Affect Substance Use Research Articles

The Factors Affecting Substance Use and the Most Effective Mental Health Interventions in Adolescents and Young Adults

Adolescents and young adults are particularly susceptible to substance abuse. They have yet to solidify their sense of self to the degree necessary to effectively resist temptations from negative peer pressure. It is vital for mental health counselors to understand the factors affecting substance abuse in adolescents/young adults and to comprehend the effectiveness of common intervention strategies fully. This paper produces a narrative literature review of 27 international journal publications from 2004 through June 2024 related to causal factors and interventions effective for treating substance abuse in adolescents and young adults. The results indicate that adolescents who idolize antisocial peers and lack a strong sense of self, family attachment, parental monitoring, and role models are more likely to suffer from substance abuse. Successful interventions include those that help strengthen the adolescent’s sense of self, a mental-health-friendly school environment staffed with professional mental health counselors, and interactive programs that engage students in positive behaviors. Positive family and peer role models can also assist in helping adolescents/young adults build a strong self-image and resist substance use. Positive peer influence is another critical factor, but more work must be undertaken to fully assess its effectiveness as an intervention.

Nurses' Experiences and Perspectives Caring for People With Substance Use Disorder and Their Families: A Qualitative Descriptive Study.

Substance use disorder is a public health crisis that is a financial strain to many healthcare systems and communities, but more importantly, it costs lives. Nurses interact with people experiencing substance use disorders and their families in many settings. Nurses can provide insights into the experiences of working with this population. This descriptive qualitative study aimed to examine nurses' experiences and perspectives on caring for people with substance use disorder and their families. After receiving institutional review approval, purposive sampling was used to recruit registered nurses (n = 16) who worked in a variety of settings, and interviews were conducted. Constant comparison analysis was conducted concurrently with data collection until saturation was reached. Code development and refinement was an iterative process. Three themes were generated from the data. Personal Experiences Affect Professional Practice represented participants varied personal experiences and included two subthemes: Reflecting on Personal Experiences and Seeing the Person Beyond the Substance Use Disorder. A second theme is Professional Experiences Affect Professional Practice, which included two subthemes: Professional Experiences are Stressful and Rewarding and Substance Use Disorder Education Increases Confidence. Finally, Stigma Affects Substance Use Disorder Care is the third theme. Future implications range from the individual engaging in self-reflection, to nursing leadership establishing a framework to incorporate reflection and creating a culture that supports and reinforces these activities. The findings of this study support the need for stigma awareness/reduction education starting in undergraduate nursing programmes, throughout practice, with extension to inter-professional groups and the community.

Bidirectional relationships between pain and patterns of cannabis and tobacco use in a US nationally representative sample.

One-fifth of US adults experience chronic pain, which is associated with increased tobacco and cannabis use. Although bidirectional relationships between tobacco and pain have been demonstrated, pathways between pain, cannabis use, and co-use of cannabis and tobacco are understudied. We aimed to estimate the effects of (1) substance use (exclusive and co-use of cannabis and tobacco) on later pain intensity, and (2) pain intensity on later substance use. Data were from 31,983 adults in biennial surveys (2015-2021) of the US nationally representative longitudinal Population Assessment of Tobacco and Health Study (n = 71,055 pairs of consecutive surveys; T1 and T2). Past-week pain intensity was dichotomized (≤4/10 no/low pain; >4/10 moderate/severe pain). Mutually exclusive substance use categories (past 30 days) were no cannabis/tobacco use; exclusive cannabis/tobacco use; and co-use. Logistic regression assessed whether T1 substance use affected moderate/severe pain at T2. Multinomial models assessed whether pain status at T1 affected substance use at T2. Compared with no cannabis/tobacco use at T1, co-use (OR: 2.29 [95% CI: 2.09-2.51]), exclusive tobacco use (2.00 [1.86-2.14]), and exclusive cannabis use (1.35 [1.13-1.61]) were all associated with moderate/severe pain at T2. Moderate/severe pain at T1 increased odds of co-use (2.43 [2.22-2.66]), exclusive tobacco (2.12 [1.98-2.28]), and exclusive cannabis use (1.46 [1.29-1.65]) compared with no cannabis/tobacco use at T2, and increased odds of co-use at T2 compared with exclusive cannabis/tobacco use. Findings demonstrated bidirectional relationships between pain and the exclusive use and co-use of cannabis and tobacco and indicate potential synergy in the co-use of cannabis and tobacco with respect to pain.

