The early impact of COVID-19 on the incidence, prevalence, and severity of alcohol use and other drugs: A systematic review

Evaluating the association between alcohol sweetness preference, alcohol harm, and alcohol value

Alcohol use disorder is prevalent, and various risk factors inform drinking onset and drinking patterns. Existing data suggest that alcohol sweet taste preference may be associated with harmful levels of alcohol use and alcohol-related harm. The present exploratory study aimed to characterize people's first alcohol use experience, probe the association between sweet taste preferences and drinking patterns over time, and evaluate the relationship between sweet taste preferences and behavioral economic variables. Participants (N = 277) were recruited through Prolific and completed an assessment of first alcohol exposure, current and historic drinking patterns, alcohol demand, and delay discounting. Participants reporting preference for less sweet alcohol beverages consumed the most drinks per week both currently and during their period of the heaviest use. Trends emerged such that rank order decreases in alcohol consumption were observed from those reporting transitioning from sweet to less sweet preference, then less sweet to sweet preference, and finally consistent sweet taste preference reporting the lowest consumption. Similar associations were observed for alcohol use disorder symptoms counts and alcohol demand intensity. These data broadly suggest that sweet taste preferences in alcohol consumption may serve as an important factor modulating patterns of alcohol use across the lifespan. In terms of translational implications, these data suggest that commonly used sucrose fades in preclinical research may reflect the trend in taste preferences of the majority of the population but do not mirror the typical onset (or course) of chronic, maladaptive drinking behaviors. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

County-Level COVID-19 Policy Comprehensiveness and Adult Behavioral Health during 2021 : County-Level COVID-19 Policy and Adult Behavioral Health

Epidemiologic research has found worsening behavioral health in the USA since 2020. Local policies may have contributed to these patterns and associated disparities. However, scant research has systematically documented county-level COVID-19-era policymaking or empirically investigated its health impacts. To investigate this question, we linked the US COVID-19 County Policy Database-a novel database with weekly data from 2020 to 2021 on 26 policies for 309 primarily urban counties-to data on adult behavioral health from the cross-sectional 2021 National Survey on Drug Use and Health (N = 25,600). We created measures of policy comprehensiveness by aggregating individual policies into an overall score, and into three domains: containment/closure, economic response, and public health. Outcomes included any past-30-day use and frequency of use of multiple substances (alcohol, binge alcohol, cigarettes, marijuana, non-marijuana illicit drug use, and vaping) and past-30-day psychological distress. Models adjusted for individual covariates, county fixed effects, and time-varying county-level COVID-19 covariates. We found that increases in overall policy comprehensiveness-and comprehensiveness in each of three domains-over time were not associated with the behavioral health outcomes assessed. Meanwhile, stratified models found some variability in associations across sex, racial/ethnic, education, and urban subgroups. This study established the feasibility, utility, and potential challenges of linking newly available COVID-19-related county policy data with health data to examine county-level policy influences on behavioral health. Further research is needed to inform responses to current behavioral health needs and future public health emergencies.

Quality of life and the associated factors among postmenopausal women during the COVID-19 pandemic: a cross-sectional study

PURPOSE

To evaluate the quality of life (QOL) of postmenopausal women during the COVID-19 pandemic in Thailand and the associated factors.

METHODS

A cross-sectional study using a validated Thai version of the WHOQOL-BREF questionnaire to assess QOL was conducted.

RESULTS

A total of 453 postmenopausal women participated in the study, with a median age of 58 years (ranging from 41 to 65). These women, residing in urban areas of Thailand such as Bangkok, Nonthaburi, Nakhon Pathom, Pathum Thani, Samut Prakan, and Samut Sakhon, completed a survey questionnaire with the assistance of health volunteers during the COVID-19 pandemic, between October 2021 and April 2022. The study revealed that 55.85% of participants reported experiencing poor quality of life (QOL) during the pandemic. Stepwise logistic regression analysis identified several significant associations with QOL. Factors linked to a poorer QOL included lower levels of well-being index (odds ratio [OR] 7.89, 95% confidence interval [CI] 3.16-19.75, P < 0.01), reduced physical activity (OR 2.72, 95% CI 1.62-4.54, P < 0.01), and the severity of menopausal symptoms (OR 1.94, 95% CI 1.42-2.66, P < 0.01). Conversely, higher education (OR 0.28, 95% CI 0.10-0.75, P < 0.01), an earlier onset of menopause (OR 0.55, 95% CI 0.39-0.78, P < 0.01), and occasional social alcohol consumption (OR 0.56, 95% CI 0.33-0.94, P = 0.03) were identified as protective factors for QOL.

CONCLUSION

These findings highlight the importance of comprehensive menopausal care, addressing both physical and mental well-being, and providing specific care for menopausal symptoms during challenging times of the COVID-19 pandemic.

Containment Measures and Alcohol Consumption Among Drinking Higher Education Students Before and During the COVID-19 Pandemic: A Multilevel Analysis in 25 Countries

Hazardous alcohol use tends to be more prominent among higher education students. The COVID-19 pandemic severely altered student life, raising questions on its impact on students' alcohol use patterns. The current study examined cross-country variations in drinking behaviors (weekly drinking and binge drinking), and the extent to which these variations were associated with containment measures implemented during the first wave of the COVID-19 pandemic. Data were obtained from the COVID-19 International Student Well-being Study, covering students in 25 middle- and upper-high income countries. Data on government responses were retrieved from the Oxford COVID-19 Government Response Tracker. Multilevel multinomial logistic regression analyses were performed on weekly drinking (n = 44,212) and binge drinking (n = 32,785). Considerable cross-country variation existed for weekly drinking and binge drinking. In the majority of countries, a self-reported decrease in weekly drinking and a substantial self-reported decrease in binge drinking were observed. Closings of schools were associated with decreases in weekly drinking, while limitations on social gatherings were associated with increases in weekly drinking. The stringency index was associated with reporting decreased binge drinking. The study findings demonstrate a number of small yet significant associations between containment measures and changes in student drinking behaviors. Future studies are required to uncover why some students increased their alcohol consumption, particularly in countries with stricter limitations on social gatherings.

Impact of the COVID-19 pandemic on alcohol consumption in young adults: A systematic review

OBJECTIVES

The COVID-19 pandemic caused unprecedented restrictions, leading to differences in the frequency and patterns of alcohol consumption, especially among young adults. This systematic review aims to investigate the overall evidence concerning changes in alcohol consumption in this period.

STUDY DESIGN

Systematic review.

METHODS

Adhering to PRISMA and SWiM guidelines, this study's review protocol is registered in PROSPERO (CRD42023464591). The studies research was carried out in PubMed, Scopus, and Web of Science. Inclusion criteria involved observational studies focusing on participants aged 18 to 35, exploring alcohol consumption during at least the first wave of COVID-19, and publications in English or Spanish.

RESULTS

A total of 28 studies conducted in different countries were included, European (18), North American (9), and Latin American (1). Although in many studies the overall prevalence of alcohol use was reduced, it was mainly among occasional users, in which the main motivation was the lack of social contact. It was exposed that participants with a high risk of problematic use increased their alcohol consumption, showing associated factors such as poor mental health, depressive symptoms, stress, and coping motivations. Males generally exhibited a higher risk of problem use and risky behaviours than females.

CONCLUSIONS

During COVID-19, youth alcohol consumption decreased overall, especially among social drinkers, but increased among high-risk users due to factors like distress and loneliness. Similar trends during other disasters emphasize the importance of addressing high-risk drinking in disaster planning. Also, preventing high-risk drinking from adolescence and youth could be helpful in reducing the global burden and impact of alcohol consumption.

Alcohol Sales and Adverse Events during the Covid-19 Pandemic

BACKGROUND

Alcohol sales increased at the onset of the coronavirus disease 2019 (Covid-19) pandemic, while alcohol-related emergency department (ED) visits decreased. It is unknown whether these patterns of alcohol use persisted or led to delayed effects on health.

METHODS

We conducted a cross-sectional time series analysis of alcohol sales and alcohol-related adverse events in Ontario, Canada. We obtained 6 years of alcohol sales data from the largest regional alcohol distributor. We obtained monthly counts of alcohol-related ED visits, hospital admissions, and toxicity deaths. We defined our exposure as the start of the Covid-19 pandemic (March 1, 2020). We used linear mixed models to compare mean monthly alcohol sales and adverse events during prepandemic and pandemic periods. We used univariate Poisson regression models to generate incident rate ratios for alcohol-related adverse events comparing the prepandemic (February 28, 2016, to February 29, 2020) and pandemic (March 1, 2020, to February 26, 2022) periods.

