BACKGROUND: SARS-CoV-2 reached Europe in early 2020 and disrupted the private and public life of its citizens, with potential implications for substance use. The objective of this study was to describe possible changes in substance use in the first months of the SARS-CoV-2 pandemic in Europe. METHODS: Data were obtained from a cross-sectional online survey of 36,538 adult substance users from 21 European countries conducted between April 24 and July 22 of 2020. Self-perceived changes in substance use were measured by asking respondents whether their use had decreased (slightly or substantially), increased (slightly or substantially), or not changed during the past month. The survey covered alcohol (frequency, quantity, and heavy episodic drinking occasions), tobacco, cannabis, and other illicit drug use. Sample weighted data were descriptively analysed and compared across substances. RESULTS: Across all countries, use of all substances remained unchanged for around half of the respondents, while the remainder reported either a decrease or increase in their substance use. For alcohol use, overall, a larger proportion of respondents indicated a decrease than those reporting an increase. In contrast, more respondents reported increases in their tobacco and cannabis use during the previous month compared to those reporting decreased use. No distinct direction of change was reported for other substance use. CONCLUSIONS: Our findings suggest changes in use of alcohol, tobacco and cannabis during the initial months of the pandemic in several European countries. This study offers initial insights into changes in substance use. Other data sources, such as sales statistics, should be used to corroborate these preliminary findings.

1 M Sechenov 1st Moscow State Medical University Trubetskaya Street 8 b 2 Moscow Russian Federation 119991

1st Faculty of Medicine and General Teaching Hospital Prague Department of Addiction Charles University Apolinarska 4 128 00 Prague 2 Czech Republic

Alcohol Research Group Public Health Institute 6001 Shellmound Street Suite 450 Emeryville CA 94608 USA

Campbell Family Mental Health Research Institute Centre for Addiction and Mental Health 33 Russell Street Toronto Ontario M5S 3M1 Canada

Center for Interdisciplinary Addiction Research Martinistraße 52 20246 Hamburg Germany

Centre for Alcohol and Drug Research Aarhus University Tuborgvej 160 2400 Copenhagen NV Denmark

Clínic Foundation for Biomedical Research 08036 Barcelona Spain

Clinical Addictions Research Group Psychiatry Department Neurosciences Institute Hospital Clínic University of Barcelona 08036 Barcelona Spain

Dalla Lana School of Public Health University of Toronto 155 College Street Toronto Ontario M5T 1P8 Canada

Department of Psychiatry Medical Faculty University of Leipzig Semmelweisstraße 10 04103 Leipzig Germany

Department of Psychiatry University of Toronto 250 College Street 8th floor Toronto Ontario M5T 1R8 Canada

Faculty of Medicine Institute of Medical Science University of Toronto Medical Sciences Building 1 King's College Circle Room 2374 Toronto Ontario M5S 1A8 Canada

Health Promotion Department of Public Health University of Southern Denmark Niels Bohrs Vej 9 DK 6700 Esbjerg Denmark

Institut d'Investigacions Biomèdiques August Pi i Sunyer 08036 Barcelona Spain

Institute for Mental Health Policy Research Centre for Addiction and Mental Health 33 Ursula Franklin Street Toronto Ontario M5S 2S1 Canada

Institute of Biometry and Clinical Epidemiology Charité Universitätsmedizin Berlin Charitéplatz 1 10117 Berlin Germany

Institute of Clinical Psychology and Psychotherapy Technische Universität Dresden Chemnitzer Str 46 01187 Dresden Germany

Norwegian Institute of Public Health Dept of Alcohol Tobacco and Drugs N 0213 Oslo Norway

Population Health Sciences Institute Newcastle University Baddiley Clark Building Newcastle Upon Tyne NE2 4AX UK

WHO European Office for the Prevention and Control of Noncommunicable Diseases 9 Leontyevsky Pereulok Moscow Russian Federation 125009

Zobrazit více v PubMed

Meier PS, Warde A, Holmes J. All drinking is not equal: how a social practice theory lens could enhance public health research on alcohol and other health behaviours. Addiction. 2018;113(2):206–213. doi: 10.1111/add.13895. PubMed DOI

