COVID-19 means long stretch of stormy weather for people with alcohol and substance use disorders

The ongoing COVID-19 pandemic has created an environment that is particularly problematic for individuals with alcohol and substance use disorders (ASUD), according to physician scientists at the National Institutes of Health.  In a commentary now online in the American Journal of Psychiatry, the researchers liken the global coronavirus emergency to a “perfect storm,” with dire consequences for ASUD prevention and treatment that may endure after the pandemic.

“ASUD patients face unique vulnerability factors during this dramatic global health crisis,” says George Koob, Ph.D., Director of the National Institute on Alcohol Abuse and Alcoholism.

In the new commentary, senior author Lorenzo Leggio, M.D., Ph.D., physician and Senior Investigator at the National Institute on Alcohol Abuse and Alcoholism, and the National Institute on Drug Abuse, and his NIH co-authors – Drs. Primavera Spagnolo and Chiara Montemitro – describe these vulnerabilities.

For example, they note that both alcohol and other substance misuse impair immune system function and increase the risk of respiratory infections and their complications.  People with ASUD also have high rates of cardiovascular and pulmonary comorbidities, which may increase their risk for infection-related consequences.  The authors add that reports of cerebral effects of COVID-19 suggest the potential for adverse interactions with ASUD-related brain effects.

The COVID-19 pandemic has increased stress for people worldwide, with millions experiencing prolonged periods of fear, anxiety and social isolation — conditions that are known to increase craving, consumption, and risk of relapse in individuals with ASUD.

COVID-19 further complicates the numerous challenges related to the availability and access to treatments for individuals with ASUD. The authors note that evidence-based treatments are often not provided to individuals with ASUD primarily due to the stigmatization of alcohol and drug misuse, limited medical education and training on addiction provided during medical schools and clinical trainings, and other factors.  They suggest that “individuals suffering from ASUD may be even more marginalized in a phase where the urgency of addressing a serious and deadly pandemic may take priority over managing this chronic health condition.”

While the present circumstances call for the use of online mutual support programs, telemedicine, and other internet technologies to help individuals with ASUD, Dr. Leggio and his colleagues note that many people with ASUD lack access to internet technology.

“These are certainly difficult times, but we can also learn from these challenges,” says Dr. Leggio.  “For example, there has been an increase in telemedicine-delivered behavioral therapies and telemedicine-based prescription of approved medications for individuals with ASUD. We hope that this experience will lead to long-term improvements in addiction medicine beyond the pandemic.”


New Challenges in Addiction Medicine: COVID-19 Infection in Patients with Alcohol and Substance Use Disorders – The Perfect Storm.

Spagnolo PA, Montemitro C, Leggio L.

American Journal of Psychiatry. Published online, 2020 July 14.

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