RESULTS

Alcohol sales increased, on average, by CA$43.5 million per month (95% confidence interval [CI], CA$26.1 million to CA$60.9 million; P<0.01) during the pandemic years compared with the prepandemic period. We observed a 7% increase (95% CI, 5 to 8) in the proportion of alcohol-related ED visits during the pandemic years, due to a modest decrease in alcohol-related ED visits and a larger decrease in all-cause ED visits. Overall, an average increase of 191 alcohol-related admissions occurred per month (95% CI, 101 to 282). We also observed an average increase of eight toxicity deaths per month (95% CI, 4 to 12).

CONCLUSIONS

Alcohol sales and alcohol-related adverse events increased during the Covid-19 pandemic.

Changes in Alcohol Consumption During and After the Covid-19 Pandemic From 2020 to 2023 in a Prospective Cohort of Italian Adults

BACKGROUND

The lockdowns imposed by the government during coronavirus disease 2019 (COVID-19) pandemic have had a significant impact on the Italian population habits.

METHODS

LOckdown and lifeSTyles in Italy and in Tuscany studies collected data on a representative sample of the Italian adult population in 2020 (n = 6,003) followed up through 2023 via four additional surveys (3,000 ≤ n ≤ 6,600) through an online self-administered questionnaire. The Alcohol Use Disorders Identification Test-Concise was used to identify at-risk drinkers. Considering the cohort of individuals who took part to the first and at least one other wave (n = 5,378), a multilevel logistic model was used to derive odds ratios (ORs) and corresponding 95% confidence intervals (CIs) of being at-risk drinkers.

RESULTS

The prevalence of at-risk drinkers was 26.4% before, 23.4% during the first lockdown, and stabilized around 30.0% thereafter. Being at-risk alcohol consumers decreased with decreasing economic status (P for trend <0.001), was less frequent among middle-aged compared to younger (OR 0.73; 95% CI, 0.60-0.89) and among divorced/separated (OR 0.77; 95% CI, 0.60-0.99) or single (OR 0.75; 95% CI, 0.64-0.89) compared to married individuals. It was more frequent among individuals with anxiety or depressive symptoms (OR 1.24; 95% CI, 1.12-1.37), those using psychotropic drugs (OR 1.99; 95% CI, 1.69-2.35) and users of conventional and/or alternative nicotine products (OR 3.67; 95% CI, 3.00-4.48).

CONCLUSION

The long-term trends in alcohol consumption after the COVID-19 pandemic are unfavorable in Italy. The results point to an increased vulnerability for at-risk alcohol consumption among younger individuals, women with higher economic status, and married individuals. At-risk drinking is strongly related to mental health symptoms and nicotine consumption.

A cohort-based assessment of drug use trends during the COVID-19 pandemic: relationship with mood and sociodemographic factors in Brazil

The COVID-19 pandemic has brought significant challenges, including severe psychological consequences, especially for vulnerable individuals, such as those with substance use disorders. This study investigated the impact of the pandemic on substance use patterns and psychological health in Brazilians, exploring associations with sociodemographic factors to identify groups at higher risk. Data were collected online to assess self-reported substance use through the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST), and psychological state, using the Depression, Anxiety and Stress Scale (DASS-21) and level of social distancing. The research was conducted in three waves: September-October 2020, April-May 2021, and September-November 2022. The ASSIST (alcohol, cannabis, hallucinogens, and cocaine/crack) and DASS-21 (anxiety, depression, and stress) scores decreased over time. Regarding sociodemographic data, being male, single, with less education, lower income and lower social distancing showed associations with alcohol and cannabis scores. All drug scores showed associations with psychological symptoms and time, suggesting a possible adaptation or resilience of the sample to the challenges of the pandemic. These findings highlight the importance of monitoring patterns of substance use and mental health in times of crisis, especially in vulnerable populations. Such knowledge is essential to inform public health strategies and prepare health systems to face future global crises.

Alcohol use and drinking motives across five countries: a post-COVID-19 pandemic update

Background: It is necessary to understand drinking motives to inform tailored interventions counteracting high-risk alcohol use and alcohol use disorder. Research suggests that, during the COVID-19 pandemic, drinking to cope with the current situation (i.e. coping motive) increased. This was alarming since the coping motive is a predictor of alcohol use and alcohol-related problems.Objective: In the current study, we aimed to elucidate whether this COVID-19-induced increase in coping-motivated alcohol use outlasted the COVID-19 pandemic in the USA, Great Britain, Mexico, Spain, and Germany. We provide a 2023 post-COVID-19 update on alcohol use and drinking motives.Methods: In spring 2023, 1032 participants recruited via Prolific (48% female) across the five countries completed a cross-sectional online survey, including the Alcohol Use Disorder Identification Test (AUDIT) for alcohol use patterns and the Drinking Motives Questionnaire-Revised (DMQ-R) for drinking motives.Results: Across all five countries, 20-30% of the participants exceeded the AUDIT cutoff score for high-risk alcohol use. The ranking of all four motives for alcohol use was cross-nationally consistent: Social > Enhancement > Conformity > Coping.Conclusion: Compared to most research before the pandemic, with a Social > Enhancement > Coping > Conformity motive ranking, and research during COVID-19, with an Enhancement > Coping > Social > Conformity motive ranking, our data suggests that post-COVID drinking to socialize and to enhance one's own mood, are again the most important motives to drink alcohol. Furthermore, it seems like the increase in the coping motive found in research during the pandemic, did luckily not persist but conversely, post- compared to pre-COVID, the conformity motive seems more important than coping motive.

How Has the COVID-19 Pandemic Impacted Addiction Services? A Study of the Different Periods of the Pandemic and Patient Treatment Follow-up Over 1 Year

Background

Various studies have provided evidence of the impact of COVID-19 and the measures adopted by governments on drug use and its treatment. After 4 years, a more precise assessment of the evolution of patients and addiction treatment services can be made. The objective of this study is to compare different periods during the COVID-19 pandemic to identify changes in patient profiles and the care activity of addiction treatment centres.

Methods

A retrospective observational study was conducted using data from March 14, 2019 to June 22, 2022, from addiction centres of Andalusia (Spain). Information related to the treatment of each patient was collected during 1 year after the initiation of treatment (until June 22, 2023). Electronic health records of 29 740 outpatients were analysed and divided into 4 periods (pre-pandemic, lockdown, return to normal and post-lockdown).

Results

Differences were found across the analysed periods. Admissions declined during the lockdown period but subsequently increased, without reaching pre-pandemic levels. Admission to treatment due to opioid dependence increased during the lockdown. In contrast, the percentage of patients with dual pathology decreased. An increase in the dropout rate of patients from treatment was observed compared to the pre-pandemic period.

Conclusions

The results revealed a similar patient profile across the different analysed periods. The most notable changes are observed in healthcare activity, which appears to have decreased. Therefore, a greater investment is likely required for the reformulation of addiction centres and increased funding to provide adequate assistance to these patients.

Perspectives of In-Hospital Intramuscular Naltrexone and Oral Medications for Alcohol Use Disorder: A Study of Addiction Clinicians and Hospitalized Patients

BACKGROUND

Alcohol-related hospitalizations are rising; however, medications for alcohol use disorder (M-AUD) are underprescribed despite their effectiveness to reduce heavy drinking. In-hospital administration of intramuscular (IM)-naltrexone may reduce negative health outcomes among people with AUD who are unable to take daily MAUD.

OBJECTIVE

To assess addiction clinicians' perceptions of offering and administering IM-naltrexone and to assess hospitalized patients' perspectives on their alcohol use and acceptance of MAUD.

DESIGN

Multi-methods using surveys and semi-structured interviews.

SETTING AND PARTICIPANTS

Hospital-based addiction clinicians (n = 20) and hospitalized patients with AUD (n = 25) at a university hospital.

APPROACH

Descriptive statistics were used for quantitative data analysis. Key informants were identified using convenience sampling; inductive and deductive methods were used to analyze interview transcripts.

KEY RESULTS

Clinicians reported that offering and administering in-hospital IM-naltrexone was acceptable, appropriate, and feasible before and after it became available to hospitalized patients. Most patients (92%) accepted IM-naltrexone before agreeing to an interview. Themes emerged related to patient's complicated relationship with alcohol, ranging from minimizing alcohol's impact on their family and health, to concerns about how alcohol was negatively affecting them and their loved ones. Many acknowledged that alcohol damaged their health, while also describing ambivalence about their alcohol use or being incapable of reducing their alcohol use. Others expressed motivation and assuredness of sobriety with IM-naltrexone. Most reported accepting IM-naltrexone because they hoped it would improve their health and relationships, because it was convenient, and because it offered security over a pill. Others used alcohol to self-manage challenging emotions and had difficulty considering a life without it.

