Among methodologic considerations and limitations, the main outcome measure in this study, initiation of any tobacco use, is a critical milestone, particularly among youth for whom daily smoking may develop over several years.However, long-term established tobacco use deserves attention in future research. Speculatively, youth might report tobacco use differently with in-home questionnaire administration versus in-school questionnaire administration, with unclear impact on the present results. In our 2- and 3-year models, we did not account for the timing of tobacco initiation or time-varying exposures or covariables. However, in an 11-year longitudinal study in Italy, the authors reported that living with smoking family members in adolescence and absence of a household smoking ban in young adulthood were both associated with established smoking among young adults.In the current study, findings were similar in a 1-year repeated measures analysis that allowed for intraperson variation.The COVID-19 pandemic has led to disruptions in daily social activities, schooling, and employment for millions of people globally. For some, the pandemic has also led to financial insecurity, exposure to potentially hazardous working conditions, illness, and the illness and/or loss of a loved one. Research has linked traumatic stress from previous viral outbreaks and other mass-traumatic events to increases in alcohol use, particularly in vulnerable groups such as those with a history of alcohol use disorders . Much less is known, however, about the risk and protective factors for alcohol use during and after prolonged stressors, such as the COVID-19 pandemic. While there is mixed evidence across different study populations,weed trimming tray several initial reports have suggested that rates of alcohol use have increased since the start of the COVID-19 pandemic for some vulnerable groups.
Researchers have posited a variety of COVID-19-related hardships, such as social disconnection, lack of access to healthcare services, and economic difficulties, as potential explanations for these increases. However, it remains unknown which specific types of stressful COVID-19-related experiences are associated with increases in alcohol misuse and what healthy coping strategies might mitigate risk. Prior research has demonstrated that some groups are more vulnerable to stress-related increases in alcohol misuse. For example, stressful events are associated with the recurrence of AUD, which underscores concern about the COVID-19 pandemic’s effect on alcohol use among individuals with a history of AUD. One recent study found that approximately half of adults in recovery from a substance use disorder reported cravings during a pandemic isolation period and that their craving was prompted by loneliness, lack of support, and financial stress, among other factors. In addition, during the COVID-19 pandemic, access to mutual-help groups and specialized AUD treatments may have diminished. This has played out in some early data on individuals with a lifetime history of AUD, which showed that ~20% of participants reported increases in their alcohol use since the pandemic began, with a significant portion of individuals reporting decreased access to substance use disorder treatment. However, other data have shown that 88.9% of women and 88.8% of men in a national survey of adults with ‘resolved’ AUD reported that the COVID-19 pandemic had not affected their recovery at all, and that ‘return to drinking’ events were infrequent. These mixed findings indicate that research is needed to understand the association between potential stressors related to the COVID-19 pandemic and increases in drinking among individuals with a past AUD, and differences between those in remission from AUD and those who are experiencing symptoms of AUD. Women may be particularly vulnerable to increases in drinking during the COVID-19 pandemic.
Two independent studies found that women were more likely than men to have a recurrence of AUD when experiencing interpersonal conflict, whereas men were more likely than women to have a recurrence of AUD in response to social isolation. Higher trauma exposure was associated with a higher risk of relapse only in women. Being married has been identified as a relapse risk factor for women but a protective factor for men. Because gender differences are often not examined in studies of individuals with AUD, robust, nuanced, and consistent findings regarding the role of gender in the associations of stress with drinking outcomes are unavailable. Since the start of the COVID-19 pandemic, some studies have found greater increases in adverse drinking outcomes among women than men. Given the unique stressors experienced by women during the COVID-19 pandemic, primarily related to balancing work and caregiving duties, further research is needed regarding gender differences in the relationships between COVID-19 pandemic stressors and increases in drinking among individuals with past AUD. In addition, individuals at heightened risk for AUD are more vulnerable to stress-related alcohol use. For example, genetic and/ or neural risk factors for AUD have been shown to increase the association between traumatic stress and alcohol use problems. There is also a growing literature suggesting that individuals exposed to traumatic stress differ in terms of temporally sensitive EEG-based measures of neural functional connectivity, which are also associated with heightened risk for alcohol use disorder. EEG coherence, the degree of synchrony in brain oscillatory activity between neural networks in two brain regions, is a heritable measure of neural functional connectivity that has been studied extensively and is correlated with various aspects of cognitive functioning and psychopathology.
