Stress is consistently associated with increased drinking. The COVID-19 pandemic puts those with current AUD at increased risk of worsening drinking but also puts those in sustained treatment at increased risk of return to drinking. Further, access to treatment supports which many patients use to manage their stress and alcohol use (e.g. group counseling, mutual-help groups such as AA or Smart Recovery, and religious services and meetings) may be limited to tele-groups. (See ASAM’s COVID-19 Guidance on Support Group Access).
Recognizing that patients are likely to need increased support during this stressful time, clinicians are encouraged to use telehealth to increase the frequency of their contact with their patients. (See ASAM’s COVID-19 Telehealth Guidance). The COVID-19 public health emergency and the associated relaxation of many of the regulatory and payer requirements for telehealth offers an opportunity for widespread expansion of telehealth to ensure access to treatment for patients with alcohol use disorder. Phone calls, video visits, and video groups are all ways to connect with patients.
Patients should be monitored for adherence to pharmacotherapy, alcohol consumption, and/or development of alcohol withdrawal symptoms. Breathalyzers can be used in conjunction with audio/video telehealth sessions to assess recent alcohol use (they can be purchased at pharmacies for about $50. Efforts can be made to have this covered as durable medical equipment for some insurance). For those patients who consent, clinicians should consider enlisting family members, significant others, and/or close friends to assist in providing support and monitoring. When possible and available, patients should also be connected to peer support, which may provide another level of support and monitoring.
FDA-approved Medications for Alcohol Use Disorder
- Naltrexone 50-100mg oral once daily (must ensure opioid abstinence for at least 7 to 10 days).
- Liver function tests should be considered when 100mg doses are prescribed.
- Naltrexone ER 380mg IM once every 28 days intramuscular (gluteal) injection (must ensure opioid abstinence for at least 7 to 10 days).
- Acamprosate 333-666mg oral three times daily.
- Disulfiram 125-500mg oral once daily.
Medication adherence can be monitored by audio visual telehealth if available.
Clinicians are encouraged to familiarize themselves with adjunct resources that can support patients during the pandemic. For example, NIAAA’s Rethinking Drinking website is a great resource for patients, families, and clinicians. The website provides a variety of tools to help patients evaluate their own drinking patterns, determine strategies they can employ to cut down on drinking, and resources for supporting individuals looking to stop drinking.
Chronic alcohol use impairs the pulmonary (lung) immune responses. Thus, those with chronic heavy alcohol use may be at increased risk for infection with the novel coronavirus, if exposed, and may be at increased risk for COVID-19 related morbidity and mortality. Patients with AUD should be advised of their potential for increased risks associated with coronavirus infection and should be educated on mitigation of risk as advised by the Centers for Disease Control and their respective state and local health departments (e.g. physical distancing, wearing of face coverings, appropriate hand washing, frequent disinfection of high-touch surfaces, etc.). Additionally, patients should be educated on recognition of COVID-19 symptoms and who to call if they develop potential COVID-related symptoms.
In summary, treatment clinicians should:
- Continue to accept new patients.
- Increase the frequency of contact with existing patients.
- Explore telehealth-based strategies for monitoring adherence to pharmacotherapy, alcohol consumption, and/or development of alcohol withdrawal symptoms.
- Encourage patients to use online and smartphone recovery support resources.
- Connect patients with peer support.
- Partner with family members and close friends to extend support and monitoring.
- Educate patients about their risks for COVID-19, how to mitigate risk, how to recognize signs and symptoms, and what to do if they develop.