Is substance use changing because of the COVID-19 pandemic? Conceptual and methodological considerations to delineating the impact of the COVID-19 pandemic on substance use and disorder

Opioid-related ambulance attendances during the first 2 years of the COVID-19 pandemic in Victoria, Australia

BACKGROUND AND AIMS

Public health measures introduced to contain the spread of the SARS-CoV-2 virus likely affected opioid supply and demand, as well as the patterns and contexts of opioid use. We measured opioid-related harms during the first 2 years of COVID-19 restrictions in Victoria, Australia.

DESIGN

We adopted an interrupted time series analysis design using interventional autoregressive integrated moving average (ARIMA) models. Opioid-related ambulance attendance data between January 2015 and March 2022 were extracted from the National Ambulance Surveillance System.

SETTING

Victoria, Australia.

PARTICIPANTS

Patients (≥15 years) attended to by an ambulance for opioid-related harms.

MEASUREMENTS

Monthly opioid-related ambulance attendances for three drug types: heroin, prescription opioids and opioid agonist therapy (OAT) medications.

FINDINGS

The monthly rate of heroin-related attendances fell by 26% immediately after the introduction of COVID-19 restrictions. A reduced rate of heroin-related attendances was observed during COVID-19 restrictions, resulting in 2578 averted heroin-related attendances. There was no change in the rate of attendances for extra-medical OAT medications or prescription opioids.

CONCLUSIONS

Strict COVID-19 restrictions in Victoria, Australia appear to have resulted in a substantial reduction in heroin-related ambulance attendances, perhaps because of border closures and restrictions on movement affecting supply, changing patterns of drug consumption, and efforts to improve access to OAT. Despite policy changes allowing longer OAT prescriptions and an increased number of unsupervised doses, we found no evidence of increased harms related to the extra-medical use of these medications.

General hospital admissions in young and middle-aged people who use psychoactive substances: Impact of Covid-19 lockdowns

BACKGROUNDS

The Covid-19 pandemic offered a unique opportunity to investigate trends in hospitalizations related to psychoactive substance intoxication, since the usual health burden of social use at parties and gatherings was likely to be decreased during lockdowns and curfew periods. Since young adults are the main users of psychoactive substances for experimental and recreational purposes, this study identified and compared hospitalization trends in young adults and adults over 30 years old.

METHODS

This national cohort study was conducted using the French hospital discharge database. An interrupted time-series analysis for the period between 2014 and 2020 was performed in two groups: young (age 18-29) and other adults (30+) to ascertain the trends in the monthly incidence of hospitalization related to psychoactive substance intoxication (opiates, cocaine, benzodiazepines, psychostimulants, alcohol and cannabis). Hospitalization characteristics during the first and second lockdown and the period between them were compared to the reference period (from 01/01/2014 to 29/02/2020).

RESULTS

Among 1,358,007 stays associated with psychoactive substance intoxication, 215,430 concerned young adults. Compared with adults 30+, hospitalization trends in young adults showed a greater decrease in the number of stays during lockdown, with a maximum decrease of -39% during the first lockdown (1,566 vs. 2,576; CI95%: 2,285-2,868) versus -20% (10,212 vs. 12,894; CI95%: 12,001-13,787) in the second lockdown. Presentations for alcohol intoxication decreased throughout the pandemic, particularly during the second lockdown, while admissions for benzodiazepine intoxication increased during both lockdowns. Admissions for cannabis intoxication increased throughout the entire period.

CONCLUSIONS

Lockdowns were associated with fewer hospitalizations related to psychoactive substance intoxication in both age groups, especially among young adults, which might reflect a decrease in social use. Recreational use might therefore be an important target for prevention and risk minimization.

Increased coping motives during the COVID-19 pandemic widen cannabis disparities between sexual minoritized and nonminoritized young adults: A bimonthly assessment of data preceding and spanning the pandemic

OBJECTIVE

Since the start of the coronavirus pandemic, some U.S. adults have increased alcohol and cannabis use frequency to cope with distress. Among sexual minoritized young adults (SM YAs), coping-related use may be greater due to disproportionate negative social and financial consequences of the pandemic. Nonetheless, it remains unclear whether pandemic substance use has increased among SM YAs compared to non-SM YAs relative to prepandemic levels and whether heightened coping motives mediate these potential differences.

