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May 19, 2022 12:06 PM EDT

The pandemic and its attendant anxiety, boredom, and loneliness have not been good for people who struggle with alcohol use. According to a new study published in JAMA Network Open, alcohol-related deaths among U.S adults ages 25 and up increased 25% in 2020, and 22% in 2021, compared to average annual deaths from 2012 to 2019.

Led by Dr. Yee Hui Yeo, an internal medicine physician at Cedars-Sinai Medical Center in Los Angeles, the study relied on a massive database maintained by the U.S. Centers for Disease and Control and Prevention (CDC) that registers nearly all deaths in the U.S. and their causes. From 2012 to 2019, about 11 to 15 annual U.S. deaths per 100,000, among adults who were at least 25 years old, were caused by alcohol-use disorder (AUD). But during 2020, that number rose to an average of 19 deaths per 100,000; in 2021, it was 20.

Not all groups were affected equally. Men and women were similar in alcohol-related mortality, with both showing a 25% increase in 2020. Age was a much more significant factor. Far and away, the hardest-hit age group was the youngest measured—25 to 44 year olds—among whom deaths rose by 40% in 2020 and 33% in 2021. In the 45-64 year old age group, deaths increased 22% and 17%, respectively; for those 65 and older, the increased mortality rates were 17% and 22%.

Isolation, stress, and the accompanying urge to self-medicate with alcohol were not the only reasons the researchers believe the death rates climbed. Across the nation, visits to doctors fell during lockdowns, exacerbating health problems for people suffering from all manner of conditions, including AUD. Therapy groups to help treat substance dependence were unavailable (or less available) during COVID-19 lockdowns, although some did move online.

“Alcoholics Anonymous and rehab centers, in which it is common to have shared rooms, were closed down during the pandemic,” said Yeo in an email to TIME. “Even when they reopened, the capacity was reduced. Additionally, individuals with AUD may have avoided going to detoxification centers due to the fear of contracting COVID-19.”

The actual numbers may be worse than what the study shows, since AUD is often overlooked as a contributing factor when there is a more-immediate cause of death like heart attack or stroke. “We know that alcohol use disorder is often under-reported,” Yeo said in a statement that accompanied the release of the study, “so actual mortality rates related to alcohol may be even higher.”

Going forward, Yeo expects that these numbers will decline. COVID-19 vaccinations, the pandemic-era expansion of Medicaid benefits, and the reopening of society—including homeless shelters, rehab centers, and social support groups—should all help to ease the number of alcohol-related deaths, he says. But lagging indicators of alcohol abuse may still keep death rates above average for a while.

“There may,” Yeo told TIME, “be a rising tide of AUD-related complications such as liver disease, mental health issues and cardiovascular disease during the post-pandemic era.”

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Write to Jeffrey Kluger at [email protected].

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