Strategies to maintain recovery from alcohol problems during the COVID-19 pandemic: Insights from a mixed-methods national survey of adults in the United States.

The COVID-19 pandemic has been associated with poorer mental health and, in some cases, increased alcohol consumption; however, little is known about the pandemic's effects on people in recovery from alcohol use disorder (AUD), especially how they have coped with novel stressors. Our mixed-methods study investigated strategies used to maintain recovery during the pandemic, with attention to variation by gender. We analyzed data obtained in fall 2020 from an online US national survey of adults with resolved AUD (n = 1,492) recruited from KnowledgePanel, a probability-based cohort of non-institutionalized adults maintained by Ipsos for internet-based research. Participants endorsed possible coping strategies on a 19-item choose-all-that-apply list, which were analyzed using chi-square tests. In addition, 1,008 participants provided text responses to an open-ended question about their strategies to maintain recovery during the pandemic, which were coded and analyzed using an inductive, thematic approach. The majority of our sample met criteria for severe lifetime AUD (72.9%), reported being in recovery more than five years (75.5%), and had never used specialty AUD services or mutual-help groups (59.7%). The ordering of the coping strategies was quite similar for women and men; however, the top strategy (talking with family and friends by phone, text, or video) was endorsed more frequently by women than men (49.7% vs. 36.1%; p < .001). Among qualitative themes, "staying connected" was the most common. It was dominated by statements about family, with women mentioning children more often than men. Among other themes, "cognitive strategies" mirrored established therapeutic modalities, and "active pursuits" aligned with many recent recommendations for service providers working with substance-using populations during the pandemic. A minority of participants invoked "willpower" for recovery or stated that pandemic restrictions helped by reducing exposure to relapse risks. These findings shed light on recovery mechanisms during the COVID-19 pandemic and suggest potential intervention targets to support recovery during other catastrophic events, such as natural disasters.

Inequitable access to general and behavioral healthcare in the US during the COVID-19 pandemic: A role for telehealth?

Wide-ranging effects of the COVID-19 pandemic have led to increased psychological distress and alcohol consumption, and disproportionate hardship for disadvantaged groups. Early in the pandemic, telehealth services were expanded to maintain healthcare access amidst lockdowns, medical office closures, and fear of infection. This study examines general and behavioral healthcare access and disparities during the first year of the pandemic. Data are from the 2019-2020 US National Alcohol Survey (collected February 2019 to April 2020) and its COVID follow-up survey conducted January 30 to March 28, 2021 (N = 1819). General and behavioral healthcare-related outcomes were assessed at follow-up, and included perceived need for and receipt of care, delayed care, and use of telehealth since April 1, 2020. Results indicate that the majority of respondents with perceived need for healthcare received some behavioral healthcare (reported by 63%) and particularly general healthcare (88%), but nearly half (48%) delayed needed care. Delays were mostly due to COVID-related reasons, but cost barriers also were common and significantly impeded care-seeking by uninsured persons, young adults, rural residents, and persons whose employment was reduced by the pandemic. Disparities in the receipt of healthcare were pronounced for Hispanic/Latinx (vs. White) and lower-income (vs. higher-income) groups (AORs <0.37, p's < 0.05). Notably, telehealth was commonly used by Hispanic/Latinx and lower-income groups for general and particularly behavioral healthcare. Results suggest that telehealth has provided an important bridge to healthcare for certain medically underserved groups during the pandemic, and may be vital to future efforts to increase equity in healthcare access.

Mental health and drinking to cope in the early COVID period: Data from the 2019-2020 US National Alcohol Survey.

BACKGROUND: Studies show drinking to cope and mental health problems have increased during the COVID-19 pandemic, however, their samples have been limited by convenience sampling or lack of a pre-pandemic measure. We examined the early impact of the COVID-19 pandemic on mental health, drinking to cope and their association using a probability-based sample of the US adult population. METHODS: Data was drawn from the probability samples of the 2019-2020 National Alcohol Survey (N = 7,233) to examine differences in drinking to cope and symptoms of depression and anxiety. Analyses compared participants who responded to the survey just prior to the widespread onset of the pandemic to those who responded after March 2020, in the total sample and by sex. RESULTS: Respondents in the early- vs. pre-COVID-19 period had a 1.48 higher odds (p = 0.03) of higher agreement with drinking to forget one's worries and problems, with a significant association observed among women only. Respondents with symptoms of depression and anxiety had a 2.94 and 1.56 higher odds, respectively, of higher agreement with drinking to forget one's worries. We observed significant associations between early- vs. pre-COVID-19 period, depression and anxiety symptoms, and drinking to forget one's worries among women only; however, moderation by sex in the total sample was not statistically significant. CONCLUSIONS: We observed higher prevalence of depression and anxiety symptoms and greater drinking to forget worries in the early months of COVID restrictions relative to the period just prior, with some effects more prominent among women. These observations call for sustained monitoring of and support for the mental health of the general population, and of women in particular during the course of the pandemic.

Maintaining recovery from alcohol use disorder during the COVID-19 pandemic: The importance of recovery capital.

BACKGROUND: The potential impact of the COVID-19 pandemic on recovery from alcohol use disorder (AUD) has received scant attention to date. In response, we investigated the stability of recovery and identified correlates of relapse, with particular interest in differences between women and men. METHODS: Data were obtained in a national survey of adults with resolved alcohol use disorder who were not drinking heavily (n = 1492). We calculated summary statistics and modeled odds of mild relapse (i.e., resolved at the time of data collection), overall and stratified by gender. RESULTS: Equivalent large majorities of women and men reported that the COVID-19 pandemic had not affected their recovery at all (88.9% and 88.8%, respectively). Mild relapse events were infrequent, with only 45 participants (3.1%) reporting a resumption of drinking after being abstinent and 35 participants (2.7%) reporting an increase from previously moderated drinking, with no differences in prevalence between men and women. Recovery capital showed consistent and comparable protective effects for both women and men (adjusted odds ratio [aOR] 0.90; 95% confidence interval [95% CI] 0.84, 0.97; and aOR 0.93; 95% CI 0.88, 0.98, respectively). We did not find any effect of pandemic-related stressors; however, there were a number of distinct correlates of mild relapse for women and men. CONCLUSIONS: Recovery capital showed a consistently protective effect and may serve as a highly suitable intervention target as it is modifiable. Given gender differences, assessments of other key factors and tailored interventions targeting women and men may be necessary to ensure stable recovery.