This study shows the timely evidence that social relations are playing a role for adolescent substance use during the Covid-19 pandemic. First, we found that adolescents’ reported increase in substance use during the pandemic was predicted by higher levels of general family conflict, increased involvement with peers, and hanging out without parents’ knowledge, as well as a decrease in quality time spent with family and lower levels of compliance with rules and restrictions during this period. Moreover, we discovered six clusters of adolescents with a grouping of scores for adolescent smoking, alcohol use, inebriation, and use of narcotics. The largest cluster of adolescents, i.e., the No Use cluster, either did not use or had decreased use of substances during the Covid-19 pandemic which indicates that most of the adolescents in our sample are handling the situation during the pandemic without substance use initiation or increase. The adolescents in five other clusters, i.e., the Tobacco and Alcohol Users (1), Alcohol Users (3), Problem Alcohol Users (4), Smokers (5), and Users of All (6) clusters, had retained or increased their level of substance use during this period. Further investigations suggested that particularly adolescents in the Tobacco and Alcohol Users (1), Problem Alcohol User (4), and Users of All (6) clusters, thus risk clusters with adolescents who had multiple use of substances and/or inebriation, reported poor parent-adolescent relations, increased peer involvement during the Covid-19 pandemic, and difficulty in conforming to the rules and restrictions during this period.
Healthy family interactions and positive emotional bonds between parents and their adolescents are consistently seen as protective factors of adolescent substance use development [13,14,15,16,17]. During challenging times, when support from other social contexts is limited, family bonds and parental support may be even more critical in terms of adolescents being able to cope with the situation they are in [6]. In addition, having knowledge of what adolescents do and where they go when away from home may prevent adolescents from engaging in misbehavior, including substance use [15]. Not all families, however, are well prepared for challenges induced by the Covid-19 pandemic, which poses a threat for both parents’ and children’s health [26, 27]. It is likely that adolescents who experience a problematic home-situation, including family conflicts and poor family bonds, lack support from family, which makes adolescents inclined to cope with the situation on their own or seek support elsewhere. In addition, if parents do not have knowledge of their adolescents’ whereabouts, adolescents may be at risk of getting involved in problematic behaviors, substance use included [15]. As adolescents and their parents are part of dynamic systems [12], it is also likely that adolescent behavior could have an adverse impact on family interactions and parental support, which yet again poses a risk to adolescent development and an increase in their substance use. Indeed, our findings suggest that conflicted family interactions, as well as a decrease in quality time spent with family added to an increase in time hanging out without parents’ knowledge, could be important risk factors in terms of adolescent substance use during a time of crisis.
Substance use can be a maladaptive strategy to cope with difficult situations [28], which is also evident during the Covid-19 pandemic [4]. In adolescence, substance use often goes hand in hand with peer interactions, parties, and places where no grownups are present [10]. This seems to be the case even during the Covid-19 pandemic, as increased engagement with peers, despite recommendations of social distancing, seems to be one of the risk factors for increases in substance use during the pandemic. It is not surprising that difficulty in following rules and recommendations that include social distancing is yet another risk factor in terms of an increase in adolescent substance use during the pandemic. Indeed, a closer look at the characteristics of adolescents in different substance use clusters revealed that adolescents in the risk clusters reported the highest levels of meeting with friends and hanging out without their parents’ knowledge. In addition, these adolescents had difficulty in conforming to governmental rules to contain the virus. In other words, adolescents who had retained or increased their level of substance use were likely to hang out with peers despite the recommendations of social distancing as a means of containing the virus. Although maintaining social distance may be especially difficult for adolescents, since interaction with friends is an important part of their everyday lives [29], these results are worrisome because peer involvement that includes the use of substances may have an adverse effect on adolescent psychosocial functioning [30] or increase the risks of contracting and spreading the virus [3]. Indeed, substance use, including smoking, seems to be associated with being affected by the Covid-19 virus [31]. In sum, adolescents with retained or increased substance use during the Covid-19 pandemic report a history of strained family interactions and bonds, meeting up with friends during the pandemic and difficulty in conforming to the government’s rules and restrictions to contain the virus, which is a potential threat both to the adolescents themselves and others in their surroundings.
There are some limitations that need attention. The survey was carried out in the early summer of 2020, a season when it is more common for adolescents to meet outside on account of warmer weather, which might have influenced the results. In addition, given the cross-sectional design in the study, we could not control for the level of substance use or family relations prior to the Covid-19 pandemic. Although we reached out to adolescents all over Sweden, there is a question of authenticity of the participants and generalizability of the results as data were collected through social media. This sort of data collection procedure was deemed necessary as traditional survey method (i.e., collecting data in schools) was not possible [32] due to school closure. Finally, given the cross-sectional nature of the data, making causal inferences is not possible. Longitudinal data, preferably with assessment starting before the pandemic and forward, would more accurately offer inferences on directions of effects.
Practical implications
There are some practical implications of the results. Adolescence is a challenging developmental period, not least during a crisis such as the Covid-19 pandemic. As our findings indicate, adolescents with poor family relations as well as those who have difficulties conforming to rules of social distancing during the outbreak, seem to be at particular risk for substance use during crisis. Providing measures to build adolescent resilience is key. However, as adolescents are a part of multiple systems [12] understanding adolescents and their behavior and providing actions to promote their resilience is barely possible without paying attention to other significant aspects of their developmental systems, such as family, school, and peers. Rather, conforming to recommendations by Masten and Motti-Stefanidi [6], we suggest that it is critical that efforts be directed to the individual together with the other systems surrounding them. In that sense, specific efforts could be aimed at adolescents, while also providing support to families and schools that, in turn, would be able to provide social, emotional or psychological support to their adolescents. With the help of this multi-system approach to resilience, public health and social services, as well as other professionals working with adolescents, could identify strategies or interventions to meet the needs of adolescents and their families and provide adequate support to optimize resilience. This would particularly benefit vulnerable adolescents with maladaptive behaviors, such as substance use, who lack support from home, as identified in the current study.