# Interrupted Time Series Analysis of Alcohol Use Disorder Treatment Utilisation During the Coronavirus Pandemic in Hamburg, Germany

## TL;DR

This study found that alcohol use disorder treatment in Germany dropped sharply during the pandemic, especially for inpatient care.

## Contribution

This is the first study to analyze long-term inpatient and outpatient AUD treatment trends across multiple pandemic phases.

## Key findings

- AUD treatment utilization dropped by 27% during the first lockdown in spring 2020.
- Inpatient treatment saw a larger decline (45%) compared to outpatient treatment (15%) during the first lockdown.
- Treatment utilization continued to decline gradually in 2021 even after lockdowns ended.

## Abstract

Alcohol use and treatment for alcohol use disorder (AUD) changed during the pandemic. Alcohol consumption increased among high‐risk groups, while treatment utilisation declined, raising concerns about an expanding treatment gap. This study analyses inpatient and outpatient AUD treatment trends during the pandemic.

We analysed electronic health records from 5671 patients residing in Hamburg, Germany, who utilised at least one alcohol‐related treatment between January 2016 and December 2021. Data from two statutory health insurance providers and two pension funds provided weekly numbers of patients receiving AUD treatment, including outpatient (psychiatric consultations, psychotherapy, pharmacotherapy), inpatient standard and intensive treatment, and outpatient and inpatient rehabilitation programs. Using a segmented regression approach, we examined changes over time for: (i) any treatment; (ii) outpatient treatment; and (iii) inpatient treatment across five periods of the pandemic: pre‐pandemic, first lockdown, between lockdowns, second lockdown and post‐second lockdown.

During the first lockdown in spring 2020, AUD treatment utilisation declined by 27% before briefly returning to near pre‐pandemic levels. A gradual decline was observed in later pandemic periods, even after containment measures were lifted. The decline was more pronounced in inpatient settings than in outpatient settings, at −45% and −15%, respectively, during the first lockdown.

The utilisation of AUD treatment services dropped substantially during the pandemic, particularly in inpatient settings. This reduction may have contributed to the rise in alcohol‐related deaths during this period. This study is the first to assess long‐term inpatient and outpatient treatment trends across multiple pandemic phases.

Interrupted time series analyses assessed COVID‐19's impact on alcohol use disorder treatment.In spring 2020, alcohol use disorder treatment utilisation dropped abruptly by 27%.Immediate declines were greater for inpatient (45%) than outpatient (15%) treatment.Gradual declines persisted in 2021 after containment measures were eased.

Interrupted time series analyses assessed COVID‐19's impact on alcohol use disorder treatment.

In spring 2020, alcohol use disorder treatment utilisation dropped abruptly by 27%.

Immediate declines were greater for inpatient (45%) than outpatient (15%) treatment.

Gradual declines persisted in 2021 after containment measures were eased.