key: cord-1010523-449spio4
authors: Balhara, Yatan Pal Singh; Singh, Swarndeep; Narang, Parul
title: The effect of lockdown following COVID‐19 pandemic on alcohol use and help seeking behaviour: Observations and insights from a sample of alcohol use disorder patients under treatment from a tertiary care centre
date: 2020-05-28
journal: Psychiatry Clin Neurosci
DOI: 10.1111/pcn.13075
sha: 409aa2e9b051804a7f350643380dffe2092994b5
doc_id: 1010523
cord_uid: 449spio4

nan

India was under nationwide lockdown since 25 th March. The lockdown included prohibition on sale of alcohol, restrictions on movement and limited availability of public transportation.

The countrywide lockdown posed unique challenges to the persons with alcohol use disorderboth active alcohol users and those seeking treatment to quit.

We contacted the patients with alcohol use disorder enrolled under an ongoing project assessing the impact of disulfiram among patients with alcohol use disorder. The research project was approved by Institutional Ethics Committee and it conformed to the provisions of the Declaration of Helsinki. The patients gave informed consent and their anonymity was preserved. Telephonic reminder calls were made to the participants to ensure therapeutic adherence and get updated information on alcohol use.

We were able to connect with 73 (76.7%) of the patients. All were male. The mean duration of alcohol use disorder was 8.66 (SD 6.20) years.

Alcohol and tobacco products were not included in the list of essential commodities during the lockdown. This meant non-availability of these substances through authorized vendors.

However, twenty percent (16) reported that they tried to procure alcohol during lockdown. Ten of them (62.5%, n= 16) were able to procure the same at least once (table 1). Most of them did so through clandestine sources and at higher prices. Additionally, alcohol procured by about one-fifth of these patients was sold in an unsealed bottle. This raised the concern on the safety of these alcoholic beverages and the possibility of exposing them to the additional health risk from consumption of adulterated or surrogate alcohol (e.g. poisonous fungus, methanol toxicity). 2, 3 Five patients (6.6%) reported experiencing alcohol withdrawal since the beginning of lockdown. One of the subjects reported experiencing withdrawal seizures. Only one patient (20%, n=5) could procure medicines to manage the withdrawals. However, most of the subjects could not access any medical help to manage their withdrawals. It is likely that the proportion of alcohol users across the country who would have experienced withdrawals was much higher than what we observed in the current study. This is so because subjects in the present study have been offered treatment for alcohol use disorder in the past and it is likely that a significant This article is protected by copyright. All rights reserved.

proportion of them was no longer using alcohol, at least on a regular basis. While the withdrawal symptoms among those physically dependent on alcohol are self-limiting, these are distressing and even lethal, if left untreated. The added mental stress due to uncertainty about the future due to COVID-19, hardships faced due to lockdown and economic and employment concerns would have made it even more challenging to bear the withdrawals. The bidirectional relationship between co-existing psychological distress and increased alcohol withdrawal symptom severity has been well established in the published literature. 4, 5 Of the 15 patients (19.7%) who tried to procure disulfiram, only 9 (60%) were able to do so. (table 1) . A reduced help-seeking behavior out of safety concerns has been reported during previous pandemics as well 7 . While it is likely that the complete lockdown shall be lifted in the coming weeks, the restrictions on movement are likely to continue further. Hence it is important to ensure the availability of public transportation as well as support from the law enforcement agencies to facilitate the movement of these patients to the treatment centers. Moreover, the treatment-seeking shall remain low despite the lifting of restrictions unless the safety concerns of this population group are addressed adequately.

In binary logistic regression model, days since last use of alcohol [OR .90 (.84-.97), p= 0.007] was the only variable independently associated (inverse association) with attempt to seek alcohol during the lockdown period.

There is a need to address barriers to help-seeking going ahead as we continue to deal with COVID-19 in the coming months. A contingency plan should be put in place to ensure continuity of care for persons with alcohol use disorder in such extraordinary situations. 

The Lockdown Shows India's Ill-Preparedness to Deal With Rampant Alcoholism

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India's problem with toxic alcohol | The BMJ

Depressive mood and craving during alcohol withdrawal: association and interaction

Psychopathology of alcoholics during withdrawal and early abstinence. -PubMed -NCBI

This article is protected by copyright. All rights reserved

A curious case of the World Health Organization's (WHO) approach on alcohol use disorders--inferences from the WHO list of essential drugs

Tracking health seeking behavior during an Ebola outbreak via mobile phones and SMS. npj Digital Medicine