Balancing Competing Priorities: Preventing Substance Misuse during COVID-19

During the COVID-19 pandemic, alcohol has been deemed an “essential” commodity. Restrictions on alcohol delivery and Internet sales have loosened dramatically. Takeout and outdoor alcohol consumption have become widespread. Some of these changes are intended to provide economic relief to alcohol-related businesses, others to reduce COVID-19 risk, and others to reduce the burden on an over-taxed health care system. All are fueled by the widespread social norm that substance use is a reasonable coping strategy.

The consequences of these policy decisions are alarming. According to a recent study from the Journal of the American Medical Association, adults aged 30–80 reported drinking 14% more frequently during the pandemic than during the previous year. Women are drinking more frequently and more heavily. More people are also drinking during the day and by themselves, where they are more likely to use alcohol in dangerous ways. These changing patterns of use lay the groundwork for long-term substance use problems.

Recognizing that there are no easy solutions, here are some suggestions for mitigating the effects of harmful policies and shaping new ones that support healthy outcomes:

• Engage stakeholders with diverse perspectives in policy decisions. This will help us anticipate the potential ramifications of new policies and develop a more informed path forward. If we continue to operate in silos and focus exclusively on short-term needs, we will continue to play “whack-a-mole,” tackling one problem just in time to see a new problem appear.
• Think comprehensively. For example, Maryland legislators recently proposed increasing its alcohol excise tax from 9% to 10% to raise revenue for the health disparities laid bare by COVID-19. This strategy will both reduce alcohol use and address the harmful impact of loosening alcohol restrictions.
• Embrace harm reduction approaches. For example, Massachusetts issued mandatory safety standards requiring restaurants to serve food with alcohol during COVID-19. While this mandate may not prevent patrons from developing substance misuse disorders, it may prevent them from becoming intoxicated and engaging in COVID-related risk behaviors, such as not wearing a mask or not maintaining physical distancing.
• Provide alternatives. If we’re going to encourage adults not to use alcohol or other mood-altering substances, we need to provide alternatives to help people cope with stress. We also need to address the normalization of unhealthy coping strategies. The Suicide Prevention Resource Center has compiled a variety of resources that address these issues. 

While reversing recent policy changes may seem impossible, we have a responsibility to stay in the game—to engage our communities in challenging conversations and to advocate for prevention in the face of competing demands and priorities.

m.adler-blogpost.png	Melanie Adler has spent more than 20 years writing about behavioral change and the impact of prevention strategies on public health.
c.goddard-blogpost.png	Chelsey Goddard is a public health and prevention specialist with a deep commitment to behavioral health equity.