(PS6-C75) Rates and Predictors of Substance Use Among Women Veterans During the COVID-19 Pandemic: The Moderating Role of Covid-specific Anxiety

Background: The COVID-19 pandemic is associated with increased substance use: 13.3% of adults reported initiating or increasing substance use to cope with pandemic stress or emotions. Emerging research suggests specific subgroups may be disproportionately impacted. Women Veterans may be at risk due to high reported rates of substance use and mental health (MH) symptoms. COVID-specific fear, worry, and trauma symptoms have emerged as predictors of substance use, however, women Veterans have been largely underrepresented in previous research. Research among women Veterans is crucial to guide targeted intervention efforts. The current study aims to: 1) describe rates of substance use among women Veterans during the COVID-19 pandemic; and 2) test COVID-specific anxiety as a moderator of relationships between demographic and MH factors and substance use.

Method: Participants were 209 women Veterans enrolled in Veterans Health Administration primary care who self-reported demographics, MH and substance use history (i.e., previous diagnoses), and completed standard measures of current MH symptoms (depression, anxiety), COVID-specific anxiety, and current alcohol/substance use via a mailed survey. Data were collected in the summer/fall of 2020. Descriptive statistics were calculated to characterize the sample. Bivariate associations were computed to examine relationships between predictors (demographic, MH/substance use history, current MH symptoms), the moderator (COVID-specific anxiety), and alcohol/substance use outcomes. For any significant predictor/outcome relationship, we tested COVID-specific anxiety as a moderator using the PROCESS macro in SPSS.

Results: 35.5% of the sample screened positive for hazardous alcohol use and 26% reported problematic substance use (17.5% low-level, 6.6% moderate-level, and 1.9% substantial substance-related problems). Significant positive associations were found between substance use and: COVID-specific anxiety (r=.20, p=.01), MH history (r=.23, p=.002), substance use history (r=.41, p< .001), and current depression symptoms (r=.15, p=.04). Alcohol use was significantly and positively associated with substance use history (r=.14, p=.04). COVID-specific anxiety was a significant moderator of the relationships between substance use history and current alcohol (b = .60, p < .001) and substance use (b = .28, p < .001). For those at high levels of COVID-specific anxiety, there was a stronger relationship between previous SUD diagnosis and current alcohol/substance use.

Conclusions: Results are consistent with previous research suggesting COVID-specific MH symptoms as a risk factor for substance use. This study extends previous research to a novel subgroup (women Veterans) and identifies COVID-specific anxiety as particularly important among those with a history of substance use disorder (SUD). Results can guide treatment efforts by suggesting intervention targets (i.e., COVID-specific anxiety) among a potentially vulnerable population. Delivering evidence-based interventions (i.e., Cognitive Behavioral Therapy for SUD) to those most in need may help ameliorate the negative impact of COVID-19 on substance use among women Veterans.