Rehm J, Kilian C, Ferreira-Borges C, Jernigan D, Monteiro M, Parry CDH, Sanchez ZM, Manthey J. Alcohol use in times of the COVID 19: implications for monitoring and policy. Drug Alcohol Rev. 2020;39(4):301–304. doi: 10.1111/dar.13074. PubMed DOI PMC

Callinan S, MacLean S. COVID-19 makes a stronger research focus on home drinking more important than ever. Drug Alcohol Rev. 2020;39(6):613–615. doi: 10.1111/dar.13125. PubMed DOI PMC

Du J, Fan N, Zhao M, Hao W, Liu T, Lu L, et al. Expert consensus on the prevention and treatment of substance use and addictive behaviour-related disorders during the COVID-19 pandemic. Gen Psychiatr. 2020;33(4):e100252. doi: 10.1136/gpsych-2020-100252. PubMed DOI PMC

Patwardhan P. COVID-19: Risk of increase in smoking rates among England’s 6 million smokers and relapse among England’s 11 million ex-smokers. BJGP Open. 2020;4(2):bjgpopen20X101067. doi: 10.3399/bjgpopen20X101067. PubMed DOI PMC

García-Álvarez L, LDL F-T, Sáiz PA, García-Portilla MP, Bobes J. ¿Se observarán cambios en el consumo de alcohol y tabaco durante el confinamiento por COVID-19? 2020. 2020;32(2):5. PubMed

de Goeij MC, Suhrcke M, Toffolutti V, van de Mheen D, Schoenmakers TM, Kunst AE. How economic crises affect alcohol consumption and alcohol-related health problems: a realist systematic review. Soc Sci Med. 2015;131:1 31–46. https://www.journals.elsevier.com/social-science-and-medicine. PubMed

Pierce M, Hope H, Ford T, Hatch S, Hotopf M, John A, et al. Mental health before and during the COVID-19 pandemic: a longitudinal probability sample survey of the UK population. The Lancet Psychiatry. 2020;7(10):883-92. PubMed PMC

Shanahan L, Steinhoff A, Bechtiger L, Murray AL, Nivette A, Hepp U, et al. Emotional distress in young adults during the COVID-19 pandemic: evidence of risk and resilience from a longitudinal cohort study. Psychol Med. 2020:1–10. 10.1017/S003329172000241X. PubMed PMC

Bommele J, Hopman P, Walters BH, Geboers C, Croes E, Fong GT, et al. The double-edged relationship between COVID-19 stress and smoking: implications for smoking cessation. Tob Induc Dis. 2020;18:63. doi: 10.18332/tid/125580. PubMed DOI PMC

Rolland B, Haesebaert F, Zante E, Benyamina A, Haesebaert J, Franck N. Global changes and factors of increase in caloric/salty food intake, screen use, and substance use during the early COVID-19 containment phase in the general population in France: survey study. JMIR Public Health Surveill. 2020;6(3):e19630. doi: 10.2196/19630. PubMed DOI PMC

Stanton R, To QG, Khalesi S, Williams SL, Alley SJ, Thwaite TL, et al. Depression, Anxiety and Stress during COVID-19: Associations with Changes in Physical Activity, Sleep, Tobacco and Alcohol Use in Australian Adults. Int J Environ Res Public Health. 2020;17(11):4065. PubMed PMC

SICAD . Comportamentos Aditivos em Tempos de COVID-19 / Álcool. Alguns resultados. 2020.

Galea S, Nandi A, Vlahov D. The social epidemiology of substance use. Epidemiol Rev. 2004;26(1):36–52. doi: 10.1093/epirev/mxh007. PubMed DOI

World Health Organization . Best buys’ and other recommended interventions for the prevention and control of noncommunicable diseases 2017. 2020.

