replacing in person contact between health care workers and patients. The new classroom is a Google hangout. Video encounters leave the victims in the homes with their abuser and provide none of the privacy or perception that in-person consultation affords. Calls to domestic violence support lines require privacy as well, although text chat is an increasingly available silent alternative.
Alcoholics Anonymous rapidly moved meetings online, but the reality is that access to a private setting and the Internet are prerequisites to participation and not universal among its members. Yet a recent analysis found that AA is the most effective means to help people stay sober. One of the authors of that report, Keith Humphreys of Stanford University, put the problem plainly to me: “When supports for sobriety are low and alcohol supply is high, more people get intoxicated and inflict harm on themselves and their families.“
The cascading effects of domestic violence also exacerbate the pandemic. Each house call by police or paramedics is another opportunity for the disease to spread. It consumes time and personal protective equipment that are in desperately short supply. Any preventable visit to the emergency room chokes off that bottlenecked resource. And even trips to the liquor store are an avoidable reason for people to come into contact under stay at home orders.
Banning alcohol sales, even temporarily, will come at some cost. Liquor stores will close. Many who enjoy a glass of wine at dinner will have to forgo that pleasure for a few weeks or months. I can give up my occasionally “quarantini” with a twist. And we can all give up the alcohol during our Zoom happy hours.
With liquor stores closed, many people addicted to alcohol will have to endure the physical effects of withdrawal. For most, it lasts days and is deeply unpleasant. For about 5 percent, it can be life threatening without medical care. Doctors will need to be on the lookout for patients who may be in need of extensive assistance. The treatments for withdrawal are well known, widely available, and effective.
Even with these possible downsides, the benefits to domestic violence victims and potential victims whom we have few other ways of helping through this crisis should be our priority.
Peter B. Bach is a physician at Memorial Sloan Kettering in New York City.