CONCLUSIONS

ACS clinicians viewed IM-naltrexone provision favorably. Some patients expressed concern about their alcohol use and its health impacts while others were ambivalent. Despite this, most accepted MAUD. All forms of MAUD should be offered in the hospital to support patients' recovery goals.

Consumption patterns before and during the COVID-19 pandemic among patients admitted to inpatient drug detoxification treatment: Results of two cross-sectional surveys from 2018 and 2021

Background

The lockdown measures during the SARS-CoV-2 pandemic could have influenced drug consumption patterns of persons with drug use disorder, especially due to a reduced availability of drugs, an increased consumption of sedating substances as a coping strategy, or a shift to novel psychotropic substances (NPS) associated with an increased drug buying in the internet. In this study, the consumption patterns of people mainly with opioid use disorder entering inpatient drug detoxification treatment were investigated in the same hospitals with the same methods before and during the pandemic.

Methods

At admission, patients were interviewed regarding their consumption patterns using the EuropASI questionnaire. In addition, changes in the routes of drug acquisition were assessed.

Results

In five hospitals in Western Germany, 213 (2021) and 175 persons (2018) were recruited. Sociodemographic data were similar in both cohorts (mean age around 40 years, mainly male, about 50% with migrant background, high unemployment rate). Rates of use of various drugs during the last 30 days were also similar. Differences were detected for gabapentinoids and opioid analgesics (increase >5%) as well as for cannabis (decrease >5%). Current use of NPS was low in both surveys. Only a minority of patients had experiences with drug acquisition in the internet.

Discussion

The pandemic had only a minor influence on consumption patterns and routes of drug acquisition in this sample. It remains to be seen whether the increased use of gabapentinoids and opioid analgesics will continue despite the end of the pandemic.

Treatment access gap during the COVID-19 Pandemic: impact on problematic alcohol use and the moderating roles of perceived stress and resilience

Objective

The COVID-19 pandemic may have interfered with individuals' access to alcohol use disorder (AUD) treatment, but limited research has documented the impact of treatment interference on drinking behavior. This study's purpose was to examine the associations of AUD treatment interference with problematic alcohol use, and the moderating roles of perceived stress and resilience.

Method

A cross-sectional survey design was employed. Data were drawn from the baseline assessment of the National Institute on Alcohol Abuse and Alcoholism COVID-19 Pandemic Impact on Alcohol Study. Between June 2020 and March 2021, 288 participants (48.6% female, 51.4% male) responded to key measures of interest by phone and/or through an online survey. Study hypotheses were tested using multiple linear regression models adjusted for demographic characteristics (age, sex, race, ethnicity, years of education, household income, marital status), study enrollment phase, and history of AUD.

Results

Self-reported AUD treatment interference was positively associated with problematic alcohol use as measured by the Alcohol Use Disorders Identification Test (b = 2.05, p < 0.001). Significant moderation effects indicated the association between AUD treatment interference and problematic alcohol use was stronger at a high level of perceived stress (b = 3.08, p < 0.001) and was attenuated at a high level of resilience (b = -0.13, p = 0.874).

Conclusions

Self-reported AUD treatment interference may indicate interruption to individuals' support systems and highlight the need for continued access to treatment. Fostering positive coping strategies and resilience may help individuals mitigate risks of problematic drinking amidst a public health crisis.

Examining how the first year of the COVID-19 pandemic affected alcohol use in different socio-demographic groups in an Australian representative longitudinal sample

BACKGROUND AND AIMS

Research examining how alcohol consumption changed across different socio-demographic groups during the pandemic has largely relied upon convenience samples recruited after the onset of the COVID-19 pandemic. The aim of this study was to measure whether the pandemic shifted alcohol consumption in different gender, age and income groups in Australia.

DESIGN, SETTING AND PARTICIPANTS

This was a longitudinal study using four waves (2017-20) of the annual Household, Income and Labour Dynamics in Australia (HILDA) Survey to compare pre-pandemic consumption (2017-19) with consumption in 2020. A total of 11 636 participants in Australia aged 15 years and older took part.

MEASUREMENTS

Participants were asked annually about their alcohol consumption, demographics and income.

FINDINGS

There was a statistically significant increase in alcohol consumption during the first year of the pandemic [incident rate ratio (IRR) = 1.1, 95% confidence interval (CI) = 1.1, 1.1], largely driven by changes in drinking frequency. We found a significant difference in consumption change from pre-COVID-19 to during COVID-19 for participants aged under 55 years compared with those aged over 55 years. In addition, participants aged 15-34 reported less alcohol consumption during the pandemic than those aged 35 years and older. No significant differences were identified across gender and income groups.

CONCLUSIONS

Alcohol consumption in Australia increased during the first year of the COVID-19 pandemic. Survey participants aged 55 years and over seemed to be the least impacted by the public health measures introduced during the pandemic, such as the closure of licensed premises.

Changes in tobacco and alcohol consumption during the COVID-19 pandemic in India: a propensity score matching approach

OBJECTIVES

The COVID-19 pandemic may have influenced alcohol and tobacco consumption in low-income and middle-income countries, yet the effects are relatively unknown. In this study, we estimated the medium-term effects of the pandemic on tobacco and alcohol consumption in India.

METHODS

We used data from the fifth round of the National Family Health Survey 2019-2021, a nationally representative survey conducted between June 2019 and April 2021. We employed propensity score matching to evaluate the change in tobacco and alcohol consumption patterns by exploiting the gap in survey activities due to the pandemic lockdown-no data collection took place from April to October 2020. Individuals surveyed after the lockdown were considered COVID-19-affected, while those surveyed before were considered as unaffected.

RESULTS

The tobacco use rate was 1.4% lower and alcohol consumption was 0.3% lower for COVID-19-affected individuals relative to non-affected individuals. By tobacco product, there was a 0.9%, 0.6% and 0.4% decrease in the use of smokeless tobacco, cigarettes and bidi, respectively. Recent initiation decreased by 2.3%, 1.6% and 1.4%, for cigarettes, smokeless tobacco and alcohol, respectively. Tobacco use declined to a greater extent in low-wealth and rural populations, and in male and older subsamples. Alcohol use decreased in urban households, and among male and young subsamples, relative to their counterparts. Secondhand smoke exposure decreased by 4.6%.

CONCLUSION

Tobacco and alcohol consumption, including recent initiation, decreased during the pandemic in India. Varying effects by subgroups suggest the need for targeted future control policies that support cessation and limit consumption.

COVID-19 Concerns, Coping and Perceived Peer Norms: Correlates of Increased Alcohol and Marijuana Use Among Sexual Minority Women

This study explored the impact of COVID-related concerns and other characteristics on alcohol and marijuana use among sexual minority women (SMW). Survey data from a racially/ethnically diverse sample of 338 SMW participants in the Chicago Health and Life Experiences of Women (CHLEW) study were used to examine correlates of three substance use outcomes: frequent intoxication (once a month or more), perceived increase in alcohol use, and perceived increase in marijuana use. Coping motives for alcohol use was positively associated with each of the substance use outcomes. Belief that peers (in terms of age, sexual identity, and gender) used alcohol often to cope was associated with higher odds of frequent intoxication. COVID-19 related financial concerns were positively associated with both frequent intoxication and increased marijuana use. Health and mental health concerns were associated with lower odds of frequent intoxication. Findings underscore the importance of enhancing coping skills, addressing perceived peer coping norms, and providing both economic and social support in intervention efforts.

The impact of the COVID-19 pandemic on calls to an alcohol and drug helpline in Victoria, Australia, for alcohol, methamphetamine and cannabis use concerns

INTRODUCTION

Helplines are often the first contact with the alcohol and other drug (AOD) treatment system. We examined call data from an AOD helpline in Victoria, Australia, to explore the association between COVID-19 lockdown measures and frequency of calls.

METHODS

This was a retrospective analysis of AOD helpline data collected between January 2018 and September 2020, for alcohol, methamphetamine and cannabis use concerns. Linear and logistic regression analyses examined differences in pre-COVID-19 (January 2018 to March 2020) and during COVID-19 (March 2020 to September 2020) caller characteristics, and interrupted time-series analyses examined changes in frequency of calls relative to lockdown measures.