Chisholm D, Moro D, Bertram M, Pretorius C, Gmel G, Shield K, Rehm J. Are the “best buys” for alcohol control still valid? An update on the comparative cost-effectiveness of alcohol control strategies at the global level. J Stud Alcohol Drugs. 2018;79(4):514–522. doi: 10.15288/jsad.2018.79.514. PubMed DOI

Bergeron A, Decary-Hetu D, Giommoni L. Preliminary findings of the impact of COVID-19 on drugs crypto markets. Int J Drug Policy. 2020;83:102870. doi: 10.1016/j.drugpo.2020.102870. PubMed DOI PMC

EU Drug Markets: Impact of COVID-19. Publications Office of the European Union, Luxembourg. 2020 Accessed 8 Oct 2020.

Canadian Centre on Substance Use and Addiction. Changes Related to COVID-19 in the Illegal Drug Supply and Access to Services, and Resulting Health Harms. CCENDU Alert. 2020; 5 October 2020. Available from: https://www.ccsa.ca/sites/default/files/2020-05/CCSA-COVID-19-CCENDU-Illegal-Drug-Supply-Alert-2020-en.pdf.

Groshkova T, Stoian T, Cunningham A, Griffiths P, Singleton N, Sedefov R. Will the current COVID-19 pandemic impact on long-term Cannabis buying practices? J Addict Med. 2020;14(4):e13–e14. doi: 10.1097/ADM.0000000000000698. PubMed DOI PMC

Anderson P, Llopis EJ, O'Donnell A, Kaner E. Impact of COVID-19 Confinement on Alcohol Purchases in Great Britain: Controlled Interrupted Time-Series Analysis During the First Half of 2020 Compared With 2015-2018. Alcohol Alcohol. 2020. 10.1093/alcalc/agaa128. PubMed PMC

Sberbank.ru. Issledovanija na osnove dannyh Sberbanka [Research based on Sberbank data] 2020 21 December 2020. Available from: https://www.sberbank.ru/ru/about/issledovaniya

Panagiotidis P, Rantis K, Holeva V, Parlapani E, Diakogiannis I. Changes in alcohol use habits in the general population, during the COVID-19 lockdown in Greece. Alcohol Alcohol. 2020;55(6):702–704. doi: 10.1093/alcalc/agaa092. PubMed DOI PMC

Impact of COVID-19 on patterns of drug use and drug-related harms in Europe. European Monitoring Centre for Drugs and Drug Addiction, Lisbon, Portugal. 2020 Accessed 5 Oct 2020.

Kilian C. Dissemination strategies 1.2: figshare; 2020 https://doi.org/10.6084/m9.figshare.12738728.v1.

Eurostat . DATASET: Population by Educational Attainment Level, Sex and Age (1 000) (Edat_lfs_9901) 2020.

Kilian C. Survey weights: figshare; 2020. 10.6084/m9.figshare.12739469.v1.

Kilian C, Rehm J, Allebeck P, Braddick F, Gual A, Barták M, et al. Alcohol consumption during the COVID-19 pandemic in Europe: a large-scale cross-sectional study in 21 countries. ResearchSquare. 2021. 10.21203/rs.3.rs-148341/v1. PubMed

Bush K, Kivlahan DR, McDonell MB, Fihn SD, Bradley KA. Ambulatory care quality improvement P. the AUDIT alcohol consumption questions (AUDIT-C) - an effective brief screening test for problem drinking. Arch Intern Med. 1998;158(16):1789–1795. doi: 10.1001/archinte.158.16.1789. PubMed DOI

Kilian C. Surveys: figshare; 2020. 10.6084/m9.figshare.12738734.v1.

R Core Team . R: A language and environment for statistical computing. 4.0.2 ed. Vienna: R Foundation for Statistical Computing; 2020.

Kilian C. ESAC database. figshare; 2021. 10.6084/m9.figshare.13580693.v1.

Manthey J, Carr S. R code for publication on substance use during first COVID. figshare; 2021. 10.6084/m9.figshare.14315606.v1.

Kilian C, Manthey J, Probst C, Brunborg GS, Bye EK, Ekholm O, Kraus L, Moskalewicz J, Sieroslawski J, Rehm J. Why is per capita consumption underestimated in alcohol surveys? Results from 39 surveys in 23 European countries. Alcohol Alcohol. 2020;55(5):554–563. doi: 10.1093/alcalc/agaa048. PubMed DOI PMC

McGregor K, Makkai T. Self-reported drug use: how prevalent is underreporting? 2003.