METHOD

A total of 563 YAs (18-24 years at baseline; 31.0% SM) provided survey data collected across 12 bimonthly assessments. Six assessments were measured in 2015 or 2016 and six across the coronavirus pandemic (2020-2021). Controlling for prepandemic assessments matched by calendar month, latent structural equation models examined group differences in alcohol and cannabis frequency and consequences across the COVID-19 period and tested coping motives as mediators of these differences.

RESULTS

Substance use and consequences were similar during the pandemic relative to prepandemic levels across groups. Nonetheless, compared to non-SM individuals, SM participants reported greater cannabis frequency, consequences, and cannabis coping motives during the pandemic independent of prepandemic levels. Cannabis use and consequences were each explained largely by coping motives during the pandemic among SM compared to non-SM YAs. These patterns were not found for alcohol outcomes.

CONCLUSIONS

The COVID-19 pandemic has widened cannabis disparities between SM and non-SM YAs, due in part to pandemic-related increases in coping motives. Responsive public policy is needed that may prevent and remit SM cannabis disparities during societal crises. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Trends in Young Adult Alcohol and Cannabis Use Through the First 1.5 Years of the COVID-19 Pandemic From a Community Cohort Sample

OBJECTIVE

There has been concern regarding increased substance use during the COVID-19 pandemic, particularly among young adults, but much of this concern stemmed from cross-sectional or short-term data collected early in the pandemic. This study followed a young adult community cohort throughout the first 1.5 years of the pandemic to examine longer-term trends/trajectories in alcohol and cannabis use behaviors.

METHOD

Beginning before the COVID-19 pandemic (January 2020), 656 young adults completed up to eight surveys on substance use and other behaviors, which extended through August 2021. Multilevel spline growth models estimated changes in alcohol/cannabis use in three segments: (a) from pre-pandemic to April 2020, (b) from April 2020 to September/October 2020, and (c) from September/October 2020 to July/August 2021. Abstainers were removed from the analyses, yielding subsamples for alcohol models (n = 545; M age = 25.6 years; 59.8% female) and cannabis models (n = 303; M age = 25.6; 61.4% female).

RESULTS

Drinking frequency initially increased (3% per month), decreased in the second segment (4% per month), and plateaued in the final segment. Drinking quantity significantly decreased in all three segments: 4% per month in segment one, 3% per month in segment two, and 1% per month in the final segment. Cannabis frequency and quantity showed no significant changes across the first two segments, then significantly decreased in the final segment (3% and 6% per month, respectively). The significant changes for cannabis frequency/quantity were moderated by age, such that older participants had steeper decreases in the final segment.

CONCLUSIONS

Findings highlight that young adult alcohol and cannabis use generally declined across the first 1.5 years of the COVID-19 pandemic, contrary to widespread concerns.

Long-term consequences of benzodiazepine-induced neurological dysfunction: A survey

BACKGROUND

Acute benzodiazepine withdrawal has been described, but literature regarding the benzodiazepine-induced neurological injury that may result in enduring symptoms and life consequences is scant.

OBJECTIVE

We conducted an internet survey of current and former benzodiazepine users and asked about their symptoms and adverse life events attributed to benzodiazepine use.

METHODS

This is a secondary analysis of the largest survey ever conducted with 1,207 benzodiazepine users from benzodiazepine support groups and health/wellness sites who completed the survey. Respondents included those still taking benzodiazepines (n = 136), tapering (n = 294), or fully discontinued (n = 763).

RESULTS

The survey asked about 23 specific symptoms and more than half of the respondents who experienced low energy, distractedness, memory loss, nervousness, anxiety, and other symptoms stated that these symptoms lasted a year or longer. These symptoms were often reported as de novo and distinct from the symptoms for which the benzodiazepines were originally prescribed. A subset of respondents stated that symptoms persisted even after benzodiazepines had been discontinued for a year or more. Adverse life consequences were reported by many respondents as well.

LIMITATIONS

This was a self-selected internet survey with no control group. No independent psychiatric diagnoses could be made in participants.

CONCLUSIONS

Many prolonged symptoms subsequent to benzodiazepine use and discontinuation (benzodiazepine-induced neurological dysfunction) have been shown in a large survey of benzodiazepine users. Benzodiazepine-induced neurological dysfunction (BIND) has been proposed as a term to describe symptoms and associated adverse life consequences that may emerge during benzodiazepine use, tapering, and continue after benzodiazepine discontinuation. Not all people who take benzodiazepines will develop BIND and risk factors for BIND remain to be elucidated. Further pathogenic and clinical study of BIND is needed.