RESULTS

There were 14,340 calls for alcohol (n = 10,196, 71.10%), methamphetamine (n = 2522, 17.59%) and cannabis (n = 1622, 11.31%). Relative to pre-COVID-19, during COVID-19 there was an increase in the rate of change over time in number of alcohol calls (b = 0.39), increase in first-time alcohol callers (OR = 1.29), and reduction in first-time methamphetamine callers (OR = 0.80). During COVID-19, alcohol callers had lower Socio-Economic Indicators for Areas scores (b = -3.06) and cannabis callers were younger (b = -2.07). During COVID-19, there were reductions in alcohol calls involving counselling/support (OR = 0.87) and information provision (OR = 0.87), cannabis calls involving information provision (OR = 0.71) and methamphetamine calls involving referral (OR = 0.80).

DISCUSSION AND CONCLUSIONS

In the first 6 months of the pandemic, frequency of alcohol-related calls increased over time, and first-time alcohol-related callers increased. The number of calls for cannabis and methamphetamine remained stable. Results suggest the helpline was not used to its full capacity, suggesting a role for further promotion during times of crises.

Changes in alcohol consumption during the COVID-19 among first-year university students in Spain, considering the risk of problematic use - UniHcos project

The aim of this study was to evaluate the possible impact of the COVID-19 pandemic on prevalence rates and self-reported changes in patterns of alcohol use among first-year university students in Spain, considering the risk of problematic alcohol use. A serial cross-sectional study based on the uniHcos project was carried out. Data from 10 518 first-year university students (73.3% female, mean age 19 (SD = 1.6)) collected between 2012 and 2022 were analysed. The evolution of the pooled prevalence rates during the time series was analysed and the risk of problematic alcohol consumption was assessed using the AUDIT. Also, self-reported changes in alcohol use patterns during the pandemic were assessed. According to the results, during the COVID-19 pandemic, the prevalence of alcohol use in the past 30-days was reduced (76.3% in 2019 vs. 63.7% in COVID-19) increasing again in the New Normal period. Thus, a similar pattern in the practice of binge drinking was observed. Regarding the AUDIT score, 21.7% (95%CI 20.9, 22.6) of the students had harmful alcohol consumption, with a higher proportion among males. In the multivariable logistic models, a higher AUDIT score was significantly associated (p-value < 0.001) with being male and living with roommates. According to self-reported changes in consumption patterns during the COVID-19 pandemic, a higher proportion of participants with harmful use reported an increase in alcohol consumption compared to those at low-risk (43% vs 19%). Finally, despite the overall reduction in drinking prevalence during COVID-19, changes were not equal for all students and depended on their previous level of problematic drinking, highlighting that this should be considered in the development of strategies against alcohol use in this population.

Epidemiology and Health Care Burden of Alcohol Use Disorder

Alcohol use disorder (AUD) is a chronic medical condition that affects over 29.5 million people and accounts for $249 billion in social and health care costs annually. Prevalence is higher among young adults, males, sexual and gender minorities, American Indians and Alaska Natives, and the uninsured. Despite its high prevalence and societal impact, AUD is often overlooked in health care settings. This has resulted in insufficient implementation of AUD screening as well as low levels of treatment uptake. Addressing these challenges requires recognition of the current epidemiology of AUD and role of social determinants of health.

Screening and early intervention for substance use during pregnancy: A retrospective case note review of antenatal care records

INTRODUCTION

Screening for substance use during pregnancy is critical for enhancing maternal health and perinatal outcomes. However, disparities persist in screening and intervention rates within maternity services. This retrospective case note review explored contemporaneous practices around screening and interventions for substance use among pregnant women during routine antenatal care.

METHODS

A random sample of 100 sets of maternity records were reviewed. Eligible cases included any woman attending initial pregnancy assessments at one of two South Australian metropolitan Hospital-based antenatal clinics, from July 2019-September 2020. Screening rates for past and current alcohol, tobacco and other substance use were identified and compared with data from a subset of a nationally representative survey. Intervention details and referral pathways were also assessed.

RESULTS

The final sample of eligible cases (n = 93) demonstrated prioritisation of screening for current use, over past use, across all substances (p < 0.001). Screening was most likely for tobacco and least likely for e-cigarettes (p < 0.001). Significant underreporting of past use compared with the benchmark was identified for all substances (except tobacco, p = 0.224). Interventions typically involved written resources, which were usually declined by clients.

DISCUSSION AND CONCLUSIONS

Despite longstanding recommendations, screening and intervention practices for substance use appear inconsistent. With the recent emergence of vaping, no evidence of updated approaches to identifying e-cigarette consumption in pregnant women was found. Several opportunities for enhancing routine screening and intervention practices within antenatal clinics were identified, and will inform the development of policy directives, targeted training modules, and other resources for health professionals working in these services.

The impact of COVID-19-related national lockdowns on alcohol-related traffic collisions, injuries, and fatalities in Lithuania

BACKGROUND

The national lockdowns that occurred all over the world in response to the Coronavirus Disease 2019 (COVID-19) pandemic have been found to have impacted alcohol use. The aim was to evaluate the impact of COVID-19-related national lockdowns on alcohol-related traffic collisions, injuries, and fatalities in Lithuania.

METHODS

Using monthly data from the Lithuanian Road Police Service for January 2004 to December 2022, we performed interrupted time-series analyses using a generalized additive model to evaluate the impact of COVID-19-related national lockdowns on alcohol-related traffic collisions, injuries, and fatalities. In Lithuania, the COVID-19-related lockdowns occurred from March 2020 to June 2020 and from November 2020 to June 2021.

RESULTS

Although overall rates for traffic collisions and injuries decreased during the COVID-19-related lockdowns in Lithuania, these lockdowns were associated with a 3.21% (95% CI: 1.19%, 5.23%) increase in the relative proportion of alcohol-related traffic collisions and a 2.46% (95% CI: 0.12%, 4.80%) increase in the relative proportion of alcohol-related traffic injuries. The association between the lockdowns and alcohol-related traffic fatalities was not statistically significant.

CONCLUSION

The COVID-19-related national lockdowns in Lithuania were associated with a decrease in the overall rate of traffic collisions and injuries, but an increase in the relative proportion of alcohol-related traffic collisions and injuries.

Prospective changes in drinking during the COVID-19 pandemic among adults with unhealthy alcohol use

AIMS

This study examined differential changes in alcohol use during the COVID-19 pandemic among adults with unhealthy alcohol use.

METHODS

Among 62 924 adults identified with unhealthy alcohol use in primary care prepandemic (1 January 2019 to 29 February 2020), changes in alcohol use during the pandemic (1 March 2020 to 30 June 2022) were examined using electronic health record data from Kaiser Permanente Northern California. Outcomes were changes in heavy drinking days in the past three months (HDDs) and overall consumption (drinks/week), including continuous and categorical measures. Differences in outcomes by sex, age, race/ethnicity, and alcohol use disorder (AUD) were examined.

RESULTS

On average, drinking was reduced by 3.0 HDDs (in the past three months) (SD = 18.4) and 4.1 drinks/week (SD = 12.2), but women, certain age groups, White patients, and patients without AUD had smaller decreases than their counterparts. Overall, 9.1% increased, 34.4% maintained, and 56.5% decreased HDDs, and 20.2% increased, 19.8% maintained, and 60.1% decreased drinks/week. Women, patients aged ≥35 years, White patients, and patients with AUD had higher odds of increasing versus decreasing HDDs, and maintaining versus decreasing, compared to their counterparts. Patients aged 18-20 years, White patients, and patients without AUD had higher odds than their counterparts of increasing versus decreasing drinks/week. Women, patients aged 18-20 years, Asian/Pacific Islander, and Latino/Hispanic patients had higher odds of maintaining versus decreasing drinks/week.

CONCLUSIONS

While alcohol use decreased overall among this sample of primary care patients with unhealthy drinking prepandemic, certain subgroups were more likely to increase drinking, suggesting a greater risk of alcohol-related problems.

