COVID-19 Impact on Alcohol Use Screenings and Mental Health Referrals in Primary Care

The COVID-19 pandemic magnified the dangerous effects of alcohol misuse globally. United States (U.S.) Veterans are disproportionately at greater risk of alcohol use disorders given exposure to catastrophic stress and comorbid mental health disorders. The purpose of this study was to explore the association between alcohol screening scores completed as part of routine VA healthcare and the reason for referrals made to primary care mental health integration (PCMHI) one year prior to the COVID-19 pandemic and during the pandemic. Chart reviews were completed for 408 Veterans referred to PCMHI. Data extraction included descriptive statistics, alcohol use disorder identification test - consumption (AUDIT-C) scores, referral diagnosis and treatment diagnosis starting March 1, 2019 through March 21, 2022. Most Veterans were white English-speaking men (>87%) with the average age of 51. Results found statistical significance based on referral reason (AUD < PTSD, MDD, anxiety, insomnia, and other) when compared to those referred for alcohol use disorder (AUD) based on AUDIT-C scores by year. Results yield a 109% increase in positive AUDIT-C scores from 2019 to 2022, with a 66% decrease in referrals for AUD follow-up care across those same years, and the majority of referrals to PCMHI were for depression, anxiety, and PTSD. Despite an increase in completed AUDIT-C screenings during the COVID-19 pandemic (2020, 2021, 2022) compared to 2019, missed opportunities averaged 50% each year. Changes in alcohol use patterns emerged as a secondary concern, signaling an important reminder to health care professionals to assess for unhealthy drinking behaviors.