Norwegian adolescents' use of energy drinks and painkillers and misuse of prescription drugs prior to and during the initial COVID-19 pandemic year: Evidence from the MyLife study

AIMS

This study aimed to examine and compare the use of energy drinks, over-the-counter (OTC) painkillers and misuse of prescription drugs in two cohorts of Norwegian adolescents entering high school (i.e. grade 11) immediately prior to and during the initial year of the COVID-19 pandemic.

METHODS

Accelerated longitudinal design and multi-cohort sampling enabled identification of the two socio-demographically comparable cohorts of grade 11 students: (a) COVID-19 cohort assessed in the autumn of 2020 (n=915) and (b) pre-COVID-19 cohort assessed in the autumn of 2018/19 (n=1621). Unadjusted and adjusted logistic and Poisson models were used to estimate the proportion of (mis)users and use frequencies among (mis)users in two cohorts.

RESULTS

Energy drinks use was both more common in the COVID-19 cohort (60.8% vs. 52.5%; adjusted odds ratio=1.40, 95% confidence interval (CI) 1.18-1.66, p<0.001) and more frequent among users from this cohort than among their pre-COVID-19 counterparts (9.58 vs. 7.79 days past month, adjusted incidence risk ratio (aIRR)=1.23, 95% CI 1.14-1.32, p<0.001). No cohort differences were observed in OTC painkillers use. Prescription drugs misuse was equally common in the two cohorts but was more frequent among misusers from the COVID-19 cohort than among their pre-COVID-19 counterparts (18.94 vs. 12.45 times past year, aIRR=1.52, 95% CI 1.10-2.10, p<0.001).

CONCLUSIONS

Norwegian adolescents from the COVID-19 cohort were more likely to use energy drinks and, once engaged in these behaviours, to use energy drinks and misuse prescription drugs more frequently than their pre-COVID-19 counterparts.

Person-centered patterns of substance use during the COVID-19 pandemic and their associations with COVID-related impacts on health and personal finances in young Black and White women

BACKGROUND

Population-level statistics on pandemic-related change in substance use can obscure patterns of use (e.g., polysubstance use) within individuals. This longitudinal study used a person-centered approach to identify subgroups with respect to patterns of substance use prior to and during the COVID-19 pandemic, and to examine profile correlates (e.g., socio-demographic characteristics), which can inform tailored intervention.

METHODS

The two youngest age cohorts of the Pittsburgh Girls Study (n = 938; 59.1 % Black, 40.9 % White; mean age= 26.2 (SD= 0.8)), a longitudinal community sample, provided data on past year frequency of cigarette/e-cigarette use, binge drinking (>4 drinks per occasion), and cannabis use prior to and during the pandemic, and perceived change in use. Latent profile analysis identified subgroups. Profile correlates were examined (e.g., sociodemographics, COVID-19 infection status and reported exposure, COVID-19 impacts on psychological health and finances).

RESULTS

Seven profiles were identified: "Low use", "Occasional binge drinking", "Cannabis use", "Cigarette/e-cigarette & binge drinking", "Occasional binge drinking & cannabis", "Binge drinking & cannabis", and "Polysubstance use". Black women were overrepresented in "Low use", which was associated with fewer pandemic effects on health. Profiles associated with more frequent binge drinking were more likely to report COVID-19 infection, whereas "Cannabis use" had lower reported infection prevalence. "Polysubstance use" had more COVID-related depression and income loss, on average, than "Low use".

CONCLUSIONS

Distinct subgroups representing single substance use, co-use, and polysubstance use prior to and during the pandemic were identified. The profiles show differential response to COVID-19 impacts, ranging from relative hardiness to specific needs to guide personalized treatment.

Post-Traumatic Stress Disorder and Alcohol Use Disorder During the COVID-19 Outbreak: Do Dissociation and Emotional Metacognitive Beliefs Mediate the Role of Emotion Dysregulation?

OBJECTIVE

Despite the well-documented relationship between emotion dysregulation and both post-traumatic stress disorder (PTSD) and alcohol use disorder symptoms, no studies investigated this issue in the context of the outbreak. Moreover, additional research investigating the role of mediators intervening in these pathways is required. Dissociation and emotional beliefs are two factors that may explain such relationships. However, a poor number of studies empirically tested their role.

METHODS

A cross-sectional study on a sample of 719 community participants (32.5% males; Mage=34.36, standard deviation=14.38 years) was conducted. Participants fulfilled a battery of self-report questionnaires measuring levels of PTSD outbreak-related symptoms, alcohol use disorder, emotion dysregulation, emotional beliefs, and dissociation.

