At-a-glance – Measuring self-reported change in alcohol and cannabis consumption during the second wave of the COVID-19 pandemic in Canada

Introduction

On 25 January 2020, Canada confirmed its first case of the novel coronavirus (COVID-19) and by early March 2020, community transmission was apparent. Since then, rigorous public health guidelines and measures, such as hand hygiene, mandating masks, school closures and physical distancing protocols, have been implemented in Canada. These public health measures have had a critical role in mitigating the spread of COVID-19 to protect the health of Canadians. However, there is increasing evidence that the pandemic and these ensuing strict public health measures have had a negative impact on the mental health and well-being of Canadians.^{Footnote 1Footnote 2Footnote 3}

Data from the first wave of the COVID-19 pandemic in Canada have shown increased prevalence of stress, anxiety and depression,^{Footnote 1Footnote 2Footnote 3Footnote 4Footnote 5} which are known risk factors for the onset and sustained misuse of substances, such as alcohol^{Footnote 6Footnote 7Footnote 8} and cannabis.^{Footnote 9} A study initiated by Mental Health Research Canada found that one-third of participants aged 18 years and above who reported having a previous diagnosis of anxiety (n = 307) or depression (n = 325) also reported an increase in alcohol and cannabis use during the pandemic.^{Footnote 4}

Furthermore, data collected between 29 March and 3 April 2020 from a national survey of 4383 participants aged 25 years and older indicate that 14% of respondents reported increased alcohol consumption and 5.5% reported increased cannabis consumption during the first wave of the pandemic.^{Footnote 10} Findings from early in the second wave (from 14 to 21 September 2020) among Canadian adults are consistent, with 40% of 3027 participants from one study indicating their mental health had deteriorated since the onset of the pandemic.^{Footnote 11} Moreover, during the same period, increased alcohol and cannabis use was reported for 30% and 20%, respectively, of individuals with a pre-existing mental health condition.^{Footnote 11} These findings highlight the intricate relationship between mental health and substance use.

These results are a significant and pressing public health concern, suggesting a widespread impact of the pandemic on behavioural health.^{Footnote 12} As the country works towards a national recovery plan in response to the repercussions and long-term consequences of the COVID-19 pandemic, more national data on population health behaviours, such as substance use, are needed to help inform public health guidance. Such guidance includes creating public health messages focussed on mitigating harms associated with alcohol and cannabis use. To date, there has been limited national information on alcohol and cannabis consumption during the second wave of the pandemic in Canada. The objective of this At-a-glance article is to (1) estimate the self-reported change in alcohol and cannabis use during the second wave of the COVID-19 pandemic, and (2) disaggregate self-reported increase in alcohol and cannabis use by sociodemographic characteristics and self-reported change in mental health.

Methods

Data collection and sampling

We used data from the Survey on COVID-19 and Mental Health (SCMH), which is a cross-sectional survey developed and funded by Statistics Canada and the Public Health Agency of Canada (PHAC). This survey was administered to 30 000 dwellings from 11 September to 4 December 2020 with the purpose of capturing information related to mental health and well-being. A simple random sample was selected for each province and the territorial capitals. Of the 14 689 people who responded to the survey, 84% agreed to share their data with PHAC, resulting in a sample size of 12 344 for this analysis. Individuals living on reserves or other Indigenous settlements, full-time members of the Canadian Armed Forces and individuals in institutions were excluded from the survey coverage. Further detail about the SCMH design and sampling framework can be found on Statistics Canada’s website.^{Footnote 13}

Self-reported change in alcohol and cannabis consumption

Respondents were asked, “How has your alcohol consumption changed since before the COVID-19 pandemic?” and “How has your cannabis consumption changed since before the COVID-19 pandemic?” Response options were: “Increased”, “Decreased” and “No change”. If respondents overlooked or refused to answer the questions, the data were considered as missing and the respondents were excluded from the analysis (n = 43).  

