How will Covid-19 Influence Addictive Behaviours and their Management?
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GUEST EDITORIAL
How will Covid-19 Influence Addictive Behaviours and their Management? Pratima Murthy
Received: 7 October 2020 / Accepted: 9 October 2020 Ó Springer Nature India Private Limited 2020
The world had witnessed a global surge in substance use and other addictive behaviours even prior to Covid-19. The World Drug Report 2020 estimates that 5.3% of the global population between 15 and 64 years, translating to about 210 million persons used substances in 2018, up 0.5% since an earlier report in 2009 [1]. This trend is also seen in low and middle income countries (LMIC) like India which has witnessed an increase in the use of cannabis, opioids and prescription drugs [2]. The World Health Organization estimates that about 350 million persons globally experience problems related to gambling, with prevalence rates ranging from 0.1 to 6% [3]. Internet addiction shows a global prevalence of 6.0% with moderate heterogeneity across the world [4]. In the past, a variety of disasters have been known to fuel substance use. Covid-19, forecasted to be a prolonged pandemic, with physical, mental, economic and social health consequences, is likely to produce greater and more enduring adverse impacts with respect to SUDs, fuelling both relapse in persons with pre-existing SUD and contributing to new-onset substance use. It is a sobering fact that the crisis of SUDs is now being described as an ‘epidemic in the midst of a pandemic’ [5], as all efforts for the effective
P. Murthy (&) Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bangalore, India e-mail: [email protected]
management and prevention of SUDs are in a complete state of disarray in many countries. The ripple effects are likely to be even stronger in LMICs, where the treatment gap for substance use disorders was already 86% or higher [6]. The pandemic has impacted addictive behaviours in a myriad ways. Lockdown and its ensuing isolation and stress have led to increase rates of psychological distress as well as substance use. It is known that individuals preconditioned to use substances for coping relieve anxiety, depression or insomnia through excessive use of tobacco, alcohol or other drugs, all of which lead to relapses or exacerbations of existing conditions [7]. In the case of AUDs, with closure of alcohol vends during lockdown, an increase in the presentation of complicated withdrawal, including delirium and seizures has been reported [8]. While the closure of all alcohol outlets may have led to improved health and reduced violence (including intimate partner violence) on the one hand, on the other, the ensuing social isolation and stress may also heighten domestic tensions, negating or reversing this possible benefit [9]. The pattern of alcohol sales has varied greatly, with a reduction in sale in some countries and stockpiling leading to a jump in sales, including online sales in others. Closure of pubs and other drinking venues may also change the patterns of drinking. While the risks of substance use have been
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