Binge drinking alcohol and circadian misalignment in night shift nurses is associated with decreased resiliency to COVID-19 infection

Background: Nurses and other first responders are at high risk of exposure to the SARS-CoV2 virus, and many have developed severe COVID-19 infection. A better understanding of the factors that increase the risk of infection after exposure to the virus could help to address this. Although several risk factors such as obesity, diabetes, and hypertension have been associated with an increased risk of infection, many first responders develop severe COVID-19 without established risk factors. As inflammation and cytokine storm are the primary mechanisms in severe COVID-19, other factors that promote an inflammatory state could increase the risk of COVID-19 in exposed individuals. Alcohol misuse and shift work with subsequent misaligned circadian rhythms are known to promote a pro-inflammatory state and thus could increase susceptibility to COVID-19. To test this hypothesis, we conducted a prospective, cross-sectional observational survey-based study in nurses using the American Nursing Association network. Method(s): We used validated structured questionnaires to assess alcohol consumption (the Alcohol Use Disorders Identification Test) and circadian typology or chronotype (the Munich Chronotype Questionnaire Shift -MCTQ-Shift). Result(s): By latent class analysis (LCA), high-risk features of alcohol misuse were associated with a later chronotype, and binge drinking was greater in night shift workers. The night shift was associated with more than double the odds of COVID-19 infection of the standard shift (OR 2.67, 95% CI: 1.18 to 6.07). Binge drinkers had twice the odds of COVID-19 infection of those with low-risk features by LCA (OR: 2.08, 95% CI: 0.75 to 5.79). Conclusion(s): Working night shifts or binge drinking may be risk factors for COVID-19 infection among nurses. Understanding the mechanisms underlying these risk factors could help to mitigate the impact of COVID-19 on our at-risk healthcare workforce.Copyright © 2023 The Authors. Alcohol: Clinical and Experimental Research published by Wiley Periodicals LLC on behalf of Research Society on Alcohol.

Prevalence of substance use in adults with cystic fibrosis

Background: Substance use is an understudied aspect of cystic fibrosis (CF) care. Even casual use of drugs or alcohol may reduce compliance with complicated treatment plans, worsen existing conditions associated with CF, or cause potential drug interactions. To understand the need for mitigation mechanisms for risky substance use in a CF population, we studied the prevalence of substance use in our adult CF clinic population to characterize relationships between substance use and health status. Method(s): In our large academic CF center, we performed a retrospective chart ion of 420 patients over a 6-year period (2015-2021). Clinical staff annually administer the Drug Abuse Screening Test (DAST-10), Alcohol Use Disorders Identification Test (AUDIT), Patient Health Questionnaire (PHQ-9), and General Anxiety Disorder (GAD-7) to assess drug use, alcohol use, depression, and anxiety symptoms, respectively. Demographic characteristics, lung function (percentage predicted forced expiratory volume in 1 second (FEV1pp)), and anxiety and depression symptom screening scores were recorded. Because substance use can change over time, we counted each assessment date as an independent observation (n = 1434). The chi-square test (Table 1) was conducted in R/RStudio [1] to assess for associations between self-reported substance use and symptoms of depression and anxiety. Because of insufficient data, aggregate datawere used to describe the presence (PHQ-9 or GAD-7 >= 10) or absence (PHQ-9 or GAD-7 < 10) of symptoms of depression and anxiety. Result(s): Positive scores for risky use were defined as a DAST score of 1 or higher and an AUDIT score of 8 or hither. Eighty-three of 326 patients (25%) met criteria for risky substance use on at least one observation. Therewas a slight male predominance (54.2%) and wide age distribution (mean age 30 +/- 7, range 20-55);Thirty (36.1%) had a higher AUDIT score, 34 (40.9%) had a high DAST score, and 19 (22.9%) had high scores on both.We selected 2019 to evaluate single-year prevalence of positive screenings to avoid the impact of COVID. In 2019, 29 patients had at least one positive screening result (DAST,15/203, 7.3%;AUDIT, 24/193,12%;both,10/193, 5.2%). In the 6- year dataset, we did not find a statistically significant association between symptoms of depression and anxiety and indication of drug or alcohol use in self-reported users (355 observations). Conclusion(s): According to a 2020 national survey of healthy Americans, 20.8% have used illicit drugs at least once in the past year, and 10.2% meet criteria for alcohol use disorder [2], compared with 7.3% of patients in our 2019 data who have used drugs (n = 15) and 12% (n = 24) who indicated risky alcohol use. In this review, positive screening scores on the DAST and AUDIT were not associated with degree of symptoms of depression and anxiety, suggesting that substance use and symptoms of depression and anxiety were not temporally associated with each other. Future work will include analysis of the relationship between substance use and mental health in the larger University of North Carolina clinic population and linear regression to evaluate possible explanatory variables for substance use in this populationCopyright © 2022, European Cystic Fibrosis Society. All rights reserved

