INFORMACIONES PSIQUIÁTRICAS 243

Informaciones Psiquiátricas 2021 - n.º 243 23 People who use drugs can be particularly vulnerable to COVID-19 due to underlying health issues, stigma, social marginalization and higher economic and social vulnerabilities (1). In this context, we have to especially consider the potential risk of alcohol abuse given its social accessibility and health consequences since its heavy consumption increases the risk of acute respiratory distress syndrome (ARDS), one of the most severe complications of COVID-19. In recent decades, we have already seen other pandemics such as the Severe Acute Respiratory Syndrome (SARS) in 2002, the A/H1N1 influenza virus in 2009, the Middle East Respiratory Syndrome Coronavirus (MERS-CoV) outbreak in 2012, or the Ebola virus in West Africa in 2013, but how does the present situation compare with them? At least from a psychopathological perspective, we are afraid that COVID-19’s magnitude and characteristics (in terms of its rapid spread, number of people infected, mortality rate, etc.) do not allow us to consider the aforementioned pandemics as reliable sources of comparison. (2). Given the above considerations, it has been somewhat surprising that during the first wave of the pandemic we did not observe in our daily practice either any clear increase of drug treatment demand or a increase in the drug treatment or a high number of COVID-19 infections among these patients in our daily practice. Although we still hope to obtain information at the national level to corroborate these findings, these are our preliminary results, from the beginning of the COVID-19 crisis in December 2019 in Wuhan and the resulting negative consequences at all levels (lockdown restrictions, recession economic, etc.). Our data reflect a decrease in admissions of new psychiatric treatments per month among the three public centres for the treatment of addictions in adulthood administered by our institution (currently 1946 patients enrolled); once we compare the psychiatric and clinical psychology new admissions between January and May 2019 (N=324) vs 2020 (N=187), we observed that while clinical psychology admissions remained fairly stable (2019, median = 6 [ interquartile ranges = 4, 8]; 2020, 6 [4, 7]), psychiatric admissions dropped significantly (2019, 59 [57, 62]; 2020, 34 [18, 50]). On the other hand, from a qualitative perspective, in our outpatient follow- up visits (mostly by telephone) we have not received up to now major complaints about the psychological discomfort of any of the patients due to their confinement. Furthermore, within these outpatient follow-up visits, our patients did not report any escalation of covid-19 infections. In any case, so far we do not have solid data in relation to this topic (in terms of viral or antibody tests). On the contrary, taking into account the informal inputs of the personnel of the primary care units, general hospital, or the social services that belong to our health sector or even what we observe in our day to day, it seems that there may be a growing trend towards alcohol consumption in the general population; this could be the case at least in our clinical context, especially in periods of decreased restrictions or after the aggravation of anxiety experienced as a result of the pandemic. Nonetheless, we are aware that this clinical impression -rather than a statement- might not reflect the reality after analyzing several international studies that did not confirm this suspected alcohol consumption scalation, even here in Spain (3). Given these circumstances, we should take into account that this ongoing complex, multiple-dimensional and multiple- THEN, WHERE DO WE PUT OUR LIMITED RESOURCES ON THE MEDIUM AND LONGER-TERM?; COMMENTS ON REHM AND COLLEAGUE’S HYPOTHESIS