On the rise or a return to pre-pandemic levels? A cross-sectional online survey on nicotine, alcohol, and illicit drug use among youth

Following the World Health Organization’s declaration of the novel coronavirus SARS-CoV 2 (COVID-19) as a pandemic in March 2020, numerous government-mandated restrictions (e.g., lockdowns, contact restriction, remote schooling) were implemented as preventive measures to curb infection rates [19]. These had unprecedented ramifications on day-to-day life and, subsequently, on the mental health of children and adolescents [10, 22, 23, 34]. Stay-at-home orders and the increased time spent at home instead of with peers seemingly disrupted youths’ development [17].

Several studies have shown changes in adolescent alcohol, nicotine, and illicit drug use since the start of the pandemic; however, findings have largely been inconclusive. Perceived social isolation during the pandemic has been described as being related to substance use in adults [4, 27]. A study reported that approximately one-fourth of respondents (24%) expressed feelings of isolation and uncertainty about where to find support, while almost half of the participating students (47%) claimed that their levels of stress and anxiety had been adversely impacted by the pandemic.

In a study by Romano et al. [24], 12% of students reported using cigarettes, alcohol, or cannabis specifically as a coping mechanism for COVID-19-related changes. Higher self-reported levels of stress predicted increased cigarette and e‑cigarette use during the pandemic in youth and young adults [6].

Even though the perceived availability of nicotine products, alcohol, and cannabis declined during the pandemic, self-reported prevalence did not [18]. For cannabis, however, findings were inconsistent [5, 6].

Substance use among adolescents and young adults is a major public health concern. Young people’s brains are still developing, making them more vulnerable to the negative effects of drug, alcohol, and nicotine use. The heightened reactivity to the release of dopamine within the mesolimbic system combined with an elevated likelihood of engaging in risky consumption behavior due to synaptic pruning makes them particularly vulnerable to addictive behaviors. The consumption of psychotropic substances has a disproportionately harmful impact on the physical well-being as well as on the development of adolescents compared with adults. Many behaviors—both adaptive and maladaptive (e.g., addictive behavior)—are established early in life. Research suggests that the age at which regular consumption is initiated is crucial to the severity of the consequences [25, 32].

While systematic reviews reported a tendency of declining or unchanged use of nicotine, e‑cigarettes, alcohol, and cannabis during the pandemic [15, 34], some studies have shown an increase in substance use, especially of “downers” (e.g., opiates, benzodiazepines), during the pandemic [29, 33]. The aim of the current study was to investigate whether and to what extent substance use has changed in the general population of youth.

An anonymous online survey was conducted from March to May 2023 using the platform SoSci Survey [16]. The survey included questions about recent and lifetime use of psychotropic substances, using questions from the 2018 HBSC (Health Behaviour in School-aged Children; [11]) and the 2019 ESPAD (European School Survey Project on Alcohol and Other Drugs; [13]) surveys. It further included questions pertaining retrospectively to substance use throughout the pandemic and screening measures for problematic substance use. Participants were required to provide informed consent prior to the start of the survey. There was no financial or other compensation for participation. The study procedure and questionnaire were approved by the Ethics Committee of the Medical University of Vienna (EK 1211/2023).

A total of 502 participants between the ages of 14 and 24 completed the survey, 60% were female and the average age was M = 19.96 years (SD = 2.63; Table 1). Of the respondents, 26.1% were high school students, 17.9% apprentices, 47.4% university students, 6% employees, 0.8% were unemployed, and 0.8% indicated that their current occupation was not listed among the options. Missing data were common and especially prevalent in the HSI questionnaire (n = 389) and CAST questionnaire (n = 399).

The objective of the current study was to assess the current and past prevalence of substance use and to retrospectively explore changes in substance use patterns in adolescents and young adults in the course of the COVID-19 pandemic.

In line with previous research [3, 15, 34], our results show declined use in a community-based sample compared with before the pandemic. However, over time, there was a trend of returning to pre-pandemic levels. Post hoc analyses indicated that there only were significant changes in alcohol consumption at two consecutive time points: from spring 2020 to summer 2020 (p < 0.001, d = 0.15) and from spring 2021 to summer 2021 (p < 0.001, d = 0.20). However, there were no changes in nicotine and illicit drug use when evaluating consecutive time periods. One reason for the increase in alcohol consumption during summer might be its prevalence at social events. Almost half of the participants stated that alcohol makes social gatherings more entertaining. Due to school holidays, vacations, and the relaxation of lockdown measures there may have been an increased number of opportunities for such events. These results are in line with Benschop et al. [2], who identified having fewer social occasions than “pre-corona” as the most important reason for decreased substance use.

