Craving variations in patients with substance use disorder and gambling during COVID-19 lockdown: The Italian experience

BACKGROUND Following the development of the coronavirus disease-2019 (COVID-19) pandemic in Italy, a strict lockdown was imposed from March 9 to May 5, 2020. The risks of self-medication through alcohol or psychoactive substance abuse were increased, as well as the tendency to adopt pathological behaviors, such as gambling and internet addiction. AIM To evaluate the impact of the COVID-19 pandemic and associated containment measures on craving in a group of patients suffering from substance use disorder and/or gambling disorder who were in treatment in outpatient units or in residency programs as inpatients. METHODS One hundred and fifty-three patients completed a structured questionnaire evaluating craving and other behaviors using a visual analogue scale (VAS). Forty-one subjects completed a pencil and paper questionnaire during the interview. The clinician provided an online questionnaire to 112 patients who had virtual assessments due to lockdown restrictions. Statistical analyses were performed using Statistica version 8.0. Quantitative parameters are presented as the mean SD and qualitative parameters as number and percentage per class. The Kolmogorov-Smirnov test was used to check for normality of distributions. Analysis of variance and Duncan post hoc test were employed to analyze differences among subgroup means. The associations between variables were measured using Pearson's correlation. A P value of < 0.05 was considered significant. RESULTS The variation in craving between the present and the month before showed VAS-related reductions of craving in 57%, increases in 24%, and no significant change in 19% of the sample. The level of craving was significantly higher (F = 4.36; P < 0.05) in outpatients (n = 97; mean = 3.8 +/- 3.1) living in their own home during the quarantine compared with inpatients (n = 56; mean = 2.8 +/- 2.8) in residential programs. Craving for tetrahydrocannabinol was the greatest (4.94, P < 0.001) among various preferred substances. CONCLUSION The unexpected result of this study may be explained by a perceived lack of availability of substances and gambling areas and/or decreased social pressure on a subject usually excluded and stigmatized, or the acquisition of a new social identity based on feelings of a shared common danger and fate that overshadowed the sense of exclusion and rejection in the abuser.

Automated summary

This study aimed to evaluate the impact of the COVID-19 pandemic and associated containment measures on craving in patients with substance use disorder and/or gambling disorder. The results showed varying changes in craving during the lockdown, with some patients experiencing reductions, increases, or no significant change. Outpatients had significantly higher levels of craving compared to inpatients, and tetrahydrocannabinol was the most craved substance.