Data analysis

We estimated the weighted prevalence (with 95% confidence interval [CI]) of self-reported (1) increased change, (2) decreased change or (3) no change in alcohol and cannabis consumption among individuals aged 18 years and older. Estimates of self-reported increase were disaggregated by gender; age group; income change since COVID-19 (increased, decreased, no change); self-reported household income quintile; number of people in household; being a parent or legal guardian of a child or children under the age of 18 years; education level (less than high school, high school graduate, postsecondary graduate); self-identification as part of a racialized group (yes/no); immigrant status; province/territorial capital; place of residence (urban/rural); and self-reported changes in mental health compared to before the pandemic.

Survey sampling weights were provided by Statistics Canada to generate nationally representative estimates. Variance was estimated using the bootstrap method, and SAS Enterprise Guide version 7.1 (SAS Institute Inc., Cary, NC, USA) was used for statistical analyses. Chi-square tests were conducted to examine significant associations between sociodemographic variables, self-reported mental health and alcohol and cannabis consumption behaviours.

Results

Based on nationally representative data, 15.7% of individuals self-reported an increase in alcohol consumption, 9.9% self-reported a decrease and 74.3% self-reported no change. For cannabis, 5.4% self-reported an increase in consumption, 1.8% self-reported a decrease, 19.5% self-reported no change and 73.3% self-reported never using cannabis. The prevalence estimates for increased alcohol or cannabis consumption varied after disaggregation. Statistically significant differences are highlighted in the Results section of this article, and all estimates can be found in Tables 1 and 2.

Alcohol consumption

The prevalence of self-reported increased alcohol consumption was higher among individuals aged 35 to 44 years (21.9%) and 45 to 54 years (21.0%), those with a postsecondary education (18.4%), and individuals who reported a change in their household income since COVID-19 (18.5% increased income, 19.1% decreased income). The prevalence of self-reported increased alcohol consumption augmented by income quintile (ranging from 7.5% to 27.2%). Yellowknife, Northwest Territories, (22.5%) had the highest prevalence of self-reported increase in alcohol consumption, while Prince Edward Island (11.0%) had the lowest prevalence. The percentage of self-reported increase in alcohol consumption was higher for individuals living in an urban area (16.2%), living in a household with four people (20.8%), parents or legal guardians of children under the age of 18 years (22.6%), born in Canada (“non-immigrants”) (18.2%) and people who did not identify as being part of a racialized group (17.8%). Lastly, the rate of increased alcohol consumption was highest among people who reported that their mental health was much worse or somewhat worse now compared to before the COVID-19 pandemic (27.0%).

Cannabis consumption

The prevalence of self-reported increased cannabis consumption was higher for males (5.8%), non-immigrants (6.3%), people who reported that their income had decreased (7.9%) since the beginning of COVID-19 pandemic and individuals who self-reported that their mental health was much worse now/somewhat worse now (10.0%). Self-reported increased cannabis consumption decreased by age (ranging from 12.1% to 1.0%), was highest in Nova Scotia (7.8%) and lowest in Saskatchewan (3.0%).

Table 1. Characteristics of respondents in study on changes in alcohol and cannabis consumption since the beginning of the COVID-19 pandemic, Canada, September to December 2020