QEEG Individualized Protocols for the Treatment of Alcohol Use Disorder

Throughout United States history, alcohol use disorder (AUD) continues to be a national health concern. Within the last few years, pandemic stressors may also increase the potential for relapse in individuals struggling with AUD (Da et al., 2020). Medical professionals are imploring helping professionals to stay aware of this rising concern and to enhance AUD treatment options. Whereas treatments such as psychotherapy and pharmacology can be efficacious for AUD, there are also limitations to these types of interventions. AUD affects brain wave activity;while the prior mentioned treatments do not directly target brain activity, one treatment that does is neuron feed back. Neurofeed back is well documented for helping individuals with AUD, and other addiction concerns, to reach an enhanced state of regulation (Sokhadze et al., 2008). After IRB approval and participant recruitment, my supervisor and I created qEEG individualized protocols while also considering Peniston and Kulkosky's (1989, 1990) seminal neuron feed back studies that recommend certain brain wave parameters for AUD protocols. In addition, we also referred to the Scott-Kaiser modification (Scott & Kaiser, 1998) of the Peniston Protocol. The Peniston Protocol uses alpha/theta training and seeks to reduce states of stress and anxiety, while the Scott-Kaiser modification (e.g., SMR-beta modulation) aims to reduce impulsivity tendencies by remedying cognitive issues (Dousset et al., 2020). Participants were asked to complete pre and post qEEG and heart rate variability (HRV) measures along with self-report assessments of pre, post, and follow-up measures of the Alcohol Use Disorders Identification Test (AUDIT;Saunders et al., 1993), and repeated measures of a craving desire assessment after every neuron feed back session. Also, participants were asked to attend twice-weekly neuron feedback sessions for 6 weeks or at least twelve 10- to 25-minute sessions. University student clinicians and neuron feedback clinicians administered the neuron feedback sessions. Due to the pandemic and subsequent limiting factors (i.e., COVID concerns or lack of money for transportation), participants were allowed remote neuron feedback. Only one participant asked to utilize remote services. The primary purpose of this study was to determine if qEEG individualized neuron feedback protocols helped participants regulate their brain activity and reduce AUD cravings. Secondary purposes included comparing physiological data to self-report data and exploring neuron feedback session-to-session changes with a single-subject approach. This poster presentation will include pre and post qEEG z-score comparisons from NeuroGuide and pre and post HRV comparisons from BioTrace. Further, I will explore individual changes over time according to participants' neuron feedback protocols using single-case research design methods and participants' individual craving desire changes. The presentation will also entail implications for future research..

Evaluating Liver Steatosis and Stiffness as a Teachable Moment in Patients with Alcohol Use Disorder: Early Results from a Pilot Study (Elisa)

Background: We have seen a concerning rise in alcohol consumption and alcohol-related hospitalizations in the US, especially since the onset of the COVID-19 pandemic. There is a dire need for effective interventions to treat alcohol use disorder (AUD), particularly in young people. Teachable moments (TMs) are health events that can motivate individuals to adopt risk-reducing health behaviors and have been proven effective for cigarette smoking. Bedside interpretation of vibrationcontrolled transient elastography (VCTE) is an opportunity for a TM. Our aim was to evaluate the effects of bedside VCTE and interpretation related to liver health on motivation to reduce alcohol use in patients with AUD. Method(s): This is an investigator-initiated, prospective, proof-of-concept pilot study of VCTE and AUD. Patients without known liver disease were prospectively recruited from inpatient and outpatient substance use units/practices within the Mount Sinai Health System. Four validated questionnaires assessing alcohol use, insight, and readiness to reduce drinking were administered (Alcohol Use Disorders Identification Test [AUDIT-C], readiness ruler tool, stages of change readiness and treatment eagerness scale [SOCRATES-8A] and Hanil Alcohol Insight Scale [HAIS]). VCTE was then performed with FibroScanTM (Echosens), and results interpreted in real-time via pre-scripted explanations. A recent metaanalysis algorithm was used to adjust fibrosis cut-offs based on available liver tests. Questionnaires were repeated immediately afterwards. The primary endpoint was a change in motivation scores after VCTE and the secondary endpoint was self-reported alcohol use at 1, 6, 12 and 24 months. Result(s): Study enrollment began in early 5/2022, with 10 patients screened and 7 eligible candidates identified: 7/7 (100%) consented to the study, 1/7 (14.3%) was excluded because of inaccurate VCTE due to body habitus. The cohort had a mean age of 51.3 (+-11.3) years, with slight male predominance (57%) and ethnically diverse (42.9% African American, 42.9% Caucasian, and 14.2% Hispanic). All had severe AUD with a mean of 16.6 (+-5.9) daily drinks consumed for 17.3 (+-7.7) years. Five of 7 (71.4%) had comorbid psychiatric diagnoses and all had a family history of AUD. Six out of 7 (85.7%) had VCTE results consistent with stage 0-1 fibrosis and 1 had stage 3-4;all had grade 1 steatosis. There was high baseline motivation and insight with a mean score of 9.8 on the readiness ruler tool (possible range 0-10), 13.0 on HAIS (-20 to +20) and 82.7 on SOCRATES-8A (19-95). After VCTE, there was an improvement in readiness to reduce drinking (mean increase of 4.7 [6%] in SOCRATES-8A) with a slight decrease in insight (mean decrease of 1.3 [10%] in HAIS). Conclusion(s): Early results from this pilot study of VCTE as a teachable moment in AUD demonstrate that this is a feasible intervention that may increase motivation to reduce drinking, which requires further study.

