Features of providing addiction medical care during the pandemic COVID-19

Patients with substance use disorders represent a vulnerable population who are at risk of getting coronavirus due to several factors related to their clinical, psychological, and psycho-social characteristics. 
The goal of this study was to examine the features of a medical condition in patients with alcohol use disorder who are admitted to the addiction hospital and to describe the specific issues of the addiction care RF region during a pandemic.
Material and methods. The online survey has been distributed to 55 addiction psychiatrists from the third-level medical organizations of 4th federal districts (including Northwestern, South, Volga, and North Caucasian) from June 09 to June 20, 2020. The survey consists of 17 items (13 questions were focused on the features of progress and clinical signs of alcohol dependence in hospitalized, in-patient individuals during April-May, 2020; 4 questions were focused on the organizational issues of addiction care in the RF regions during the COVID-19 pandemic).
Results. Based on the expert`s assessment, the number of admissions at inpatient and outpatient clinical settings was reduced during the pandemic. In addition, the intensity of alcohol withdrawal among patients who were hospitalized during April-May, 2020 were significantly more severe compared to patients who were hospitalized during February-March, 2020 (Pearson’s chi-squared test). Moreover, alcohol withdrawal was more severe and was associated with alcohol withdrawal delirium (4,7%) or seizures (4,7%) in 9,4% of cases among patients with COVID positive status, which exceeds the data of epidemiological studies. The intensity of alcohol withdrawal delirium among patients with COVID positive status was more severe compared to those who had COVID negative status. During April-June, 2020, the few addiction clinics were temporally closed due to quarantine but a majority of clinics were not (n = 14 (25,5%) vs. n = 41 (74,5%)).
Conclusion. During the COVID-19 pandemic, the state of patients hospitalized for treatment of alcohol dependence may be considered more severe, compared to the period February-April 2020.

1. Sorokin MYu, Kasyanov ED, Rukavishnikov GV, Makarevich OV, Neznanov NG, Lutova NB, Mazo GE. Psychological reactions of the population as a factor of adaptation to the COVID-19 pandemic. Obozrenie psiphiatrii i medicinskoj psiphologii im. V.M.Bekhtereva. 2020; 2:87-94. (In Russ.). doi: 10.31363/2313-7053-2020-2-87-94

2. Sorokin MYu, Kasyanov ED, Rukavishnikov GV, Makarevich OV, Neznanov NG, Semyonova NV, Lutova NB, Mazo GE. Impact of the COVID-19 pandemic on the mental health of healthcare workers in Russia. Medicinskaya Etika. 2020; 2(10):27-35. (In Russ.).

3. Bråthen JS, Ferrara GM, Keindl M, Ben-Menachem E, Tanasescu R, Brodtkorb E, Hillbom M, Leone MA, Ludolph AC. Alcohol withdrawal syndrome: mechanisms, manifestations, and management. Acta Neurol Scand. 2017; 135(1):4-16. https://doi.org/ 10.1111/ane.12671

4. Chodkiewicz, J; Talarowska, M; Miniszewska, J; Nawrocka, N; Bilinski, P. Alcohol Consumption Reported during the COVID-19 Pandemic: The Initial Stage. Int. J. Environ. Res. Public Health. 2020; 17:4677. https://doi.org/10.3390/ijerph17134677

5. Dubey M.J, Ghosh R, Chatterjee S, Biswas P, Chatterjee S, Dubey S. COVID-19 and addiction. Diabetes Metab Syndr. 2020; 14(5):817–823. https://doi.org/10.1016/j.dsx.2020.06.008

6. Ellul MA, Benjamin L, Singh Bh, Lant S, Michael BD, Easton A, Kneen R, Defres S, Sejvar J, Solomon T. Neurological associations of COVID-19. Lancet Neurol. 2020; 19(9):767-783. https://doi.org/10.1016/S1474-4422(20)30221-0

7. Gianni Testino G, Pellicano R. Alcohol consumption in the COVID-19 era. Minerva Gastroenterologica e Dietologica. 2020; 66(2):90-2. https://doi.org/10.23736/S1121-421X.20.02698-7

8. Koopmann A, Georgiadou E, Kiefer F, Hillemacher Th Did the General Population in Germany Drink More Alcohol during the COVID-19 Pandemic Lockdown? Alcohol and Alcoholism. 2020; 55(6):698-699. https://doi.org/10.1093/alcalc/agaa058

9. Lagisetty PA, Maust D, Heisler M, Bohnert A. Physical and mental health comorbidities associated with primary care visits for substance use disorders. J. Addict. Med. 2017; 11(2):161-162. https://doi.org/10.1097/ADM.0000000000000280

10. Neill E, Meyer D, Toh WL, Van Rheenen TE, Phillipou A, Tan EJ Rossell SL. Alcohol use in Australia during the early days of the COVID-19 pandemic: Initial results from the COLLATE project. Psychiatry Clin Neurosci. 2020. https://doi.org/10.1111/pcn.13099. [https://www.pubmed.com]. Pubmed; 2020 [процитировано 20 ноября 2020]. Доступно: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7436134

11. Ornell F, Moura HF, Scherer JN, Pechansky F, Kessler FHP, von Diemen L. Psychiatry Res. The COVID-19 pandemic and its impact on substance use: Implications for prevention and treatment. 2020; 289:113096. https://doi.org/10.1016/j.psychres.2020.113096

12. Pasala S, Barr T, Messaoudi I. Impact of Alcohol Abuse on the Adaptive Immune System. Alcohol Res. 2015; 37(2):185-97. https://doi.org/10.1111/j.1530-0277.2011.01624.x

13. Peacock A, Leung J, Larney S, Colledge S, Hickman M, Rehm J, Giovino GA,Wes Hall RtW, Griffiths P, Ali R, Gowing L, Marsden J, Ferrari AJ, Grebely J, Farrell M, Degenhardt L. Global statistics on alcohol, tobacco and illicit drug use: 2017 status report. Addiction. 2018; 113(10):1905-1926. https://doi.org/10.1111/add.14234

14. Rogers JP, Chesney E, Oliver D, Pollak ThA, McGuire Ph, Fusar-Poli P, Zandi MS, Lewis G, David AS. Psychiatric and neuropsychiatric presentations associated with severe coronavirus infections: a systematic review and meta-analysis with comparison to the COVID-19 pandemic. Lancet Psychiatry. 2020; 7(7):611-627. https://doi.org/10.1016/S2215-0366(20)30203-0

15. Serafini K, Toohey MJ, Kiluk BD, Carroll KM Anger and its association with substance use treatment outcomes in a sample of adolescents. J. Child Adolesc. Subst. Abuse. 2016; 25(5):391–398. https://doi.org/10.1080/1067828X.2015.1049394

16. Simou E, Britton J, Leonardi-Bee J. Alcohol and the risk of pneumonia: a systematic review and meta-analysis. BMJ Open 2018; 8:e022344. https://doi.org/10.1136/bmjopen-2018-022344

17. Sinha R, Fox HC, Hong KA, Bergquist K, Bhagwagar Z, Siedlarz KM Enhanced negative emotion and alcohol craving, and altered physiological responses following stress and cue exposure in alcohol dependent individuals. Neuropsychopharmacology. 2009; 34(5):1198–1208. https://doi.org/10.1038/npp.2008.78

18. Stratton SJ. COVID-19: not a simple public health emergency. Prehospital Disaster Med. 2020;35(2):119. doi:10.1017/S1049023X2000031X

19. Volkow ND. Collision of the COVID-19 and Addiction Epidemics. Ann Intern Med. 2020: 2020; 173(1):61-62. https://doi.org/10.7326/M20-1212