Risk factors for elevations in substance use and consequences during the COVID-19 pandemic among sexual and gender minorities assigned female at birth

Background: Problematic substance use (SU) has increased substantially during the COVID-19 pandemic. While studies have identified risk factors for problematic SU during the pandemic (e.g., anxiety, depression, using substances to cope), these studies have been predominately cross-sectional, rarely examined changes in SU contexts during the pandemic as potential risk factors, and neglected sexual and gender minorities (SGM) – a health disparity population disproportionately impacted by substance use disorders and the pandemic. Method: We utilized two waves of data collected one month apart from a sample of 212 SGM assigned female at birth who used alcohol and/or cannabis (18–25 years old) collected between August 2020-February 2021. We examined associations between potential risk factors (i.e., retrospectively reported changes in anxiety/depression and in using substances in different contexts since before the pandemic): and 1) retrospectively reported changes in alcohol and cannabis consumption; 2) coping motives for use and SU consequences; and 3) subsequent changes in coping motives and consequences. Results: An increase in solitary SU was a robust risk factor for concurrent and prospective increases in SU, coping motives, and consequences. Increases in SU with romantic partners were associated with concurrent increases in alcohol/cannabis consumption and consequences. Increases in anxiety and depression were associated with concurrent increases in SU and higher coping motives and consequences. Conclusions: Results indicate that solitary SU and increases in SU with romantic partners are robust risk factors for increases in SU and consequences in the context of the pandemic. Further, findings provide support for the self-medication theory of substance use.