Loneliness and Increased Hazardous Alcohol Use: Data from a Nationwide Internet Survey with 1-Year Follow-Up.

We aimed to examine the association between loneliness and developing alcohol dependence or hazardous alcohol use. A cohort study was conducted utilizing data from a nationwide internet survey in 2021 and 2022 in Japan. A total of 15,854 follow-up participants (55% men, with a mean age of 52.8 years) were divided based on AUDIT scores: nondrinkers (AUDIT: 0), low-risk drinkers (AUDIT: 1-7), medium-risk drinkers (AUD: 8-14), high-risk drinkers (AUDIT: 15-19), and probable alcohol dependence (AUDIT: 20-40). The University of California, Los Angeles Loneliness Scale (Version 3), a short-form three-item scale, was used to assess loneliness (high loneliness score of ≥6). The prevalence of high loneliness was higher in nondrinkers than that in low- and medium-risk drinkers, i.e., 22%, 18%, and 17%, respectively, as well as in high-risk drinkers (32%) and those with probable alcohol dependence (43%) compared to non-high-risk drinkers (19%). After adjusting for various factors (sociodemographic, social isolation, psychological distress, and smoking), non-high-risk drinkers (AUDIT: 0-14) with high loneliness were more likely to become high-or-over-risk drinkers (AUDIT: 15-40) than those without high loneliness, with adjusted risk ratios of 1.45 (95% confidence interval: 1.08-1.96) through multivariable binary logistic regression. Among non-high-risk drinkers, people with high loneliness scores at baseline were associated with increased high-risk drinking patterns with probable alcohol dependence.

Alcohol Use and misuse during the COVID-19 pandemic

GPs can play a pivotal role in the identification and management of alcohol problems at any time, and their role is even more important during the COVID-19 pandemic as more and more patients are resorting to alcohol to manage the stress and anxiety created by the pandemic. © 2021 Medicine Today Pty Ltd. All rights reserved.

EXAMINING CHANGES IN AUDIT SCORE DURING THE COVID-19 PANDEMIC AND ASSOCIATED MEASURES THROUGH THE ADDICTIONS NEUROCLINICAL ASSESSMENT FRAMEWORK

