Factors associated with problematic substance use before and during the COVID-19 pandemic among a drug addiction recovery cohort: a prospective study in the Netherlands, Belgium, and UK

Background – The COVID-19 pandemic and measures have placed various burdens on societies and individuals. Emerging evidence suggests that people in drug addiction recovery were negatively affected. This study investigates whether risk and protective factors associated with return to problematic substance use differed between the periods before and during the pandemic for those in recovery.
Methods – A convenience sample of persons in drug addiction recovery for at least three months, completed an assessment at baseline before the pandemic (T0, N=367) and at two consecutive follow-ups 12 months apart (T1, N=311; T2, N=246). The final follow-up took place during the pandemic (2020-2021). We analysed rates and predictors of problematic substance use in both periods, and whether relations between predictors and problematic use differed between the periods.
Results – Rates of problematic use did not differ significantly before and during the pandemic for those who were followed-up. However, the relationship between problematic use and commitment to sobriety differed between both periods (OR=3.24, P=0.010), as higher commitment was only associated with lower odds of problematic use during (OR=0.27, P
Conclusions – The COVID-19 pandemic may not have been followed by significant return to problematic substance use for people in recovery. However, with restricted access to environmental resources, they may have been more dependent on internal commitment from themselves. Targeting personal recovery resources with interventions could therefore reduce the chances of return to problematic substance use during a pandemic.