Self-help group (SHG) attendance and treatment outcomes among older adults in the US

BackgroundSubstance dependency is a global problem and significantly affects the geriatric population in the United States. This study aims to determine how self-help group (SHG) attendance affects substance use treatment outcomes among older adults in the US. MethodsThis cross-sectional study used the 2020 discharge treatment episodes data set (TEDS-D)fromthe Substance Abuse and Mental Health Services Administration (SAMHSA). Multivariable logistic regression was used to evaluate the relationship between self-help group attendance and treatment outcomes among older adults. ResultsWe included 3,424 older adults (19.2% female). The primary substance use was alcohol in more than two-thirds of the participants (67.9%), while heroin (17.1%), cocaine (5.8%), and other opiates/synthetics (3.3%) were the other common primary substance of abuse among other participants. In the multivariate logistic regression analysis, SHG attendance at discharge from treatment facility was significantly associated with reduced frequency of use of primary substance -FUPS (p-value = 0.013) and increased odds of treatment completion (p-value <0.001) but no significant association with arrests at discharge from treatment facility (p-value = 0.101). SHG attendance on admission into treatment facility was associated with reduced odds of treatment completion (p-value <0.001). Having a living arrangement at discharge was found to be associated with reduced FUPS (p-value <0.001) but with lower odds of treatment completion (p-value <0.001). ConclusionAssociation of SHG attendance with positive treatment outcomes indicates the need to enhance access to this service in the geriatric population.

The Mediating Effect of Depression on the Relationship between Loneliness and Substance Use in Korean Adolescents.

Substance use among adolescents is a major emerging health problem worldwide. Although loneliness and depression are major risk factors for substance use, few studies have examined the relationship between loneliness, depression, and substance use in adolescents. This study aimed to determine the mediating effect of depression on the relationship between loneliness and substance use among Korean adolescents, based on the data from 53,310 adolescents from the 17th Korea Youth Risk Behavior Web-based Survey in 2021. Using a complex sample analysis module, hierarchical logistic regression analysis was employed to confirm the mediating effect of depression on the relationship between loneliness and substance use. The results showed that loneliness and depression have a significant effect on substance use (smoking, drinking alcohol, and drug use). Depression was found to have a partial mediating effect on the relationship between loneliness and substance use. Overall, the results suggested that loneliness and depression in adolescents increase substance use, and loneliness can affect substance use through depression. Therefore, proactive strategies to prevent and reduce loneliness and depression in adolescents can be effective in preventing substance use.

Health consequences of a death threat: How terrorist attacks impact drinking

AbstractTerrorist attacks, war, violent acts, and their media coverage remind us of our own mortality, which may provoke stress and coping mechanisms. The terror management health model (TMHM) proposes that even subliminal thoughts about existential threats trigger worldview defense and self‐esteem‐related behaviors. Based on the TMHM, our field experiment (N = 228) examines the impact of a terrorist attack on death‐thought accessibility, the choice between alcoholic and nonalcoholic beverages, and if the impact on this choice is moderated by the importance of alcohol to one's self‐esteem (i.e., alcohol‐based self‐esteem), and the consciousness of the terrorist attack. Results show that thoughts about the terrorist attack increased death‐thought accessibility. The salience of the terrorist attack had no main effect on beverage choice, but alcohol‐based self‐esteem predicted choosing an alcoholic beverage. However, in the unconscious thought condition, participants who had low alcohol‐based self‐esteem and were provoked with death‐related thoughts about terrorism were more likely to choose an alcoholic beverage. In the conscious thought condition, participants who had high alcohol‐based self‐esteem were less likely to choose alcohol. This study suggests that thoughts about terrorism and, therefore, the threat of death, can be provoked in everyday situations and affect substance use behaviors with potentially adverse health consequences.

