COVID-19: Attitudes towards drinking in LD patients during lockdown
Research type
Research Study
Full title
A qualitative study looking at the effect of COVID-19 on the risk of return to drinking in patients with chronic liver disease during lockdown
IRAS ID
287586
Contact name
Tracey Stone
Contact email
Sponsor organisation
University of Bristol
Clinicaltrials.gov Identifier
n/a, n/a
Duration of Study in the UK
1 years, 4 months, 0 days
Research summary
Research Summary
There is currently an epidemic of liver disease, which is now the second most common cause of preventable death in the UK(1). Once liver disease is present, ongoing alcohol use leads to markedly increased morbidity and mortality. Continued drinking following diagnosis leads to ~50% mortality at 3 years, whereas with abstinence >75% are alive at 7 years(2). The effect of lockdown on alcohol consumption in Alcohol-related liver disease (ARLD) patients is largely unknown. Population level data supports an increase in heavy alcohol consumption during lockdown amongst heavy drinkers(3). However, the specific effect of lockdown on alcohol behaviour in ARLD patients remains unknown. Importantly, ARLD patients have different triggers and stressors for alcohol consumption, hence the effect of lockdown cannot extrapolated from studies in the general population. Moreover, with the likelihood of ongoing social distancing and telemedicine, these data will potentially influence the provision and delivery of alcohol support services for ARLD patients as services are re-designed.
The specific aim of the study is to carry out a series of thematic interviews with ARLD patients recruited from hepatology clinics and inpatients at Southmead Hospital, under the supervision of consultant hepatologists. Additional input will be provided by a hepatologist with expertise in ARLD from UCL, and an expert in qualitative research methods. The data collection and analysis will be primarily undertaken by two 4th year medical students from the University of Bristol.
1. Williams R, et al. Addressing liver disease in the UK: a blueprint for attaining excellence in health care and reducing premature mortality from lifestyle issues of excess consumption of alcohol, obesity, and viral hepatitis. Lancet 2014; 384:1953-97.
2. Diehl AM. Alcoholic liver disease: natural history. Liver Transpl Surg. 1997; 3:206-211.
3. Jackson SE, et al. Association of the Covid-19 lockdown with smoking, drinking, and attempts to quit in England: an analysis of 2019-2020 data. Medrxiv 2020; doi: https://doi.org/10.1101/2020.05.25.20112656.Summary of results
There is currently an epidemic of liver disease; now the second commonest cause of preventable death in the UK, largely driven by an increase in Alcohol Related Liver Disease (ARLD.) Population-level data suggest increased alcohol consumption amongst heavy drinkers during lockdown. However, the specific effect of the pandemic and lockdown on alcohol behaviour in patients with ALRD remains unknown.
This study conducted semi-structured interviews with ARLD patients recruited from a large teaching hospital in South-West UK to: 1) identify factors contributing to abstinence from alcohol during lockdown, and 2) attitudes towards drinking and care received.
The inclusion criterion was an established diagnosis of ARLD. Patients were screened and recruited from Hepatology outpatients, and subsequently underwent telephone interview using a topic guide. Participants were asked about: 1) drinking history prior to and during lockdown, 2) triggers to relapse 3) previous attempts to abstain, 4) physical and mental health issues. Interviews were recorded, transcribed, anonymised and coded using NVIVO software. Double coding was undertaken by 3 researchers on 4 early interviews. Framework analysis was used to organise thematically coded data.
Results: Fifteen (9 male/6 female) patients were interviewed (mean age 57.7yrs). Twelve participants were abstinent at the time of interview. Five of these were abstinent prior to lockdown and remained so. Three were still drinking. Seven acknowledged alcohol dependence (5 previously and 3 currently). The most common triggers for drinking were trauma, stress, and employment issues. All participants with a formal mental health diagnosis (6/6) said it was the main contributor to problematic drinking, whilst only 14% (1/7) of those with physical comorbidities said it was a trigger. The most common factor predicting abstinence was hospitalisation for acute decompensation (7/15) or being given a diagnosis of ARLD (2/15). Most interviewees (14/15) had previous alcohol-related hospitalisation. Eight participants out of 12 abstinent said that lockdown had not affected their ability to abstain, whilst 4 who abstained subsequently said the temptation to drink was higher. Of the 3 participants who continued to drink through lockdown and afterwards 2 said they were drinking more during the lockdown period and 1 that it made no difference.
Whilst lockdown contributed to relapse in just under half of participants, a sentinel event such as new ARLD diagnosis or hospitalisation was the strongest predictor of abstinence. As pre-existing mental health problems also predicted ongoing alcohol use, abstinence may be improved with greater emphasis on mental health support in treatment plans.
REC name
HSC REC B
REC reference
21/NI/0008
Date of REC Opinion
16 Feb 2021
REC opinion
Further Information Favourable Opinion