Title : COVID-19 and the “Check Effect”
Abstract:
Background: Income assistance programs serve a crucial role in influencing the health and well-being of those with socio-economic marginalization. The term “Check Effect” refers to the cyclical pattern of substance use that correlates with the timing of social assistance payments. The COVID-19 pandemic has seen an unprecedented economic crisis, leading to various mitigation measures including eviction moratoriums and increased financial assistance. Unsurprisingly, the pandemic has also led to an increase in prevalence, frequency, intensity of substance use. This poses the question: does this supplemental financial aid lead to unintended increases in drug-related harm and overall drug use?
Methods: A retrospective chart review was performed on admissions with a primary diagnosis of a substance use disorder from October 1, 2019, to the end of the calendar year 2021 to the James A. Haley Veterans Affairs Hospital. From this data set, patients were grouped by their substance use disorder diagnosis. As all our patients receive some government assistance on the first Friday of every month, analysis was performed with patients placed in one of two categories, either admitted within 5 days of their government assistance check or admitted outside of this window. Furthermore, data sets were made comparing admission rates before statewide COVID-19 lockdown (April 1, 2020) and afterwards to see what, if any, the impact of the pandemic and its policies may have had.
Results: Analyzing trends in Cocaine Use Disorder both before and after statewide lockdown revealed that in the 6 months before lockdown, 5 out of 14 total admissions occurred within five days of receiving their government funded assistance. Comparatively, in the 6 months after the lockdown, 5 of the 6 total encounters occurred within 5 days government assistance: an overall decrease in total number of admissions but a substantial increase during the timing of government assistance (35.7% to 83.3%). Analysis of alcohol related disorders showed in the 6 months prior to the lockdown, 44 out of the total 155 patients were admitted within 5 days of receiving their government funds. In the 6 months following the lockdown’s initiation, 32 out of 123 admissions occurred within 5 days receiving their government assistance, a decrease from 28.4% to 26.02%. Overall, this trend in alcohol related admissions was not statistically significant (p = 2.4) but further analysis revealed that the total amount of alcohol related admissions of patients with comorbid Post Traumatic Stress Disorder (PTSD) significantly decreased from 73 admissions 6 months prior to lockdown to 46 admissions after the lockdown (p = 0.044).
Discussion: The ongoing COVID-19 pandemic has led to worse mental health outcomes and increased substance use. It has posed heavy economic and health system burden on the country; relief measures have included availability of additional financial assistance programs. This review establishes an association between the timing of financial assistance and hospitalizations as well as provides insight into the impact comorbid psychiatric conditions have on admission rates. Serious consideration should be given for increased money management interventions in the comprehensive treatment of those with substance use disorders.
What will audience learn from your presentation?
- Understanding the “Check Effect” and how it can be used to explain certain patterns of substance use and admissions.
- The impact covid and mandated lockdown orders have on admission rates of substance use disorders.
- The role of a comorbid PTSD diagnosis and how this may affect substance use disorder in veterans during a pandemic
- The importance of money management interventions in the comprehensive treatment of those with substance use disorders.