Examination of COVID stress syndrome facets and relations to substance misuse using profile analysis via multidimensional scaling (PAMS)

The COVID-19 pandemic has contributed to significant societal challenges, including increased substance misuse. The COVID stress syndrome is a constellation of interrelated processes that occur in response to pandemics, including danger/contamination fears, fears concerning economic consequences, xenophobia, compulsive checking/reassurance-seeking, and pandemic-related traumatic stress symptoms. In the present study, using a sample of 812 adults collected during the early stages of the COVID-19 pandemic in May 2020, we examined the relations between identified profiles of the COVID Stress Scales (CSS) and behavioral and cognitive aspects of substance misuse. Using profile analysis via multidimensional scaling (PAMS), we identified two core profiles of the CSS, which explained 60 % of the variance in participant responding: 1) High compulsive checking & Low xenophobia and 2) High xenophobia & Low danger/contamination. The first profile is consistent with the COVID stress syndrome, while the second profile aligns with the COVID disregard syndrome, which is a constellation of interrelated processes distinguished by a denial or downplaying of the seriousness of the COVID-19 pandemic and lack of perceived vulnerability to disease. Both profiles demonstrated significant positive correlations with drug and alcohol misuse, respectively. However, only the High xenophobia & Low danger/contamination profile demonstrated relations with cognitive aspects of substance misuse via positive and negative correlations with positive and negative expectancies of alcohol use, respectively. These findings provide further support for the relationship between the COVID stress syndrome and substance misuse and offer insight into how unique profiles of this syndrome may impact pandemic-related mental and public health interventions.

Parental Patterns of Alcohol Consumption During the COVID-19 Pandemic: Scoping Review

BACKGROUND

The declaration of the COVID-19 pandemic led to public health restrictions that impacted the lives of people across the globe. Parents were particularly burdened with balancing multiple responsibilities, such as working from home while caring for and educating their children. Alcohol use among parents is an area that warrants further exploration.

OBJECTIVE

This study aimed to investigate patterns of parental alcohol consumption during the COVID-19 pandemic, focusing on relative changes in the frequency and quantity of alcohol use compared to prepandemic use, nonparent adult samples, or both.

METHODS

A scoping review informed by the methodology of Arksey and O'Malley explored patterns of parental alcohol consumption during the COVID-19 pandemic. Searches were conducted in CINAHL, Ovid MEDLINE, PsycINFO, and Web of Science. Search terms were created using the Joanna Briggs Institute framework of Population, Concept, and Context, with the population being parents and the concept being alcohol consumption during the COVID-19 pandemic.

RESULTS

The database search yielded 3568 articles, which were screened for eligibility. Of the 3568 articles, 40 (1.12%) met the inclusion criteria and were included in the scoping review. Findings indicated the following: (1) having children at home was a factor associated with parental patterns of alcohol use; (2) mixed findings regarding gender-related patterns of alcohol consumption; and (3) linkages between parental patterns of alcohol use and mental health symptoms of stress, depression, and anxiety.

CONCLUSIONS

This scoping review revealed heterogeneous patterns in parental alcohol use across sociocultural contexts during the COVID-19 pandemic. Given the known harms of alcohol use, it is worthwhile for clinicians to assess parental drinking patterns and initiate conversations regarding moderation in alcohol use.

Testing the incremental effectiveness of pay-for-performance to improve implementation of a motivational interviewing brief intervention for substance use disorders in HIV settings: Results of a parallel cluster-randomized type 3 hybrid trial

Background

Substance use disorders (SUDs) have a serious adverse impact on the physical and mental well-being of people with HIV. Previously, using a 39-site dual-randomized type 2 hybrid trial design, findings from the Substance Abuse Treatment to HIV Care Project supported the Implementation and Sustainment Facilitation (ISF) strategy to improve implementation and effectiveness of a motivational interviewing brief intervention (MIBI) for SUD within HIV service settings across the United States (US). Building on this trial, this parallel cluster-randomized type 3 hybrid trial aimed to test the incremental effectiveness of a pay-for-performance (P4P), a form of the "alter incentive/allowance structures" strategy.

Methods

Twenty-six HIV service organizations, their staff participants (N=87), and their client participants (N=341) were cluster-randomized to one of two implementation conditions. The control condition included staff-focused training, feedback, and consultation (TFC) and team-focused implementation and sustainment (ISF). The experimental condition included TFC+ISF as well as P4P (TFC+ISF+P4P). P4P used financial incentives to reward MIBI implementation (US$10 per MIBI delivered) and MIBI implementation at or above a pre-defined level of quality (US$10 per demonstration). In addition to these outcomes, past 4-week changes/reductions in client participant's days of primary substance use and anxiety symptoms were examined.

Results

The addition of P4P had a large and significant effect on the number of MIBIs implemented (d=1.30, p<.05) and reduction in anxiety (d=-1.54), but there was no impact on days of substance use. P4P had large effects on MIBI quality (d=1.24) and MIBI implementation effectiveness (d=1.28), but these were not significant (p<.10).

Conclusions

P4P is a form of the "alter incentive/allowance structures" strategy. Its function is to reward the implementation of a clinical innovation. Rewarding implementation is consistent with the theory of implementation effectiveness, which suggests implementation climate (i.e., the extent to which implementation is expected, supported, and rewarded) is a key antecedent of implementation effectiveness (i.e., the consistency and quality of implementation). We found that P4P had a significant, positive impact on MIBI implementation in HIV service settings, but client-level outcomes were mixed. Future research should examine the effectiveness of the P4P strategy to improve implementation and sustainment of other evidence-based innovations.

Trial registration

ClinicalTrials.gov: NCT04687917. Registered 12/18/2020.

Elevated risk for psychiatric outcomes in pediatric patients with Multisystem Inflammatory Syndrome (MIS-C): A review of neuroinflammatory and psychosocial stressors

Multisystem Inflammatory Syndrome in Children (MIS-C) is a secondary immune manifestation of COVID-19 involving multiple organ systems in the body, resulting in fever, skin rash, abdominal pain, nausea, shock, and cardiac dysfunction that often lead to hospitalization. Although many of these symptoms resolve following anti-inflammatory treatment, the long-term neurological and psychiatric sequelae of MIS-C are unknown. In this review, we will summarize two domains of the MIS-C disease course, 1) Neuroinflammation in the MIS-C brain and 2) Psychosocial disruptions resulting from stress and hospitalization. In both domains, we present existing clinical findings and hypothesize potential connections to psychiatric outcomes. This is the first review to conceptualize a holistic framework of psychiatric risk in MIS-C patients that includes neuroinflammatory and psychosocial risk factors. As cases of severe COVID-19 and MIS-C subside, it is important for clinicians to monitor outcomes in this vulnerable patient population.

Changes in the prevalence of mental health problems during the first year of the pandemic: a systematic review and dose-response meta-analysis

AIM

To describe the pattern of the prevalence of mental health problems during the first year of the COVID-19 pandemic and examine the impact of containment measures on these trends.

METHODS

We identified articles published until 30 August 2021 that reported the prevalence of mental health problems in the general population at two or more time points. A crowd of 114 reviewers extracted data on prevalence, study and participant characteristics. We collected information on the number of days since the first SARS-CoV-2 infection in the study country, the stringency of containment measures and the number of cases and deaths. We synthesised changes in prevalence during the pandemic using a random-effects model. We used dose-response meta-analysis to evaluate the trajectory of the changes in mental health problems.

RESULTS

We included 41 studies for 7 mental health conditions. The average odds of symptoms increased during the pandemic (mean OR ranging from 1.23 to 2.08). Heterogeneity was very large and could not be explained by differences in participants or study characteristics. Average odds of psychological distress, depression and anxiety increased during the first 2 months of the pandemic, with increased stringency of the measures, reported infections and deaths. The confidence in the evidence was low to very low.

CONCLUSIONS

We observed an initial increase in the average risk of psychological distress, depression-related and anxiety-related problems during the first 2 months of the pandemic. However, large heterogeneity suggests that different populations had different responses to the challenges imposed by the pandemic.

Analysis of the BDNF Gene rs6265 Polymorphism in a Group of Women with Alcohol Use Disorder, Taking into Account Personality Traits

It seems that BDNF has a direct influence on the brain pathways and is typically engaged during the processing of rewards. A surge in BDNF levels in the ventral tegmental area (the region from which the dopaminergic neurons of the mesocorticolimbic dopamine system originate and extend to the dorsolateral and ventromedial striatum) triggers a state of reward similar to that produced by opiates in animal studies. The aims of the study were (1) to analyze the association of the BDNF gene rs6265 polymorphism with AUD (alcohol use disorder) in women, (2) analyze personality and anxiety in alcohol-dependent and control woman, and (3) conduct an interaction analysis of rs6265 on personality, anxiety, and alcohol dependence. Our study found a notable interaction between the anxiety (trait and state), neuroticism, rs6265, and AUD. The alcohol AUD G/A genotype carriers revealed higher level of the anxiety trait (p < 0.0001) and neuroticism (p < 0.0001) compared to the control group with G/A and G/G genotypes. The alcohol use disorder subjects with the G/A genotype displayed higher levels of an anxiety state than the control group with G/A (p < 0.0001) and G/G (p = 0.0014) genotypes. Additionally, the alcohol use disorder subjects with the G/G genotype obtained lower levels of agreeability compared to the controls with G/A (p < 0.0001) and G/G (p < 0.0001) genotypes. Our study indicates that anxiety (trait and state) and neuroticism are interacting with the BDNF gene rs6265 polymorphism in alcohol-dependent women. Characteristics like anxiety (both as a trait and a state) and neuroticism could have a significant impact on the mechanism of substance dependency, particularly in females who are genetically susceptible. This is regardless of the reward system that is implicated in the emotional disruptions accompanying anxiety and depression.

