The Association of COVID-19 Stressors with Drug & Alcohol Misuse Early in the Pandemic

Background & Purpose: The emergence of the COVID-19 pandemic over the past year adversely impacted the psychological well-being of people throughout the US. Research in the past year has suggested that the pandemic increased stress associated with these disruptions. A substantial body of research from other catastrophic events (such as 9/11) suggests that substance misuse is a direct consequence of stress and that substance misuse spikes in communities and populations that are forced to struggle with stress-inducing catastrophic events. Building on this prior research, we sought to investigate the association between COVID-19 stress and substance use in a US adult population during the early phases of the pandemic.

Methods: Using a Qualtrics survey delivered in the Mechanical Turk worker platform, we initially surveyed 1550 adults in April, 2020. The sample was diverse in terms of age (31% were 18-25; 39% were 26-40; and 30% were over 40 years), gender (55% were women) and race/ethnicity (32% were people of color). Outcome measures included the following dichotomous indicators of substance use: hazardous drinking since the start of the pandemic, past two-week binge drinking (instances of 5+ drinks in one sitting), frequent (>3 times) past month marijuana use, past month other drug use and past month polysubstance use. Our main independent variable was a 30-item, internally consistent (alpha=.92), COVID019 stressor scale that asked respondents to evaluate the amount of stress they felt during the past week (on a scale of 1 to 5) in each of four areas related to the COVID-19 pandemic: stress related to fear of infection, restrictions in daily activities, reductions in financial resources, and family caregiving.

Results: Logistic regression models controlling for age, gender, and race/ethnicity suggested higher COVID-19 stress was associated with elevated risk of substance use. Compared with those in the lowest stress quartile (stress scores <24), those in the highest stress quartile (stress scores >47) had 1.8 times the odds of reporting hazardous drinking during the pandemic (95% CI: 1.3, 2.5), 2.5 times the odds of binge drinking during the past two weeks (95% CI: 1.8, 3.7), 1.8 times the odds of frequent marijuana use (95% CI: 1.2, 2.5), 4.3 times the odds of other substance use during the past month (95% CI: 2.4, 7.7) and 3.4 times the odds of any past month polysubstance use (95% CI 2.1, 5.4).

Conclusions and Implications. Those who were most stressed by the pandemic on multiple domains were most likely to turn to substance use/misuse early on. Substance misuse impact was observed for all substance categories – not just drinking. While these findings are possibly limited by the cross sectional nature of the data, they also underscore adverse ramifications of the pandemic that will need attention from policy makers, public health experts, social workers and counselors in the years ahead.