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Alcohol Use and Misuse During the COVID-19 Pandemic: A Potential Public Health Crisis?
April 17, 2020   

An editorial by Marsden and colleagues details how some people with addictive disorders may be especially vulnerable to COVID-19 infection and the inadvertent negative consequences of social distancing implemented specifically to curtail the rate of infection. Individuals with addiction are more likely to be impacted by poverty, physical and mental health vulnerabilities and disrupted access to services, which may be exacerbated by the current pandemic. Many individuals with opioid use disorder live in areas characterized by high population densities, poor quality housing and homelessness, which places them at greater risk for infection and transmission of COVID-19. Coexisting health problems such as chronic pulmonary disease in opioid use disorder, respiratory disease among tobacco smokers and cardiovascular disease among stimulant users increase risk of mortality with COVID-19 infection. For individuals who are able to practice social distancing there are inadvertent negative consequences that place them at risk for injury or drug relapse. Among individuals with opioid use disorder who are seeking treatment, less frequent dispensation of medication for self-administration may lead to increases in medication diversion and fatal opioid poisoning. Disruption to the supply of illicit opioids in the community may lead to more cases of overdose from consumption of other opioids or increased harm associated with the substitution of opioids with other more available substances such as alcohol. Furthermore, serious withdrawal symptoms may occur in individuals with alcohol use disorder if access to alcohol is limited. Social isolation, financial pressures and stress resulting from social distancing practices may also lead to the initiation or exacerbation of addiction behaviors such as online gambling. Due to these complications, there is an urgent need for coordinated efforts to mitigate these problems and find innovative ways to provide clinical and public health services to people with addictive disorders.


Alcohol Use and Misuse During the COVID-19 Pandemic: A Potential Public Health Crisis?
Following the outbreak of COVID-19, governments across the world have implemented social distancing measures to slow the rate of infection. The public health effects of long-term isolation on alcohol use and misuse are currently unknown. However, stress and impulsivity are prominent risk factors for the onset and maintenance of alcohol misuse. Furthermore, impulsivity can moderate stress-induced consumption of alcohol, and is associated with relapse in addicted individuals. Therefore, Clay and Parker argue that isolation due to social distancing may lead to a spike in alcohol misuse, relapse and the development of alcohol use disorder in at-risk individuals, placing additional strain on health services during and after the pandemic. They highlight the importance of governments issuing public health warnings about excessive alcohol consumption during isolation to protect vulnerable populations.

References:

Marsden J et al. Addiction 2020. Epub ahead of print. Abstract

Clay JM, Parker MO. Lancet Public Health 2020. Epub ahead of print. Abstract


For more information on treating patients with substance use disorder:

Alcohol Use Disorder: Treatment in the Context of Mental Illness (NEI Members only)
CME credits: 1.25

Addiction/Reward
Cases of Comorbid Substance Use (NEI Members only)
CME credit: 0.75