Pandemic-related stressors and

changes in substance use among

young adults in Washington State
AN ANALYSIS OF A STATEWIDE SURVEY DATA FROM
THE FALL OF 2020

Daniela Acuna, Katarina Guttmannova, Charles Fleming,

Jason Kilmer, Isaac Rhew, Rachel Cooper,
Brittney Hultgren, Mary Larimer
Supported by National Institute on Drug Abuse grant
R01DA047996 (PI: K. Guttmannova) and
the Division of Behavioral Health and Recovery,
Washington State Health Care Authority
contract 1265-62496 (PI: J. R. Kilmer).

My views do not necessarily represent the views of the National Institute

on Drug Abuse, the Washington State Health Care Authority, or the
University of Washington
Research Questions

1) Did young adult alcohol and cannabis use change in

Washington state during the stay-at-home period in
2020?
• Did these changes differ by age and sex?
2) How common were COVID pandemic-related
stressors in 2020?
• Did prevalence of stressors differ by age and sex?
3) Were pandemic-related stressors associated with
changes in substance use?
Rationale

• The COVID-19 pandemic has disrupted young

adults’ (YA) lives in numerous ways
• Young adults show higher reported anxiety
and depression compared to other age
groups
 Indicators of anxiety or depression based on reported frequency of
symptoms in last 7 days
UNITED STATES DATA

Symptoms of Anxiety Disorder Symptoms of Depressive Disorder

60%

Source: National Center for Health Statistics w/Census Bureau, Household Pulse Survey
50%

40%

30%

20%

10%

0%

8/ 20
9/ 18

1/ /5
5/ 5 /5

6/ 6 /2

7/ /14

2/ /1
3/ 3 /1

9/ 16

3/ /7
14
5/ 19

6/ /16

7/ 30

4/ /29

5/ /26

Br 6/9 4
2

Br 1/2 /9

/2 7

1/ 13
/
9/ 9/1

k : 6/2

9/ 9/1
/2
10 0/1

12 0/1
11

k : -12

-2

-2
/

2/
7/
/

8/

3/
2-
-

-
-8
7
-5

-6

-6

-3

-4

-5
23

28

20

17

26
9-

2-

4-

1-

2-
8-

6-
-1

-1

-1
14

11

25

17

14

12
5
22

7/
30

/2

29

/1
4/

12
1
k:

ea
ea

ea

2020 2021 2022

Br
 Indicators of anxiety or depression based on reported frequency of
symptoms in last 7 days
(Nationwide: 18-29 year olds only)

Symptoms of Anxiety Disorder Symptoms of Depressive Disorder

60%
Source: National Center for Health Statistics w/Census Bureau, Household Pulse Survey
50%

40%

30%

20%

10%

0%

8/ 20
9/ 18

1/ /5
5/ 5 /5

6/ 6 /2

7/ /14

2/ /1
3/ 3 /1

9/ 16

3/ /7
14
5/ 19

6/ /16

7/ 30

4/ /29

5/ /26

Br 6/9 4
2

Br 1/2 /9

/2 7

1/ 13
/
9/ 9/1

k : 6/2

9/ 9/1
/2
10 0/1

12 0/1
11

k : -12

-2

-2
/

2/
7/
/

8/

3/
2-
-

-
-8
7
-5

-6

-6

-3

-4

-5
23

28

20

17

26
9-

2-

4-

1-

2-
8-

6-
-1

-1

-1
14

11

25

17

14

12
5
22

7/
30

/2

29

/1
4/

12
1
k:

ea

2022
ea

ea

2020 2021
Br
Rationale

• Young adulthood is a time of transitions and critical

development, which was disrupted by the pandemic
• Young adults show elevated risk for misuse of
substances such as alcohol and cannabis compared
to other age groups
• Interested in differences between those under and
over 21 considering legal access to cannabis and
alcohol in WA
• Also interested in differences between females and males
Washington Young Adult Health Survey

• Funded by Washington State Healthcare

Authority
• Cohorts of statewide samples of young adults in
Washington (ages 18–25) every year since 2014
• Two recruitment sources
• Mailing letters to a randomized list of Washingtonians
from the WA State Department of Licensing (DOL)
• Reaching young adults online through social media
advertising
• Cohorts are followed longitudinally
• This study focuses only on the 2020 cohort
2020 Cohort

• Participants for the 2020 cohort were recruited in

October – December 2020
• 1,643 participants
1) Did young adult alcohol and cannabis
use change in Washington state during
the stay-at-home period in 2020?
 Changes in Alcohol Use After Stay-At-Home Period

Reported Changes in Alcohol Frequency* Reported Changes in Alcohol Quantity*

50% 50% 47%

40% 35%
40%
% reported

29%
30% 30%

21%
20% 17% 20% 16%
14% 14%

10% 10%
5%
2%
0% 0%
A lot less Less often About the More A lot more A lot less Less About the More A lot more
often same often often same