RESULTS

Partial r-Pearson correlations showed that PTSD symptoms' level was positively and significantly related to all variables investigated in the study whereas alcohol use disorder level was positively and significantly associated with emotion dysregulation and only some dimension of emotional beliefs and dissociation. Results drawn from a structural equation model highlight the mediating role of both emotional belief and dissociation in the relationship linking emotion dysregulation and alcohol use disorder whereas only dissociation, but not emotional beliefs, mediated the link between emotion dysregulation and PTSD symptoms.

CONCLUSION

Most of the hypotheses have been supported stressing the relevance of both dissociation and emotional beliefs in PTSD and alcohol use disorder symptoms. These two variables appear important framework from which deepen the impact of emotion dysregulation in psychopathology.

Characteristics and reasons for use associated with solitary alcohol and marijuana use among U.S. 12th Grade Students, 2015-2021

BACKGROUND

Little is known regarding what sociodemographic characteristics and reasons for use are associated with adolescent solitary alcohol and marijuana use.

METHODS

Data from 7845 12th grade students participating in the nationally-representative Monitoring the Future study from 2015 to 2021 were used to examine cross-sectional associations between sociodemographics, heavy drinking/marijuana use, reasons for use, and past 12-month solitary alcohol or marijuana use among past 12-month users. Historical trends and possible differences related to the COVID-19 pandemic also were examined.

RESULTS

Solitary use prevalence increased from 2015 to 2021 with no evidence of significant COVID-19 deviations. In 2021, solitary alcohol use was reported by 32.1% (SE 3.01) and solitary marijuana use by 55.8% (4.72) of those reporting past 12-month use. Common and substance-specific sociodemographic risk factors were observed. Binge drinking was associated with solitary alcohol use; frequent marijuana use was associated with solitary marijuana use. Reasons for use related to coping with negative affect were associated with solitary use. Compulsive use reasons were more strongly associated with solitary alcohol than marijuana use. Drinking to have a good time with friends was negatively associated with solitary alcohol use but this association was not seen for solitary marijuana use.

CONCLUSIONS

The percentage of adolescents who use alcohol or marijuana when they were alone has increased among those who report using each substance. Associations between solitary use and (a) higher levels of consumption and (b) coping with negative affect highlight the importance of solitary use as a risk indicator.

Longitudinal assessment of drinking changes during the pandemic: The 2021 COVID-19 follow-up study to the 2019 to 2020 National Alcohol Survey

Background

Surveys of changes in drinking during the COVID‐19 pandemic have primarily relied on retrospective self‐report. Further, most such surveys have not included detailed measures of alcohol use patterns, such as beverage‐specific consumption, nor measures of alcohol use disorder (AUD) symptoms that would allow a comprehensive understanding of changes in alcohol use.

Methods

Data from 1819 completed interviews from the N14C follow‐up survey to the 2019 to 2020 National Alcohol Survey (N14) were conducted between January 30 and March 28, 2021. Questions on alcohol use from the Graduated Frequency series, beverage‐specific quantity and frequency, and DSM‐5 AUD items were asked in both surveys and used to estimate changes from pre‐pandemic drinking to drinking during the pandemic. Analyses focus on changes in these measures over time and comparisons between key subgroups defined by gender, race/ethnicity, and age.

Results

Key findings include particularly large increases in drinking and AUD for African Americans and women, reduced drinking and heavy drinking prevalence among men and White respondents, and a concentration of increased drinking and AUD among respondents aged 35 to 49. Increases in alcohol use were found to be driven particularly by increases in drinking frequency and the consumption of spirits.

Conclusions

Results confirm prior findings of overall increases and subgroup‐specific changes, and importantly, provide detailed information on the patterns of change across major socio‐demographic subgroups. Substantial increases in the prevalence of DSM‐5 moderate to severe AUDs are a novel finding that is of particular concern.

Alcohol use and the COVID-19 pandemic: Historical trends in drinking, contexts, and reasons for use among U.S. adults

Objective

The current study used U.S. national data to examine drinking trends prior to and during the COVID-19 pandemic in 2020, focusing on changes in U.S. young- and middle-adult alcohol prevalence, frequency, and drinking contexts and reasons, and whether they differed by age and college status.