Purpose: The Addictions Neuroclinical Assessment (ANA) is a neurobehavioral framework designed to better understand the heterogeneity of Alcohol Use Disorder (AUD). The aim of this analysis was to examine measures representing the ANA domains of incentive salience, negative emotionality, and executive function, and their associations with changes in alcohol problems related to the COVID-19 pandemic in AUD and non-AUD groups. Methods: Incentive salience measures included Self-Report of the Effects of Alcohol Scale (SRE), Anticipated-Biphasic Alcohol Effects Scale (A-BAES), and Penn Alcohol Craving Scale (PACS). Negative emotionality measures included Perceived Stress Scale (PSS), and executive function measures included Impaired Control Scale (ICS). All ANA domain measures were collected during the pandemic. Alcohol problems were measured using Alcohol Use Disorder Identification Test (AUDIT) and collected pre-and during pandemic. Participants were categorized into three groups based on their AUDIT score change: no change (n = 162), decrease (n = 141), or increase (n = 135). Data: Participants (n = 438;mean age = 44.8 years;52.0% male) previously enrolled in the NIAAA Natural History Protocol were recruited for a follow-up longitudinal survey study. Results: Data were analyzed using general linear models covarying for history of AUD, sex, age, enrollment phase, and time since screened in the natural history protocol. Participants reporting an increase in AUDIT scores from pre-pandemic had significantly higher scores on incentive salience (PACS, p <0.001;A-BAES sedation, p <0.001;trending for SRE, p = 0.06), negative emotionality (PSS, p <0.001), and executive function (ICS failed attempts to control drinking, p <0.005) during the pandemic than those with a decrease or no change in AUDIT scores. History of AUD was significant in all models (all p's<0.01). Age was negatively associated with negative emotionality, while males showed significantly higher scores on incentive salience measures. Finally, those enrolled in the early pandemic phase scored the highest on negative emotionality measures. Conclusions: An increase in AUDIT scores from pre-pandemic to during the pandemic was associated with higher scores in measures across all three ANA domains than those with a decrease or no change in their AUDIT scores. These associations were stronger in those with a history of AUD and highlight potential bio behavioral correlates of vulnerability of those with a history of AUD and those at risk for heavier drinking.

ALCOHOL CONSUMPTION AND MISUSE AMONG PATIENTS WITH RESPIRATORY FAILURE BEFORE AND DURING THE COVID-19 PANDEMIC

Alcohol misuse is associated with the development of respiratory failure, including the acute respiratory distress syndrome (ARDS), with attendant poorer outcomes. Epidemiologic data suggest that alcohol consumption increased during the COVID-19 pandemic;however, consumption habits among critically ill patients are not well-described. We hypothesized that the prevalence of alcohol consumption and misuse among patients with respiratory failure would be greater during the pandemic relative to years prior. Patients with respiratory failure requiring mechanical ventilation in a single academic hospital were enrolled from 2015-19 (pre-pandemic) and 2020-21 (pandemic). Data regarding demographics and alcohol use were obtained from the medical record. Phosphatidylethanol (PEth) was measured in a subset of patients in red blood cells collected within 48 hours of intubation. Patients were characterized as follows: (1) likely drinking: patient or proxy endorsed any drinking on the Alcohol Use Disorders Identification Test (AUDIT) or in social history;or patient was admitted for an alcohol-related diagnosis;or patient had detectable blood alcohol or PEth;(2) likely alcohol misuse: PEth ≥ 250;or AUDIT-C ≥3 (women) or ≥4 (men);or AUDIT ≥5 (women) or ≥ 8 (men);or patient was admitted for an alcohol-related diagnosis;(3) likely severe alcohol misuse: PEth ≥400. Univariable statistics were utilized as appropriate (Fisher's Exact Test, Kruskal- Wallis Test). The prevalence of likely drinking in the study population (n = 195) varied over time (p <0.0001). When pandemic (n = 67) and pre-pandemic patients (n = 128) were compared, the prevalence of likely drinking (93% vs 58%, p <0.0001), likely alcohol misuse (49% vs 33%, p <0.03) and likely severe alcohol misuse (32% vs 10%, p <0.003) were all greater during the pandemic. Among likely drinking patients with available PEth data (n = 97), median PEth was significantly higher during the pandemic compared to pre-pandemic years (251 [135-702] versus 87 [16-374], p = 0.002). Among the subset of patients enrolled during the pandemic, the prevalence of likely current drinking was 100% in those with COVID-19 compared to 76% among non-COVID patients (p = 0.002), but alcohol misuse did not differ. We conclude that alcohol consumption, and alcohol misuse, have increased during the pandemic in this patient cohort. These changes in drinking patterns are concerning and warrant additional research regarding their impact on susceptibility and outcomes for respiratory failure.

