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Research Article Open Access
Treatment of Alcohol Dependence in the Context of the COVID-19
Pandemic
1Department of Psychiatry and Addiction, Azerbaijan State Advanced Training Institute for Doctors named by A Aliyev, Baku City, U Chagibekov Street, 46/50,
F. 1. Baku P.O. AZ0010, Azerbaijan Republic
2Azerbaijan Medical University, Department of Psychiatry, Azerbaijan
Nadir A Aliyev1* and Zafar N Aliyev2
*Corresponding author
Nadir A. Aliyev, Department of Psychiatry and Addiction, Azerbaijan State Advanced Training Institute for Doctors named by A. Aliyev, Baku City,
U. Chagibekov Street, 46/50, F. 1. Baku P.O. AZ0010, Azerbaijan Republic; E-mail: aliyevnadir@yahoo.com
Received: February 09, 2021; Accepted: February 22, 2021; Published: February 26, 2021
Journal of Drugs Addiction &
erapeutics
Volume 2(1): 1-4
Keywords: Alcohol Dependence, Treatment, COVID-19 pandemic
Introduction
Alcohol is an addictive psychoactive substance that is a Group 1
carcinogen for humans and has a signicant impact on the health of
the population worldwide [1,2]. Harmful use of alcohol is broadly
dened as “use of alcohol that causes detrimental effects on the
health and social life of the drinker, the people around him and
society as a whole, as well as creates patterns of alcohol use that are
associated with an increased risk of adverse health effects” [3]. This
denition refers to consequences that go beyond the clinical context
and emphasizes that alcohol use is one of the leading risk factors for
health deterioration, disability and death worldwide. It is emphasized
that alcohol affects not only consumers, but also many third parties,
including victims of road trafc accidents or violence, as well as
children born with fetal alcohol spectrum disorders or parents with
alcohol problems; alcohol consumption also increases health care
costs and decreases labor productivity [4]. Alcohol consumption
is responsible for more than 200 diseases and injuries according to
the International Classication of Diseases, and at least 40 diseases
and injuries are 100% associated with alcohol consumption. The
burden of mortality attributable to alcohol consumption goes back
to 2 broader categories: chronic noncommunicable diseases (NCDs;
neurological disorders, cancer, cardiovascular disease and cirrhosis
of the liver) and the group of acute, intentional and unintentional
injuries [1,4,5,6].
Literature evidence suggests an increase in alcohol abuse during
the COVID-19 pandemic and rising risks of alcohol and drug
addiction in a lockdown situation [7,8]. Earlier we described
Mental Disorders Caused by the COVID-19 Pandemic [9].
The main goal of this work is to develop therapy for alcohol
dependence in the context of the COVID-19 pandemic.
Materials and Methods
All patients was examined
This was a double-blind trial for patients diagnosed with DSM-
5 for of alcohol dependence. The patients gave their informed,
written consent to participate. In accordance with the Helsinki
Declaration of the World Medical Association “Recommendations
for doctors engaged in biomedical research involving people”,
adopted by the 18th World Medical Assembly (Finland, 1964,
revised in Japan in 1975, Italy-1983, Hong Kong-1989, the South
African Republic-1996, Edinburgh-2000); The Constitution of
the Republic of Azerbaijan, the Law “On Psychiatric Assistance”
(adopted on 12.06.2001, with amendments and additions
-11.11.2011, Decisions of the Cabinet of Ministers of the Republic
of Azerbaijan No. 83, dated April 30, 2010 “On Approval of the
Rules for Conducting Scientic, Preclinical and Clinical studies
of medicines” are established. The conditions of the conducted
researches corresponded to the generally accepted norms of
morality, the requirements of ethical and legal norms, as well as
J Drug Addi er 2021
ABSTRACT
Objective: e literature on psychiatric disorders associated with the coronavirus pandemic is scarce. In publications, indicate increased alcohol misuse.
However, there is not treatment of alcohol dependence in the context of the COVID-19 pandemic
Materials and Methods: is was a double-blind trial for patients diagnosed with DSM-5 for of alcohol dependence. Eligible 100 participants all men to
meeting the DSM-5 criteria alcohol dependence.
Results: As shown by catamiasis (12 months), among the patients treated with IF, (50 people), 5 had short-term breakdowns associated with exposure to
microsocial causes. Among the patients who received disulram (50 people), all had cases of relapse.
Conclusion: e clinical, neuroendocrine and immune data demonstrate the high ecacy of the use of interferon in alcoholics. e mechanisms of the
drug action are under discussion
Volume 2(1): 2-4
the rights, interests and personal dignity of the participants of the
studies were observed.
a) Conducted research is adequate to the topic of research work.
b) There is no risk for the subject of research.
c) Participants in the study were informed about the goals,
methods, expected benets of the study and associated with
risk and inconvenience in the study.
d) The subject’s informed consent about participation in the
research was received.
