While our understanding of the psychosocial impacts of the pandemic remains limited as would be expected of an externality that is constantly changing, there is clear evidence that the rates of substance use among adults in the time of the coronavirus pandemic are increasing (Spagnolo et al, 2020). Increased use of alcohol has been reported and, more ominously, there are indicators and concerns about the increased morbidity and mortality associated with use of opioids and, in particular, fentanyl.
Less is known about the impact of the pandemic in teenagers who in most communities, have, along with the rest of society have been affected by social distancing and various quarantine orders (Richter, 2020). While the limitations placed by the pandemic may increase parental observation, other risks increase including increased exposure to virtual platforms of all sorts and more pervasive contact and exposure to family, with both positive and negative impacts.
Dumas, Ellis and Litt have explored post-Covid use patterns in adolescents in Canada and they report that teens continue to use in social settings (including in person, in virtual interactions, as well as alone). They have further reported that there are increasing rates of alcohol and marijuana consumption, solitary use that seems correlated with increased fear about the pandemic, and an increase exposure to parental substance use as well as an increase in substance use with parents (Dumas et al., 2020). More research is needed in the United States, however, substance use patterns are likely shifting in similar ways, and, as a significant element of the stress occurring from the pandemic, adolescent substance abuse needs to be on healthcare providers’ radar as a significant challenges for our youth.
What can be done in the primary care setting? As with all risk factors and behavioral issues that can be impacted through encounters with primary care providers, inquiring about and showing concern for risk behaviors can have positive impact. So minimally, in contacts with teens and their parents, and especially important in these times, it is good to ask about substances and seek to identify both those at risk and those already in potential trouble. The act of inquiring (regardless of one’s level of suspicion about a particular patient) and having a brief discussion(s) about the risks and dangers of substance use can be quite beneficial – for the patient, for the parent and, as a piece of public health messaging, for their peers.
More formally, use of screening tools can be an important augmentation of such inquiries and educational discussions. The CRAFFT (Car, Relax, Alone, Forget, Friends, Trouble) is an effective evidence-based screening tool for youth 12-21. Having patients and families complete the screening in itself highlights the health concern with substance use and a positive finding can present a meaningful segue to begin a discussion about the need for further intervention. http://crafft.org/
A referral for therapy is a good place to start. For families with commercial health insurance, a referral to a SUD counselor or a generalist mental health therapist will have some experience in providing evidence -supported interventions for substance use, including motivational interviewing and as needed potential referral for more intensive services. The County of San Diego has multiple programs for the MediCal and the uninsured population, that provide substance abuse interventions, ranging from early intervention activities on to more intensive programs for those with moderate and severe substance abuse challenges.
Regardless of the referrals and interventions made, follow up on patients with substance use issues in the primary care setting is warranted—whether as part of an active monitoring program (i.e., lab testing for ongoing use) or simply as a reinforce of the on ongoing potential health concern.
San Diego County Adolescent Substance Abuse Resources: https://www.sandiegocounty.gov/content/dam/sdc/hhsa/programs/bhs/homepage/BHS_SUD_Brochures/BHS%20AOD%20Adolescent%2008-01-17_FINAL.pdf
National Institute on Alcohol Abuse and Alcoholism: https://www.niaaa.nih.gov/
Substance Abuse and Mental Health Services Administration: https://www.samhsa.gov/find-treatment
Smartcare: http://www.smartcarebhcs.org/ :
Dumas, T. M., Ellis, W., & Litt, D. M. (2020). What Does Adolescent Substance Use Look Like During the COVID-19 Pandemic? Examining Changes in Frequency, Social Contexts, and Pandemic-Related Predictors. Journal of Adolescent Health, 67(3), 354–361. https://doi.org/10.1016/j.jadohealth.2020.06.018
Richter, L. (2020). The Effects of the COVID-19 Pandemic on the Risk of Youth Substance Use. Journal of Adolescent Health, 67(4), 467–468. https://doi.org/10.1016/j.jadohealth.2020.07.014
Spagnolo, P., Montemitro, C., & Leggio, L. (2020). New Challenges in Addiction Medicine: COVID-19 Infection in Patients With Alcohol and Substance Use Disorders—The Perfect Storm. American Journal of Psychiatry, appi.ajp.2020.2. https://doi.org/10.1176/appi.ajp.2020.20040417