(158) Alcohol Withdrawal and Implicated Deaths During the Early COVID-19 Pandemic: Case Report and International Literature Review
Abstract:
Background: Alcohol use disorder (AUD) and alcohol withdrawal syndrome (AWS) are among the leading causes of mortality worldwide. When faced with the COVID-19 pandemic in 2020, governments globally considered policy choices with regard to alcohol access. Here we report an AUD case complicated by AWS and near death by suicide to investigate the impact of the pandemic on AWS and related deaths.
Case: A 36-year-old man presented to an emergency department in New York City with confusion and hallucinations in the setting of heavy alcohol use and pandemic-related stressors. He was admitted to a medicine service for AWS management. Overnight, the patient broke a window and jumped from the 5th floor of the hospital, sustaining significant injuries. Throughout his surgical course and recovery he was followed by consult-liaison psychiatry for delirium management and safety assessments; psychosis and suicidal ideation did not recur. After discharge from physical rehabilitation, he moved out-of-state to pursue AUD treatment.
Discussion: In New York City, access to alcohol was increased during the pandemic by way of delivery services and restaurant to-go cocktail offerings. Visits to emergency departments for AWS, however, also increased from March-May 2020 (Schimmel, 2021). In Pennsylvania, liquor stores were closed from March-August 2020, and there was no significant difference in AWS emergency department consults between pre-pandemic and the closure period (Amaducci, 2021). In India, alcohol sales were banned from March-April 2020, and daily cases of AWS briefly doubled (Narasimha, 2020). Also in India, during a similar time period, 23 men completed suicide due to AWS (Ahmed, 2020). Ultimately, it is unclear whether these deaths should be characterized as suicides at all, as numerous were by way of poisonous liquids, perhaps ingested in search of an alcohol substitute.
Conclusion: Disparate alcohol laws in the early pandemic resulted in immediately inconsistent trends in AWS cases, and thereby clear conclusions are difficult to draw. Furthermore, it is not evident that the data from India suggesting a spike in AWS-related suicides is significant or generalizable. Future research should seek out any enduring effects of the pandemic on these topics globally. Alcohol education remains essential, and our addiction treatment services must withstand crisis.
References: 1) Schimmel J, et al. Changes in alcohol‐related hospital visits during COVID‐19 in New York City. Addiction 2021;116(2):3525-3530. 2) Amaducci AM, et al. Influence of Pennsylvania liquor store closures during the COVID-19 pandemic on alcohol withdrawal consultations. The American Journal of Emergency Medicine 2021;50:156-159. 3) Narasimha VL, et al. Complicated Alcohol Withdrawal—An Unintended Consequence of COVID-19 Lockdown. Alcohol and Alcoholism 2020;55(4):350-353. 4) Ahmed S, et al. COVID-19 lockdown in India triggers a rapid rise in suicides due to the alcohol withdrawal symptoms: Evidence from media reports. International Journal of Social Psychiatry 2020;66(8):827-829.