Systematic Review and Meta-Synthesis of Research Studies Related to Factors Affecting Substance Use in Iran from 2002 to 2021

Systematic Review and Meta-Synthesis of Research Studies Related to Factors Affecting Substance Use in Iran from 2002 to 2021

Exams-related stress and the pattern of substance use and misuse among Palestinian medical and health sciences students

Substance use among school students is a public health concern. Exam-related anxiety is one of the main motives for drug use. This research aimed to determine the prevalence and characteristics of psychostimulant and antidepressants use and misuse among medical and health sciences students at two large representative medical schools in West Bank Palestine. The results of a cross-sectional study, that surveyed 984 Palestinian medical and health sciences students revealed how educational experiences and newfound independence affect substance use behaviors among Palestinian medical and health sciences students. In total, 7.7% of the students reported using illicit drugs. Hallucinogens were the most commonly used drugs (2.9%), followed by central nervous system (CNS) stimulants (2.4%) and CNS depressants (1.4%), while 4.4% were using nonprescribed antidepressants, with Fluoxetine being the most used. Most drug users (72.4%) started using before they enrolled in university, and 39.5% did not realize the potential harm of these drugs. Medical students tend to use these substances less frequently than their non-medical peers. The study indicated that exam-related stress was a crucial factor in the prevalence of drug use and misuse. Peer pressure, academic, psychological, and family pressures were other primary reasons behind drug use. The study’s results indicated that the misuse of antidepressant medications and other licit and illicit substances is highly prevalent among Palestinian medical and non-medical students. The results also underscore the importance of raising awareness about drug use and providing students with accurate information about the safe use of these substances.

Factors associated with receptive injection equipment sharing among people who inject drugs: findings from a multistate study at the start of the COVID-19 pandemic

BackgroundReceptive injection equipment sharing (i.e., injecting with syringes, cookers, rinse water previously used by another person) plays a central role in the transmission of infectious diseases (e.g., HIV, viral hepatitis) among people who inject drugs. Better understanding these behaviors in the context of COVID-19 may afford insights about potential intervention opportunities in future health crises.ObjectiveThis study examines factors associated with receptive injection equipment sharing among people who inject drugs in the context of COVID-19.MethodsFrom August 2020 to January 2021, people who inject drugs were recruited from 22 substance use disorder treatment programs and harm reduction service providers in nine states and the District of Columbia to complete a survey that ascertained how the COVID-19 pandemic affected substance use behaviors. We used logistic regression to identify factors associated with people who inject drugs having recently engaged in receptive injection equipment sharing.ResultsOne in four people who inject drugs in our sample reported having engaged in receptive injection equipment sharing in the past month. Factors associated with greater odds of receptive injection equipment sharing included: having a high school education or equivalent (adjusted odds ratio [aOR] = 2.14, 95% confidence interval [95% CI] 1.24, 3.69), experiencing hunger at least weekly (aOR = 1.89, 95% CI 1.01, 3.56), and number of drugs injected (aOR = 1.15, 95% CI 1.02, 1.30). Older age (aOR = 0.97, 95% CI 0.94, 1.00) and living in a non-metropolitan area (aOR = 0.43, 95% CI 0.18, 1.02) were marginally associated with decreased odds of receptive injection equipment sharing.ConclusionsReceptive injection equipment sharing was relatively common among our sample during the early months of the COVID-19 pandemic. Our findings contribute to existing literature that examines receptive injection equipment sharing by demonstrating that this behavior was associated with factors identified in similar research that occurred before COVID. Eliminating high-risk injection practices among people who inject drugs requires investments in low-threshold and evidence-based services that ensure persons have access to sterile injection equipment.

