Substance use behaviours and COVID

This resource is for clinical and non-clinical professionals who work with young people. It may also be helpful for families, carers, friends or other close supports of young people.

It is designed to help people understand how substance use behaviours may have changed during the COVID-19 pandemic restrictions and lockdowns and how these changes in behaviours may affect young people, both during and after lockdown. It can also be used as an aid to open conversations with young people about their substance use behaviours and staying safe during the COVID-19 pandemic.

This tip sheet will cover:

the COVID-19 pandemic and some of its effects on the way society works;
how drug and alcohol behaviours appear to have changed during lockdown;
the implications that these changes in drug and alcohol use may have for young people during and after lockdown;
harm-reduction tips for young people;
how to start a conversation with a young person about their substance use behaviours and well-being; and
where a young person and their family or close supports can find help.

WHAT IS THE CHALLENGE?

Most of us have had to change our lifestyles and behaviours recently to help stop the spread of the COVID-19 pandemic. In many parts of Australia, and indeed the world, people have been living in various forms of restrictions and lockdown – that is, sets of rules that reduce people’s movements and social contact and, thus, their potential to carry and spread the virus.(1-5) For some young people, the COVID-19-related restrictions and lockdowns have led to some big life changes and increased instability or uncertainty. For example, many young people are having to learn remotely, are unable to work or are not able to see family or friends in person. The COVID-19 pandemic is a new and unique challenge, and so are the measures being used to contain it.(5) This means that we have not yet had enough time to fully study and understand all the possible effects of the pandemic, and its associated restrictions, on young people. In particular, recent data have emerged that point to potential changes in substance use behaviours in Australia during lockdown. It is important to understand what these changes are, as they may have implications for young people both in the present and as lockdowns and restrictions are eased.

HOW DOES SUBSTANCE USE CHANGE IN LOCKDOWN?

Substance use in Australia started to look a little different during COVID-19 lockdowns. Although researchers have not yet produced a strong, gold-standard evidence base, emerging reports provide us with a rough snapshot. The nationwide Australians’ drug use: adapting to pandemic threats (ADAPT) study(6) and the Alcohol and Drug Foundation(7) have highlighted some patterns. Based on this data, it appears that in people over the age of 18 years who use drugs:

alcohol and cannabis use may have increased; • MDMA, cocaine and ketamine use may have decreased;
heroin use may have decreased;
use of pharmaceutical opioids, GHB, benzodiazepines, tobacco, e-cigarettes, and LSD appear to have remained relatively stable;
young people were the most likely group to report increased alcohol consumption during lockdown;
approximately 28 per cent of young people reported wanting to reduce
their alcohol intake; and
Australians who increased their alcohol consumption during lockdown were likely to continue to consume alcohol at elevated levels after restrictions eased.

WHAT DOES THIS MEAN?

Changes in a young person’s substance use behaviours can affect their safety and their mental and physical health. Some points to consider when working with young people who may have changed the way they use substances include:

Changed substance use patterns do not necessarily mean reduced substance use overall. For example, while a young person may report decreased use of stimulants, such as MDMA or cocaine, they may have increased their use of cannabis or alcohol. It is important to get the whole story from a young person and their family or close supports.
Increased use of any substance, including alcohol or cannabis, during lockdown may have flow-on effects for a young person’s physical and mental health. In one study, for example, increased alcohol consumption during lockdown was associated with decreased exercise, increased unhealthy eating and changed sleep patterns.(7)
Changes in substance use will lead to changes in a young person’s biology. For example, reduced use of particular substances during lockdown may reduce a young person’s tolerance of those substances. This means that if they return to previous habits after lockdown, the doses they were used to taking previously without issues may suddenly present a high risk of overdose, no matter how frequently they were used before.
Habits formed during lockdown may persist after it. It is important to identify changes in substance use patterns early, before they become entrenched.
It may be important to assess how young people are obtaining and using drugs during and after lockdown. Physical contact with friends or others who supply drugs, using drugs with others (including sharing equipment), and handling drug packages and cash may present a COVID-19 transmission risk.
Using things that involve frequent contact between the hands or equipment and the face, such as vaping (e-cigarettes), may elevate the risk of exposure to COVID-19.(8)
Changes in the global landscape and economy due to COVID-19 may have interfered with supply chains (for example, ingredients, ingredient quality, etc.), potentially changing the strength and impurities present in drugs. This means that a substance and dose that a young person is used to taking may not have the same effects during or after lockdown. It may also be liable to change again as the pandemic stabilises, meaning doses that were previously tolerated during lockdown or restrictions may suddenly become very unsafe at any point.

