Changes in Alcohol-Related Behaviors and Quality of Life During the COVID-19 Pandemic: Impact of Alcohol Use Disorder Diagnosis and Treatment History

Association between prolonged stress caused by COVID-19 pandemic and earthquakes and quality of life, anxiety, depression, psychoactive substances, and problematic alcohol use in adult Croatian population

Background

The prolonged stress experience caused by the COVID-19 pandemic and two earthquakes led to increased alcohol and psychoactive substance use (PSU) accompanied by a decrease in mental wellbeing and quality of life (QoL) in the Croatian population. Our aim was to determine the relationship between alcohol and PSU and mental health outcomes including anxiety and depression, and QoL.

Methods

A cross-sectional online survey conducted from September 30 to October 27, 2021, included 1,118 Croatian adults (220 men and 898 women; mean age, 35.1 ± 12.3 years) recruited through non-probabilistic convenience sampling. The survey consisted of a self-reported questionnaire on PSU, the CAGE Alcohol Questionnaire, the Hospital Anxiety Depression Scale, and the World Health Organization Quality of Life (WHOQoL)-BREF. Structural equation modeling was used to evaluate the association between PSU, problematic alcohol use (PAU), mental health outcomes, and QoL.

Results

The model demonstrated a good fit and indicated that PSU increase, PAU, and anxiety and depression symptoms significantly explained all QoL domains (p < 0.001 for all). Both PSU increase and PAU during prolonged stress were directly associated with decreased QoL. These relationships were also indirectly mediated through increased anxiety and depression symptoms.

Conclusion

These results showed the need to direct public health interventions and treatment interventions during and after long-term stress (pandemics and earthquakes) to reduce the negative impact on substance use and QoL by reducing depression and anxiety, which ultimately may contribute to better wellbeing and rapid recovery of individuals affected by prolonged stress.

Problematic alcohol use and its impact on liver disease quality of life in a multicenter study of patients with cirrhosis

BACKGROUND

Management of cirrhosis is challenging and has been complicated by the COVID-19 pandemic due to decreased access to care, increased psychological distress, and alcohol misuse. Recently, The National Institute on Alcohol Abuse and Alcoholism has broadened the definition of recovery from alcohol use disorder to include quality of life (QoL) as an indicator of recovery. This study examined the associations of alcohol-associated cirrhosis etiology and problematic drinking with liver disease QoL (LDQoL).

METHODS

Patients with cirrhosis (N=329) were recruited from 3 sites (63% from 2 Veterans Affairs Health Care Systems and 37% from 1 safety net hospital) serving populations that are economically or socially marginalized. Cirrhosis etiology was ascertained by chart review of medical records. Problematic drinking was defined by ≥8 on the Alcohol Use Disorders Identification Test. Multivariable general linear modeling adjusting for age, sex, race/ethnicity, site, pandemic-related stress, and history of anxiety/depressive disorder were conducted. Sensitivity analyses further adjusted for indicators of liver disease severity.

RESULTS

Participants were on average 64.6 years old, 17% female, 58% non-White, 44% with alcohol-associated cirrhosis, and 17% with problematic drinking. Problematic drinking was significantly associated with worse LDQoL scores in the overall scale and in the memory/concentration and health distress subscales. These associations remained significant after adjusting for indicators of liver disease severity, including Model for End-Stage Liver Disease-Sodium score and decompensated cirrhosis status.

CONCLUSIONS

Among patients with cirrhosis, problematic drinking was associated with worse LDQoL, especially in the domains of memory/concentration and health distress. Assessment and awareness of cognitive deficits and negative emotionality within the context of cirrhosis and problematic drinking may help clinicians provide better integrated care for this population.

Social media addiction as a mediator of the associations between fear of COVID-19, mental health symptoms, and problematic alcohol use

Background

Fear of COVID-19 is a risk factor for anxiety and depressive symptoms. During the COVID-19 pandemic, drinking to cope with psychological distress has been proposed as a key mechanism leading to problematic drinking. The goal of this study was to test social media addiction as a mediator linking fear of COVID-19 to mental health symptoms and problematic alcohol use.

Methods

In between April 6 and July 2 of 2022, 250 participants completed an online survey as part of the National Institute on Alcohol Abuse and Alcoholism COVID-19 Pandemic Impact on Alcohol Study. Path analyses were conducted to test the mediational pathways.

Results

Using the polythetic classification scheme, 13.2% (n = 33) of participants were classified as having social media addiction. Compared with participants without social media addiction, participants with social media addiction spent significantly more time on social media platforms and on digital communications with a family member or friend. They also reported greater fear of COVID-19, higher anxiety symptoms, and higher depressive symptoms. Path analyses indicated that social media addiction mediated the associations of fear of COVID-19 with anxiety and depressive symptoms. Furthermore, there were indirect pathways linking fear of COVID-19 to problematic alcohol use through higher social media addiction and higher anxiety and depressive symptoms.

Conclusion

Social media addiction may be a maladaptive coping mechanism that individuals with high fear of COVID-19 utilized to deal with uncertainty and perceived risks during the pandemic. Findings underscore the need to examine cognitions related to fear of COVID-19 and address excessive social media use in the context of mental health and alcohol interventions.