Evaluating substance use outcomes of recreational cannabis legalization using a unique co-twin control design

ABSTRACT Background: As more states pass recreational cannabis legalization (RCL), we must understand how RCL affects substance use. Objectives: The current study aims to examine the effect of RCL on lifetime and past-year use of cannabis, alcohol, tobacco, and other drugs, frequency of cannabis, alcohol, and tobacco use, co-use of cannabis with alcohol and tobacco, and consequences from cannabis and alcohol use. Methods: We used a unique, co-twin control design of twin pairs who were discordant for living in a state with RCL between 2018 and 2021. The sample consisted of 3,830 adult twins (41% male), including 232 twin pairs discordant for RCL. Problems from alcohol and cannabis use were assessed via the Brief Marijuana Consequences Questionnaire and the Brief Young Adult Alcohol Consequences Questionnaire. Results: Results indicated that the twin living in an RCL state was more likely to endorse past-year cannabis use (OR = 1.56, p = .009), greater number of cannabis use days in the past 6 months (β = 0.47, p = .019), but not more negative consequences from cannabis use (β = 0.21, p = .456) compared to their co-twin in a non-RCL state. There were no differences within-twin pairs in frequency of alcohol use (β=-0.05, p = .601), but the RCL twin reported fewer negative consequences from alcohol use (β=-0.29, p = .016) compared to their co-twin in a non-RCL state. We did not observe any other differences within-twin pairs on other outcomes. Conclusion: These results suggest that living in an RCL state is associated with greater cannabis frequency but not more negative consequences from cannabis use than living in a non-RCL state.

Tobacco, Alcohol, Cannabis, and Other Drug Use in the US Before and During the Early Phase of the COVID-19 Pandemic

Information about national substance use trends among youths and adults after mid-March 2020 is limited due to constraints on surveillance during the COVID-19 pandemic. To evaluate whether substance use prevalence in the early part of the pandemic (2020) differed from the prepandemic periods of 2018 to 2019 and 2016 to 2018. This cross-sectional study was a repeated analysis of 2016 to 2020 data from a nationally representative sample of youths and adults in the Population Assessment of Tobacco and Health (PATH) Study. Participants were representative of the US civilian noninstitutionalized population. Household residents age 13 years or older were interviewed in person from 2016 to 2019 and via telephone in 2020. Age, calendar year. Past 30-day self-reported use of any tobacco, any alcohol, binge drinking, cannabis, and any other illegal or misused prescription drugs. The overall nationally representative 2020 sample included 7129 youths (ages 13-17 years), 3628 young adults (ages 18-20 years), and 8874 adults (ages ≥21 years). Comparing 2018 to 2019 with 2020 among youths, prevalence of all substances used declined (eg, cannabis use declined in those aged 16-17 years from 14.9% to 7.6%; absolute difference, -7.3 percentage points [95% CI -8.8 to -5.8 percentage points]). Among young adults, prevalence of all substances other than any alcohol decreased significantly (eg, tobacco use declined from 37.8% to 22.8%; absolute difference, -15.1 percentage points [95% CI -16.8 to -13.3 percentage points]). In adults ages 21 to 24 years, any tobacco use declined from 39.0% to 30.9% (absolute difference, -8.2 percentage points [95% CI, -10.6 to -5.7 percentage points]), and alcohol use increased from 60.2% to 65.2% (absolute difference, 5.0 percentage points [95% CI, 2.3 to 7.7 percentage points]). Among adults aged 25 years or older, any tobacco use declined from 39.0% to 30.9% (absolute difference, -8.2 percentage points [95% CI, -10.6 to -5.7 percentage points]), cannabis use increased from 11.3% to 12.4% (absolute difference, 1.2 percentage points [95% CI, 0.3 to 2.0 percentage points]), and other substance use declined from 5.8% to 3.7% (absolute difference, -2.1 percentage points [95% CI, -2.9 to -1.4 percentage points]). In this cross-sectional study, substance use decreased between 2019 and 2020 among those aged 13 to 20 years; consistent declines were not seen in older persons other than tobacco use reductions, and cannabis use increased among adults ages 25 years and older. While social changes during the COVID-19 pandemic could have affected substance use, findings should be interpreted with caution due to differences in data collection methods in 2016 to 2019 and 2020.