Methods

Data from 2015 to 2020 from 16,987 young adults (ages 19–30) and 23,584 middle adults (ages 35–55) in the national Monitoring the Future study were used to model historical trends and potential 2020 shifts (data collection April 1 to November 30, 2020) in prevalence (30-day, daily, binge drinking) and frequency (30-day, binge drinking). For young adults, data on drinking contexts and negative affect reasons for drinking were examined. Moderation by age and college status was also tested.

Results

2020 was associated with (1) downward deviation in 30-day (young and middle adults) and binge drinking (young adults) prevalence; (2) upward deviation in daily drinking prevalence (middle adults); (3) among drinkers, upward deviation in frequency of 30-day (young and middle adults) and binge drinking (young adults); and (4) changes in drinking contexts and reasons among drinkers. Among college students, in particular, 2020 was associated with a downward deviation from expected historical trends in drinking prevalence. Upward deviations in daily prevalence and both binge and 30-day drinking frequency were stronger at ages 25–30 (vs. 19–24) and 35–45 (vs. 50–55).

Conclusions

Among U.S. young and middle adults, deviations from expected historical trends in population alcohol use that occurred during the pandemic included decreases in alcohol use prevalence, increases in alcohol use frequency, and increases in the use of alcohol to relax/relieve tension and because of boredom. These shifts were likely due, in part, to drinking while alone and at home—which increased during the pandemic.

Employment, Economic, and Sociodemographic Factors Associated with Changes in Smoking and Drinking Behaviors during the COVID-19 Pandemic in South Korea

The societal disruptions resulting from the coronavirus disease 2019 (COVID-19) pandemic may have caused changes in smoking and alcohol consumption. Using data from the Koreans’ Happiness Survey, a nationally representative survey in South Korea, we (1) described population-level smoking and drinking behaviors; (2) assessed changes in smoking and drinking behaviors during the COVID-19 pandemic; and (3) identified employment, economic, and sociodemographic factors associated with these changes using multinomial logistic regression. The overall amount of smoking and drinking decreased during the pandemic, but the changes were heterogeneous across subgroups. Male gender, receipt of the basic living allowance, self-employment, unemployment, and chronic disease status were associated with increased smoking, while higher household income, temporary worker status, living with someone (versus alone), and having fewer offline friends were associated with decreased smoking. Male gender, self-employment, living alone, having more offline friends, and chronic disease status were associated with increased drinking, while younger age, male gender, low and high household income (i.e., a U-shaped relationship), long-term rent with a deposit, temporary worker status, and chronic disease status were associated with decreased drinking. Our findings provide evidence on changes in smoking and drinking during the COVID-19 pandemic in South Korea and differential changes across subgroups.

Self-reported changes in alcohol and tobacco use during COVID-19: findings from the eastern part of WHO European Region

Background

The COVID-19 pandemic might impact substance use behaviours around the globe. In this study, we investigate changes in alcohol and tobacco use in the second half of 2020 in countries of the eastern part of the WHO European Region.

Methods

Self-reported changes in alcohol and tobacco use among 11 295 adults from 18 countries in the eastern part of the WHO European Region were collected between August 2020 and January 2021. The non-probabilistic sample was weighted for age, gender and education. For each country, proportions of respondents reporting a decrease, no change or increase in substance use over the past 3 months were examined, and multinomial regression models were used to test associations with age, gender and past-year alcohol use.

Results

In most countries, about half of the respondents indicating past-year alcohol or tobacco use reported no change in their substance use. Of those alcohol users who reported changes in their alcohol use, a larger proportion reported a decrease than an increase in most countries. The opposite was true for tobacco use. Women, young adults and past-year harmful alcohol users were identified as being more likely to change their substance use behaviour.

Conclusion

We found diverging overall trends for alcohol and tobacco use in the second half of 2020. The patterns of change vary according to age, gender and past-year substance use. Individuals at risk to increase their substance use during the COVID-19 pandemic require most policy considerations.

Changes in alcohol use during COVID-19 and associations with contextual and individual difference variables: A systematic review and meta-analysis

OBJECTIVE

The present study meta-analyzed studies examining changes in alcohol consumption during the coronavirus disease (COVID-19) pandemic and systematically reviewed contextual and individual difference factors related to these changes.

METHOD

Following the preferred reporting items for systematic reviews and meta-analysis (PRISMA) protocol, studies were gathered via PsycINFO, PubMed/MEDLINE, and preprint databases (published April 29, 2021) that examined individual-level changes in consumption during the initial COVID-19 mitigation measures (before October 2020). Next, sample proportion increases and decreases in consumption, in addition to mean change in consumption variables from pre- to during-COVID, were meta-analyzed, and contextual and individual difference variables related to consumption changes during the pandemic were summarized.

