Associations of Substance Use With Behavioral Adherence to Centers for Disease Control and Prevention Guidelines for COVID-19 Mitigation: Survey Study

Monnig, Mollie A; Treloar Padovano, Hayley; Sokolovsky, Alexander W; DeCost, Grace; Aston, Elizabeth R; Haass-Koffler, Carolina L; Szapary, Claire; Moyo, Patience; Avila, Jaqueline C; Tidey, Jennifer W; Monti, Peter M; Ahluwalia, Jasjit S

BACKGROUND: Substance use is a risk factor for COVID-19 infection and adverse outcomes. However, reasons for elevated risk in substance users are not well understood. OBJECTIVE: To evaluate whether alcohol or other drug use is associated with adherence to CDC guidelines for COVID-19 mitigation. Pre-registered analyses tested the hypothesis that greater use of alcohol and other drugs would be associated with lower CDC guideline adherence. A secondary objective was to determine whether substance use was associated with the likelihood of COVID-19 testing or outcome. METHODS: A cross-sectional online survey was administered to a convenience sample recruited through the MTurk platform from June 18-July 19, 2020. Individuals 18 years or older and residing in Connecticut, Massachusetts, New Jersey, New York, or Rhode Island were eligible to participate. The exposure of interest was past-7-day use of alcohol, cigarettes, e-cigarettes, cannabis, stimulants, and non-medical opioids. The primary outcome was CDC guideline adherence measured using a scale developed from behaviors advised to reduce the spread of COVID-19. Secondary outcomes were likelihood of COVID-19 testing and a positive COVID-19 test result. All analyses accounted for sociodemographic characteristics. RESULTS: The sample included 1,084 individuals (mean age = 40.9  13.4; gender: 48.8% men, 50.1% women, 1.1% other gender identity; race: 68.5% White individuals, 24.6% Black individuals; ethnicity: 25.5% Hispanic individuals). Daily opioid users reported lower CDC guideline adherence than non-daily users (B = -0.24, 95% CI [-.44, -0.05]) and non-users (B = -0.57, 95% CI [-0.76, -0.38]). Daily alcohol drinkers reported lower adherence than non-daily drinkers (B = -0.16, 95% CI [-0.30, -0.02]). Non-daily alcohol drinkers reported higher adherence than non-drinkers (B = 0.10, 95% CI [0.02, 0.17]). Daily opioid use related to greater odds of COVID-19 testing, and daily stimulant use related to greater odds of a positive test. CONCLUSIONS: In a regionally specific, racially and ethnically diverse convenience sample, adults who engaged in daily alcohol or opioid use also reported lower CDC guideline adherence. Any opioid use was associated with greater odds of COVID-19 testing, and daily stimulant use was associated with greater odds of COVID-19 infection. Cigarettes, e-cigarettes, cannabis, or stimulant use were not statistically associated with CDC guideline adherence, after accounting for sociodemographic covariates and other substance use variables. Findings support further investigation into whether COVID-19 testing and vaccination should be expanded among individuals with substance-related risk factors.