Are We Prepared for Adolescent Substance Use After COVID-19?


Studies show that disaster exposures will result in increased substance use among adolescents, and substance use in turn results in functional impairments at schools.

Increased Substance Use

Researchers found that in the long run, the effects of disaster decrease regarding behavioral and emotional problems, but the effects remain regarding alcohol misuse among adolescents.

After the 911 attacks, researchers conducted a large-scale survey of students in areas surrounding World Trade Center, and found that exposure to the WTC attacks was associ­ated with increased substance use following the attacks, relative to those with none exposure:

  • students with one exposure risk factor* were at a more than five-­fold greater risk

  • those with two, at an eight­-fold risk;

  • those with three or more, at a nearly 19-­fold greater risk of increased substance use

Specifically, the survey results show that high school students (grades 9 to 12, aged 14 to 18 years old) compared to middle school students (grades 6 to 8, aged ten to 13 years old) were three times more likely to report increased substance use after the WTC attacks.

* Exposure-­related risk factors include: 1) worry about their own safety; 2) worry about the safety of their loved ones; 3) knowing somebody killed in the attacks; 4) parental impairment after the attacks; and 5) proximity of the WTC to the school.

The Functional Impairment

What also made researchers worry is the associated functional impairment among adolescents. The WTC attacks survey showed that increased substance use was independently associated with functional impairment in behavior at school. Students with increased substance use, compared with those without:

  • had significantly more impairment in school work (18.1 per cent versus 7.8 per cent)

  • more impaired school behavior (6.7 per cent versus 3.0 per cent)

  • worsened grades (38.2 per cent versus 0 per cent)

  • a marginally significant dif­ference in student–teacher relationship (11.4 per cent versus 7.0 per cent)

However, there were no differences in impairment in family and friend relationships.

Are We Now Better Prepared?

An alarming takeaway from the WTC attacks study is that students with increased substance use, relative to those without, were nearly twice as likely to want mental health services 18 months after the attacks, but they did not receive more services than other youths.

Considering the similar “exposure risk factors” during the coronavirus outbreak, are we now better prepared for the increased mental health needs of our students in the post-COVID-19 era?

Sources consulted:

Sijmen A. Reijneveld, Mathilde R. Crone, Annemarie A. Schuller, Frank C. Verhulst and S. Pauline Verloove-Vanhorick. 2005. “The changing impact of a severe disaster on the mental health and substance misuse of adolescents: follow-up of a controlled study.” In Psychological Medicine, 35, 367–376.

Stefan Vetter, Astrid Rossegger, Wulf Rossler, Jonathan I Bisson and Jerome Endrass. 2008. “Exposure to the tsunami disaster, PTSD symptoms and increased substance use – an Internet based survey of male and female residents of Switzerland.” In BMC Public Health, 8:92 doi:10.1186/1471-2458-8-92.

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