Abstinence Among Alcohol Use Disorder Patients During the COVID-19 Pandemic: Insights From Spain.

BACKGROUND: Patients with alcohol use disorder (AUD) are likely to suffer disproportionate harms related to the COVID-19 pandemic and related policy measures. While many surveys have been conducted, most are focused on drinking changes in the general population and validation with biological markers is lacking. METHOD: We performed a retrospective cohort study among patients with AUD attending a urine drug screening program. With mixed-effects logistic regression models, we assessed the probability of screening positive for ethyl glucuronide according to patients' main clinical characteristics and time of analysis (either prior to or after a lockdown was implemented in Spain). RESULTS: A total of 362 patients provided 2,040 urine samples (1,295 prior to lockdown, 745 during lockdown). The mean age of participants was 52.0 years (SD 12.6), and 69.2% were men. Of the 43% of patients tested for other drugs 22% screened positive. After adjusting for all covariates, the odds of screening positive for ethyl glucuronide during lockdown almost doubled (OR = 1.99, 95% CI 1.20 to 3.33, p = 0.008). Other significant covariates included testing positive for other drugs (OR = 10.79, 95% CI 4.60 to 26.97) and length of treatment (OR = 0.59, 95% CI 0.47 to 0.74). CONCLUSIONS: Our data support an association between the lockdown due to COVID-19 and increased alcohol use in patients with AUD. Thus, addiction healthcare systems could face significant challenges ahead. In light of these findings, it is essential to evaluate prospectively how patients with AUD are affected by the pandemic and how health systems respond to their needs.

Possibilities and pitfalls? Moderate drinking and alcohol abstinence at home since the COVID-19 lockdown.

The global 'lockdowns' and social distancing measures triggered by the COVID-19 pandemic have brought about unprecedented social changes, including the sudden, temporary closure of licensed venues and significant modifications to leisure and drinking practices. In this piece, we argue that these changes invite researchers to consider the short and longer-term consequences in terms of continuities and changes to the practices and symbolism of alcohol consumption both within and beyond domestic spaces. We do this by drawing on illustrations from our emergent qualitative research involving internet-mediated semi-structured interviews and focus groups with 20 participants from the UK (aged 26-65) concerning experiences of drinking in and beyond 'lockdown'. In sharing these early findings, we hope to highlight themes relevant to understanding drinking behaviour during the COVID-19 pandemic and to stimulate dialogue for immediate research priorities in this area. Key topic areas in our data appear to concern; variability in heavy/moderate/light/non-drinking practices while drinking at home, lockdown as an opportunity to reassess relationships with alcohol, and the symbolic role of alcohol in internet-mediated communications and interactions. Longstanding policymaker and practitioner concerns with managing public drinking and public order may have been unsettled by a growth in home-based drinking, although, as we argue, such changes were in motion before the global pandemic. We propose that a greater understanding of the challenges and opportunities the pandemic presents for (re)negotiating relationships with alcohol may offer wider lessons around how individuals and communities might be supported via innovative policy measures to change their relationships with alcohol both during and beyond lockdown.

COVID-19 and forced alcohol abstinence in India: The dilemmas around ethics and rights.

In response to the COVID-19 pandemic, as with other countries across the world, the Central and State Governments of India initiated several measures to slow down the spread of the virus and to 'flatten the curve'. One such measure was a 'total lockdown' for several weeks across the country. A complex and unexpected outcome of the lockdown which has medical, ethical, economic, and social dimensions is related to alcohol consumption. The lockdown and consequent acute non-availability of alcohol resulted in people with alcohol dependence going into withdrawals, black marketing of alcohol, and in extreme cases suicide resulting from the alleged frustration of not having access to alcohol. The health dilemmas around this situation are biological (e.g. pushing people into risky situations-potentially fatal alcohol withdrawal, consumption of illicit or other non-consumable alcohol) and psychosocial (e.g. isolation increasing the risk of relapses, loss of control over the decision to abstain which can be detrimental to recovery, restriction of access to services for alcohol problems). The legal and rights-related dilemmas are centred around whether States have the right to impinge on individual autonomy on the grounds of public health, the capacity of the health systems to provide appropriate services to cope with those who will struggle with the unavailability of alcohol, the constitutionality of the Central government's impinging on jurisdiction of states under the guise of a health emergency caused by the pandemic, and the ability of the State to make unbiased decisions about this issue when it is highly dependent on the revenue from the sale of alcohol and associated industries. The way forward could be a pragmatic and utilitarian approach involving continued access to alcohol, while observing all physical distancing norms necessary during the pandemic, for those who want to continue drinking; and implementing innovative measures such as tele-counselling for those who wish not to return back to drinking.