**1. Introduction**

The impact of the COVID-19 pandemic on mental health has been extensively documented [1–4]. Increased diagnoses of anxiety and depression have been described [5–8], as well as a rise in the number of suicides in the population [9]. In addition, several authors have pointed out that the consequences of the pandemic have been more negative for people who had previously been suffering from other mental disorders, including addictive disorders [10–12].

Some authors have reported that at the onset of confinement there was an increase in drug use, as reflected in indicators suggesting increased sales of alcohol [13,14] and cannabis [15]. Furthermore, higher rates of alcohol [16], cannabis, and other forms of drug abuse [17–21] have also been documented. For example, Chappuy et al. [19] reported a 29.2% increase in alcohol use, a 27.6% increase in cannabis use, a 36.2% increase in psychostimulant use, and a 25.9% increase in hypnosedative and opiate use. In addition, a 48.7% increase in behaviors associated with pathological gambling has also been detected. Other authors have reported increases in self-medication patterns in patients with opioid dependence [11] and a rise in overdose rates [22,23]. However, despite the above data, it

**Citation:** Mancheño-Velasco, C.; Dacosta-Sánchez, D.; Blanc-Molina, A.; Narvaez-Camargo, M.; Lozano-Rojas, Ó.M. Changes in the Care Activity in Addiction Centers with Dual Pathology Patients during the COVID-19 Pandemic. *J. Clin. Med.***2022**, *11*, 4341. https://doi.org/ 10.3390/jcm11154341

Academic Editors: Ana Adan and Marta Torrens

Received: 23 June 2022 Accepted: 25 July 2022 Published: 26 July 2022

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**Copyright:** © 2022 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https:// creativecommons.org/licenses/by/ 4.0/).

should be borne in mind that consumption patterns may vary according to the country and the specific regulations in force during the pandemic [18,24].

In terms of health care provision, the pandemic, confinement, and the policy measures adopted by governments have led to significant changes in the care activities of specialized addiction centers. For example, Mark et al. [25] found a 28% decrease in admissions to treatment during the beginning of the pandemic compared to the previous year. In contrast, Aguilar et al. [26] noted an increase in care activity and higher relapse rates during the second half of confinement. In addition, other authors have reported changes in care patterns, with online appointments being prioritized and an increase in attendance at these appointments [27]. Likewise, it has been shown that confinement has led to an increase in the therapeutic needs of patients with addiction, with these patients also encountering more barriers to receiving therapeutic sessions and pharmacological treatments [11,28,29]. Some authors have also reported a slight increase in requests for pharmacological prescriptions by new patients, although an overall decrease in patients has also been noted [30]. On the other hand, Huskamp et al. [31] reported a decrease in the number of toxicological tests carried out in outpatient addiction centers.

These changes in healthcare activity may have had a greater impact on patients with dual pathology. Generally, these patients require more extensive follow-up due to the greater therapeutic complexity involved in comparison with patients without dual pathology [32,33]. In addition, the closure of some addiction centers [34] and the shift to virtual treatment have posed a major challenge to meeting the therapeutic needs of these patients. Therefore, some authors have warned of the worsening of comorbid mental disorders and disruptive behaviors both in confinement periods [35–37] and in the subsequent periods [38], in addition to a likely increase in relapses [39].

Although previous studies have suggested the potential impact of the pandemic on patients diagnosed with dual pathology, no studies have ye<sup>t</sup> compared the treatment indicators of care activities implemented for patients with dual pathology in addiction centers across the pre-confinement, confinement, and post-confinement periods. Thus, the present study had the following objectives: (i) to examine the evolution of admissions to treatment for patients with dual pathology receiving coordinated care with mental health centers between February 2019 and June 2021; (ii) to analyze the sociodemographic profiles, consumption patterns, and psychopathological profiles of these patients; and (iii) to compare care indicators related to therapeutic appointments, toxicological tests, and treatment abandonment across the three specified time periods. As hypotheses based on those objectives, it is expected that:


#### **2. Material and Methods**
