Growing in the face of challenge: What the COVID-19 pandemic can teach us about reducing substance use?

The COVID-19 pandemic has affected everyone in one way or another. These global events can flood us with uncertainty and can challenge our world-views. Naturally, the pandemic has forced us to re-organize our life priorities – health being the number one. Most research about disaster events has focused on the relationship with negative consequences, such as negative emotions, mental health disorders (post-traumatic stress disorder (PTSD), anxiety and depression), and increases in substance use1–3. It can’t be denied that negative consequences are important and should not be overlooked. But is it all there is to it? For example, highly stressful life experiences can also bring a new sense of meaning to life. Could a life-crisis result in a new lifestyle that discourages maladaptive behaviours such as substance use?


Posttraumatic growth (PTG) describes the phenomenon in which critical life experiences result in (positive) transformation4,5. This concept does not contradict the hardships of stressful life events; it highlights the potential for positive change that can co-exist in a critical situation. To experience this growth, an individual would have to perceive a threat, an “inflection point”, in which his or her established set of schemas do not longer suffice. It goes beyond returning to a pre-crisis state, but it is about experiencing meaningful development. This idea of growth after stress is very attractive, but you may wonder whether this remains a philosophical suggestion or whether empirical studies can support the growth of vulnerable individuals amid challenging life events.

PTG is a relatively new concept in psychological research. Overall, it can be measured by five domains of growth5: a) gratitude and alteration of life priorities; b) greater relationship quality; c) increases in perception of personal strength; d) acknowledgement of new opportunities; and e) engagement in existential questions. Post-traumatic growth has been explored mainly in connection with general psychological well-being and adjustment after highly stressful life events. Not many studies have looked into the association between the mentioned domains of growth and substance use. However, there are some indications of a relationship between stressful life events, PTG, and a decrease in problematic substance use.

Some research has explored the positive impact of stressful events in substance use in at-risk populations6. For example, qualitative interviews of ex-smokers smoking have described to be “at a critical” point in their lives when they quitted 7. Furthermore, a very large study of 4569 young adults found that experiencing stressful events was associated with decreases in alcohol use mainly for dependent drinkers8. These stressful life events could have acted as a “critical transition point” for them. However, as they did not measure PTG per se, the interpretation remains speculative. Interestingly, a two-year study in adolescents at risk for maladaptive behaviours applied a PTG scale to quantify the relationship between amount of stressful-life events, PTG and substance use6. They did find that higher stressful events were associated with increased substance use in adolescence; however, those who could find positive change in life altering events were more protected against problematic alcohol and cannabis use.

Finally, some preliminary results about general COVID-19 mental health and positive appraisal supports this idea for mental health generally9. A positive evaluation of these events appear to protect against psychological distress amid the COVID-19 pandemic. Particularly, those who reported that they could learn and change for the better, both personally and as a society, preserved a good mental health during the first weeks of the European Corona lockdown. We still need to determine whether this same mechanism can apply to substance use behaviour specifically for the COVID-19 pandemic, although the described literature does provide some indications.

To summarize, our ability to learn from a specific, life-altering, event may influence how we modify unhealthy patterns (such as decreasing substance use). Yet, this stressful experience may have to provide a critical transition point, and “eye-opening” experiences for those engaged in substance use. It might not be about the accumulation of stressful life events in itself, but about how that particular event has shaken your life views and has presently impacted you. Now it may be your job to find personal meaning in this corona situation and ask yourself some tough questions!

This blog was written by Milagros Rubio (Radboud University) for RAD-blog, the blog about smoking, alcohol, drugs and diet.

1. Wu P, Liu X, Fang Y, et al. Alcohol abuse/dependence symptoms among hospital employees exposed to a SARS outbreak. Alcohol Alcohol. 2008;43(6):706-712. doi:10.1093/alcalc/agn073
2. Lau JTF, Yang X, Pang E, Tsui HY, Wong E, Yun KW. SARS-related perceptions in Hong Kong. Emerg Infect Dis. 2005;11(3):417-424. doi:10.3201/eid1103.040675
3. Brooks SK, Webster RK, Smith LE, et al. The psychological impact of quarantine and how to reduce it: rapid review of the evidence. Lancet. 2020;395(10227):912-920. doi:10.1016/S0140-6736(20)30460-8
4. Tedeschi RG, Calhoun LG. The posttraumatic growth inventory: Measuring the positive legacy of trauma. J Trauma Stress. 1996;9(3):455-471. doi:10.1002/jts.2490090305
5. Tedeschi RG, Calhoun LG. Posttraumatic Growth : Conceptual Foundations and Empirical Evidence ” Posttraumatic Growth : A Developmental Perspective. Psychol Inq. 2004;15(1):1-18. doi:10.1207/s15327965pli1501
6. Arpawong TE, Sussman S, Milam JE, et al. Posttraumatic growth, stressful life events, and relationship with substance use behaviors among alternative high school students: a prospective study. Psychol Heal. 2015;30(4):475-494. doi:10.1080/08870446.2014.979171
7. Tsourtos G, Ward PR, Muller R, et al. The importance of resilience and stress to maintaining smoking abstinence and cessation: A qualitative study in Australia with people diagnosed with depression. Heal Soc Care Community. 2011;19(3):299-306. doi:10.1111/j.1365-2524.2010.00973.x
8. Hoyland MA, Latendresse SJ. Stressful life events influence transitions among latent classes of alcohol use. Psychol Addict Behav. 2018;32(7):727-737. doi:10.1037/adb0000412
9. Veer IM, Riepenhausen A, Zerban M, Wackerhagen C, Hajduk M. Mental resilience in the Corona lockdown : First empirical insights from Europe. :1-15.

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