COVID-19’s Impact on Substance Use and Well-Being of Younger Adult Cannabis Users in California: A Mixed Methods Inquiry

• Published date: 01 April 2022
• Author: Ekaterina V. Fedorova,Ellen Iverson,Stephen E. Lankenau,Carolyn F. Wong,Janna Ataiants,Bridgid M. Conn
• DOI: 10.1177/00220426211052673
• Date: 01 April 2022
• Subject Matter: Articles

Article

Journal of Drug Issues

2022, Vol. 52(2) 207–224

© The Author(s) 2021

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DOI: 10.1177/00220426211052673

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COVID-19’s Impact on

Substance Use and Well-Being

of Younger Adult Cannabis

Users in California: A Mixed

Methods Inquiry

Ekaterina V. Fedorova

1

, Carolyn F. Wong

2,3,4

,

Bridgid M. Conn

2,3

, Janna Ataiants

1

, Ellen Iverson

2,3

, and

Stephen E. Lankenau

1

Abstract

Few qualitative studies have examined the impact of COVID-19 on cannabis and alcohol use, and

overall well-being among cannabis users. Cannabis users (aged 26-32) were surveyed quanti-

tatively (n=158) and interviewed qualitatively (n=29) in April 2020–May 2021 in Los Angeles.

63.3% of the quantitative sample reported increasing use of either cannabis (29.1%) or alcohol

(15.2%) or both (19.0%) following the COVID-19 outbreak. Qualitative data revealed that in-

creases in cannabis and alcohol use were largely attributed to changes in employment and sta ying

at home resulting in fewer impediments and boredom. Themes of loneliness and utilization of

various coping strategies were more pronounced among those who increased cannabis and/or

alcohol use. For some, increases in cannabis/alcohol use were temporary until participants

adjusted to “a new normal”or embraced more adaptive coping strategies. Results suggest

monitoring cannabis/alcohol use trends and identifying coping strategies to reduce the pandemic’s

impact on substance use and mental health.

Keywords

COVID-19, cannabis, alcohol, young adults, loneliness, social isolation, qualitative, mixed

methods

1

Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, Philadelphia, PA,

United States

2

Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States

3

Division of Adolescent Medicine, Children’s Hospital Los Angeles, Los Angeles, CA, United States

4

Division of Research on Children, Youth, & Families, Children’s Hospital Los Angeles, Los Angeles, CA, United States

Corresponding Author:

Ekaterina V. Fedorova, Department of Community Health and Prevention, Dornsife School of Public Health, Drexel

University, 3215 Market Street, Philadelphia, PA 19104, United States.

Email: evf26@drexel.edu

Introduction

The COVID-19 pandemic caused a total of 225 million cases and over 4 million deaths worldwide

with over 41 million cases and 662,000 deaths in the U.S. alone as of late 2021 (CSSE, 2021).

Safer-at-home orders and social isolation requirements were implemented in the U.S. in response

to the COVID-19 pandemic with the goals of curbing the spread of the virus and reducing

mortality rates starting in March 2020 (Moreland et al., 2020). This unprecedented move led to a

number of unintended consequences, including heightened stressful experiences bordering on

trauma (e.g., intense or incessant fear of contracting the virus or infecting others, uncertainty about

the future) (Brooks et al., 2020;Dumas et al., 2020;Kwai & Peltier, 2021;Vidot et al., 2021) and

increased daily stressors (e.g., unemployment, loss of structure, boredom, loneliness, and de-

pression) (Bochicchio et al., 2021;Killgore et al., 2020;McKay & Asmundson, 2020;Rajkumar,

2020). In line with the self-medication hypothesis (Khantzian, 1997), increases in substance use to

manage COVID-19-related stressors were expected (McKay & Asmundson, 2020). Previous

research on major population-level disasters and crises, including the SARS outbreak in 2003,

indicates that substances are frequently used to cope with elevated levels of stress months and even

years after a traumatic event to deal with its lingering impact on mental health ( Boscarino et al.,

2011;Gonçalves et al., 2020;North et al., 2011;Vetter et al., 2008;Walsh et al., 2014).

In the context of the COVID-19 pandemic, cannabis use, smoking or vaping in particular, is of

concern given increased vulnerability of contracting the virus and risk of more severe disease

progression due to often compromised immune and respiratory systems (Wei & Shah, 2020). Thus

far, several studies have investigated the impact of COVID-19 on cannabis and alcohol use within

the general population (Vanderbruggen et al., 2020), adolescents (Dumas et al., 2020), adult

cannabis users (Boehnke et al., 2020;Cousijn et al., 2021;van Laar et al., 2020;Vidot et al., 2021),

alcohol users (Rodriguez et al., 2020), and young adult cannabis and alcohol users (Bartel et al.,

2020;White et al., 2020), which have shown increases in frequency and quantity of cannabis and

alcohol use. Only two studies were conducted among young adults (aged 18–25 years) (Bartel

et al., 2020;White et al., 2020) who have the highest rates of cannabis and alcohol use compared to

other age groups (SAMHSA, 2020). COVID-19-related factors contributing to increased cannabis

and alcohol use included unemployment, boredom, reduced opportunities for leisure activities,

COVID-19 anxiety, depression, loneliness, and younger age (Bartel et al., 2020;Boehnke et al.,

2020;Cousijn et al., 2021;Dumas et al., 2020;van Laar et al., 2020;Vanderbruggen et al., 2020).

Moreover, young adults aged 18–24 years were found to be particularly vulnerable to the effects of

the pandemic, reporting the highest rates of mental health disorders, suicidal thoughts, and

substance use to cope with pandemic-related stress (Czeisler et al., 2020). During the pandemic,

transition into adult roles (e.g., self-actualization in career; building relationships and family) was

interrupted for many young adults due to social isolation requirements, school closures, and rising

unemployment rates while also increasing risk of substance use within this population (Arnett,

2000;Kwai & Peltier, 2021;Schulenberg et al., 2008). Easy access to alcohol and cannabis due to

their legality across many locations within and outside of the U.S. (i.e., alcohol outlets and medical

cannabis dispensaries were deemed essential businesses during lockdown) is an additional reason

for these increases (Booker, 2020;Levin, 2020;McKay & Asmundson, 2020;NABCA, 2021).

Furthermore, spikes in substance use may be even more pronounced among medical cannabis

users (Boehnke et al., 2020;Vidot et al., 2021). Previous research reported that mental health

problems (i.e., anxiety, depression) were the most common reasons for medical cannabis use

(Lankenau et al., 2017a;Walsh et al., 2013). As a result, the COVID-19 pandemic may exacerbate

these conditions which could lead to subsequent increases in cannabis, and, potentially, other

substance use (Boehnke et al., 2020;Vidot et al., 2021).

208 Journal of Drug Issues 52(2)