The decision of the Ethical Committee at the Azerbaijan Psychiatric
Association on the article of NA Aliev, ZN Aliev “Treatment of
alcohol dependence in the context of the COVID-19 pandemic”
submitted for publication in psychiatric journals: in connection
with compliance with its legislative requirements and regulatory
documents is to approve the article by N.A. Aliyev, Z.N. Aliev
“Mental disorders caused by the COVID-19 pandemic”. The
method of randomiza¬tion was given by lottery. Each patient was
randomized to re¬ceive either human alpha interferon (50 patients)
500 mg three times per day for 6 weeks or matched placebo (48
patients) in a double-blind manner.
Patients were observed at the Mental Health Center of the
Ministry of Health of the Republic of Azerbaijan. The study
was conducted from January 01, 2020 to 01 of the January 2021
years. Also we excluded sexually active subjects with active
or unstable epilepsy, other genetic syndromes or congenital
infections associated with autistic-like syndromes, prematurity;
subjects who have been treated within the previous 30 days by any
medication known to have a clearly dened potential for toxicity
or with any psychotropic drugs; subjects with clinically signicant
abnormalities in laboratory tests or physical examination; subjects
with a history of hypersensitivity or serious side effects associated
with the use any drugs A detailed clinical interview with parents
by a clinical expert, accompanied by physical examination and
blood analysis, was used to ensure that subjects did not meet any
exclusion criteria. A structured clinical interview, for DSM-5
Axis I Disorder, Patient Edition, was used to diagnose alcohol
dependence to DSM-5 [10]. Hundred patients all men whom we
studied were under observation in Mental Health Center of the
Ministry of Health of the Republic of Azerbaijan. The length of
the washout was 2 weeks. Patients were washout from the all
medications. Eligible participants were required to be between
18 and 65 years of age. We excluded serious medical conditions
including with other psychiatric disorders (e.g. bipolar disorder
II tipi, schizophrenia, patients judged to be at serious suicidal
or homicidal risk, dependence of psychoactive drugs, somatic,
neurological illness etc). Also we excluded unstable epilepsy, other
genetic syndromes or congenital infections associated with autistic-
like syndromes, prematurity; subjects who have been treated
within the previous 30 days by any medication known to have
a clearly dened potential for toxicity or with any psychotropic
drugs; subjects with clinically signicant abnormalities in
laboratory tests or physical examination; subjects with a history
of hypersensitivity or serious side effects associated with the
drug use, and subjects who, during the previous 3 months, started
new non- pharmacological procedures, such as diet, vitamins and
psychosocial therapy. A detailed clinical interview with parents
by a clinical expert, accompanied by physical examination and
blood analysis, was used to ensure that subjects did not meet any
exclusion criteria.
Patients clinically signicant of abnormal laboratory or EEG
ndings were ineligible. Patients before the study had not used
antidepressants, antipsychotics, anxiolytics, benzodiazepines.
Washout of all medicines was two weeks. In the context of the
COVID-19 pandemic, for the treatment of alcohol dependence,
we approached a new aspect, namely, we used interferon in the
treatment of alcoholism. The examined patients were divided into
2 groups of 50 people each. Patients of group 1 took human alpha
interferon (IF) for 30 days; group 2 received disulram 2 times a
day (at 9 and 19 hours, 0.25 g per dose). In each nasal passage, 5
drops (0.25 ml) were instilled 2 times a day with an interval of at
least 6 hours. Like disulram, IF was given to patients who were
sober without hangover symptoms for 30 days.
Patients of the 2nd group received human leukocyte IF (produced
by the Tbilisi Research Institute of Vaccines and Serums). The
ampoule with the preparation was opened before use, 2 ml of
distilled water at room temperature was poured into it. The
contents were shaken until complete dissolution.
Human alpha interferon was instilled into each nasal passage 5
drops (0.25 ml) 2 times a day with an interval of at least 6 hours.
Like disulram, IF was given to sober patients without hangover
symptoms for 30 days.
Results
Clinical indicators were used to assess the results and mechanisms
of therapeutic efcacy. As such, the duration of remission, the
presence of alcoholic breakdowns during treatment, a change in
the pathological craving for alcohol, and the clinical dynamics
of the disease were selected.
In the approach to the clinical assessment of a symptom, syndrome
and stage of alcoholism, we were mainly guided by the DSM-5
data [10].