Our findings suggest that the COVID-19 pandemic did not lead to an overall increase in the prevalence of substance use. However, some subgroups might have increased their use during this period. Youth who scored above the cutoff on screening measures increased their substance use more significantly during the pandemic than those who scored below the cutoff. These participants reported a higher frequency of substance use than participants who scored below the cutoff at all time points (Fig. 4). A clinically significant difference between the consumption frequency of the two groups was identified only for alcohol, F(4.09, 1300.28) = 2.46, p = 0.04, but not for nicotine, F(3.02, 585.98) = 2.47, p = 0.06, and illicit drugs, F(3.77, 568.87) = 2.06, p = 0.09.

Despite an overall decline in consumption during the analysis period, adolescents exhibiting conspicuous consumption patterns did not experience a comparable decrease. Youths who scored above the designated cutoff on screening measures showed a greater increase in substance use during the pandemic compared with those who scored below the cutoff. While the subgroup who scored above the cutoff consistently demonstrated a higher frequency of substance use at all time points, only the differences in alcohol consumption were statistically significant, F(4.09, 1300.28) = 2.46, p = 0.04. Both nicotine, F(3.02, 585.98) = 2.47, p = 0.06, and illicit drugs, F(3.77, 568.87) = 2.06, p = 0.09, did not show statistical significance. The data do not provide sufficient evidence to draw conclusions about the causes of this consumption behavior. However, previous studies support the hypothesis that the COVID-19 pandemic measures might have disproportionately impacted certain subgroups. This specific increase in at-risk groups is attributed to familial issues [21], pandemic-related stress [5], socioeconomic challenges [21], and social isolation [3]. Additionally, the pandemic might have contributed to an increase in solitary consumption [8], which is linked to factors such as increased alcohol consumption, social discomfort, and negative affect [26].

Furthermore, the data suggest differences in usage patterns between the two age categories (14–18 and 19–24). Throughout most of the observed assessments, the cohort comprising young adults demonstrated a higher frequency of consumption compared to their adolescent counterparts. Notably, there was a gradual decrease over time in the discrepancy in consumption rates between the two groups. Although there was a notable disparity in consumption patterns during the summer of 2020, adolescents and young adults showed a more similar profile for cigarettes and alcohol during the summer of 2022.

In this study, we conducted a cross-sectional online survey to investigate changes in nicotine, alcohol, and illicit drug use among youth during the COVID-19 pandemic. Our findings indicated a trend of declining or stable substance use during the initial years of the pandemic, followed by a return to pre-pandemic levels or even an increase in the third year. Adolescents exhibited a more pronounced increase in substance use compared with young adults. Those who scored above the cutoff for problematic substance use on screening measures showed a greater increase in cigarette and illicit drug, but not alcohol use. Increased alcohol consumption during lockdowns was associated with a higher likelihood of problematic alcohol and cannabis use. Moreover, participants who reported increased usage of one psychotropic substance during lockdowns were more likely to have increased their use of other substances as well. While the pandemic seemed to result in initial decreases in substance use, especially during lockdown periods, the subsequent return to pre-pandemic levels or even higher use suggests that the impact of the pandemic on youth substance use is complex and multifaceted. These findings underscore the importance of continued monitoring of substance use trends among young people and the need for targeted interventions for specific subgroups, particularly those with pre-existing problematic substance use or mental health issues.

It is crucial for policymakers, educators, and healthcare professionals to recognize the potential impact of prolonged periods of isolation, stress, and disrupted routines on youth substance use behaviors. Prevention strategies and interventions should consider the dynamic nature of substance use patterns and the interplay between substance use, mental health, and social factors. As the world navigates the post-pandemic phase, these insights can inform the development of effective measures to mitigate the potential negative consequences of substance use among adolescents and young adults. Additionally, further research using longitudinal designs and face-to-face interviews will be valuable in obtaining a more comprehensive understanding of the complex relationship between the pandemic and youth substance use.