HOW CAN YOUNG PEOPLE STAY AS SAFE AS POSSIBLE?

Most people who participated in the ADAPT study(6) reported they were using at least one harm-reduction behaviour when using substances in lockdown (for example, washing hands). However, 30 per cent reported engaging in no harm-reduction behaviour. This, however, may be an under-representation of the number of people in the general population who are not employing harm-reduction behaviours because the ADAPT sample was disproportionately highly educated and lived in capital cities. This highlights a need to ensure that young people are provided with as much knowledge about harm reduction as possible while using substances during and after lockdown, as this can reduce the potential harms of their drug use.

HARM REDUCTION TIPS FOR YOUNG PEOPLE

Harm reduction tips for young people include:

Wash or sanitise your hands before and after handling drugs, cash or equipment.
Wash or wipe down drug packages and cash with disinfectant wipes, soap or sanitiser.
Sanitise equipment, such as vapes, frequently – especially the mouthpiece.
Avoid physical contact with dealers or groups of friends – make sure you follow social distancing guidelines.
Prepare drugs yourself – for example, rolling your own joints, etc.
Avoid sharing equipment – for example, bongs, vaping devices, etc.
Avoid sharing drugs – for example, passing joints, etc.
Avoid touching parts of equipment that come into contact with the mouth
– for example, vape mouthpieces.
Avoid touching your face with your hands at all times, but in particular while using things like e-cigarettes or bongs.
Be aware that your tolerance may have changed substantially if your use of a particular substance has changed.
Be aware that your usual dose of a particular drug may have unpredictable effects every time that drug is taken because of changes to the supply chain; this may be the case long after lockdown is lifted or restrictions are eased.

HOW DO I TALK TO YOUNG PEOPLE ABOUT THIS?

It is always a good idea to regularly check-in with young people about their drug and alcohol use, if and how it may be changing, and how it might be affecting them. This is especially the case when a young person is experiencing uncertain circumstances or big life changes, such as those that may accompany COVID-19-related lockdowns or restrictions.

You may like to ask the young people you work with or care for some of the following questions:

How are you coping with all the changes going on at the moment?
How do you feel these changes are affecting the way you are using drugs or alcohol?
Is anything different about the way you are using drugs or alcohol lately? Are you using more or less of anything?
How do you feel about these changes in the way you are using drugs or alcohol?
Why do you think the way you use drugs or alcohol has changed?
Have these changes affected how you feel in general?

If you’re a clinician speaking to a young person about their substance use, try to
link the conversation to an intervention. This may involve giving advice and agreeing to follow up about it at your next session, using a motivational approach or brief intervention if you are familiar with these, or referring the young person to a drug and alcohol support service. For further information on motivational approaches and brief interventions in a youth drug and alcohol context, see the ‘Related
resources’ section below.

If you’re a family member or close support speaking to a young person about their substance use and you are concerned, you can refer them to an online or in-person treatment service. The Alcohol and Drug Foundation provides resources that can help start the conversation about drugs and alcohol with young people.

For a list of some of the services that both clinicians and family members or close supports can refer a young person to, see the section, ‘Where can young
people find help?’.

Where can young PEOPLE FIND HELP?

There are a number of free and confidential services in Australia that offer help to young people who are struggling with drugs or alcohol. If a young person you work
with would like to access help for their substance use behaviours, you can suggest a service that you know of and are comfortable with, or any of the services included in
this section.

IN AN EMERGENCY

If a young person is in immediate danger, they should contact emergency services immediately and directly on 000.

YOUTH DRUG AND ALCOHOL ADVICE SERVICE (YODAA)/h4>

Youth Drug and Alcohol Advice service (YoDAA) is a one-stop, multichannel service offering youth drug and alcohol information and advice and referrals for young people, their families and teachers. Its website offers a suite of resources for young people and those who care for them. The website also offers one-on-one advice and referrals via web chat, phone, or email.

