key: cord-0812081-8ufnrq22
authors: Maggs, Jennifer L.
title: Adolescent Life in the Early Days of the Pandemic: Less and More Substance Use
date: 2020-07-13
journal: J Adolesc Health
DOI: 10.1016/j.jadohealth.2020.06.021
sha: ee28782173cb8318a18f29bbf9dda37afe70f157
doc_id: 812081
cord_uid: 8ufnrq22

nan

Everyone needed to stay home, except for essential workers. Physically attending school was no longer essential. Staying inside with parents, siblings, or whoever was theredand no longer seeing friends, teachers, coaches, counselors, grandparents, or other supportive adultsdbecame the new normal.

In this context, Dumas and colleagues' paper [4] on substance use among 14-to 18-year-old adolescents before and after the emergency stay-at-home order in Ontario is fascinating. How did adolescents respond to the abrupt end to the pursuits and pleasures of their daily lives? Specifically, how did their alcohol use, binge drinking, cannabis use, and vaping change in the first few weeks at home?

Notably, the number of 14-to 18-year old adolescents in this sample who used substances was significantly lower post shutdown, with a 1/5 to 2/5 reduction in the percent who binge drank, used cannabis, and vaped. There was no change (and no increase) in the number who used alcohol. Adolescent and young adult substance use is volatile and opportunistic [5] . Most research on situational variations in substance use focuses on event-specific occasions when use and abuse spikes, for example, weekends or holidays such as Spring Break [5, 6] . Although Dumas et al.'s work identifies an ebb, rather than a flow, in substance use, their finding of fewer users overall similarly highlights the importance of immediate context in providing opportunity and reward for substance use.

Conversely, among those who did use substances, the number of days of alcohol and cannabis use increased. Popularity and reputational worries about social distancing together predicted use of specific substances in specific contexts, as did depression and COVID-19 fears. These findings shed light on two motivations for substance use: social enhancement and coping. The authors interpret findings regarding links of popularity and reputationrelated fears with substance use as reflecting normative social motivations, consistent with prior work [7] . Given the social function of (or at least the context of most) adolescent substance use [2, 8] , it makes sense that one fourth to one third of substance users reported having done so with peers in person, online, and/or shared via social media, even during the pandemic.

Regarding coping motivations for substance use, the results highlight solitary drinking as greater among youth with more depressive symptoms and COVID-19 concerns. Using substances to regulate affect is less common than to enhance social experiences [7, 8] , but under these challenging conditions (e.g., forced solitude, health, and dystopian fears), a subset showed a pattern consistent with coping-related use. Solitary substance use is unlikely to help, and this group is more vulnerable because of feelings of depression and anxiety.

Future research will examine explanations for and longer term impacts of the shutdown. Three possible hypotheses for impact on substance use are increased heterogeneity, simple opportunity, and exceptional thinking. First, widening achievement gaps because of extended time away from traditional schools are already a significant concern being debated in returnto-school costebenefit discussions [3]. The same increased heterogeneity or exacerbation of prior tendencies in substance use and mental health may occur. Consistent with this concern, in this study, although fewer adolescents used substances during the early weeks of the shutdown, those who did so reported using substances more often than before.

Second, studies with more intensive data collection may focus on changes in opportunities to use substances. Many peer contexts where substances might be available or consumed were curtailed. Perhaps as a result, cannabis use, vaping, and binge Disclaimer: The content is solely the responsibility of the author and does not necessarily represent the official views of the National Institutes of Health.

www.jahonline.org drinkingdall behaviors parents tend to disapprove of for teensd decreased. However, family members had greater stress and altered routines, and parents may have been using more substances, particularly alcohol, themselves. [9] Older siblings may have facilitated teens' use by being home, legally purchasing products, or needing a companion during their own isolation [10] . How use patterns change when opportunity structures are further altered remains to be seen.

Finally, the finding that alcohol use was higher with parents post shutdown may suggest that parents viewed the pandemic period as exceptional, that is, challenging, nonprecedent setting, and generating needs for compromises and treats. COVID-19e related risks of adolescents rebelling and sneaking out may have seemed greater than risks of some relaxing of the rules, particularly if parents viewed the acute risks of substance use (e.g., injury and risky sex) as low with supervised home use [11] . The authors note that continued parent permissiveness is a risk, predicting, for example, faster escalations to heavier drinking [12] . Ongoing longitudinal studies should examine longer term sequelae of shutdowns, including exceptional permissiveness in other domains (e.g., screen time, sleeping, and eating patterns).

Finally, in the study by Dumas and colleagues [4] , during the first 3 weeks at home, 8% of girls and 14% of boys used substances in the presence of peers (22% and 32% of substance users, respectively). This noncompliance with stay-at-home orders combined with illegal (i.e., underage) substance use is potentially very harmful, as the authors highlight. However, the vast majority did not report these behaviors, despite likely loneliness, anxiety, boredom, family conflict, and worse [1, 3] . Adolescents' solidarity with the demands of a public health emergency deserves the positive attention of parents, professionals, and the media, along with our support.

J.L.M. was supported by award R01AA025331 from the National Institute on Alcohol Abuse and Alcoholism.

A future for the world's children? A WHOeUNICEFeLancet Commission

A developmental perspective on alcohol and youths 16 to 20 years of age

What does adolescent substance use look like during the COVID-19 pandemic? Examining changes in frequency, social contexts and pandemic-related predictors

Ups and downs of alcohol use among firstyear college students: Number of drinks, heavy drinking, and stumble and pass out drinking days

How many versus how much: 52 weeks of alcohol consumption in emerging adults

Motivational models of substance use: A review of theory and research on motives for using alcohol, marijuana, and tobacco

Adolescent substance use

COVID-19 and increased alcohol consumption: NANOS Poll Summary Report

Similarities and differences in adolescent siblings' alcohol-related attitudes, use, and delinquency: Evidence for convergent and divergent influence processes

Parents who allow early adolescents to drink

Parents allowing drinking is associated with adolescents' heavy alcohol use

Jennifer L. Maggs, Ph.D.

Pennsylvania State University University Park, Pennsylvania