People in Treatment for Alcohol Use Disorder may Struggle to Abstain During COVID-19 Lockdown

Research Society on Alcoholism

Newswise — The first-wave COVID-19 lockdown in Barcelona, Spain, has been linked to increased drinking among people recovering from alcohol use disorder (AUD), as reported in Alcoholism: Clinical and Experimental Research.Pandemic-associated stress has already been associated with increased drinking in the general population, but few studies have examined the impact among people with a clinical diagnosis of AUD, who may be particularly susceptible to using alcohol as a coping mechanism. Additionally, almost all COVID-19 studies to date have been based on self-reported alcohol use, which does not always provide an accurate measure, particularly among heavy drinkers and those with AUD. In the latest study, researchers used the results of urine alcohol tests to assess changes in alcohol consumption among people with AUD before and after the first-wave lockdown. Although the lockdown in Spain was one of the strictest in the world, with residents allowed to leave homes for basic needs only, alcohol remained widely available in supermarkets and other essential stores.

Researchers extracted data from the electronic medical records of patients with AUD who were attending an addiction unit outpatient service in Barcelona, at which patients receive ongoing psychiatric care. As part of routine monitoring, patients were encouraged to provide frequent urine samples, to be screened for a chemical called ethylglucoronide (a biological marker of alcohol use). Those who test positive are more likely to abandon treatment, so are provided with additional support to continue. The researchers performed statistical modeling to assess whether different factors – including whether the sample was provided pre- (Jan 31 to March 13, 2020) or post- (March 14 to June 30, 2020) lockdown – were associated with an increased risk of a positive alcohol screen. Because attendance at medical appointments was permitted during lockdown, the assessment routine in each time period can be considered the same.

In total, 362 patients provided 2,040 urine samples (1,295 before, and 745 during the lockdown period). Patients’ average age was 52, and two-thirds were men. Almost half the patients were tested for other drug use, in addition to alcohol. After the lockdown was enforced, the number of visits plummeted. for those patients who continued to visit the clinic after the start of lockdown, the odds of a positive alcohol test were double those of the pre-lockdown period. Use of other drugs – a well-established risk factor for relapse in AUD – was another strong predictor of a positive alcohol test; patients who tested positive for any other drug were ten times as likely to test positive for alcohol as those without a positive drug test. A positive alcohol test was negatively associated with the length of time that a patient had been in treatment for AUD, with longer treatment periods reducing the likelihood of a positive urine screening test for alcohol.

This short-term study thus provides evidence for increased drinking among patients with AUD during the pandemic first wave lockdown. Although the study was not able to assess the causes of relapse, pandemic-related mental distress was likely to be a major factor at a time when social support and other activities were lacking. The findings highlight the challenges faced by addiction services as more patients may require help for their drinking and its health effects. The researchers note that longer-term studies will be needed to assess how patients with AUD and other addictive disorders are affected by the pandemic over time, and to investigate how addiction healthcare systems can best respond.

Abstinence among alcohol use disorder patients during the COVID-19 pandemic: Insights from Spain. Barrio, N. Baldaquí, M. Andreu, C. Killian, J. Rehm, A. Gual, J. Manthey (pages xxx).



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