Alcohol use disorder as a potential risk factor for COVID-19 severity: A narrative review

Alcohol Consumption Modulates the Development of Chronic Pain in COVID-19 Patients: A Network Meta-Analysis

The mechanisms underlying the onset and progression of chronic pain in COVID-19 patients have been understudied. Using network meta-analysis, we previously demonstrated that alcohol augments COVID-19 symptoms and pathologies possibly by inducing a severe cytokine storm. We and others have also reported that acute alcohol consumption produces analgesic effects, while chronic alcohol consumption results in hyperalgesia and chronic pain. This study aimed to identify the influence of alcohol consumption and COVID-19 on pain. Using publicly available curated gene expression data sets of differentially expressed genes (DEGs) in the prefrontal cortex (PFC) and amygdala of COVID-19 patients, we employed a bioinformatics application, QIAGEN ingenuity pathway analysis (IPA), to identify the key signaling pathways, upstream regulators, and biological functions in these brain areas known to play a role in pain. Canonical pathway analysis revealed activation of the neuropathic pain pathway and signaling pathways involving the cytokine storm, S100 family, IL-6, and neuroinflammation. IPA's network builder was employed to construct a network map of shared molecules between alcohol and pain-related constructs (discomfort, neuropathic pain, and inflammatory pain). The simulation of alcohol consumption inhibited pain in this network map. To study the influence of COVID-19, we overlaid the DEGs from the PFC and amygdala onto these networks, mimicking alcohol consumption during SARS-CoV-2 infection. Upregulation of molecules in the amygdala and PFC predicted an increase in neuropathic pain, as well as an increase in inflammatory pain in the PFC. Our results suggest that while alcohol consumption directly inhibits pain, the presence of COVID-19 exaggerates impaired cytokine signaling, neuroinflammation, and neuropathic pain signaling in the CNS providing novel insights into the signaling pathways associated with chronic pain of the COVID-19 patients.

Was receipt of any specialty alcohol treatment during the pandemic effective at reducing drinking for patients with or at risk of AUD?

INTRODUCTION

The COVID-19 pandemic changed the way healthcare providers delivered most health services, including treatment for alcohol use disorder (AUD). Specialty alcohol treatment remained available through the pandemic, and within some systems treatment use increased likely due to telehealth availability. However, the field knows little about the relationship between the pandemic's expanded access to specialty alcohol treatment and alcohol use outcomes.

METHODS

The sample included 14,712 patients from Kaiser Permanente Northern California who screened positive for unhealthy alcohol use in primary care and had an AUD diagnosis or risked developing an AUD by reporting 5 or more heavy drinking days in a 3-month period between 1/1/2019 and 2/29/2020 (pre-pandemic). The study examined the receipt of any specialty alcohol treatment (including at least one outpatient, inpatient, or telehealth specialty treatment encounter, or pharmacotherapy prescription) from 3/1/2020 (pandemic start) to either the first completed follow-up alcohol screening or 6/20/2022 (study period end). The outcomes of alcohol use included changes in heavy drinking days, drinks per week, drinking days per week, and drinks per drinking day between the pre- and post-pandemic periods.

RESULTS

On average patients significantly decreased alcohol use across all four alcohol use measures examined, regardless of whether they received treatment. However, those who received any treatment compared to those who did not had greater reductions in alcohol use, with an additional decrease of -3.55 heavy drinking days (95 % CI = -5.93, -1.17), -3.80 drinks per week (95 % CI = -5.18, -2.42), -0.72 drinks per drinking day (95 % CI = -1.14, -0.30), and - 1.01 drinking days per week (95 % CI = -1.30, -0.72). Treatment effects were greatest among patients who exceeded both daily and weekly limits pre-pandemic, with an additional decrease of -10.75 heavy drinking days (95 % CI = -15.28, -6.21), -12.83 drinks per week (95 % CI = -16.31, -9.35), -1.67 drinks per drinking day (95 % CI = -2.19, -1.14), and -2.02 drinking days per week (95 % CI = -2.41, -1.63).

CONCLUSIONS

On average, patients decreased alcohol use during the onset of the pandemic, however, those who had any specialty alcohol treatment had significantly greater decreases, suggesting that the hybrid in-person and telehealth treatment approach was effective during the pandemic.

Perceived social measures and drinking behavior during the COVID-19 pandemic in Thailand

During the COVID-19 pandemic, national policymakers implemented many public health social measures to cease the spread of the disease, while, those interventions also affected population health behaviors, including drinking alcohol. We analyzed national survey data of 7731 respondents to investigate drinking behavioral patterns, as well as measure the strength of association between social measures and alcohol consumption among the Thai populations during the COVID-19 pandemic. We demonstrated that perceptions on temporary suspension of entertainment events and a ban on alcohol sales during the pandemic were significantly associated with alcohol consumption behaviors. Specifically, the negative perceptions of these social measures were associated with the increase of drinking: OR = 1.42; 95% CI = [1.19, 1.69] and OR = 2.50; 95% CI = [2.11, 2.97], respectively. We recommended to assess the long-term effects of targeted social measures on drinking behavior, especially the post pandemic.

COVID-19, Possible Hepatic Pathways and Alcohol Abuse-What Do We Know up to 2023?

The pandemic period due to coronavirus disease 2019 (COVID-19) revolutionized all possible areas of global health. Significant consequences were also related to diverse extrapulmonary manifestations of this pathology. The liver was found to be a relatively common organ, beyond the respiratory tract, affected by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Multiple studies revealed the essential role of chronic liver disease (CLD) in the general outcome of coronavirus infection. Present concerns in this field are related to the direct hepatic consequences caused by COVID-19 and pre-existing liver disorders as risk factors for the severe course of the infection. Which mechanism has a key role in this phenomenon-previously existing hepatic disorder or acute liver failure due to SARS-CoV-2-is still not fully clarified. Alcoholic liver disease (ALD) constitutes another not fully elucidated context of coronavirus infection. Should the toxic effects of ethanol or already developed liver cirrhosis and its consequences be perceived as a causative or triggering factor of hepatic impairment in COVID-19 patients? In the face of these discrepancies, we decided to summarize the role of the liver in the whole picture of coronavirus infection, paying special attention to ALD and focusing on the pathological pathways related to COVID-19, ethanol toxicity and liver cirrhosis.