A PROSPECTIVE STUDY OF SEX DIFFERENCES IN QUALITY OF LIFE, ANXIETY, AND ALCOHOL USE RESPONSE TO THE COVID-19 PANDEMIC

Purpose: The COVID-19 pandemic has affected psychological health related to quality of life, anxiety, and alcohol use. To assess differences in pandemic response related to clinical status and sex, we used prospective data collected in a clinical sample of adults with Alcohol Use Disorder (AUD), HIV infection, or both diagnoses (AUD+HIV) and a control group. Methods: Data were collected between 2015-2018 during pre-COVID laboratory visits and later with an online survey to assess psychological health during COVID. Change scores (COVID score - pre- COVID score) evaluated differences in quality of life (QoL;Short-Form-21), state anxiety (State- Trait-Anxiety Inventory), and alcohol use (Alcohol Use Disorders Identification Test, AUDIT). Of the 218 participants we attempted to contact, 89 completed the survey. The clinical sample included 18 AUD (9M, 9F), 22 HIV (15M, 7F), and 15 AUD+HIV (6M, 9F);the Control group included 17M and 17F. Results: All groups reported decreases in QoL during COVID (X2 = 8.26, p = .04). Women in the clinical sample (regardless of diagnosis) reported an even greater decrease in QoL during COVID than clinical men (Z = 2.12, p = .016), control women (Z = 2.38, p = .017), or control men (Z = 2.41, p = .034). The greater decrease in QoL in clinical women was supported by analysis of the separate AUD, HIV, and AUD+HIV sub-samples. Regarding state anxiety, the clinical sample showed a greater increase during COVID than the control group (X2 = 5.64, p = .018). Regardless of group or sex, however, participants did not report significant change in pandemic alcohol use. Nonetheless, for clinical women, correlational analyses indicated that greater decline in QoL was related to increased anxiety (rho = -.49, p = .03) and increased alcohol use (rho = -.49, p = .02), and that increase in anxiety was related to increase in alcohol use (rho = .46, p = .04). By contrast, in clinical men, change in anxiety was related to change in QoL (rho = -.49, p = .02) but not alcohol use (rho = -.26, p = .24). Conclusions: Clinical men and women reported greater increase in anxiety and decrease in QoL than controls during COVID vs. pre-COVID assessment. The relation between increase in self-reported alcohol use and increased anxiety and decline in QoL in the clinical women suggests greater drinking-to-cope motivation to relieve emotional distress during COVID in women already burdened with a clinical diagnosis.

EXAMINING DISTRESS TOLERANCE AND COPING DRINKING MOTIVES AS THEY RELATE TO POST-MOOD NEGATIVE INDUCTION ALCOHOL CRAVING

Purpose: The current study aimed to better understand predictors of alcohol craving in the context of negative mood. We predicted that individuals would endorse higher alcohol craving following a negative mood induction. Furthermore, we hypothesized that momentary distress intolerance would be predictive of this change in craving and that this relationship would be moderated by coping drinkingmotives. Methods: Participants were 92 college students (56.52% female) ages 18 years or older (Mage = 19.53, SDage = 2.04) who endorsed past-year alcohol use. All study procedures were completed online due to the COVID-19 pandemic. Participants completed the Alcohol Use Disorders Identification Test (AUDIT;Babor et al., 2001) to assess past-year alcohol use and the coping motives subscale of DrinkingMotives Questionnaire-Revised (DMQ-R;Cooper, 1994) prior to a negative mood induction task (Vanderveen et al., 2016). Participants completed the emotionality and expectancy subscales of Alcohol Craving Questionnaire-Short Form-Revised (ACQ-SF-R;Singleton, 1997) and Affect Grid (Russell, Weis, & Mendelsohn, 1989) pre- and post-induction. The Momentary Distress Intolerance Scale (MDIS;Veilleux et al., 2018) was given post-task. Only individuals who demonstrated a reduction in emotional valence on the Affect Grid post-task were included. Data and Results: There was no significant change in craving from pre- to post-task, t(91) = 1.11, p = 0.27;however, there was a significant correlation between emotional valence change scores and craving change scores, r = -0.23, p < 0.05. Subsequent regression analyses predicting change in craving from MDIS and coping motives were non-significant. Interestingly, post-task craving scores were correlated with MDIS post-task, r = 0.22, p < 0.05, and coping motives, r = 0.34, p < 0.01. Conclusions: These findings suggest that there may be an association between alcohol craving with momentary distress intolerance and reductions in mood. Understanding these momentary predictors of alcohol use, in addition to coping drinking motives,may be a useful treatment target worthy of greater study. The absence of change in craving from pre- to post-negative mood induction may be due to sample characteristics (e.g., low alcohol use, non-clinical). Future studies should examine these relationships in individuals at higher risk for alcohol use problems and who experience more psychological distress.

