Published online Jan 21, 2022. doi: 10.12998/wjcc.v10.i3.882
Peer-review started: February 8, 2021
First decision: March 8, 2021
Revised: March 18, 2021
Accepted: December 22, 2021
Article in press: December 22, 2021
Published online: January 21, 2022
Following the development of the coronavirus disease-2019 (COVID-19) pandemic in Italy, a strict lockdown was imposed from March 9 to May 5, 2020. In the general population, problems such as depression, anxiety, post-traumatic stress symptoms, insomnia, and adjustment disorder symptoms increased. The risks of self-medication through alcohol or psychoactive substances abuse were also increased, as well as the tendency to adopt pathological behaviors, such as gambling and internet addiction.
Substance users and gamblers are groups at risk of developing psychopathological symptoms in a lockdown situation. The phenomenon is likely due to various reasons, including: (1) The limited availability of illegal substances on the black market; (2) the insufficient presence of active treatment programs and the low availability of substitute drugs; and (3) the greater psychopathological susceptibility and lower resilience in a period of reduced economic resources and financial hardship.
The objective of this study was to evaluate the impact of the COVID-19 pandemic and associated containment measures on craving in a group of patients suffering from SUD and/or gambling disorder (GD) who were in treatment in outpatient units or in residency programs as inpatients.
In this cross-sectional study, 153 patients completed a structured questionnaire evaluating craving and other behaviors using a visual analogue scale (VAS). In each recruitment center, a clinician introduced the survey to all the eligible subjects. No compensation was provided for participation in the study. Of the 253 subjects recruited, 153 (mean age 39.8; 77.8% male) gave their consent and anonymously completed the questionnaire. Forty-one subjects completed a pencil and paper questionnaire during the interview. The clinician provided an online questionnaire to112 patients who had virtual assessments due to lockdown restrictions. Questionnaires were anonymous and each subject was identified through a unique code with no other identifying data. Anonymity was maintained by placing the completed questionnaires in a box by the subject himself, so that the clinician could not associate the subject with his/her questionnaire. All participants provided informed consent. The inclusion criteria were: (1) Diagnosis of SUD or GD according to The Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders; and (2) being older than 18 years. The exclusion criteria were: (1) Diagnosis of dementia; and (2) refusal to give informed consent.
Sixty-seven (43.8%) of the participants reported a comorbid psychiatric condition, especially mood disorders (depression, bipolar disorder) and anxiety. In this subsample, a psychopharmacological treatment was reported by 94% of subjects. The variation in craving between the present and the month before showed VAS-related reductions of craving in 57%, increases in 24%, and no significant change in 19% of the sample. The level of craving was significantly higher (F = 4.36; P < 0.05) in outpatients (n = 97; mean = 3.8 ± 3.1) living in their own home during the quarantine compared with inpatients (n = 56; mean = 2.8 ± 2.8) in residential programs. Craving for tetrahydrocannabinol was the greatest (4.94, P < 0.001) among various preferred substances. Patients with a dual diagnosis did not show a significant difference in the levels of craving [F (1; 150) = 2.43, P > 0.121] with respect to patients without psychiatric comorbidities (n = 86; mean craving VAS = 3.1). Reduced quality of life due to COVID-19 driven by the lockdown was present in 51% of the patients; 25.5% declared no significant changes, and, surprisingly, 23.5% increased quality of life. Low levels of quality of life correlated with high craving scores (r = -0.226, P = 0.005).
Our data suggest that craving, regardless of whether determined by substances or behaviors, was globally reduced in a period that could be highly stressogenic. This data leads us to hypothesize that despite a substantial reduction in the perceived quality of life, the levels of craving have in any case been reduced, as a counter-proof of how much the unavailability of the substance and the increase in social integration may have had a direct positive effect on the reduction of craving.
Our results can lay the groundwork for future treatment policies in the direction of strategies that limit the availability of the substance and in parallel towards strategies that aim at greater social integration of subjects affected by addiction disorders.