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©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
Craving variations in patients with substance use disorder and gambling during COVID-19 lockdown: The Italian experience
Maria Chiara Alessi, Giovanni Martinotti, Domenico De Berardis, Antonella Sociali, Chiara Di Natale, Gianna Sepede, Daniela Pia Rosaria Cheffo, Laura Monti, Pietro Casella, Mauro Pettorruso, Stefano Sensi, Massimo Di Giannantonio
Maria Chiara Alessi, Giovanni Martinotti, Antonella Sociali, Chiara Di Natale, Gianna Sepede, Mauro Pettorruso, Stefano Sensi, Massimo Di Giannantonio, Department of Neuroscience, Imaging, Clinical Sciences, University G. d'Annunzio, Chieti-Pescara 66100, Italy
Giovanni Martinotti, Department of Pharmacy, Pharmacology, Clinical Sciences, University of Hertfordshire, Hertfordshire AL10 9AB, United Kingdom
Domenico De Berardis, National Health Care System, Mazzini Hospital, Teramo 64100, Italy
Daniela Pia Rosaria Cheffo, Laura Monti, Department of Mental Health, UOS Psicologia Ospedaliera Fondazione Policlinico Gemelli IRCSS, Rome 00118, Italy
Pietro Casella, Department of Mental Health and Addiction Services, ASL Roma 1, Rome 00118, Italy
Author contributions: Martinotti G and Alessi MC designed the study and wrote the protocol; Sociali A and Di Natale C conducted literature searches and provided summaries of previous research studies; Sepede G conducted the statistical analysis; Casella P, Martinotti G, Sociali A, Cheffo DPR, Monti L, De Berardis D, and Sensi S recruited the patients with COVID; Martinotti G, Pettorruso M, and Di Giannantonio M wrote the first draft of the manuscript; and all authors contributed to and have approved the final manuscript.
Institutional review board statement: This study was approved by the Institutional Review Board of the Department of Neuroscience, Imaging, and Clinical Sciences of the University G. d'Annunzio of Chieti-Pescara (Prot. 042/2020) and fully complied with the guidelines of the Ethical Committee.
Conflict-of-interest statement: Giovanni Martinotti has been a consultant and/or a speaker and/or has received research grants from Angelini, Doc Generici, Janssen, Lundbeck, Otsuka, Pfizer. Massimo di Giannantonio has been a consultant and/or a speaker and/or has received research grants from Angelini, Janssen, Lundbeck, Otsuka, Pfizer, Recordati.
Data sharing statement: Raw data and all the statistical procedures are available upon request to the corresponding author.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Domenico De Berardis, MD, PhD, Adjunct Professor, Chief Doctor, National Health Care System, Mazzini Hospital, Piazza Italia 1, Teramo 64100, Italy.
domenico.deberardis@aslteramo.it
Received: February 8, 2021
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
Processing time: 340 Days and 20.3 Hours
BACKGROUND
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. The risks of self-medication through alcohol or psychoactive substance abuse were increased, as well as the tendency to adopt pathological behaviors, such as gambling and internet addiction.
AIM
To evaluate the impact of the COVID-19 pandemic and associated containment measures on craving in a group of patients suffering from substance use disorder and/or gambling disorder who were in treatment in outpatient units or in residency programs as inpatients.
METHODS
One hundred and fifty-three patients completed a structured questionnaire evaluating craving and other behaviors using a visual analogue scale (VAS). Forty-one subjects completed a pencil and paper questionnaire during the interview. The clinician provided an online questionnaire to 112 patients who had virtual assessments due to lockdown restrictions. Statistical analyses were performed using Statistica version 8.0. Quantitative parameters are presented as the mean ± SD and qualitative parameters as number and percentage per class. The Kolmogorov-Smirnov test was used to check for normality of distributions. Analysis of variance and Duncan post hoc test were employed to analyze differences among subgroup means. The associations between variables were measured using Pearson's correlation. A P value of < 0.05 was considered significant.
RESULTS
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.
CONCLUSION
The unexpected result of this study may be explained by a perceived lack of availability of substances and gambling areas and/or decreased social pressure on a subject usually excluded and stigmatized, or the acquisition of a new social identity based on feelings of a shared common danger and fate that overshadowed the sense of exclusion and rejection in the abuser.
Core Tip: Our data suggest that craving, regardless of whether determined by substances or behaviors, was globally reduced in a period that could be highly stressogenic such as the coronavirus disease-2019 lockdown.