SELF-REPORTED CHEMOSENSORY CHANGES IN ALCOHOL CONSUMPTION GROUPS AND ASSOCIATED IMPACT ON QUALITY OF LIFE

Purpose: Chemosensory alteration in excessive alcohol drinkers substantially impacts their quality of life (QoL). Early assessment of chemosensory loss can help in early prediction of disease severity and associated comorbidities in heavy drinkers (HDs). In the present study we examined smell and taste self-reports of individuals with different alcohol drinking behaviors and association with change in overall QoL. Methods: Participants (n = 466;224 females/242 males) were recruited between June 2020 and September 2021 into the COVID-19 Pandemic Impact on Alcohol Study. Alcohol Use Disorders Identification Test (AUDIT) consumption scores across four time points (at enrollment, and after four, eight and twelve weeks) were analyzed by group based trajectory modeling to stratify participants into three groups (non-drinkers, NDs;moderate drinkers, MDs;and HDs). Results: Linear mixed effects analysis of self-reported taste abd smell data revealed that, in HDs compared to NDs, there was a significant reduction smell ability (F1,224 = 4.40, p = 0.03) after adjusting for age and smoking status, but group differences in taste ability did not reach statistical significance (F1,241 = 3.55, p = 0.06). The smell/taste measures did not significantly differ between the MDs and NDs. Further, the reduced smell and taste ability of HDs was significantly associated with deterioration in several QoL domains, including physical health (smell: coeff = 0.13, 95% CI 0.04 to 0.21, p = 0.003;taste: coeff = 0.13, 95% CI 0.03 to 0.22, p = 0.01), psychological (smell: coeff = 0.15, 95% CI 0.06 to 0.24, p = 0.001;taste: coeff = 0.13, 95% CI 0.03 to 0.24, p = 0.01), social relationships (smell: coeff = 0.20, 95% CI 0.10 to 0.30, p < 0.001;taste: coeff = 0.30, 95% CI 0.19 to 0.41, p < 0.001), and environmental health (smell: coeff = 0.18, 95% CI 0.09 to 0.26, p < 0.001;taste: coeff = 0.21, 95% CI 0.12 to 0.31, p < 0.001). Conclusion: The reduced olfactory and taste function of HDs and association with poorer QoL indicates that early assessment of chemosensory changes may be crucial in identifying the risk for poorer outcomes in heavy drinkers.

The Extent of Alcohol-Related Problems Among College and University Students in Norway Prior to and During the COVID-19 Pandemic.

Aim: To provide estimates of the distribution of alcohol-related problems in a national sample of college and university students in 2021, i.e., during the COVID-19 pandemic, in comparison with pre-pandemic data from 2018. Design: Longitudinal data from linkage of two recent national health surveys from 2018 to 2021. Setting: Students in higher education in Norway (the SHoT-study). Participants: 8,287 fulltime students (72.5% women, 27.6% men) that were 18 years or more at the time of the first survey in 2018, and 21 years or more at the time of the second survey in 2021. Measurements: The Alcohol Use Disorders Identification Test (AUDIT) was used to assess potential alcohol-related problems. Findings: 37.0% of male students and 24.1% of female students reported either risky, harmful, or dependent alcohol use in 2021, compared with 55.0% of male students and 43.6% of female students in 2018. This decrease in alcohol-related problems was most pronounced for dependent alcohol use, where we observed a 57% relative reduction among male students (from 3.5% in 2018 to 1.5% in 2021) and a 64% relative reduction among female students (from 1.4% in 2018 to 0.5% in 2021). Conclusions: The present study demonstrated a sharp decline in alcohol-related problems among students during the COVID-19 pandemic, that were present across gender, age groups, and geographical study locations. Universal preventive measures to limit students' alcohol use should be considered when restrictions related to the pandemic is lifted.

Changes in Alcohol Use in Denmark during the Initial Months of the COVID-19 Pandemic: Further Evidence of Polarization of Drinking Responses.

INTRODUCTION: The year 2020 was marked by the COVID-19 pandemic. Policy responses to COVID-19 affected social and economic life and the availability of alcohol. Previous research has shown an overall small decrease in alcohol use in Denmark in the first months of the pandemic. The present paper focused on identifying which subgroups of individuals had decreased or increased their consumption. MATERIALS AND METHODS: Data were collected between May and July 2020 (n = 2,566 respondents, convenience sample). Weights were applied to reflect the actual Danish general population. Variables included the pre-pandemic alcohol consumption, change in alcohol consumption in the past month, socio-demographics, and reported economic consequences. Responses to a single item assessing changes in alcohol consumption in the past month were classified as no change, increase, or decrease in consumption. Regression models investigated how changes in consumption were linked to pre-pandemic drinking levels, socio-demographics (gender, age groups, education), and reported economic consequences. RESULTS: While 39% of participants reported decreased consumption levels and 34% had stable levels, 27% increased consumption. Characteristics associated with changes in consumption were associated with both increases and decreases in consumption: younger people, those with higher consumption levels before the pandemic, and those with lower education more often both reported increases as well as decreases in consumption. DISCUSSION/CONCLUSIONS: We confirmed that more people decreased rather than increased their alcohol consumption in the first few months of the pandemic in Denmark. Characteristics associated with changes in consumption such as younger age, higher consumption levels, and lower education demonstrated a polarization of drinking since these were associated with both increases and decreases in consumption. Public health authorities should monitor alcohol use and other health behaviours for increased risks during the pandemic.