The role of brain serotonin signaling in excessive alcohol consumption and withdrawal: A call for more research in females

Alcohol Use Disorder (AUD) is a leading cause of death and disability worldwide, but current treatments are insufficient in fully addressing the symptoms that often lead to relapses in alcohol consumption. The brain's serotonin system has been implicated in AUD for decades and is a major regulator of stress-related behaviors associated with increased alcohol consumption. This review will discuss the current literature on the association between neurobiological adaptations in serotonin systems and AUD in humans as well as the effectiveness of serotonin receptor manipulations on alcohol-related behaviors like consumption and withdrawal. We will further discuss how these findings in humans relate to findings in animal models, including a comparison of systemic pharmacological manipulations modulating alcohol consumption. We next provide a detailed overview of brain region-specific roles for serotonin and serotonin receptor signaling in alcohol-related behaviors in preclinical animal models, highlighting the complexity of forming a cohesive model of serotonin function in AUD and providing possible avenues for more effective therapeutic intervention. Throughout the review, we discuss what is known about sex differences in the sequelae of AUD and the role of serotonin in these sequelae. We stress a critical need for additional studies in women and female animals so that we may build a clearer path to elucidating sex-specific serotonergic mechanisms and develop better treatments.

Evidence to support health system prioritization of health behaviors in the COVID-19 era

BACKGROUND

Since the COVID-19 pandemic health systems have shifted necessarily from chronic to infectious disease treatment, but chronic disease remains critical. One large health system uniquely tracks member health behaviors. This analysis compares data from select months of an ongoing monthly cross-sectional survey before and during the pandemic.

METHODS

Responses in April 2019 (pre-pandemic), April 2020 (early pandemic) or April 2021 (later pandemic) were included in the primary analysis (N = 252). Differences in meeting health behavior guidelines were analyzed via logistic regression.

RESULTS

A significant decline was seen for physical activity (19% not meeting guidelines pre-pandemic vs. 41% later pandemic) but not fruit/vegetable, alcohol, or sleep from early to later pandemic. Prevalence of women not meeting tobacco guidelines increased from early (5%) to later pandemic (10%) while prevalence in men decreased (10% vs 4% respectively). The percent of people not thinking about the good things that happen to them fluctuated closely with reports of new COVID-19 cases.

CONCLUSIONS

Findings show the nuance of changing health behaviors throughout the pandemic. Results should be used by health systems to tailor support based on insights from the pandemic experience.

Bed Nucleus of the Stria Terminalis (BNST) neurons containing the serotonin 5HT2c receptor modulate operant alcohol self-administration behavior in mice

The serotonin 5HT2c receptor has been widely implicated in the pathophysiology of alcohol use disorder (AUD), particularly alcohol seeking and the affective consequences of chronic alcohol consumption. However, little is known about the brain sites in which 5HT2c exerts its effects on specific alcohol-related behaviors, especially in females. Here, we investigated the effects of site-specific manipulation of the 5HT2c receptor system in the BNST on operant alcohol self-administration behaviors in adult mice of both sexes, including the acquisition and maintenance of fixed-ratio responding, motivation for alcohol (progressive ratio), and quinine-adulterated responding for alcohol on a fixed-ratio schedule (punished alcohol seeking). Knockdown of 5HT2c in the BNST did not affect the acquisition or maintenance of operant alcohol self-administration, nor did it affect progressive ratio responding for alcohol. This manipulation had only a subtle effect on responding for quinine alcohol selectively in females. On the other hand, chemogenetic inhibition of BNST 5HT2c-containing neurons (BNST5HT2c) increased operant alcohol self-administration behavior in both sexes on day 2, but not day 9, of testing. It also increased operant responding for 1000 μM quinine-adulterated alcohol selectively in males. Importantly, chemogenetic inhibition of BNST5HT2c did not alter operant sucrose responding or motivation for sucrose in either sex. We then performed cell-type specific anterograde tracing, which revealed that BNST5HT2c project to similar regions in males and females, many of which have been previously implicated in AUD. We next used chemogenetics and quantification of the immediate early gene cFos to characterize the functional influence of BNST5HT2c inhibition on vlPAG activity. We show that chemogenetic inhibition of BNST5HT2c reduces vlPAG cFos in both sexes, but that this reduction is more robust in males. Together these findings suggest that BNST5HT2c neurons, and to a small extent the BNST 5HT2c receptor, serve to promote aversive responses to alcohol consumption, potentially through sex-dependent disinhibition of vlPAG neurons.

How did COVID-19 restrictions impact alcohol consumption in Australia? A longitudinal study

INTRODUCTION

The state of Victoria experienced more stringent public health measures than other Australian states during the COVID-19 pandemic. This study investigated how these public health measures impacted: (i) total alcohol consumption; (ii) location-specific consumption; and (iii) consumption among different pre-pandemic drinking groups, in Victoria compared to the rest of Australia during the first year of the pandemic.

METHOD

A longitudinal study with six survey waves was conducted between April and December 2020. A total of 775 adults completed data on alcohol use, including detailed consumption location information. Based on their 2019 consumption, participants were classified into low, moderate or high-risk groups. Data were analysed descriptively.

RESULTS

There was no difference in total alcohol consumption from 2019 levels among Victorians and those from the other Australian states when Victoria was the only state in lockdown. Location-specific consumption was relatively similar for Victoria and the rest of Australia, with an increase in home drinking, and a decrease in consumption in someone else's home, licensed premises and public spaces during lockdown compared with 2019. Participants in the high-risk group reported a reduction of two standard drinks per day in November 2020 compared with 2019. In contrast, consumption remained relatively stable for participants in the low and moderate-risk groups once accounting for regression to the mean.

DISCUSSION AND CONCLUSION

Contrary to expectations, restrictions on licensed premises appeared to impact high-risk drinkers more than low and moderate-risk drinkers. Reducing availability of on-premise alcohol may be an effective way to reduce consumption in heavier drinkers.

Disruption of circadian rhythms promotes alcohol use: a systematic review

This systematic review investigates the bidirectional relationship between alcohol consumption and disrupted circadian rhythms. The goal of this study was to identify (i) the types of circadian rhythm disruptors (i.e. social jet lag, extreme chronotypes, and night shift work) associated with altered alcohol use and (ii) whether sex differences in the consequences of circadian disruption exist. We conducted a search of PubMed, Embase, and PsycINFO exclusively on human research. We identified 177 articles that met the inclusion criteria. Our analyses revealed that social jet lag and the extreme chronotype referred to as eveningness were consistently associated with increased alcohol consumption. Relationships between night shift work and alcohol consumption were variable; half of articles reported no effect of night shift work on alcohol consumption. Both sexes were included as participants in the majority of the chronotype and social jet lag papers, with no sex difference apparent in alcohol consumption. The night shift research, however, contained fewer studies that included both sexes. Not all forms of circadian disruption are associated with comparable patterns of alcohol use. The most at-risk individuals for increased alcohol consumption are those with social jet lag or those of an eveningness chronotype. Direct testing of the associations in this review should be conducted to evaluate the relationships among circadian disruption, alcohol intake, and sex differences to provide insight into temporal risk factors associated with development of alcohol use disorder.

Testing the incremental effectiveness of pay-for-performance to improve implementation of a motivational interviewing brief intervention for substance use disorders in HIV settings: Results of a cluster-randomized type 3 hybrid trial

Background

Substance use disorders (SUDs) have a serious adverse impact on people living with HIV. Previously, using a 39-site dual-randomized type 2 hybrid trial design, findings from the Substance Abuse Treatment to HIV Care Project supported the Implementation and Sustainment Facilitation (ISF) strategy to improve implementation and effectiveness of a motivational interviewing brief intervention (MIBI) for SUD within HIV service settings across the United States (US). Building on this trial, this cluster-randomized type 3 hybrid trial aimed to test the incremental effectiveness of a pay-for-performance (P4P), a form of the "alter incentive/allowance structures" strategy.