Variable	Proportion, % (95% CI)
Gender
Male	49.1 (48.9–49.3)
Female	50.7 (50.6–50.7)
Age group
18–24 years	9.5 (8.6–10.4)
25–34 years	18.7 (17.8–19.6)
35–44 years	16.8 (16.8–16.8)
45–54 years	15.6 (15.6–15.6)
55–64 years	17.2 (17.2–17.2)
65+ years	22.2 (22.2–22.2)
Income change since COVID-19
Increased	6.0 (5.3–6.7)
Decreased	37.5 (36.3–38.8)
No change	56.5 (55.2–57.7)
Self-reported total household income quintile
Q1	21.1 (20.0–22.2)
Q2	20.2 (19.1–21.3)
Q3	22.4 (21.2–23.6)
Q4	18.3 (17.2–19.4)
Q5	18.0 (16.9–19.1)
Province/territorial capital
British Columbia	13.4 (13.4–13.4)
Alberta	11.4 (11.4–11.4)
Saskatchewan	2.8 (2.8–2.8)
Manitoba	3.3 (3.3–3.3)
Ontario	39.5 (39.5–39.5)
Quebec	22.9 (22.9–22.9)
New Brunswick	2.0 (2.0–2.0)
Nova Scotia	2.6 (2.6–2.6)
Prince Edward Island	0.4 (0.4–0.4)
Newfoundland and Labrador	1.4 (1.4–1.4)
Whitehorse, Yukon	0.1 (0.1–0.1)
Yellowknife, Northwest Territories	0.1 (0.1–0.1)
Iqaluit, Nunavut	0.02 (0.02–0.02)
Place of residence
Urban	82.3 (81.5–83.1)
Rural	17.7 (16.9–18.5)
Number of people in household
1	14.5 (14.1–14.9)
2	35.5 (34.8–36.2)
3	17.5 (16.5–18.5)
4	18.6 (17.4–19.7)
5 and more	13.9 (12.7–15.1)
Parent/legal guardian of a child or children under 18 years
Yes	27.6 (26.6–28.5)
No	72.4 (71.5–73.4)
Education level
Less than high school	7.6 (6.9–8.3)
High school graduate	23.6 (22.4–24.8)
Postsecondary graduate	68.8 (67.5–70.0)
People who self-identify as part of a racialized group
Yes	24.3 (23.1–25.4)
No	75.7 (74.6–76.9)
Immigrant
Yes	25.6 (24.4–26.8)
No	73.0 (71.8–74.1)
Non-permanent resident	1.4Footnote * (1.1–1.8)
Self-rated mental health compared to before the COVID-19 pandemic
Much better now/somewhat better now	7.6 (6.8–8.3)
About the same	59.0 (57.6–60.3)
Much worse now/somewhat worse now	33.5 (32.2–34.8)
Self-reported change in alcohol consumption
Increased	15.7 (14.7–16.7)
Decreased	9.9 (9.1–10.8)
No change	74.3 (73.2–75.5)
Self-reported change in cannabis consumption
Increased	5.4 (4.8–6.1)
Decreased	1.8 (1.4–2.1)
No change	19.5 (18.4–20.5)
Never used cannabis	73.3 (72.1–74.5)
Data source: 2020 Survey on COVID-19 and Mental Health. Abbreviations: CI, confidence interval; Q, quintile. Footnote * As per the Survey on COVID-19 and Mental Health release guidelines, prevalence estimates should be interpreted with caution, as the unweighted total sample size is between 75 and 150. Please look at the confidence intervals when interpreting these estimates. Return to footnote * referrer

Table 2. Percentage of self-reported increase in alcohol and cannabis consumption since COVID-19, disaggregated by sociodemographic characteristics, adults aged 18 years and older, Canada, September to December 2020