The study showed that after treatment with disulram, patients
experienced drowsiness, internal discomfort, and difculty
concentrating. In addition, they had a decreased mood tone,
headaches, dizziness, heartbeat, complaints of sexual weakness,
intense craving for alcohol, which manifested itself in repeated
alcohol breakdowns during treatment, evasion from participation
in labor, lack of criticism to their condition, ill will towards
relatives and friends.
Follow-up observation (within 12 months) showed that among
the patients who received disulram (50 people), no one was
in remission during this time. After treatment, all patients, as a
rule, resumed their alcohol intake during the rst 3 months. It
should be especially noted that patients treated with disulram
experienced an increased attraction to alcohol, more than before
the therapy with this drug. Alcoholization in these persons acquired
a malignant character.
Observations of the patients receiving IF showed that in their
clinical state opposite changes were observed in comparison
with those treated with disulram. In patients of this group,
alcoholic breakdowns were not noted ‘, the craving for alcohol
was suppressed, active participation in labor processes, a friendly
attitude towards relatives and friends, and a critical attitude to
their condition prevailed; side effects from taking the drug were
not observed. As shown by catamiasis (12 months), among the
patients treated with IF, (50 people), 5 had short-term breakdowns
associated with exposure to microsocial causes. Among the
patients who received disulram (50 people), all cases of relapse
were recorded.
J Drug Addi er 2021
Citation: Nadir A. Aliyev (2021) Treatment of Alcohol Dependence in the Context of the COVID-19 Pandemic. Journal of Drugs Addiction & erapeutics.
SRC/JDAT-108.
Volume 2(1): 3-4J Drug Addi er 2021
It should be said that especially interesting results were found in the study of neuroendocrine and immune parameters before and
after treatment with disulram and IF. A preliminary analysis showed that in terms of background (before treatment) biological
indicators, patients in both groups did not differ statistically signicantly. The legitimacy of comparing biological indicators in each
of the studied groups after a course of appropriate treatment with the background parameters of the general group lies in the fact
that, as indicated above, neurotransmitter, neurohormonal and ionological indicators did not differ statistically when compared with
each other and with the general group.
Table 1: Changes in neuroendocrine and immune parameters in alcoholic patients before and after treatment with IF and
in patients with disulram
Indicator Healthy Patients with alcoholism
before treatment after treatment with IF after treatment with
disulram
DA, ng / ml 220,0± 14,0 98,0± 10,0
p1<0,001;
р3<0,001
200,0±8,0 р2— nss 100,0±8,0
р2<0,001
С ng / ml 44,5±6,3 382,0±12
р1 <0,001;
Рз<0,001
250,0±10,0
р2<0,0!
469,0±13,6
р2<0,001
GABA, ng / ml 45,8±6,8 70,6±5,9
P1<0,001
50,2±4,0 Р2—ND 110,0±8,0
Р2<0,001
ACTH. ng / ml 2,7±0,2 123,8±7,2
P1 <0,001 Р3<0,001
76,0±8,4
р2< 0,02
155,4±8,6
р2<0,001
PRL, ng / ml 2,4±0,2 3,6±0,2
p1<0,001
р3<0,001
1,7±0,1
р3<0,001
5,8±0,2
р2<0,001
STH, ng / ml 2,4±0,2 1,1±0,1
Pi<0,001
2,0±0,1
Р2—nd
0,5±0,1
р2<0,001
cAMP, pmol / l 1010 12,7±0,5 27,7±0,7
p1 <0,001; р3<0,001
14,0±0,5 36,5±1,8
cGMP, pmol / l 1010 4,5±0,3 2,0±0,3
p1 <0,001; р3<0,001
4,0±0,5
Р2— nss
1,1±0,1
р2<0,001
Lymphocytes % 33,9±1,0 28,2±1,0; р1 <0,001
Рз—nd
30,0±1,0
р2<0,02
20,07±0,8
р2<0,001
Note: p1 statistically reliability between healthy and alcoholic patients before treatment; p2 - between healthy and alcoholic patients
after treatment, p3 - between alcoholics before and after treatment, nss - not statistically signicant.
It was found that compared with the control, patients with
alcoholism showed a signicant decrease in the level of DA, STH,
cGMP. On the contrary, the content of GABA, ACTH, PRL, cAMP
was higher than in the control. Under the inuence of disulram,
patients with alcoholism developed even more serious disorders
in the neuroendocrine and immune systems. At the same time,
the treatment of patients with IF promoted a tendency towards
the normalization of neuroendocrine and immune values. Our
Follow-up observation (catamnesus), was conducted from January
01, 2020 to January 01, 2021.