Methods

Twenty-six HIV service organizations, their staff participants (N=87), and their client participants (N=341) were cluster-randomized to one of two implementation conditions. The control condition included staff-focused training, feedback, and consultation (TFC) and team-focused implementation and sustainment (ISF). The experimental condition included TFC+ISF as well as P4P (TFC+ISF+P4P). P4P used financial incentives to reward MIBI implementation (US$10 per MIBI delivered) and MIBI implementation at or above a pre-defined level of quality (US$10 per demonstration). In addition to these outcomes, past 4-week changes/reductions in client participant's days of primary substance use and anxiety symptoms were examined.

Results

The addition of P4P had a large and significant effect on the number of MIBIs implemented (d=1.30, p<.05) and reduction in anxiety (d=-1.54), but there was no impact on days of substance use. P4P had large effects on MIBI quality (d=1.24) and MIBI implementation effectiveness (d=1.28), but these were not significant (p<.10).

Conclusions

P4P is a form of the "alter incentive/allowance structures" strategy Its function is to reward the implementation of a clinical innovation. Rewarding implementation is consistent with the theory of implementation effectiveness, which suggests implementation climate (i.e., the extent to which implementation is expected, supported, and rewarded) is a key antecedent of implementation effectiveness (i.e., the consistency and quality of implementation). We found that P4P had a significant, positive impact on MIBI implementation in HIV service settings, but client-level outcomes were mixed. Future research should examine the cost-effectiveness of this strategy, as well as to examine the effectiveness of P4P to improve the implementation of other evidence-based innovations.

Trial registration

ClinicalTrials.gov: NCT04687917. Registered 12/18/2020.

Changes in Alcohol-Specific Mortality During the COVID-19 Pandemic in 14 European Countries

Aim

Exploring trends in 1) alcohol-specific mortality and 2) alcohol sales in European countries in the years before and during the COVID-19 pandemic.

Method

Complete data on alcohol-specific mortality and alcohol sales were obtained for 14 European countries (13 EU countries and UK) for the years 2010 to 2020, with six countries having mortality data available up to 2021. Age-standardised mortality rates were calculated and descriptive statistics used.

Results

When compared to 2019, alcohol-specific mortality rates in 2020 increased by 7.7 % and 8.2 % for women and men, respectively. Increases in alcohol-specific mortality were seen in the majority of countries and continued in 2021. In contrast, alcohol sales declined by an average of 5.0 %.

Conclusion

Despite a drop in alcohol consumption, more people died due to alcohol-specific causes during the COVID-19 pandemic in Europe.

Patterns of anxiety, depression, and substance use risk behaviors among university students in Canada

Objective: To identify subgroups of students with distinct profiles of mental health symptoms (MH) and substance use risk (SU) and the extent to which MH history and socio-demographics predict subgroup membership. Participants: University students (N = 10,935: 63% female). Methods: Repeated cross-sectional survey administered weekly to stratified random samples. Latent class analysis (LCA) was used to identify subgroups and multinomial regression was used to examine associations with variables of interest. Results: LCA identified an optimal 4-latent class solution: High MH-Low SU (47%), Low MH-Low SU (22%), High MH-High SU (19%), and Low MH-High SU (12%). MH history, gender, and ethnicity were associated with membership in the classes with high risk of MH, SU, or both. Conclusion: A substantial proportion of students presented with MH, SU, or both. Gender, ethnicity and MH history is associated with specific patterns of MH and SU, offering potentially useful information to tailor early interventions.

The effect of the COVID-19 pandemic on the treated incidence of psychotic disorders in South London

Evidence on the impact of the COVID-19 pandemic on psychotic disorders is so far scarce. We conducted an incidence study to ascertain rates of first-episode psychosis (FEP) before and during the COVID-19 pandemic in South London. We screened clinical records of individuals living in the London boroughs of Southwark and Lambeth who were referred to the early intervention services before (from 1/3/2019 to 28/2/2020) and during (from 1/3/2020 to 28/2/2021) the COVID-19 pandemic. We used the Office for National Statistics to determine the population at risk. We computed crude and sex-age standardised FEP incidence per 100,000 person-years. We used Poisson regression to calculate the incidence rate ratio (IRR) across the COVID-19 pandemic. A total of 321 incident cases of FEP were identified during the COVID-19 pandemic, accounting for a crude rate of 69.8 (95% CI 62.1-77.4) per 100,000 person-years. The crude rate for the year before was 47.5 (95% CI 41.2-53.8). The incidence variation between the two years accounted for an adjusted IRR of 1.45 (95% CI 1.22-1.72). The pandemic was accompanied by a 45% spike in the rates of first-episode psychosis. This finding should inform public health research and demonstrate the need for adequate resources for secondary care.

Improving population health and well-being in academic institutions and health care systems with the Chief Wellness Officer: A vital yet untapped nursing leadership role

BACKGROUND

There is an epidemic of chronic conditions throughout the world. Although the majority of chronic disease can be prevented, the U.S. invests so little of its healthcare spending in wellness and prevention. Nurses are an ideal profession to lead a needed paradigm shift as chief wellness officers (CWOs).

PURPOSE

The aim of this paper is to describe the role of the CWO in improving population health and well-being in universities and health systems.

METHODS

An example of how the CWO role was implemented at a large public land grant university is provided. The socioecological model and life course perspective was adopted as the framework to guide an ambitious wellness strategic plan using an evidence-based quality improvement strategy.

DISCUSSION

The CWO is a vital leadership role in today's institutions of higher learning and health systems.

CONCLUSION

There is an urgent need for nurses to step up into these impactful CWO positions.

Cognitive decline in older adults in the UK during and after the COVID-19 pandemic: a longitudinal analysis of PROTECT study data

BACKGROUND

Although the long-term health effects of COVID-19 are increasingly recognised, the societal restrictions during the COVID-19 pandemic hold the potential for considerable detriment to cognitive and mental health, particularly because major dementia risk factors-such as those related to exercise and dietary habits-were affected during this period. We used longitudinal data from the PROTECT study to evaluate the effect of the pandemic on cognition in older adults in the UK.

METHODS

For this longitudinal analysis, we used computerised neuropsychology data from individuals aged 50 years and older participating in the PROTECT study in the UK. Data were collected from the same participants before the COVID-19 pandemic (March 1, 2019-Feb 29, 2020) and during its first (March 1, 2020-Feb 28, 2021) and second (March 1, 2021-Feb 28, 2022) years. We compared cognition across the three time periods using a linear mixed-effects model. Subgroup analyses were conducted in people with mild cognitive impairment and in people who reported a history of COVID-19, and an exploratory regression analysis identified factors associated with changes in cognitive trajectory.

FINDINGS

Pre-pandemic data were included for 3142 participants, of whom 1696 (54·0%) were women and 1446 (46·0%) were men, with a mean age of 67·5 years (SD 9·6, range 50-96). Significant worsening of executive function and working memory was observed in the first year of the pandemic across the whole cohort (effect size 0·15 [95% CI 0·12-0·17] for executive function and 0·51 [0·49-0·53] for working memory), in people with mild cognitive impairment (0·13 [0·07-0·20] and 0·40 [0·36-0·47]), and in people with a history of COVID-19 (0·24 [0·16-0·31] and 0·46 [0·39-0·53]). Worsening of working memory was sustained across the whole cohort in the second year of the pandemic (0·47; 0·44-0·49). Regression analysis indicated that cognitive decline was significantly associated with reduced exercise (p=0·0049; executive function) and increased alcohol use (p=0·049; working memory) across the whole cohort, as well as depression (p=0·011; working memory) in those with a history of COVID-19 and loneliness (p=0·0038; working memory) in those with mild cognitive impairment. In the second year of the pandemic, reduced exercise continued to affect executive function across the whole cohort, and associations were sustained between worsening working memory and increased alcohol use (p=0·0040), loneliness (p=0·042), and depression (p=0·014) in those with mild cognitive impairment, and reduced exercise (p=0·0029), loneliness (p=0·031) and depression (p=0·036) in those with a history of COVID-19.

INTERPRETATION

The COVID-19 pandemic resulted in a significant worsening of cognition in older adults, associated with changes in known dementia risk factors. The sustained decline in cognition highlights the need for public health interventions to mitigate the risk of dementia-particularly in people with mild cognitive impairment, in whom conversion to dementia within 5 years is a substantial risk. Long-term intervention for people with a history of COVID-19 should be considered to support cognitive health.

FUNDING

National Institute for Health and Care Research.