P.0338 Chronotype and area-specific deficits in mental health

Background: The COVID-19 pandemic has caused a palpable rise in mental health conditions, including greater anxiety, depression and stress. There have been many suggested driving factors for this rise, from unemployment to exposure to negative news. However, during the pandemic there have been both a rise in drug consumption and a shift to a later chronotype. Chronotype is a measure of the timing of an individual's behavioural patterns, with early and late chronotypes being more colloquially known as ‘early larks’ and ‘night owls’ respectively. Later chronotype has often been associated with increased drug consumption and there have not yet been investigations into the influence of these factors on the rise of mental ill-health during the COVID-19 pandemic. Objectives: We aimed to investigate the effect of chronotype on mental health in the general public. The Munich Chronotype Questionnaire (MCTQ) was used to assess the chronotype of each participant. The 21-item Depression Anxiety Stress Scale (DASS21) was used to assess mental health. As it is known that drug consumption increases with later chronotype, we then assessed whether increased drug consumption was responsible for these relationships. We used the Alcohol Use Disorders Identification Test (AUDIT), Revised Cannabis Use Disorders Identification Test (CUDIT-R) and the Fagerström Test for Nicotine Dependence (FTND) to quantify alcohol, cannabis and tobacco use respectively. We hypothesised that a later chronotype would be associated with poorer mental health and that total drug consumption would mediate this relationship. Methods: This was a cross-sectional study in the Cambridge county area (N=209), with data collection being completed using an online survey. The MCTQ gathers data regarding sleep timing throughout the week, allowing us to generate a mid-sleep time which has been validated as an indicator of chronotype. The DASS21 with its individual subscales allowed us to generate scores for depression, anxiety, stress and overall mental health. We then completed multiple regression analysis to investigate the associations between chronotype and these mental health measures. Mediation pathway analysis was used to examine whether total drug consumption was responsible for the significant associations. Total drug consumption was calculated by summing the scores from the AUDIT, CUDIT-R and the FTND. Results: Multivariate regression analyses revealed that chronotype was significantly associated with overall mental health score (β=0.16, p=0.022) and anxiety (β=0.18, p=0.009). Chronotype was not significantly associated with depression or stress. Causal mediation analysis showed that overall drug consumption mediated both relationships. Conclusion: The association between later chronotype and poorer mental health is driven by increased anxiety rather than depression or stress. However, these relationships can be explained by the increased drug consumption that occurs in these late chronotypes. These results can inform counselling and future treatments for late chronotypes that focus on reducing their drug consumption. The evidence that anxiety drives the relationship with mental health will also allow healthcare professionals to screen for anxious symptoms to identify those that require interventions more effectively. No conflict of interest

P.0019 Alcohol use increase in polysubstance users during quarantine related to SARS-Cov2 infection-19