Substance use disorder treatment and technology access among people who use drugs in rural areas of the United States: A cross-sectional survey.

To evaluate how technology access affected substance use disorder (SUD) treatment prior to COVID-19 for people who use drugs in rural areas. The Rural Opioid Initiative (January 2018-March 2020) was a cross-sectional study of people with prior 30-day injection drug or nonprescribed opioid use from rural areas of 10 states. Using multivariable mixed-effect regression models, we examined associations between participant technology access and SUD treatment. Of 3,026 participants, 71% used heroin and 76% used methamphetamine. Thirty-five percent had no cell phone and 10% had no prior 30-day internet use. Having both a cell phone and the internet was associated with increased days of medication for opioid use disorder (MOUD) use (aIRR 1.29 [95% CI 1.11-1.52]) and a higher likelihood of SUD counseling in the prior 30 days (aOR 1.28 [95% CI 1.05-1.57]). Lack of cell phone was associated with decreased days of MOUD (aIRR 0.77 [95% CI 0.66-0.91]) and a lower likelihood of prior 30-day SUD counseling (aOR 0.77 [95% CI 0.62-0.94]). Expanding US rural SUD treatment engagement via telemedicine may require increased cell phone and mobile network access.

Effect of COVID-19 Lockdown on Substance Use Among Middle School and High School Students: A Natural Experiment.

Research on COVID-19's effect on substance use is mixed, and few studies have focused on adolescents. We assessed whether implementation of the COVID-19 lockdown affected substance use and changed perceptions of psychoactive substance availability in middle and high school students. We assessed self-reported use and perceived availability of alcohol, tobacco cigarettes, electronic cigarettes, marijuana, synthetic marijuana, nonprescribed prescription drugs, and illicit drugs (heroin, inhalants) among middle and high school respondents aged 11-18 years to the Rhode Island Student Survey (N = 17 751). An administrative pause because of COVID-19 lockdowns allowed us to divide results into surveys completed before (January through March 2020; n = 13 259) and after (November 2020 through May 2021; n = 4492) the lockdown implementation. We determined the effects of the COVID-19 lockdown using logistic regression models, adjusting for age, gender/sexual orientation, middle/high school level, and city/town classification. After the COVID-19 lockdown implementation, the odds of respondents using psychoactive substances decreased, with the largest decreases occurring for prescription drugs (odds ratio [OR] = 0.39; 95% CI, 0.28-0.54) and inhalants (OR = 0.37; 95% CI, 0.26-0.53). The odds of respondents perceiving difficulties in obtaining psychoactive substances significantly increased after lockdown implementation, with the largest increases occurring for prescription drugs (OR = 1.53; 95% CI, 1.39-1.69) and illicit drugs (OR = 1.65; 95% CI, 1.44-1.88). COVID-19 lockdown implementation was associated with a decreased perception of availability of psychoactive substances and use of psychoactive substances. Decreases in substance use may be because of decreased perceived availability and increased parental support and oversight. Interventions that focus on parental oversight and strengthened policies to disrupt the licit and illicit drug markets are needed.

Self-control, peers, and adolescent substance use: an international analysis

Background Adolescent substance use continues to be a global concern. Research has shown that two consistent predictors of this behavior are self-control and peer substance use. The objective of this study was to determine if these two variables interact to affect the frequency of substance use among young people. Methods The analysis utilized three years of data from the Second International Self-Report Delinquency study (2005-2007) (ISRD-2), which gathered information from youth, ages 12-17, residing in 30 nations (n = 72,206). Illicit substance use included cannabis, ecstasy, stimulants, and other substances. A zero-inflated negative binomial model that adjusts for selection effects was estimated to predict the frequency of substance use. Results The results showed that adolescents with low self-control who associated with substance using peers tended to be the most frequent substance users. Yet, youth with higher levels of selfcontrol were likely to report no or low frequency use regardless of the number of their friends who used illicit substances. Conclusions Self-control affects substance use among adolescents and can attenuate the influence of peer substance use. Research using longitudinal data is needed to disentangle changes in self-control, peer substance use, and one’s own substance use.

