Austin Fast and Brendon Derr

Special to the Republic

Within six hours of losing access to alcohol, withdrawal symptoms ranging from the shakes, vomiting, hallucinations or seizures can send people with alcoholism to hospital intensive care units.

“You can die from alcohol withdrawal,” said Max Jordan Nguemeni Tiako, a Yale School of Medicine addiction researcher. “You can’t just stop drinking overnight.’’

With 15 million people in the United States dependent on alcohol, according to the National Institute on Alcohol Abuse and Alcoholism, banning liquor sales might flood already overwhelmed hospital emergency rooms with countless thousands of additional patients.

Forty-seven states, including Arizona, have included alcohol sales as an “essential service’’ during the COVID-19 pandemic. Three states have placed some limits on sales: Curbside pickup only in Alabama, a shutdown of stand-alone liquor stores in New Mexico, and a ban on in-person hard liquor sales in Pennsylvania.

Concerns about alcohol withdrawal may have influenced those decisions in many states, but few governors have addressed the issue directly. And other factors led to decisions to keep the alcohol flowing.

Asked this week why Arizona decided liquor sales are essential, Patrick Ptak, the spokesman for Gov. Doug Ducey, issued a statement: “In making all our decisions during this time, we have relied on the advice of public health officials. We have also sought to have the least amount of interference on people's daily lives and on the economy, while ensuring we have physical distancing and are slowing the spread of COVID-19.”

And others are mindful of history.

“Prohibition didn't work 100 years ago, and it won't work today,” said David Delos, president of the Arizona Licensed Beverage Association. “If you can't get a glass of wine or a bottle of beer at the end of the day, then people might look toward alternative ways to find different liquor. We're providing a safe way to obtain liquor.”

Tiako notes cases of people drinking mouthwash and rubbing alcohol to stave off withdrawals — some even turning to the especially lethal option of car coolant.

Federal agencies provided states with no explicit guidance on alcohol sales, leaving it to governors to make that call. Ducey’s executive orders have made it clear minimizing economic harm is an important element of the state’s response to coronavirus.

The National Governors Association, which has served as a principal resource for the nation’s governors as they grappled with what an essential business is, relied on risk assessments by the Cybersecurity and Infrastructure Security Agency, an arm of the Department of Homeland Security. The agency advised the NGA on what it considered essential.

On its list of essential functions: “Workers supporting groceries, pharmacies and other retail that sells food and beverage products.’’ It did not specify the type of beverages.

When New Jersey Gov. Phil Murphy was asked on March 24 why he deemed alcohol sales essential, he answered by citing an alcohol recovery coach thanking him for the decision.

“She was on her knees profusely thanking me for keeping the liquor stores open as it relates to just the whole addiction front,” Murphy said. “She said the alternative would have been crushing for a lot of people.’’

With tax revenues dropping dramatically in every state, keeping liquor flowing also keeps the spigot of alcohol-related taxes open. And it is not a small change.

Alcoholic beverages contributed an estimated $432 million to Arizona’s coffers through sales taxes, excise taxes and licensing fees in 2019, according to Lisa Hawkins, spokeswoman for the Distilled Spirits Council of the United States. Nationwide, states’ revenues exceeded $23 billion for 2017, the last year for which complete data is available.

“Governors across the United States recognize that there is a careful balance between protecting public health while also protecting state and local economies and continuing to serve consumers,” Hawkins said.

She added many stores are trying to reduce risk by limiting the number of customers allowed in a liquor store at any given time, having store personnel retrieve customers’ products, encouraging credit card purchases and requiring employees to wear gloves.

“With neighborhood liquor stores, people don't have to go far from home and they provide a service that’s vital,” Delos said. “A lot of people don't want to go into grocery stores and bigger stores because of the social distancing aspect, but with liquor stores, you have the ability to create social distancing space, and you also have a lot of drive-thrus.”

One small liquor store owner, Craig Dziadowicz of Hidden Track Bottle Shop in downtown Phoenix, said he’s limiting the number of customers to two at a time, encouraging curbside pickup and wearing rubber gloves to select bottles for his patrons.

To ensure his business remains classified as “essential,” Dziadowicz recently converted his cafe next door into a bodega to provide fresh produce to neighborhood residents inconvenienced by the coronavirus.

The economic benefit aside, the public health downside of banning alcohol has been most concerning to alcohol abuse experts.

Dr. George F. Koob, director of the National Institute on Alcohol Abuse and Alcoholism, said in an interview that in the eyes of someone with alcohol use disorder, alcohol is an “inelastic commodity” — meaning that demand will not change when the supply disappears.

When the decision is between safe access to alcohol or people desperately reaching for alternatives, safe access through liquor stores should take priority as “a harm reduction public health intervention,” according to Tiako’s co-author Kelsey Priest, an MD/Ph.D. candidate at Oregon Health and Science University.

Even as bars and restaurants have closed, alcohol sales have risen nationally since social distancing began, but Hawkins of the Distilled Spirits Council of the United States is advising consumers not to overdo consumption.

“The simple pleasure of making a cocktail can bring a little joy to adults who are hunkered down at home, but moderation is key,” Hawkins said.

For help

If you or someone you know would like to seek treatment, FindTreatment.gov can help you locate options, and the National Institute of Alcohol Addiction and Alcoholism has resources available at https://www.rethinkingdrinking.niaaa.nih.gov/ and https://alcoholtreatment.niaaa.nih.gov.

This article was prepared by students in an Investigative Reporting course at the Walter Cronkite School of Journalism and Mass Communication at Arizona State University. Email the reporters at arfast@asu.edu and bcderr@asu.edu.