Excessive alcohol use is associated with a wide range of physical, psychological and social consequences, and is responsible for a significant proportion of the burden of disease globally. An area which has received increasing interest is alcohol-related brain damage, not just because of the cost to the individual and society through resource utilization, but also because of the potential for prevention and reversibility. This paper aims to review the current literature on this subject and seeks to explore issues around diagnosis and treatment of alcohol-related brain damage.

IMPORTANCE Patient-reported outcomes in the treatment of opioid dependence may differ between subcutaneously administered depot buprenorphine and daily sublingual buprenorphine.

Introduction In early 2020, many services modified their delivery of opioid treatment in response to the COVID‐19 pandemic, to limit viral spread and maintain treatment continuity. We describe the changes to treatment and preliminary analysis of the association with patients' substance use and well‐being. Methods A pre‐post comparison of treatment conditions and patient self‐reported outcomes using data extracted from electronic medical records in the 5 months before (December 2019–April 2020) and after (May 2020–September 2020) changes were implemented in three public treatment services in South Eastern Sydney Local Health District. Results Data are available for 429/460 (93%) patients. Few (21, 5%) dropped out of treatment. In the ‘post’ period there was significantly more use of depot buprenorphine (12–24%), access to any take‐away doses (TAD; 24–69%), access to ≥6 TAD per week (7–31%), pharmacy dosing (24–52%) and telehealth services. There were significant reductions in average opioid and benzodiazepine use, increases in cannabis use, with limited group changes in social conditions, or quality of life, psychological and physical health. At an individual level, 22% of patients reported increases in their use of either alcohol, opioids, benzodiazepines or stimulants of ≥4 days in the past 4 weeks. Regression analysis indicates increases in substance use were associated with higher levels of supervised dosing. Discussion and Conclusions These preliminary findings suggest that the modified model of care continued to provide safe and effective treatment, during the pandemic. Notably, there was no association between more TAD and significant increases in substance use. Limitations are discussed and further evaluation is needed.