The Link Between Early COVID-19 Infection and Alcohol Use Disorder Diagnoses

Patients who were diagnosed with COVID-19 in the early phases of the pandemic were more likely to be diagnosed with new alcohol use disorder (AUD) compared to their non-COVID-19 respiratory infection counterparts, according to a paper published in JAMA Network Open.

Investigators from Case Western Reserve University School of Medicine in Cleveland, Ohio compared retrospective electronic health records (EHR) in order to determine if there was a spike in AUD diagnosis after a person received a COVID-19 infection. The study authors used 3-month intervals of the EHRs collected between January 2020-January 2022 for U.S. patients aged 12 years or older. The investigators compared groups who had new diagnoses of AUD and COVID-19 compared to those with AUD diagnoses and other, non-COVID-19 respiratory infections (ORI).

The study authors wrote that persons treated for other mental health disorders, persons who consumed alcohol hazardously prepandemic, and those with caregiving responsibilities were all more likely to increase their alcohol use during the COVID-19 pandemic. Additionally, a previously published study that retrospectively examined the possible increase of AUD in the Veterans Affairs population found that there was an increased risk of AUD diagnoses following COVID-19 diagnoses.

In this study, the investigators matched 1201082 patients aged 12 years and older with a diagnosis of COVID-19 with 1620100 patients who had ORI but no prior COVID-19 diagnoses documented in their EHR. The COVID-19 group was 56% female, 65% White, and had mean age of 46 years. The ORI group was 60% female, 71% White, and had a mean age of 44 years.

For the first interval (January-March 2020), the study authors observed significantly increased risk for a new diagnosis of AUD for a patient in the 14 days to 3 months after diagnosis with COVID-19 (0.4% of the COVID-19 group and 0.2% of the ORI group). From 3-6 months after diagnosis, there was also significant increased risk for AUD development in that time period for both groups (0.3% COVID-19; 0.1% ORI), the study authors found.

There was no increased risk for AUD diagnosis after COVID-19 in intervals 2, 3, and 4, corresponding to April-December 2020, the study authors said.

For intervals 5 and 6—corresponding to January-July 2021—the investigators observed increased risk for AUD post-COVID-19. And during intervals 7 and 8—considered August 2021-January 2022—the study authors said the risk for AUD post-COVID-19 became nonsignificant.

The spikes during these intervals were consistent with the US Centers for Disease Control and Prevention (CDC) reports of COVID-19 cases in the US during the corresponding time periods, the study authors noted.

“It seems likely that the social context of the pandemic, including anxiety, fear, social isolation, stress, and other contextual factors, is associated with this time-related trend,” the study authors wrote. “An encounter diagnosis of COVID-19, particularly at the outset of the pandemic, was alarming because of the high rate of hospitalization and death from COVID-19, the persistence of symptoms long after acute disease subsided, and the suggestion that unknown long-term consequences of COVID-19 infection might ensue.”

Factors throughout the pandemic, such as effective vaccines and effective treatments, may have mitigated the anxiety and stress, the study authors added. The pandemic response over time may have also had an effect on anxiety and stress, and in turn, AUD diagnoses, the study authors suggested.

While the reasons for the increased risk of AUD diagnosis following COVID-19 infection in the first interval have not yet been definitively determined, the study authors said, “contextual factors of SARS-CoV-2 infection and the pandemic itself are likely important factors. Future work is required to clarify the relative associations of COVID-19 itself and the pandemic context in increasing risk for addictive disease.”