(PS6-D86) Does Having Two Diagnoses Mean Double the Burden? An Examination of the Impacts of the COVID-19 Pandemic on U.S. Veterans with Anxiety and Alcohol Use Disorder Using Mixed Methods

Objective: The COVID-19 pandemic generated concerns about rising stress and alcohol use, especially in U.S. veterans who experience higher rates of anxiety disorders (ADs), alcohol use disorder (AUD), and dual AD+AUD diagnoses compared to the general public. To evaluate the impact of pandemic experiences for these veterans, the present study investigated differences among veterans in three diagnostic groups (AD, AUD, and AD+AUD) in terms of their COVID-19 related concern, impacts, and worries, as well as self-reported changes in urges to drink and frequency of drinking.

Method: A nationally administered online survey was given to a sample of U.S. veterans reporting substance use issues during the pandemic. Veterans included in the current analysis self-reported lifetime alcohol use and AD (n = 84), AUD (n = 50) or AD+AUD diagnoses (n = 63). Group frequencies on drinking behavior items (modified Alcohol, Smoking, and Substance Involvement Screening Test; ASSIST) and types of COVID-19 worries (multiple checkbox item question) were calculated. Differences between groups in level of COVID-19 concern (5-point Likert scale item) and negative COVID-19 impacts (modified Pain Management Collaboratory Coronavirus Pandemic 5-Item Measure; PMC-5) were examined using one-way ANOVA. Pearson and Spearman Rho correlations assessed for relationships among variables. Finally, an open-ended question about COVID-19 impact was analyzed via modified consensual qualitative research approach.

Results: A higher percentage of veterans with AD+AUD reported greater urges to drink during the pandemic (74.6%) compared to those with AUD (60%) or AD (42%). Similar results were found regarding changes in drinking frequency, with 73% (AD+AUD), 58% (AUD), and 41.7% (AD) reporting more drinking. Greater urges and frequency of drinking were associated with greater PMC-5 scores (r = .26 and .22, respectively). There were no group differences on the PMC-5 (F = 2.43, p = .090) or COVID-19 concern item (F = 0.86, p = .425). However, examination of specific COVID-19 worries and qualitative data revealed that veterans with AD+AUD reported a disproportionate psychosocial burden, including negative mental health impacts, social isolation, difficulty getting needed health care, financial concerns, and difficulty meeting basic needs due to the pandemic.

Conclusions: All diagnostic groups reported increased alcohol consumption during the pandemic, which is supported by research showing that as stress, boredom, and social isolation increase during disasters, stress-induced alcohol consumption is likely to follow, regardless of mental health status. Although the diagnostic groups did not differ on global negative impacts and concerns about the pandemic, a closer look at specific COVID-19 worries and narrative responses from veterans revealed that the AD+AUD group experienced both an increase in alcohol use and a disproportionate psychosocial burden. Screening and treatment for rising alcohol use, potentially as self-medication to cope, is needed as pandemic stress may exacerbate drinking among veterans, especially those with AD+AUD.