Exposure to state violence and substance use

We analyze whether exposure to state violence affects substance use at the individual level. In doing so, we bring together the political science and public health literatures on the effects of violence, analyzing an outcome that is neglected in political science and a type of violence that remains understudied in public health. We leverage a unique panel study, the Population Council’s Survey of Young People in Egypt (SYPE), to test whether rates of substance use are higher among those who were exposed to violence during the country’s 2011 revolution, a moment of intense state violence against civilians. Results demonstrate that direct exposure to state violence increases substance use; respondents exposed to violence are significantly more likely to use drugs, alcohol, and tobacco than those who were not. Our findings are robust to specifications that control for respondents’ reported exposure to state violence prior to the revolution and substance use among family and friends, factors identified in medical research as key predictors. Our study sheds light on a fundamental predicament of authoritarian governance and the downstream effects of state violence.

Comparison of Stimulant-Related Presentations to Victorian Emergency Departments Pre-pandemic and During the COVID-19 Pandemic.

IntroductionVictoria, Australia, holds the unenviable record for the longest number of lockdown days in the world (262 days) and some of the most rigid restrictions. The purpose of this study was to determine whether changes in harmful drug use occurred during the pandemic by comparing stimulant-related presentations to Victorian emergency departments before and during the COVID-19 pandemic.MethodsA retrospective analysis of data from the Victorian Injury Surveillance Unit was undertaken for two time periods, March 2019 to September 2019 and March 2020 to September 2020.ResultsThe proportion of people presenting to an ED who used methylamphetamine/methamphetamine/amphetamine significantly increased from 2019 to 2020. Conversely, there was a significant reduction in ED presentations among people who used 3,4-methylenedioxy​methamphetamine (MDMA) and ecstasy during the study period.ConclusionsCOVID-19-related restrictions can affect mental health due to depression, or anxiety, particularly if people also experience loss of employment and income. In addition, mental health issues may affect substance use, including increased frequency of use and dose. This has implications for policy and planning during a pandemic and may be overlooked as the focus is on planning and resources for patients with COVID-19.

Cognitions mediate the influence of personality on adolescent cannabis use initiation

AimsMuch research indicates that an individual’s personality impacts the initiation and escalation of substance use and problems in youth. The acquired-preparedness model suggests that personality influences substance use by modifying learning about substances, which then affects substance use. The current study used longitudinal data to test whether automatic cannabis-related cognitions (memory associations and outcome expectancy liking) mediate the relationship between four personality traits with later cannabis use. MethodsThe study focused on initiation of use in a sample of adolescents who had not previously used (n = 670). ResultsA structural equation model supported a full mediation effect and the hypothesis that personality affects cannabis use in youth by influencing automatic memory associations and outcome expectancy liking. Further findings from the same model also indicated a mediation effect of these cognitions in the relationship between age and cannabis use. ConclusionThe findings of the study support the acquired-preparedness model where personality influences automatic associations in the context of dual-processing theories of substance use.