Variable	% of self-reported increase in alcohol consumption (95% CI)	p-value	% of self-reported increase in cannabis consumption (95% CI)	p-value
Gender
Male	15.2 (13.8–16.6)	0.5902	5.8 (4.8–6.8)	< 0.001
Female	16.2 (14.9–17.5)		4.9 (4.1–5.8)
Age group
18–24 years	14.1 (10.0–18.3)	< 0.001	12.1 (8.0–16.1)	< 0.001
25–34 years	18.2 (15.5–20.8)		9.8 (7.7–12.0)
35–44 years	21.9 (19.6–24.3)		6.0 (4.6–7.4)
45–54 years	21.0 (18.4–23.7)		4.4 (3.2–5.7)
55–64 years	13.8 (11.9–15.7)		3.1 (2.2–3.9)
65+ years	7.3 (6.0–8.6)		1.0 (0.5–1.4)
Income change since COVID-19
Increased	18.5 (14.3–22.6)	< 0.001	5.4 (2.8–8.0)	< 0.001
Decreased	19.1 (17.2–20.9)		7.9 (6.5–9.3)
No change	13.3 (12.2–14.3)		3.8 (3.1–4.5)
Self-reported total household income quintile
Q1	7.5 (6.0–9.0)	< 0.001	4.2 (3.0–5.4)	0.1351
Q2	12.7 (10.7–14.7)		5.0 (3.7–6.4)
Q3	15.9 (13.8–18.1)		6.5 (4.7–8.2)
Q4	21.1 (18.5–23.8)		6.7 (5.1–8.2)
Q5	27.2 (24.2–30.2)		5.6 (3.7–7.4)
Province/territorial capital
British Columbia	19.2 (16.6–21.8)	0.0013	5.0 (3.4–6.6)	< 0.001
Alberta	17.0 (14.4–19.7)		6.0 (4.4–7.6)
Saskatchewan	15.3 (14.5–18.1)		3.0 (1.6–4.3)
Manitoba	16.2 (13.5–18.8)		5.2 (3.6–6.8)
Ontario	14.9 (13.1–16.6)		6.5 (5.1–7.8)
Quebec	14.7 (12.9–16.5)		3.8 (2.7–4.9)
New Brunswick	14.1 (11.5–16.7)		5.1 (3.2–7.0)
Nova Scotia	16.5 (13.4–19.5)		7.8 (5.6–9.9)
Prince Edward Island	11.0 (8.4–13.5)		5.5 (3.5–7.4)
Newfoundland and Labrador	14.0 (11.1–16.9)		4.1 (2.5–5.8)
Whitehorse, Yukon	17.7 (13.8–21.6)		5.3 (2.9–7.6)
Yellowknife, Northwest Territories	22.5 (17.1–27.9)		5.9 (3.1–8.6)
Iqaluit, Nunavut	18.0 (12.1–23.9)		6.4 (2.5–10.3)
Place of residence
Urban	16.2 (15.1–17.3)	0.0105	5.6 (4.8–6.3)	0.3146
Rural	13.1 (11.2–15.1)		4.7 (3.3–6.1)
Number of people in household
1	11.9 (10.4–13.4)	< 0.001	5.3 (4.2–6.3)	0.3663
2	13.5 (12.2–14.8)		4.9 (4.1–5.8)
3	17.1 (14.6–19.6)		5.1 (3.6–6.6)
4	20.8 (18.0–23.5)		6.9 (4.8–9.0)
5 and more	17.0 (13.6–20.4)		5.5 (3.2–7.8)
Parent/legal guardian of a child or children under 18 years
Yes	22.6 (20.6–24.5)	< 0.001	4.8 (3.8–5.7)	0.1749
No	13.1 (12.0–14.2)		5.7 (4.8–6.5)
Education level
Less than high school	4.9 (3.2–6.6)	< 0.001	3.6 (0.9–6.3)	0.3849
High school graduate	11.5 (9.5–13.5)		5.3 (3.9–6.7)
Postsecondary graduate	18.4 (17.2–19.6)		5.7 (4.9–6.5)
People who self-identify as part of a racialized group
Yes	9.4 (7.4–11.4)	< 0.001	5.1 (3.5–6.8)	0.6659
No	17.8 (16.7–18.9)		5.5 (4.8–6.2)
Immigrant
Yes	8.8 (7.3–10.4)	< 0.001	3.1 (1.8–4.4)	0.0024
No	18.2 (17.1–19.4)		6.3 (5.5–7.1)
Non-permanent resident	14.5Footnote * (2.4–26.6)		6.6Footnote * (0.2–12.9)
Self-rated mental health compared to before the COVID-19 pandemic
Much better now/somewhat better now	13.6 (10.3–16.9)	< 0.001	8.8 (5.0–12.6)	< 0.001
About the same	9.5 (8.6–10.5)		2.4 (1.8–3.0)
Much worse now/somewhat worse now	27.0 (24.9–29.1)		10.0 (8.5–11.5)
Data source: 2020 Survey on COVID-19 and Mental Health. Abbreviations: CI, confidence interval; Q, quintile. Footnote * As per the Survey on COVID-19 and Mental Health release guidelines, prevalence estimates should be interpreted with caution, as the unweighted total sample size is between 75 and 150. Please look at the confidence intervals when interpreting these estimates.  Return to footnote * referrer

