Associations of Substance Use with Non-Adherence to Covid-19 Public Health Guidelines in a US Sample

Introduction: The emergence of the Covid-19 pandemic in recent months, and concomitant enforcement of “Shelter in Place” regulations and other public health measures, has already caused major disruptions to the physical health and financial well-being of the worldwide population. Many states in the US and many Asian and European nations have implemented rigorous social distancing measures as well as clearly-prescribed and proscribed public health measures designed to reduce viral transmission in the community. In the context of an extensive body of research demonstrating associations between substance misuse non-compliance with protective health guidelines in relation to HIV transmission, this paper investigates the association between substance misuse and lack of adherence to guidelines promoted by the US CDC to prevent the spread of Covid-19.

Methods: A Qualtrics survey was delivered in the MTurk worker platform, where over 1500 adults from throughout the continental US responded during April, 2020. The sample was diverse in terms of age (31% were 18-25 years; 39% 26-40; and 30% older than 40), gender (45% were women) and race/ethnicity (42% were people of color). Outcome measures, which included a social distancing scale and a protective hygiene scale, were each regressed on the substance use measures (hazardous drinking, past two-week binge drinking, any past month marijuana use, past month frequent marijuana use, past month other drug use, and past month poly substance use) and demographic controls (age, gender, race/ethnicity, and residential region), using Stata software to calculate robust variance estimators.

Results: Noteworthy in the sample was the relatively elevated prevalence of both hazardous (42%) and binge drinking (22%). Substance use measures were consistently significant negative predictors of adherence to social distance and protective hygiene. The significant betas for the adherence to social distance models ranged from a low of -.09 (for frequent marijuana use) to a high of -.26 (for any other drug use). Poly substance use and other drug use (non-marijuana drugs) were particularly problematic, especially in the context of social distancing; these two indicators were among the strongest predictors of non-adherence to social distancing, showing relatively large partial regression coefficients (betas of - .26 and -.23, respectively) in social distancing models The significant betas for the adherence to personal hygiene models ranged from a low of -.06 (hazardous drinking) to a high of -.14 (any other drug use).

Conclusions/Implications: The role of “other drugs,” in association with non-adherence was particularly alarming, especially since this category includes opioid drugs. Our findings suggest that failure to systematically address substance misuse (including opioid addiction), which is an ongoing epidemic in the US, may have considerable adverse ramifications for successful implementation of public health measures addressing Covid-19. Further, our data show patterns of associations in line with previous research exploring links between substance use and other high-risk behaviors. Just as substance use hampered messages and measures encouraging safe sex to minimize the spread of HIV, our recent data from the current pandemic suggest that this behavior undermines protective designed to minimize the spread of Covid-19.