Social relationships, homelessness, and substance use among emergency department patients

Background: Emergency department (ED) patients commonly experience both substance use and homelessness, and social relationships impact each in varied ways not fully captured by existing quantitative research. This qualitative study examines how social relationships can precipitate or ameliorate homelessness and the connection (if any) between substance use and social relationships among ED patients experiencing homelessness. Methods: As part of a broader study to develop ED-based homelessness prevention interventions, we conducted in-depth interviews with 25 ED patients who used alcohol or drugs and had recently become homeless. We asked patients about the relationship between their substance use and homelessness. Interviews were recorded, transcribed, and coded line-by-line by investigators. Final codes formed the basis for thematic analysis through consensus discussions. Results: Social relationships emerged as focal points for understanding the four major themes related to the intersection of homelessness and substance use: (1) Substance use can create strain in relationships; (2) Help is there until it’s not; (3) Social relationships can create challenges contributing to substance use; and (4) Reciprocal relationship of substance use and isolation. Sub-themes were also identified and described. Conclusions: The association between substance use and homelessness is multifaceted and social relationships are a complex factor linking the two. Social relationships are often critical for homelessness prevention, but they are impacted by and reciprocally affect substance use. ED-based substance use interventions should consider the high prevalence of homelessness and the impact of social relationships on the interaction between homelessness and substance use.

Impacts of changes in alcohol consumption patterns during the first 2020 COVID-19 restrictions for people with and without mental health and neurodevelopmental conditions: A cross sectional study in 13 countries.

BackgroundThe initial period of COVID-19-related restrictions affected substance use in some population groups. We explored how changes in alcohol use at the beginning of the pandemic impacted the health and wellbeing of people with and without mental health and neurodevelopmental conditions (MHDCs).MethodsData came from the Global Drug Survey Special Edition on COVID-19 conducted in May-June 2020. Measured were; changes in drinking compared to February 2020 (pre-COVID-19 restrictions), reasons for changes, and impact on physical health, mental health, relationships, finances, work/study, and enjoyment. This study included 38,141 respondents (median age = 32 IQR 25-45; 51.9% cis man; 47.8% cis woman; 1.2% trans/non-binary; 30.2% with MHDCs e.g. depression 20.0%, anxiety 16.3%, ADHD 3.8%, PTSD 3.3%).ResultsA third (35.3%) of respondents with MHDCs and 17.8% without MHDCs indicated that increased drinking affected their mental health negatively (p<.001); 44.2% of respondents with MHDCS compared to 32.6% without MHDCs said it affected their physical health negatively (p<.001). Reduced drinking was associated with better mental health among a fifth (21.1%) of respondents with MHDCS and 14.4% without MHDCs (p<.001). Age, relationship status, living arrangements, employment, coping and distress were significant predictors of increases in drinking.ConclusionAmong people with MHDCS, reduced alcohol consumption was associated with better mental health, while the negative effects of increased drinking were more pronounced when compared to people without MHDCS. When supporting people in reducing alcohol consumption during uncertain times, people with MHDCS may need additional support, alongside those experiencing greater levels of distress.

Cannabis sales increases during COVID-19: Findings from Alaska, Colorado, Oregon, and Washington.

Following emergency declarations related to COVID-19 in the United States, many states issued stay-at-home orders and designated essential business categories. Most states allowed medical and/or non-medical adult-use cannabis retailers to remain open. This study assesses changes in cannabis sales across Alaska, Colorado, Oregon, and Washington before and during the pandemic. Pre-tax sales data from cannabis marketplaces in four states were analyzed to identify trends from January 2018-December 2020. Mean monthly sales and relative percent change in mean monthly sales were compared by state from April-December (coinciding with the pandemic) in 2018, 2019, and 2020. Differences were assessed using the nonparametric Mann-Whitney-U test. Mean monthly cannabis sales in all four states were higher during the pandemic period in 2020 compared to the same period in 2019. Sales reached a three-year peak in Washington in May 2020 and in Alaska, Colorado, and Oregon in July 2020. From April-December, the percent change in mean monthly sales from 2019 to 2020 was significantly higher than 2018-2019 in all four states, though Alaska saw similar increases between 2018-2019 and 2019-2020. To date, cannabis sales in Alaska, Colorado, Oregon, and Washington have increased more during the COVID-19 pandemic than in the previous two years. In light of these increases, data monitoring by states and CDC is warranted to understand how patterns of use are changing, which populations are demonstrating changes in use, and how such changes may affect substance use and related public health outcomes.