Bed Nucleus of the Stria Terminalis (BNST) neurons containing the serotonin 5HT2c receptor modulate operant alcohol self-administration behavior in mice

The serotonin 5HT2c receptor has been widely implicated in the pathophysiology of alcohol use disorder (AUD), particularly alcohol seeking and the affective consequences of chronic alcohol consumption. However, little is known about the brain sites in which 5HT2c exerts its effects on specific alcohol-related behaviors, especially in females. Here, we investigated the effects of site-specific manipulation of the 5HT2c receptor system in the BNST on operant alcohol self-administration behaviors in adult mice of both sexes, including the acquisition and maintenance of fixed-ratio responding, motivation for alcohol (progressive ratio), and quinine-adulterated responding for alcohol on a fixed-ratio schedule (punished alcohol seeking). Knockdown of 5HT2c in the BNST did not affect the acquisition or maintenance of operant alcohol self-administration, nor did it affect progressive ratio responding for alcohol. This manipulation had only a subtle effect on responding for quinine alcohol selectively in females. On the other hand, chemogenetic inhibition of BNST 5HT2c-containing neurons (BNST5HT2c) increased operant alcohol self-administration behavior in both sexes on day 2, but not day 9, of testing. It also increased operant responding for 1000 μM quinine-adulterated alcohol selectively in males. Importantly, chemogenetic inhibition of BNST5HT2c did not alter operant sucrose responding or motivation for sucrose in either sex. We then performed cell-type specific anterograde tracing, which revealed that BNST5HT2c project to similar regions in males and females, many of which have been previously implicated in AUD. We next used chemogenetics and quantification of the immediate early gene cFos to characterize the functional influence of BNST5HT2c inhibition on vlPAG activity. We show that chemogenetic inhibition of BNST5HT2c reduces vlPAG cFos in both sexes, but that this reduction is more robust in males. Together these findings suggest that BNST5HT2c neurons, and to a small extent the BNST 5HT2c receptor, serve to promote aversive responses to alcohol consumption, potentially through sex-dependent disinhibition of vlPAG neurons.

Increased alcohol use during the COVID-19 pandemic among people with HIV from racial/ethnic minority groups in South Florida

People with HIV (PWH) from racial/ethnic minority groups may be particularly vulnerable to the effects of the COVID-19 Pandemic. Exacerbated COVID-19-related stressors may lead to maladaptive coping mechanisms such as increased alcohol use. This study examined socioeconomic and psychosocial predictors of increased alcohol use during the first year of the COVID-19 Pandemic among PWH from racial/ethnic minority groups in South Florida. Data were collected from Ryan White Program clients during October 2020-January 2021 using a cross-sectional phone survey, and were analyzed using logistic regression modeling. Among 139 participants, 20% reported increased alcohol use. Findings showed that being unable to buy needed food (adjusted odds ratio [aOR]: 3.37; 95% confidence interval [CI]: 1.01-11.31) and spending more time caring for children (aOR: 5.22, 95% CI: 1.61-16.88) was associated with increased alcohol use during the Pandemic. Providing support to alleviate food insecurity and manage caregiving burden during public health crises like the COVID-19 Pandemic might help prevent increases in alcohol use among PWH.

Qualitative study of states' capacity to support alcohol prevention policies during the COVID-19 pandemic in the USA

INTRODUCTION

The onset of the COVID-19 pandemic accelerated rates of alcohol purchasing and related harms in the USA. The increases followed governors' emergency orders that increased alcohol availability, including the allowance of alcohol home delivery, alcohol to-go from restaurants and bars, and curbside pickup from retailers.

METHODS

Semi-structured interviews were conducted with 53 participants involved in state-level alcohol prevention policy across 48 states. Interviewees' perspectives on changes to alcohol prevention policies during the COVID-19 pandemic, including capacity to respond to alcohol-focused executive and legislative changes to alcohol availability, were explored. Initial codes were developed collectively and refined through successive readings of transcripts using a phenomenological, action-oriented research approach. Themes were identified semantically after all transcripts were coded and reviewed.

RESULTS

Four themes were developed including: (i) alcohol prevention policies and capacity during COVID-19; (ii) industry-related challenges during COVID-19; (iii) limited pre-COVID-19 alcohol prevention capacity; and (iv) needs to strengthen alcohol prevention capacity.

DISCUSSION AND CONCLUSIONS

The pandemic exacerbated states' capacity limitations for alcohol prevention efforts and created additional impediments to public health messaging about alcohol health risks related to greater alcohol availability. Participants offered a myriad of strategies to improve alcohol prevention and to reduce alcohol-related harms. Recommendations included dedicated federal and state prioritisation, more funding for community organisations, greater coordination, consistent high-quality trainings, stronger surveillance and widespread prevention messaging. States' alcohol prevention efforts require dedicated leadership, additional funding and support to strengthen population-based strategies to reduce sustained alcohol-related harms associated with increases in alcohol availability.

The impact of COVID-19 on alcohol sales and consumption in the United States: A retrospective, observational analysis

Understanding the COVID-19 pandemic's effect on alcohol sales and consumption is critical in mitigating alcohol abuse and morbidity. We sought to determine how the onset of the COVID-19 pandemic and changes in viral incidence affected alcohol sales and consumption in the United States. We conducted a retrospective observational analysis regressing National Institute on Alcohol Abuse and Alcoholism (NIAAA) alcohol sales data and Behavioral Risk Factor Surveillance System (BRFSS) survey data for 14 states for 2017 to 2020 with COVID-19 incidence in 2020 in the United States. The onset of the pandemic was associated with higher monthly alcohol sales per capita of 1.99 standard drinks (95% Confidence Interval: 0.63 to 3.34, p = 0.007). Increases of one COVID-19 case per 100 were associated with lower monthly alcohol sales per capita of 2.98 standard drinks (95% CI: -4.47 to -1.48, p = 0.001) as well as broad decreases in alcohol consumption, notably 0.17 fewer days per month with alcohol use (95% CI: -0.31 to -0.23, p = 0.008) and 0.14 fewer days per month of binge drinking (95% CI: -0.23 to -0.052, p < 0.001). The COVID-19 pandemic is associated with increased monthly average alcohol purchases, but higher viral incidence is linked to lower alcohol purchases and consumption. Continued monitoring is needed to mitigate the effects of higher population alcohol use during the pandemic.

Substance use disorders and COVID-19: reflections on international research and practice changes during the "poly-crisis"

Since March 2020, the COVID-19 pandemic has had a disproportionately high toll on vulnerable populations, coinciding with increased prevalence of alcohol-and drug-related deaths and pre-existing societal issues such as rising income inequality and homelessness. This poly-crisis has posed unique challenges to service delivery for people with substance use disorders, and innovative approaches have emerged. In this Perspectives paper we reflect on the poly-crisis and the changes to research and practice for those experiencing substance use disorders, following work undertaken as part of the InterGLAM project (part of the 2022. Lisbon Addictions conference). The authors, who were part of an InterGLAM working group, identified a range of creative and novel responses by gathering information from conference attendees about COVID-19-related changes to substance use disorder treatment in their countries. In this paper we describe these responses across a range of countries, focusing on changes to telehealth, provision of medications for opioid use disorder and alcohol harm reduction, as well as changes to how research was conducted. Implications include better equity in access to technology and secure data systems; increased prescribed safer supply in countries where this currently does not exist; flexible provision of medication for opioid use disorder; scale up of alcohol harm reduction for people with alcohol use disorders; greater involvement of people with lived/living experience in research; and additional support for research in low- and middle-income countries. The COVID-19 pandemic has changed the addictions field and there are lessons for ongoing and emerging crises.

Food Insecurity and Transmission Risks Among People with HIV Who Use Substances

Food insecurity (FI) impacts people with HIV (PWH) and those who use substances (i.e. drugs and alcohol). We evaluated the longitudinal association between FI and HIV transmission risks (unprotected sexual contacts and shared needles/syringes). Among 351 PWH who use substances in Russia, 51.6% reported FI and 37.0% past month injection drug use. The mean number of unprotected sexual contacts in the past 90 days was 13.4 (SD 30.1); 9.7% reported sharing needles/syringes in the past month. We did not find a significant association between mild/moderate FI (adjusted IRR = 0.87, 95% CI 0.47, 1.61) or severe FI (aIRR = 0.84, 95% CI 0.46, 1.54; global p = 0.85) and unprotected sexual contacts. We observed a significant association between severe FI and sharing needles/syringes in the past month (adjusted OR = 3.27, 95% CI 1.45, 7.39; p = 0.004), but not between mild/moderate FI and sharing needles/syringes in the past month (aOR = 1.40,95% CI 0.58, 3.38; p = 0.45). These findings suggest that severe FI could be a potential target for interventions to lower HIV transmission.