Discussion

Overall, we found that 15.7% of individuals living in Canada self-reported an increase in their alcohol consumption and 5.4% self-reported an increase in their cannabis consumption during the second wave of the COVID-19 pandemic. Self-reported increase in alcohol and cannabis use were disaggregated by sociodemographic characteristics and self-reported change in mental health, providing additional evidence of the wider impacts of the pandemic. Our result for cannabis was consistent with the increase reported early in the pandemic from 29 March to 3 April 2020 (first wave) in the Canadian Perspective Survey Series (CPSS) (5.5%).^{Footnote 10} Our estimate of increased alcohol consumption was slightly higher than what was found in series 1 of the CPSS (14%).^{Footnote 10}

Once disaggregated, results differed by various sociodemographic variables, which indicates potential disparities for certain groups. The increase in consumption of alcohol and cannabis differed significantly by age group, province and change in household income since the beginning of the COVID-19 pandemic. Interestingly, the number of individuals who self-reported an increase in alcohol consumption increased with age, whereas increases in cannabis consumption appeared to decrease with age. Moreover, individuals who rated their mental health as much worse/somewhat worse compared to before the COVID-19 pandemic also had a higher proportion of increased alcohol (27%) and cannabis consumption (10%) compared to those who rated their mental health as about the same, or much better/somewhat better now. This result is consistent with existing literature^{Footnote 4Footnote 11} and highlights the complex relationship between mental health and alcohol and cannabis use.

We also observed substance-specific differences. Among those who self-reported an increase in alcohol consumption, significant differences were observed by household income quintile, place of residence (urban/rural), size and composition of household, and racialized groups. Interestingly, gender differences were not observed for alcohol use. Among those who self-reported an increase in cannabis consumption, proportionally more men reported an increase in cannabis consumption compared to women.

It is important to note that these estimates are representative of the entire survey population, including people who have never used alcohol or cannabis. These results would likely vary significantly if we restricted our sample to respondents who had used these substances before. As Canada is currently in the recovery stage, subsequent studies should continue monitoring alcohol and cannabis consumption for the entire population, which includes non-consumers, but also specifically for individuals who do consume these substances to inform public health prevention and harm reduction strategies. Future research evaluating certain policies that may have contributed to increased alcohol and cannabis use (for example, access to alcohol through home deliveries) is also warranted.

Conclusion

During the second wave of the COVID-19 pandemic in Canada, an estimated 15.7% of Canadians self-reported an increase in their consumption of alcohol and 5.4% an increase in their consumption of cannabis. These nationally representative estimates varied by sociodemographic characteristics, which indicates the importance of understanding the social determinants of health. Future studies should focus on the association between the determinants and substance use during COVID-19 to help identify the at-risk populations that may benefit from increased awareness, mitigation efforts and resources pertaining to alcohol- and cannabis-related harms.

Acknowledgements

The authors would like to thank Lil Tonmyr (of the Public Health Agency of Canada) and Statistics Canada for their contribution to the design of the Survey on COVID-19 and Mental Health. We would like to thank Jeyasakthi Venugopal (Public Health Agency of Canada) for double-checking the analysis and results. We would also like to thank the staff at Statistics Canada and the Data Coordination and Access Program (DCAP) at the Public Health Agency of Canada for their assistance with data dissemination. We would like to thank every individual at Statistics Canada that participated in data collection. Lastly, we would like to thank all of the people who participated in this survey.

Conflicts of interest

The authors have no conflicts of interest to disclose.

Authors’ contributions and statement

MV, KHM, NH and MB drafted this At-a-glance article. MV did the statistical analyses. All co-authors interpreted the data, and revised the article.

The content and views expressed in this article are those of the authors and do not necessarily reflect those of the Government of Canada.

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