Introduction A quarantine related to the spread of coronavirus SARS-CoV-2 was mandatory in France from March 17 to May 10, 2020. This quarantine could have psychological consequences on general population and vulnerable people such as substances users [1]. Anticipated consequences of behavioral changes related to substance use in context of quarantine have emerged in literature [2]. Changes in substances use could led to an increase of health issues such as mortality due to overdose notably [3]. Some authors suggested that quarantine related to covid-19 pandemic could increase alcohol use [4,5]. The objective of this study was to assess the frequency of polysubstance users who have increased their alcohol use and determine risk factors for these changes. Methods: An anonymous Internet-based cross-sectional survey was conducted between April 8 and May 10, 2020. Participants were recruited via posts and Internet messages on a French online Forum related to drug use (www.psychoactif.org). This website is a forum dedicated to harm reduction and information on psychoactive drugs and lead by volunteers. We included participants that reported at least the use of two substances including alcohol. Only French citizen living on French territories were included Since 30 % of visitors on psychoactif web site are living in others francophone countries, we excluded them, due to different quarantine conditions between countries. Study variables were collected by using a questionnaire designed for the present study. Declarative data from this survey questions included socio demographical informations and questions on quarantine conditions notably number of days of quarantine and quarantine domestic conditions. Participants were asked on questions pertaining to use of alcohol (“Since the beginning of the quarantine, have you increased, diminished, quitted or maintained your alcohol consumption). Current alcohol use was examined using the Alcohol Use Disorder Identification Test Consumption (AUDIT). Alcohol craving during quarantine was assessed using Obsessive Compulsive Drinking Scale (OCDS), and Depressive and anxiety symptoms were assessed using Hospital Depression and Anxiety scale (HAD). Substances use and medication use were reported. The rates of users were presented with 95% confidence intervals (CI) and the associations of demographic or clinical variables with alcohol increase were assessed using odds ratios (OR) with 95% CI from a multivariate logistic regression. Results: 1310 polysubstance users completed the survey. A total of 974 (74.3%, [95%CI, 72.2-76.4]) participants reported alcohol use of whom 405 participants (41.6 %, [IC95 38.5-44.7]) reported an increase in alcohol use since the start of quarantine. Odds of alcohol use increase was higher for participants with married/domestic partnership (OR, 1.8 [95%CI, 1.4- 2.5]), and those with HAD scores higher than 7 (OR, 1.7 [95%CI, 1.2-2.3]), AUDIT scores lower than 8 (OR, 2.0 [95%CI, 1.4-2.8]), and OCDS scores greater than 7(IQR) (OR, 3.2 [95%CI, 2.3 - 4.5]). Odds of alcohol use increase was higher for psychostimulant users (OR, 1.7 [95%CI, 1.3 -2.5]). Conclusion: Prevention on the emergence of alcohol use disorders in light and moderate drinkers during quarantine should be considered by health policies and target specifically polysubstance users who reported psychostimulant use, higher levels of alcohol craving, anxiety and depression. No conflict of interest

Alcohol Use and Its Related Psychosocial Effects during the Prolonged COVID-19 Pandemic in Japan: A Cross-Sectional Survey.

We conducted a large-scale survey in the Japanese population, about one year after the initial declaration of the state of emergency, to investigate alcohol use under the prolonged coronavirus disease 2019 (COVID-19) pandemic and its related psychosocial and demographic characteristics. The survey was conducted online between 15 and 20 June 2021. A total of 11,427 participants were included in the analysis (48.5% female, 48.82 ± 13.30 years, range = 20-90 years). Compared with females, males were more prevalent in the hazardous user and the potential alcoholism group and were less prevalent in the no alcohol-related problem group. However, the prevalence of potential alcoholism among the participants in our study was higher than that previously reported. This trend was particularly pronounced in women. The presence of potential alcoholism was related to a deteriorated psychological status, particularly depression and anxiety, and various difficulties in their daily lives due to the COVID-19 pandemic. In the future, intervention methods and systems should be developed to provide optimal assistance to people with psychological problems who are vulnerable to alcohol-related problems during the COVID-19 pandemic, while conducting further long-term follow-up studies.

THE ANALYSIS OF ALCOHOL CONSUMPTION DURING THE SEVERE ACUTE RESPIRATORY SYNDROME CORONAVIRUS 2 ITALIAN LOCKDOWN

Background and aim: The SARS-CoV-2 lockdown resulted in deep changes in lifestyles, promoting in many people the onset of psychological symptoms generally associated with drug and alcohol abuse. The aim was to assess the variation of alcohol drinking habits in a sample of Italian citizens during the lockdown and to identify the psychosocial factors surrounding it. Materials and methods: An online anonymous questionnaire was created and submitted from 9th April 2020 to 28th April 2020. Questions were related to personal psychosocial details and alcohol drinking habits during the lockdown, including Alcohol Use Disorders Identification Test (AUDIT C) questions Results: On a total of 1234 surveys, the increase of both anxiety and fear was largely detected (63% and 61% respectively). The 18% increased alcohol consumption during the lockdown and it showed a significant correlation with anxiety and fear experienced (both p<0.001). The relative risk for 7 to 9 and more than 10 drinks per day consumption was directly linked to these symptoms (p<0.001). The most involved categories of participants showed this harmful association were self-employed workers and participants who live alone, subject aged 30-50 with a high level of instruction or students and not occupied people in the age range 18-19 (all p<0.001). Additionally, the subset of the study population that showed low alcohol consumption before the lockdown has demonstrated the worsening of alcohol assumption during the quarantine (p<0.0001). (figure presented) Conclusions: Several psychosocial factors are involved in determining the increase of alcohol consumption during the lockdown and need healthcare support to avoid an awful impact on human life.