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Psychiatry and Behavioral Health

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

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

1 Credit CME

JAMA Network Open

Published Online: March 3, 2021

Research Letter

Article Information and Disclosures

Ram A. Sharma, MD¹;

Keshab Subedi, MS, MSc²;

Bayo M. Gbadebo, MBA²;

Beverly Wilson, MS¹;

Claudine Jurkovitz, MD, MPH²;

Terry Horton, MD¹

Author Affiliations

¹Department of Psychiatry, Christiana Care, Newark, Delaware
²Value Institute, Christiana Care, Newark, Delaware

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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

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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.2015.02.025 PubMed Google Scholar Crossref

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.2020.22942 PubMed Google Scholar

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.12671 PubMed Google Scholar Crossref

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

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.x PubMed Google Scholar Crossref

AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
1.00 credit toward the CME [and Self-Assessment requirements] of the American Board of Surgery’s Continuous Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.