Kilian C, Rehm J, Allebeck P, Barták M, Braddick F, Gual A, et al. Conducting a multi-country online alcohol survey in the time of the COVID-19 pandemic: opportunities and challenges. Int J Methods Psychiatr Res submitted. PubMed PMC

Rehm J, Kilian C, Rovira P, Shield KD, Manthey J. The elusiveness of representativeness in general population surveys for alcohol. Drug Alcohol Rev. 2020; n/a(n/a). PubMed

Rehm J, Kilian C, Manthey J. Future of surveys in the alcohol field. Drug Alcohol Rev. 2021;40(2):176–178. doi: 10.1111/dar.13180. PubMed DOI

Georgiadou E, Müller A, Koopmann A, Leménager T, Kiefer F. Die COVID-19-Pandemie als idealer Nährboden für Süchte. Ärzteblatt. 2020;117(25):1251–1254.

Neufeld M, Lachenmeier DW, Ferreira-Borges C, Rehm J. Is alcohol an "essential good" during COVID-19? Yes, but only as a disinfectant! Alcohol Clin Exp Res. 2020;44(9):1906–1909. doi: 10.1111/acer.14417. PubMed DOI PMC

Manthey J, Kilian C, Schomerus G, Kraus L, Rehm J, Schulte B. [alcohol use in Germany and Europe during the SARS-CoV-2 pandemic] Alkoholkonsum in Deutschland und Europa während der SARS-CoV-2 Pandemie. SUCHT. 2020;66(5):247–258. doi: 10.1024/0939-5911/a000686. DOI

Barrio P, Baldaqui N, Andreu M, Kilian C, Rehm J, Gual A, et al. Abstinence among alcohol use disorder patients during the COVID-19 pandemic: insights from spain. Alcohol Clin Exp Res. 2021. 10.1111/acer.14555. PubMed

Narasimha VL, Shukla L, Mukherjee D, Menon J, Huddar S, Panda UK, Mahadevan J, Kandasamy A, Chand PK, Benegal V, Murthy P. Complicated alcohol withdrawal—an unintended consequence of COVID-19 lockdown. Alcohol Alcohol. 2020;55(4):350–353. doi: 10.1093/alcalc/agaa042. PubMed DOI PMC

Testino G. Are patients with alcohol use disorders at increased risk for Covid-19 infection? Alcohol alcohol. 2020. PubMed PMC

Heerfordt C, Heerfordt IM. Has there been an increased interest in smoking cessation during the first months of the COVID-19 pandemic? A Google Trends study. Public Health. 2020;183:6–7. doi: 10.1016/j.puhe.2020.04.012. PubMed DOI PMC

Zvolensky MJ, Garey L, Rogers AH, Schmidt NB, Vujanovic AA, Storch EA, Buckner JD, Paulus DJ, Alfano C, Smits JAJ, O'Cleirigh C. Psychological, addictive, and health behavior implications of the COVID-19 pandemic. Behav Res Ther. 2020;134:103715. doi: 10.1016/j.brat.2020.103715. PubMed DOI PMC

Aston ER, Smith JE, DiBello AM, Farris SG. Effects of acute distress and tobacco cues on tobacco demand. Drug Alcohol Depend. 2021;221:108522. PubMed PMC

DESTATIS. Pressemitteilung Nr. N 003 vom 18. Januar 2021 2021 26 Mar 2021. Available from: https://www.destatis.de/DE/Presse/Pressemitteilungen/2021/01/PD21_N003_799.html.

Folkehelseinstituttet. Vedleggstabeller til Folkehelseinstituttets rapport Tobakk i Norge 2020 26 March 2021. Available from: https://www.fhi.no/contentassets/4354197c0c964778b2c53472af8a796e/vedleggstabeller-til-tobakk-i-norge-2020.pdf.

Hegarty R. Tobacco category report 2021: why are tobacco sales up in the middle of a global health pandemic? The grocer. 2021.

United Nations. Sustainable Development Goals: Good Health and Well-being 2016 [Available from: https://sustainabledevelopment.un.org/sdg3.