RESULTS

One hundred and twenty-eight studies provided data from 58 countries (M n = 3,876; Mdn n = 1,092; aggregate sample n = 492,235). The average mean change in alcohol consumption was nonsignificant (Cohen's d = -0.01, p = .68); however, meta-analysis revealed that 23% of participants reported increases in consumption and 23% reported decreases. These changes were moderated by per capita gross domestic product and country. Narrative synthesis revealed multiple predictors of increased drinking, including contextual changes (e.g., children at home, income loss, working remotely), individual difference variables (being female, a young-to-middle aged adult, or Black), and mental health/alcohol-related risk factors (e.g., depression).

CONCLUSIONS

The identified factors associated with increased alcohol consumption should be considered in planning behavioral health services during future crisis events that abruptly alter everyday environments in ways that increase stress and decrease access to naturally occurring rewards. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Is talk cheap? Correspondence between self-attributions about changes in drinking and longitudinal changes in drinking during the coronavirus disease 2019 pandemic

Background

There are concerns that the coronavirus disease 2019 (COVID‐19) pandemic may increase drinking, but most accounts to date are cross‐sectional studies of self‐attributions about alcohol‐related impacts and the accuracy of those perceptions has not been investigated. The current study examined the correspondence between self‐attributions of pandemic‐related changes in drinking and longitudinally‐measured changes in drinking and alcohol‐related consequences in a sample of emerging adults.

Methods

In an existing ongoing longitudinal study on alcohol misuse (≥1 heavy episodic drinking day/month) in emerging adults, 473 individuals (M_age = 23.8; 41.7% male) received a supplemental assessment from June 17th to July 1st, 2020, during public health restrictions in Ontario, Canada. These intrapandemic data were matched to the most recent assessment prior to the pandemic (~8 months earlier). Self‐attributions about changes in drinking were assessed globally (i.e., increases/decreases/no change) and with higher resolution questions clarifying the magnitude of changes.

Results

Global self‐attributions about changes in drinking substantively paralleled longitudinal changes in weekly drinking days (DD). In the longitudinal data, individuals’ who self‐reported increases in drinking exhibited significant increases; individuals’ who self‐reported decreases exhibited significant decreases; and individuals who self‐reported no change exhibited nonsignificant changes. Higher resolution items likewise revealed longitudinal patterns of weekly drinking that were substantively consistent with self‐attributions. Heavy DD and alcohol‐related consequences exhibited similar patterns, but only individuals who self‐reported large increases in drinking exhibited increases on these outcomes. Individuals who reported large increases in drinking also exhibited significant increases in depression and posttraumatic stress disorder symptoms.

Conclusions

Self‐attributions about drinking closely corresponded to longitudinal changes in drinking, supporting the validity of self‐attributions in population‐level surveys, particularly in young adults. Notably, a subgroup was identified that exhibited pronounced increases for all alcohol‐related outcomes and concurrent increases in internalizing psychopathology.

The impact of COVID-19 on gambling and gambling disorder: emerging data

PURPOSE OF REVIEW

The lockdown response to the COVID-19 pandemic has significantly impacted commercial gambling in many jurisdictions around the world. The goal of this review is to systematically identify and describe the survey data and findings to date examining the effect on individual gambling and gambling disorder.

RECENT FINDINGS

Of the 17 publications meeting inclusion criteria, the majority reported cross-sectional assessments (n = 11, 65%) and remainder were longitudinal in that they had earlier gambling data for participants (n = 6, 35%). Not surprisingly given the closure of land-based gambling, an overall reduction in gambling frequency and expenditure was reported in all studies. The estimate of the proportion of participants in both the general population and the population that gambles who increased overall gambling or online gambling was variable. The most consistent correlates of increased gambling during the lockdown were increased problem gambling severity, younger age groups, and being male.

SUMMARY

These results suggest that the impacts of the COVID-19 pandemic on gambling and problematic gambling are diverse - possibly causing a reduction in current or future problems in some, but also promoting increased problematic gambling in others. The longer-term implications of both the reduction in overall gambling, and the increase in some vulnerable groups are unclear, and requires assessment in subsequent follow-up studies. However, in the short term, individuals with existing gambling problems should be recognized as a vulnerable group.