1800 458 685
[email protected]
www.yodaa.org.au/

FAMILY DRUG SUPPORT AUSTRALIA

Family Drug Support Australia is an Australia-wide service for families of people using drugs and alcohol. It provides a 24/7 telephone support line, as well as support groups, education programs and counselling for families. It also provides access
to an online program to help families deal with their loved ones’ drug and alcohol use in a way that strengthens relationships and achieves positive outcomes.

1300 368 186
www.fds.org.au/family-drugsupport-australia

YOUTH SUPPORT AND ADVOCACY SERVICE (YSAS)

YSAS provides drug and alcohol support to young people aged 12–21 years. It provides day programs, outreach, home-based support, inpatient support and rehabilitation, supported accommodation and specialist programs. It also provides
resources for young people, their families and professionals.

www.ysas.org.au/

NATIONAL ALCOHOL AND OTHER DRUG HOTLINE

The National Alcohol and Other Drug Hotline is an Australia-wide service that will automatically direct a young person to the alcohol and drug information service in
their state or territory for free and confidential advice.

1800 250 015

DIRECTLINE

Directline is a free, 24/7 service that offers confidential alcohol and drug counselling in Victoria.

1800 888 236
www.directline.org.au/

REACHOUT

ReachOut is an online mental health organisation that provides self-help resources, a peer support program and forums, and referral tools for young people and their families.

https://au.reachout.com/tough-times/addiction

HEADSPACE

headspace provides free and confidential support for young people aged 12–25 years and their families and close supports. It provides support online, over the
phone, and in person.

1800 650 890
headspace.org.au/eheadspace/

KIDS HELPLINE

Kids Helpline offers free counselling to people up to the age of 25 years via phone, online or via web chat.

1800 55 1800
www.kidshelpline.com.au/

LIFELINE

Lifeline offers free counselling via phone, text or web chat.

13 11 14
www.lifeline.org.au/

COUNSELLING ONLINE

Counselling Online offers free and confidential, 24/7 support to people across Australia affected by alcohol or drug use. It offers direct support via web chat, email
and peer support forums. It also offers a range of self-help and selfassessment
tools, and motivational SMS programs. For phone support, the Counselling Online website lists telephone numbers for each state: https://www.counsellingonline.org.au/how-we-can-help

THE DAYBREAK APP

Health service Hello Sunday Morning’s Daybreak app is a free and confidential app. It is available in Australia on Android, Apple and PC. It is designed to help people change their relationship with alcohol and provides access to professional coaches, an anonymous supportive community, activities and exercises, and resources.

hellosundaymorning.org/daybreak/

Download these tips

References:

1. Lau H, Khosrawipour V, Kocbach P, Mikolajczyk A,
Schubert J, Bania J, et al. The positive impact of
lockdown in Wuhan on containing the COVID-19 outbreak
in China. Journal of travel medicine. 2020;27(3):1-7.

2. Khanna RC, Cicinelli MV, Gilbert SS, Honavar SG,
Murthy GS. COVID-19 pandemic: Lessons learned and
future directions. Indian Journal of Ophthalmology.
2020;68(5):703-10.

3. Andrews D. Statement on changes to Melbourne’s
restrictions Melbourne, Victoria, Australia: Victoria State
Government; 2020 [updated 2 August 2020. Available
from: https://www.premier.vic.gov.au/statementchanges-
melbournes-restrictions.

4. Lippi G, Henry BM, Bovo C, Sanchis-Gomar F. Health risks
and potential remedies during prolonged lockdowns
for coronavirus disease 2019 (COVID-19). Diagnosis.
2020;7(2):85-90.

5. Hsiang S, Allen D, Annan-Phan S, Bell K, Bolliger I, Chong
T, et al. The effect of large-scale anti-contagion policies
on the COVID-19 pandemic. Nature. 2020;2020(June):1-
24.

6. Key findings from the ‘Australians’ drug use: adapting to
pandemic threats’ (ADAPT) study. Australia: Australians’
drug use: adapting to pandemic threats (ADAPT) study;
2020.

7. Foundation AaD. Kantar Poll Data (July 22-23, 2020).
Australia: Australian Government Department of Helath,
Foundation AaD; 2020.

8. Gaiha SM, Cheng J, Halpern-Felsher B. Association
Between Youth Smoking, Electronic Cigarette Use, and
Coronavirus Disease 2019. Journal of Adolescent Health.
2020;In press:1-5.

For young people and families