Droogers M, Jansen D, Lindert J, Saboga-Nunes L, Ruden M, Guichardon M, et al. Health-related Sustainable Development Goals: countdown on alcohol use, smoking prevalence, child overweight and suicide mortality. Eur J Public Health. 2020;30(Supplement_1):i10–ii3. doi: 10.1093/eurpub/ckaa027. PubMed DOI PMC

Rehm J, Manthey J, Shield KD, Ferreira-Borges C. Trends in substance use and in the attributable burden of disease and mortality in the WHO European region, 2010-16. Eur J Pub Health. 2019;29(4):723–728. doi: 10.1093/eurpub/ckz064. PubMed DOI

GBD Results Tool. University of Washington, Seattle, USA. 2020 http://ghdx.healthdata.org/gbd-results-tool. Accessed 6 Oct 2020.

NCD Countdown 2030 collaborators. NCD Countdown 2030: pathways to achieving Sustainable Development Goal target 3.4. Lancet. 2020. PubMed PMC

Cousijn J, Kuhns L, Larsen H, Kroon E. For better or for worse? A pre-post exploration of the impact of the COVID-19 lockdown on cannabis users. Addiction. 2021. https://onlinelibrary.wiley.com/doi/10.1111/add.15387. PubMed DOI PMC

Werse B, Kamphausen G. Cannabis und Coronavirus SARS-CoV-2 – Eine Online-Kurzbefragung während der Kontaktbeschränkungen in der frühen Phase der Pandemie. Suchttherapie. (EFirst).

Manthey J. Cannabis use in Europe: current trends and public health concerns. Int J Drug Policy. 2019;68:93–96. doi: 10.1016/j.drugpo.2019.03.006. PubMed DOI

European Monitoring Centre for Drugs and Drug Addiction . European Drug Report 2019: Trends and developments. Luxembourg: Publications Office of the European Union; 2019.

Eurostat. European Health Interview Survey (EHIS) 2021. Available from: https://ec.europa.eu/eurostat/cache/metadata/en/hlth_det_esms.htm.

Freeman TP, Groshkova T, Cunningham A, Sedefov R, Griffiths P, Lynksey MT. Increasing potency and price of cannabis in Europe. Addiction. 2006-2016:2018. PubMed PMC

Claudet I, Mouvier S, Labadie M, Manin C, Michard-Lenoir AP, Eyer D, et al. Unintentional Cannabis Intoxication in Toddlers. Pediatrics. 2017;140(3):e20170017. PubMed

O'Donnell A, Addison M, Spencer L, Zurhold H, Rosenkranz M, McGovern R, Gilvarry E, Martens MS, Verthein U, Kaner E. Which individual, social and environmental influences shape key phases in the amphetamine type stimulant use trajectory? A systematic narrative review and thematic synthesis of the qualitative literature. Addiction. 2019;114(1):24–47. doi: 10.1111/add.14434. PubMed DOI PMC

Slavova S, Rock P, Bush HM, Quesinberry D, Walsh SL. Signal of increased opioid overdose during COVID-19 from emergency medical services data. Drug Alcohol Depend. 2020;214:108176. doi: 10.1016/j.drugalcdep.2020.108176. PubMed DOI PMC

Ochalek TA, Cumpston KL, Wills BK, Gal TS, Moeller FG. Nonfatal opioid overdoses at an urban emergency department during the COVID-19 pandemic. JAMA. 2020;324(16):1673. doi: 10.1001/jama.2020.17477. PubMed DOI PMC

Glober N, Mohler G, Huynh P, Arkins T, O'Donnell D, Carter J, et al. Impact of COVID-19 Pandemic on Drug Overdoses in Indianapolis. J Urban Health. 2020;97:802-7. 10.1007/s11524-020-00484-0. PubMed PMC

Lutz M. Zahl der Drogentoten steigt um 13 Prozent. WELT. 2020. https://www.welt.de/politik/deutschland/article216112708/Erstes-Halbjahr-2020-Zahl-der-Drogentoten-steigt-um-13-Prozent.html.

Alcohol use and COVID-19: three-year impact for the Czech Republic