While decades of research have focused on genetic and neurocognitive differences observed among those with alcohol use problems, few studies have examined interactions between measures of brain functioning and social environmental factors with respect to risk for alcohol use/misuse. Research teasing apart specific types of stressful COVID-19- related experiences associated with problematic alcohol use , and detailing how they interact with individualized risk factors , will allow us to better understand strategies that may buffer against the re-emergence, exacerbation, or new development of AUD that may occur as the COVID-19 pandemic continues to unfold. This study analyzed new data collected during the first months of the COVID-19 pandemic from longtime participants in the Collaborative Study on the Genetics of Alcoholism study, in conjunction with their data on AUD and drinking collected in prior assessments. The primary aim of this study was to examine the associations between COVID-19-related stressors and coping activities with changes in drunkenness frequency since the start of the pandemic among men and women with and without a history of AUD. Using information from earlier data collections, we further categorized individuals as having had no prior history of AUD pre-pandemic, having been symptomatic of AUD prepandemic, having been in remission from AUD but drinking prepandemic, or having been in remission from AUD and abstinent pre-pandemic. Gender differences in the associations of COVID- 19-related stressors and coping activities with changes in drunkenness frequency were also examined. An exploratory aim was to examine the roles that polygenic risk for problematic alcohol use and neural connectivity played as moderators of these associations.Details on the Collaborative Study on the Genetics of Alcoholism data collection and procedures have been published previously. Briefly,cannabis grow setup since 1990 over 17,000 individuals from families densely affected with AUD and from community comparison families have participated in the COGA study. Participants were administered a comprehensive evaluation that included clinical assessments of substance use and psychiatric disorders using the Semi-Structured Assessment for the Genetics of Alcoholism research interview. In a subset of families, DNA was collected, and a brain functioning protocol was administered that included measures of EEG during resting state, such as measures of neural connectivity. The current COGA protocol began in 2019 when the project turned to a onetime follow-up assessment of previous COGA participants currently in two life stages: participants aged 50 or older , the majority of whom have a lifetime history of AUD, and participants aged 30–40 from a longitudinal study of youth and young adult offspring from COGA families, approximately half of whom have a lifetime history of AUD. In these samples, over 95% had DNA and GWAS data available, and over 75% completed at least one EEG assessment. Further details on these earlier studies have been published.Descriptive characteristics of the analytic sample are displayed in Table 1. Briefly, the average age of participants was 51; 62% were women, 16% self-identified as Black, and 8% self-identified as Hispanic . Differences in characteristics of each analytic group as a function of past AUD history are depicted in Table 1. Individuals without a history of AUD were more likely to be women and Black and had less severe alcohol-related history and other substance use, compared to individuals with a history of AUD and were younger compared only to abstinent individuals in remission from AUD. Increases in drunkenness frequency since the start of the pandemic as a function of pre-pandemic AUD status are displayed in Fig. 1.
Increases in drunkenness frequency since the start of the pandemic were significantly greater among those experiencing AUD symptoms prior to the start of the pandemic when compared to those without a history of AUD . Among individuals in remission from AUD prior to the start of the pandemic, rates of increased drunkenness were 10% for those who were drinking pre-pandemic and 4% for those who had previously been abstinent. Across all groups, women reported nominally greater increases in drunkenness frequency when compared with men; however, only women experiencing pre-pandemic AUD symptoms reported significantly greater rates of increased drunkenness since the start of the pandemic compared to women without a history of AUD . To capture the shared variance represented by the 33 COVID- 19-related stress and coping activities items shown in Supplementary Table 1 and to reduce the multiple test burden, each item was entered into an exploratory factor analysis. While models ranging from 7 to 11 factors all provided a good fit to the data , a 9-factor solution provided the best balance of model fit and interpretability. To obtain factor scores, we subsequently conducted a confirmatory factor analysis including 9 latent factors indexing COVID-19 related illness and severity, family member illness and death, media consumption, perceived stress, economic hardship, healthy coping activities, relationship quality, social disconnection, and essential worker status. Several of the COVID-19-related factors were correlated ; among the most highly correlated factors were perceived stress with social disconnection , media consumption , and economic hardships . Essential worker status was also highly correlated with COVID illness . The main effects of COVID-19-related stress and healthy coping latent factors on change in drunkenness frequency are displayed in Table 2 and Fig. 2. Note, Fig. 2 depicts group-level change in terms of participants who reported that their frequency of drunkenness has increased or decreased since the start of the pandemic. Among those without a prior history of AUD, associations between COVID-19 risk and protective factors with increases in drunkenness frequency were not observed. Among all groups with a history of AUD , perceived stress was associated with increases in drunkenness. Among the remitted-abstinent group, essential worker status was associated with increases in drunkenness. Gender differences in these associations were observed . Among women in the remitted-abstinent group, essential worker status, perceived stress, media consumption, and social disconnection were associated with increases in drunkenness. Among men in the remitted-drinking group, perceived stress was associated with increases in drunkenness, and increased relationship quality was associated with decreases in drunkenness. Exploratory analyses examining whether polygenic risk for ‘problematic alcohol use’ and/or low alpha EEG interhemispheric coherence moderate the associations of the COVID-19 factors and changes in drunkenness are presented in Supplementary Table 3. Exploratory analyses indicated that associations between family illness or death with increases in drunkenness and increased relationship quality with decreases in drunkenness were more pronounced among the remitted-drinking participants with higher PRS. Associations between family illness or death, media consumption, and economic hardships with increases in drunkenness and healthy coping with decreases in drunkenness were more pronounced among the remitted-abstinent group with lower interhemispheric alpha EEG connectivity. In this study, we examined the association of COVID-19-related stress and healthy coping activities with changes in drunkenness frequency since the start of the COVID-19 pandemic among participants with and without a history of AUD, including those experiencing symptoms and those in remission from AUD prior to the pandemic. Our results demonstrated that compared to those without a lifetime history of AUD, non-remitted individuals with a history of AUD reported greater increases in drunkenness frequency since the start of the COVID-19 pandemic; however, this difference was not observed among those who had been in remission from their AUD, regardless of their drinking status.