We have been tracking the illness and deaths caused by a global pandemic for more than a year. But we may not know the true costs of COVID-19 for a few years.

That’s how long it will take to find out whether the stress caused by the pandemic, and the coping behaviors many people have turned to, will add to the death toll of the disease itself.

Excessive alcohol use is the third leading preventable cause of death in this country, accounting for deaths by poisoning, dangerous driving and health conditions like alcoholic liver disease. Alcohol consumption is on the rise, in Maine and nationally.

Tobacco smoking is the No. 1 preventable cause of death in America, contributing to various cancers, heart disease and respiratory disease. Smoking is also  increasing.

If these trends continue, we can expect them to deliver more bad health outcomes in the years ahead unless people change their behavior.

Alcohol-related deaths have been on the rise, nationally and in Maine, for nearly 20 years, but COVID may accelerate a bad trend.

After averaging a 4.4 percent annual increase in all alcohol-related deaths over a five-year period ending in 2019, Maine saw them jump 28 percent in 2020, from 455 to 584. Data collected from alcohol sales, impaired-driving crashes and surveys indicate that more people report drinking more than they were before the pandemic, creating habits that will be hard to break.

Maine reports having one of the highest rates in the nation of binge drinking, defined as five or more drinks for men and four or more for women consumed in about two hours. The federal Centers for Disease Control and Prevention says this is the most “common, costly and deadly pattern of excessive alcohol use.”

Smoking rates, on the other hand, had been moving the right direction for years before COVID.

In 1999, the CDC identified tobacco control as one of the 10 greatest public health achievements of the 20th century. Among adults, smoking had dropped from 42.4 percent in 1965 to 24.7 percent at the start of the new millennium. It has dropped significantly since then, declining to 14 percent before the pandemic.

But something happened in 2020. Tobacco companies had projected that cigarette sales would continue to drop last year at the same rate they had for the previous five years, between 4 to 5 percent. But the companies had to revise their estimates to investors midyear, projecting only a 1 percent decline.

At the same time, calls to state hotlines for advice on quitting smoking took a dramatic drop in 2020, falling more than 25 percent from the previous year, 715,600 to 525,600.

It’s easy to see what’s going on here. It’s been a stressful 14 months, filled with disruptions and uncertainty.

In addition to worrying about their own health or the health of their family members, millions of Americans were out of work and many more had to cope with isolation, closed schools and other disruptions.

Researchers have documented increases in alcohol and tobacco consumption after natural disasters, like hurricanes and forest fires.

But they have never studied a public health disaster that has lasted as long or affected as many people as the coronavirus pandemic, which is still spreading worldwide. There is no vaccine for stress, and once started, habitual use of highly addictive substances is hard to stop.

We have asked a lot of our public health agencies during this pandemic, but their work won’t end when the virus is under control.

If we are going to prevent the deaths that are sure to follow from increased binge drinking and cigarette smoking, it will take well-resourced public health departments committed to fighting these addictions – the same way they fought COVID.