Open Access
Feature Article

Alcohol – use and misuse during the COVID-19 pandemic

Open Access
Feature Article

Alcohol – use and misuse during the COVID-19 pandemic

VICKI GIANNOPOULOS, KIRSTEN C. MORLEY, PAUL S. HABER

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© motortion/stock.adobe.com model used for illustrative purposes only
© motortion/stock.adobe.com model used for illustrative purposes only
Dr Giannopoulos is a Senior Clinical Psychologist from Sydney Local Health District Drug Health Service, NSW and the Edith Collins Centre, Royal Prince Alfred Hospital, Sydney. Associate Professor Kirsten Morley is an Associate Professor in the Sydney School of Medicine (Central Clinical School) Faculty of Medicine and Health, The University of Sydney, NSW and the Edith Collins Centre, Royal Prince Alfred Hospital, NSW. Professor Haber is Clinical Director of Drug Health Services, Royal Prince Alfred Hospital; and Head of Discipline and Conjoint Professor, Addiction Medicine, The University of Sydney, Sydney, NSW.

During lockdown, rates of solitary drinking at home increased, with people reporting a tendency to not monitor their alcohol intake given the usual restraints such as driving home from licensed venues was no longer a concern. Traditionally, solitary drinking has been associated with more alcohol-related harm.13 One NSW study found that people who increased their alcohol intake during lockdown continued to drink excessively even once lockdown restrictions were eased.14 

The GP consultation

Around one in four Australians delayed seeing a GP during the height of the COVID-19 pandemic.15 GPs in Australia reported fewer face-to-face consultations since the pandemic, with most consultations conducted via telehealth.16 Telehealth consultations have a number of benefits, particularly for patients in rural or remote areas, such as increasing access to care. Telehealth consultations also limit unnecessary travel and reduce community transmission of COVID-19 and other diseases. However, there are numerous barriers to consultation including privacy concerns, access issues for patients without internet or technology and the fact that some procedures such as pathology or physical examinations necessitate a face-to-face consultation. 

Despite this, GPs are well placed to assess and screen for alcohol problems given that 83% of the population visited a GP in 2019-2020.15 GPs play a pivotal role in identifying alcohol problems as well as providing advice to patients on how to reduce or abstain from alcohol and monitor their alcohol use (Box 1).

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Screening and identifying alcohol use disorder

Patients rarely present to a GP specifically to request assistance with their alcohol use. As recommended by the RACGP’s Red Book, GPs should screen every patient  for alcohol misuse, even if they do not  suspect alcohol misuse. The Alcohol Use Disorders Identification Test for Consumption (AUDIT-C) is a brief three-item scale that can be integrated into routine history taking during a standard consultation (Table) along with information on what constitutes a standard drink.17 This rapid screener has been developed by the World Health Organization and has been extensively validated in Australian populations. The AUDIT-C can be administered in a nonjudgemental way to enable open discussion of the patient’s alcohol use, especially with patients who may be reluctant to freely discuss their drinking. Total AUDIT-C scores above 4 in men and 3 in women warrant a further comprehensive assessment of alcohol use using the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th Edition) criteria for alcohol use disorder (AUD).18

Comprehensive assessment  of alcohol use 

GPs should ask the patient each of the 11 items in the DSM-5 checklist (Box 2) in order to provide a more in-depth assessment of the patient’s alcohol use. The presence of two or more items from the DSM-5 checklist suggests AUD; however, the results from this checklist should not be used alone to make a formal diagnosis of AUD. In addition to the DSM-5 checklist, GPs should gather information on the patient’s typical daily use of alcohol, including quantity and frequency of alcohol use as well as identifying any triggers to drink (e.g. low mood, boredom). The Australian Guidelines for Treatment of Alcohol Problems provides further information on assessment and treatment options.19

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Readiness to change alcohol use 

The results of the DSM-5 checklist should be fed back to the patient in a neutral, nonjudgemental manner, keeping in mind that ambivalence on the patient’s part is normal. Principles of motivational interviewing should be used when discussing the patient’s alcohol use.  Regardless of the patient’s results on the DSM-5 checklist, the GP should keep in mind that not all patients will consider their drinking to be problematic, nor will they necessarily be ready to change their drinking habits right now. One quick way to determine how ready patients are to change their drinking is to ask: