Efficacy and feasibility of tele-based interventions in maintaining abstinence in persons who had past deaddiction treatment- a mixed methods study

COVID-19  pandemic poses vast challenges to population worldwide. First case of COVID-19 in India was confirmed on January 30th 2020. Since then the cases started rising up and the government started taking measures to control the spread. As a part of control measure, a nation-wide lockdown was announced on March 24th 2020. First, all non-emergency services were shut down. Second, patients suspected with COVID-19 were seen only in dedicated hospitals. Third, during the lockdown all states and union territories allowed basic amenities and banned alcohol. Lockdown had negative impact on mental health services as patients were treated on outpatient basis in many psychiatric clinics and emergency psychiatric facilities were only available in tertiary health care centers. Substance use disorders have been recognized as a major public health problem globally including India. Alcohol is a major contributor to mortality and morbidity in South Asian Region. There is already an existing huge treatment gap for alcohol problems (86%), the highest amongst all mental and substance use disorders,the lockdown had further restricted access to all face to face services that they were already accessing or wanted to access. Psychosocial factors play a major role in patient’s maintaining abstinence who had been treated for de-addiction for alcohol dependence. Social isolation, unemployment issues and income reductions result in psychological distress which eventually lead to increased substance use. The exacerbated anxiety and negative thinking that is inherent to the current experience of the pandemic and consequent lockdown can by itself be a signiï¬cant trigger for relapse. The other mechanism suggests that due to tighter budget constraints, less money may be spent on alcohol use. Nation-wide lockdown was called off and access to alcohol was started on May 4th 2020. This lead to greater commotion in procuring alcohol. Even people who were maintaining abstinence during lockdown period due to inability to procure alcohol might have relapsed. Psychiatric services have been restricted in many hospitals and the access to inpatient treatment for alcohol de-addiction varies from place to place. Patients are also afraid to get access to tertiary care centers because of the high load of COVID-19 cases. This pandemic has caused uncertainty in treating the psychiatric illnesses and telemedicine based approaches are followed in many centers to treat the patients. This study aims to elucidate  the pattern of current alcohol use in previously treated patients for de-addiction during COVID-19 and also their craving for alcohol during this period. After assessing their alcohol use pattern, they will be recruited for telemedicine based interventions to know the feasibility of these interventions to reduce the craving and to motivate them to prevent relapses using psychoeducational programme.

AIM : To assess the pattern of alcohol use in alcohol dependent patients during COVID -19 and to explore the effectiveness of telemedicine based interventions in maintaining abstinence in these patients.