Discussion
Thus, it has been shown that, rstly, the treatment with disulram
is inappropriate, and secondly, a new direction in the search for
the means of the immune system is determined. At this stage of
our understanding, it is difcult to give an exhaustive explanation
of the anti-alcohol action of IF. When using this drug in mentally
healthy people, an increase in mood tone (mania-like state), an
exaggerated idea of their capabilities, ignorance of nutrition and
daily regular physiological activities, and in some, refusal drinking
[11]. This condition, in our opinion, partially corresponds to the
symptomatology observed with hyperactivity of the dopaminergic
and hypoactivity of the GABA- and serotonergic systems, which
is conrmed by the results of this work.
A study on rats of the effect of IF and ethanol on the opioid system
of the brain showed that when a 15% solution of ethanol is used for
14 months for drinking in animals, the binding afnity of labeled
3H-naloxone and 3H-enkephalin to the brain structures decreases.
At the same time, if a-IF were administered to animals during the
last 1.5 months of the experiment, then any changes in the afnity
of opioid receptors were observed for only 24 hours after ethanol
was discontinued. On the other hand, preliminary administration
of α-IF into the cerebral ventricles or intraperitoneally increased
the decrease in the methenkephalin content in the striatum caused
by a single administration of ethanol and prevented the decrease
in the β-endorphin content in the anterior pituitary gland caused
by it [12].
Thus, interferon, rstly, is involved in neurotransmitter processes
(dopamine, serotonin and GABAergic), and secondly, it affects the
opioidergic system. The role of violations of these systems in the
pathogenesis of alcoholism is now being actively studied [13,14].
It was found that, compared with the control, patients with
alcoholism showed a signicant decrease in the level of DA, STH,
cGMP. On the contrary, the content of GABA, ACTH, PRL, cAMP
was higher than in the control. Under the inuence of disulram,
patients with alcoholism developed even more serious disorders
in the neuroendocrine and immune systems. At the same time,
the treatment of patients with IF promoted a tendency towards
Citation: Nadir A. Aliyev (2021) Treatment of Alcohol Dependence in the Context of the COVID-19 Pandemic. Journal of Drugs Addiction & erapeutics.
SRC/JDAT-108.
Volume 2(1): 4-4
Copyright: ©2021 Nadir A. Aliyev. This is an open-access article distributed
under the terms of the Creative Commons Attribution License, which permits
unrestricted use, distribution, and reproduction in any medium, provided the
original author and source are credited.
J Drug Addi er 2021
Citation: Nadir A. Aliyev (2021) Treatment of Alcohol Dependence in the Context of the COVID-19 Pandemic. Journal of Drugs Addiction & erapeutics.
SRC/JDAT-108.
the normalization of neuroendocrine and immune values. Our
Follow-up observation (catamnesus), was conducted from January
01, 2020 to January 01, 2021.
Regarding the causes of immunological changes under the inuence
of a-IF, it should be said that they are apparently associated with
changes in intracellular cyclic nucleotides and, most likely, can be
explained by the inuence of a-IF on neuroendocrine regulation of
immune function. The presence of an afferent connection between
the immune and neuroendocrine systems conrms the validity of
this approach.
The neurohormonal effects of a-IF, apparently, can be explained
by the effect of the drug on the neurotransmitter and opioid
systems. Another hypothetically possible way of the effect of
IF on neurotransmitter and neurohormonal systems may be
associated with the effect of the drug on the synthesis and secretion
of immune cells of peptide hormones, which are modied post-
translational products. In this regard, it is extremely important
to present modied post-translational products. In this regard,
a regulatory factor that controls the synthesis and secretion of
peptide hormones by immunocompetent cells, which give a wide
range of biological effects, including psychophysiological ones,
is extremely important in the present and future studies of the
neuroimmune link in the pathogenesis of alcoholism.
Regarding the causes of immunological changes under the inuence
of a-IF, it should be said that they are apparently associated with
changes in intracellular cyclic nucleotides and, most likely, can be
explained by the inuence of a-IF on neuroendocrine regulation of
immune function. The presence of an afferent connection between
the immune and neuroendocrine systems conrms the validity of
this approach. The neurohormonal effects of a-IF, apparently, can
be explained by the effect of the drug on the neurotransmitter and
opioid systems.
Conclusion
A hypothetically possible pathway for the effect of IF on
neurotransmitter and neurohormonal systems may be associated
with the effect of the drug on the synthesis and secretion of
immune cells of peptide hormones, which are modied post-
translational products. In this regard, modied post-translational
products are extremely important. In this regard, a regulatory factor
that controls the synthesis and secretion of peptide hormones by
immunocompetent cells, which give a wide range of biological
effects, including psychophysiological, is extremely important
in current and future studies of the neuroimmune link in the
pathogenesis of alcoholism.
Acknowledgment
The authors would like to thank staff of the Mental Health Center
of the Ministry of Health of the Republic of Azerbaijan.
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