The effects of the coronavirus disease 2019 pandemic on the risk of youth substance use.

There is little doubt that coronavirus disease 2019 is wreaking havoc on the lives of people across the globe and straining the public’s physical and mental health and social and financial security.

The pandemic has brought incalculable suffering to many families in terms of stress, economic devastation, severe illness, and loss of life. Even for those less hard hit, family life has been completely upended—schools are closed, socializing is limited, and many parents are juggling childcare with working from home or are out of work. It is safe to assume that many young people are experiencing significant hardship during this time because of social isolation, overexposure to family members who may be unsupportive or even abusive, lack of athletics and other healthy outlets, broken ties to school and community supports, and severe restrictions on the much-needed freedom to express independence and take healthy risks.

There is good reason to believe that substance use risk and consequences among adults are increasing because of the pandemic [[1]]. The effects on youth, however, are less obvious. Although the pandemic might very well increase substance use as a means of coping, self-medication, or even social enhancement in vulnerable children, the full effects of the pandemic on youth substance use might not be all negative [[2],[3]]. Although it is difficult and even somewhat unseemly to look for a possible bright side to this crisis, it is important to examine the totality of its effects on young people.

Certain conditions or “factors” are known to increase the risk of unhealthy behaviors in youth, whereas others serve to protect them, even in the face of considerable challenges. A reduction in some well-documented risk factors for substance use undoubtedly has taken place during this period, potentially benefiting some youth by reducing their likelihood of initiating substance use. The virtually universal stay-at-home orders that have closed schools throughout the country and the social distancing measures instituted in many states have increased the time that young people are spending with family while decreasing time spent in the physical company of peers. This presents an opportunity to test some of the core principles of effective substance use prevention.

For example, decades of research have shown that children and teens benefit from more time spent with their parents, whether by having meals together, engaging in shared activities, or having more opportunities for open communication [[4]]. At the same time, despite it being developmentally appropriate for children to increase their reliance on peers as they age, time spent with peers who engage in unhealthy behaviors is one of the strongest risk factors for substance use [[5]]. School also presents challenging academic and social pressures that leave many young people feeling stressed and anxious. For children whose home is not an adverse environment, remote learning has allowed many to be relieved of this stress. It also has alleviated the persistent state of sleep deprivation driven by early school start times, which undermine adolescents’ natural circadian rhythms and increase their risk of poor mental health outcomes and substance use [[6]].

Another significant risk factor for youth substance use is easy to access to nicotine, alcohol, and drugs [[7]]. Stay-at-home orders have made it difficult to go shopping or receive illicit online orders in the mail without parents’ knowledge. That, along with reduced time spent with peers, have likely reduced young people’s access to substances. At the same time, it is important to acknowledge that, even as they have become less accessible outside of the home, increases in mental health and substance use problems among adults due to the pandemic might make addictive substances more accessible to youth in some homes, as might more relaxed parental rules around youth substance use within the home [[3]].

The most consistent research finding with regard to youth substance use, however, is that the earlier a child initiates substance use, the higher the likelihood of developing substance-related problems and addiction later in life [[8]]. There is little debate that early adolescence represents a period of especially heightened vulnerability to substances and their consequences, due in large part to their effects on the developing brain [[9]]. Therefore, preventing or delaying the onset of substance use is a primary objective in prevention science and implementation. In the course of each year, millions of young people try or use substances for the first time. In 2018 alone, an estimated 2.4 million adolescents used alcohol, 1.3 million used marijuana, 571,000 smoked a cigarette, 308,000 used inhalants, 310,000 misused prescription opioids, 234,000 used hallucinogens, 215,000 misused prescription tranquilizers, 181,000 misused prescription stimulants, 36,000 misused prescription sedatives, 74,000 used cocaine, 31,000 used methamphetamine, and 7,000 used heroin for the first time in their lives [[10]].

Young people spending more time at home and away from peers typically means having higher levels of parental supervision, fewer opportunities for impulsive behavior, and less access to nicotine, alcohol, and drugs. It is reasonable to assume that for some adolescents—especially younger ones—the initiation of substance use that may have occurred under normal circumstances has been delayed during these months of social distancing. Such delays would be expected to reduce the odds of future addiction among these youth.

Exploring the nuanced ramifications of the coronavirus disease 2019 crisis for young people can further our understanding of substance use risk and protection and how any potential benefits might be extended once normal life resumes. Such research has begun in Canada, where the virus is getting under control [[3]]; similar efforts should be taken to evaluate substance use risk and protection among youth in the U.S. and other countries where the trajectory of the pandemic is much more uncertain. As we learn more about the relative risks and protections, we must target interventions to capitalize on the fortuitous protective factors while addressing the inevitable risk factors wrought by this pandemic.

Journal of Adolescent Health. 2020. doi: 10.1016/j.jadohealth.2020.07.014.