*Excludes those who said they don’t use alcohol (n = 1581, original n = 1643)
 Changes in Cannabis Use After Stay-At-Home Period

Reported Changes in Cannabis Frequency*

50%
53%

40%
35%
% reported

30% 27%

20% 18%
11%
9%
10%

0%
A lot less often Less often About the same More often A lot more often

*Excludes those who said they don’t use cannabis

(n = 868, original n = 1643)
 Reported changes in substance use based on Age

Alcohol Frequency Alcohol Quantity Cannabis Frequency

100% 100% 100%

80% 80% 80%

% reported

60% 60% 60%

40% 40% 40%

20% 20% 20%

0% 0% 0%
Less About More Less About the More Less often About the More
often the same often same same often
18-20 21-25 18-20 21-25 18-20 21-25
 Reported changes in substance use based on Sex

Alcohol Frequency Alcohol Quantity Cannabis Frequency

100% 100% 100%

80% 80% 80%

% reported

60% 60% 60%

40% 40% 40%

20% 20% 20%
0% 0% 0%
Less About More Less About the More Less About More
often the same often same often the same often
Female Male Female Male Female Male
2) How common were COVID
pandemic-related stressors in 2020?
 Prevalence of pandemic-related stressors
Reported occurrences of pandemic-related stressors
50% 44%
42%
40% 36%
33% 33%
30%
% reported

30%
22%
20%

10%
4%
0%
Event Losing work* Increasing College plans Trouble Living Trouble Loss of a
cancelled work* changed accessing situation paying bills loved one
healthcare changed

n = 1,643
*Losing work: reduced hours, laid off, or lost job
*Increasing work: more hours, new job, or an additional job
 Prevalence of pandemic-related stressors based on Age

Reported occurrences of pandemic-related stressors by Age

50%

40%
% reported

30%

20%

10%

0%
Losing work Increasing Canceled Change in Loss of loved Change in Paying bills Trouble
work event college plans one living accessing
situation healthcare
Age 18 - 20 Age 21 - 25
 Prevalence of pandemic-related stressors based on Sex

Reported occurrences of pandemic-related stressors by Sex

50%

40%
% reported

30%

20%

10%

0%
Losing work Increasing Canceled Change in Loss of loved Change in Paying bills Trouble
work event college plans one living situation accessing
healthcare
Female Male
3) Were pandemic-related
stressors associated with
changes in substance use?
Changes in substance use based on stressor

Associations between changes in alcohol frequency and stressors

1.42*
Healthcare
1.57*
Paying bills
0.83
Living situation
1.53
Loved one
1.00
College plans change
1.13
Event canceled

0.88
New job or more hours
1.15
Job loss or less hours

0 1 2 3
Odds Ratio
*statistically significant
Changes in substance use based on stressor

Associations between changes in alcohol quantity and stressors

1.14
Healthcare
1.47*
Paying bills
0.62*
Living situation
1.31
Loved one
0.95
College plans change
0.82
Event canceled

0.88
New job or more hours
1.35*
Job loss or less hours

0 1 2 3
Odds Ratio

*statistically significant
Changes in substance use based on stressor

Associations between changes in cannabis frequency and stressors

1.58*
Healthcare
1.58*
Paying bills
0.93
Living situation

1.06
Loved one

1.09
College plans change

1.31
Event canceled

1.03
New job or more hours

1.31
Job loss or less hours

0 1 2 3
*statistically significant Odds Ratio
Discussion

Research Question 1
• Substance use changed with the onset of the pandemic,
and more than half of those who use substances
reporting change in use
• Higher proportions of young adults reported using cannabis
more frequently than alcohol (53% vs. 34%)
• 31% reported using alcohol in lesser quantities
• Those over 21+ were more likely to report increased
substance use in all categories
Discussion

Research Question 2
• Half of the sample experienced at least one stressor
• Women and those 21+ were more likely to report stressors
Research Question 3
• Financial stress, trouble accessing healthcare, having an
event cancelled, losing a loved one and job loss were
positively associated with increased substance use across
all categories
• Change in living situation was negatively associated with
change in alcohol quantity
Discussion

• Findings consistent with other community and

college samples
• e.g. White et al., 2020; Jaffe et al., 2022
• Prevention Screening and Intervention
• Check in With Yourself (Lee, 2020)
• Brief Personalized Feedback Intervention
Future Research

• Will be important to look at reported SU both

cross sectionally and longitudinally at later
time points in the pandemic
• Will discuss differences in stressors and
substance use for the general YA population in
WA based on:
• race and ethnicity, sexual/gender minority status,
college status and living situation
Special Thanks
Charlie Fleming M.A., Katarina Guttmannova Ph.D., Brittney
Hultgren Ph.D., Jason Kilmer Ph.D., and everyone else who
helped me with this presentation