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Alcohol Withdrawal Rates in Hospitalized Patients During the COVID-19 Pandemic

Educational Objective
To identify the key insights or developments described in this article

Coronavirus disease 2019 (COVID-19) is disrupting communities across the globe, causing physical, mental, and financial distress.1 Economic crises have been associated with increased alcohol consumption.2 Necessary public health measures may exacerbate isolation and stress, negatively impacting those who are at risk for harmful alcohol use. Increased alcohol use has been documented in the US and other countries during the pandemic, and a recent study3 has identified associated consequences. Alcohol withdrawal (AW) is a potentially dangerous complication of alcohol use disorder (AUD) in up to 8% of all hospitalized patients with AUD.4 AW has been suspected to worsen after the COVID-19 stay-at-home orders,5 but, to our knowledge, no objective data have been reported in the literature. We hypothesized that AW rates in hospitalized patients with AUD increased during the pandemic and conducted a cohort study at Christiana Care, a large, tertiary care hospital system in Newark, Delaware.

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Article Information

Accepted for Publication: January 11, 2021.

Published: March 3, 2021. doi:10.1001/jamanetworkopen.2021.0422

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2021 Sharma RA et al. JAMA Network Open.

Corresponding Author: Ram A. Sharma MD, Department of Psychiatry, Christiana Care, 4735 Ogletown Stanton Rd, MAP 2, Ste 1201, Newark, DE 19713 (drramabhisheksharma@gmail.com).

Author Contributions: Dr Sharma had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Sharma, Subedi, Jurkovitz, Horton.

Acquisition, analysis, or interpretation of data: Sharma, Subedi, Gbadebo, Wilson, Jurkovitz.

Drafting of the manuscript: Sharma, Subedi.

Critical revision of the manuscript for important intellectual content: Sharma, Gbadebo, Wilson, Jurkovitz, Horton.

Statistical analysis: Sharma, Subedi.

Administrative, technical, or material support: Sharma, Wilson, Jurkovitz.

Supervision: Jurkovitz, Horton.

Conflict of Interest Disclosures: Dr Horton reported being a consultant for and serving on the advisory board of Masimo, a medical device company. No other disclosures were reported.

Funding/Support: Dr Jurkovitz is supported by an Institutional Development Award (IDeA) from the National Institute of General Medical Sciences of the National Institutes of Health under grant numbers U54-GM104941 and P20-GM103446. Mr Subedi is supported by an IDeA from the National Institute of General Medical Sciences of the National Institutes of Health under grant number U54-GM104941 (Principal Investigator: Hicks).

Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

References
1.
Wang  C , Pan  R , Wan  X ,  et al.  Immediate psychological responses and associated factors during the initial stage of the 2019 coronavirus disease (COVID-19) epidemic among the general population in China.   Int J Environ Res Public Health. 2020;17(5):E1729. doi:10.3390/ijerph17051729PubMedGoogle Scholar
2.
de Goeij  MCM , Suhrcke  M , Toffolutti  V , van de Mheen  D , Schoenmakers  TM , Kunst  AE .  How economic crises affect alcohol consumption and alcohol-related health problems: a realist systematic review.   Soc Sci Med. 2015;131:131-146. doi:10.1016/j.socscimed.2015.02.025PubMedGoogle ScholarCrossref
3.
Pollard  MS , Tucker  JS , Green  HD  Jr .  Changes in adult alcohol use and consequences during the COVID-19 pandemic in the US.   JAMA Netw Open. 2020;3(9):e2022942. doi:10.1001/jamanetworkopen.2020.22942PubMedGoogle Scholar
4.
Jesse  S , Bråthen  G , Ferrara  M ,  et al.  Alcohol withdrawal syndrome: mechanisms, manifestations, and management.   Acta Neurol Scand. 2017;135(1):4-16. doi:10.1111/ane.12671PubMedGoogle ScholarCrossref
5.
World Health Organization. Alcohol does not protect against COVID-19; access should be restricted during lockdown. Published April 14, 2020. Accessed August 27, 2020. https://www.euro.who.int/en/health-topics/disease-prevention/alcohol-use/news/news/2020/04/alcohol-does-not-protect-against-covid-19-access-should-be-restricted-during-lockdown
6.
Sullivan  JT , Sykora  K , Schneiderman  J , Naranjo  CA , Sellers  EM .  Assessment of alcohol withdrawal: the revised Clinical Institute Withdrawal Assessment for Alcohol Scale (CIWA-Ar).   Br J Addict. 1989;84(11):1353-1357. doi:10.1111/j.1360-0443.1989.tb00737.xPubMedGoogle ScholarCrossref
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