The IsoLation and Loneliness Underlying Misuse and INcreased use of Alcohol as a function of sTress and coping Efforts (ILLUMINATE) project will test adaptive/maladaptive coping as the mechanisms of action linking objective social isolation and subjective feelings of loneliness with alcohol use/misuse across the United States and stress as the moderator of these mediational effects in two separate studies. We will enhance our ability to test this model in our in-hand self-reported data from Study 1 on loneliness, stress, coping, and alcohol use during the COVID-19 pandemic when changing executive orders limited social interaction by dint of closures and reduced capacity. We collected data on a national sample of adults (N=1,550) during the first peak of US average COVID-19 daily infections in April, 2020 and at five additional points over the subsequent 12 months. Our surveys collected key self-report data on how people coped in the face of extensive social isolation, loneliness and concurrent pervasive chronic stress and alcohol consumption. We propose to add geographic location of the sample participants, which will allow us to create indicators of place-based social isolation and stressors (including an index of shelter-in-place, restrictions/closing of places of social interaction, and unemployment rates at each assessment point during COVID) and other stressors specific to a location such as economic and social vulnerabilities, housing instability, racial and ethnic segregation, and crime rates. Our first aim is to test adaptive (active coping, reappraisal) and maladaptive (avoidance) coping efforts as the behavioral mechanism driving alcohol use and high risk drinking over the course of the pandemic, testing the extent to which these coping processes mediate linkages between social isolation/loneliness and alcohol use/misuse, and our second aim is to determine whether cumulative-multilevel stress burden (individual and place-based) moderates the linkages between social isolation, loneliness, adaptive/maladaptive coping, and alcohol use/misuse. We will then collect prospective data for Study 2 in a nationally representative sample over 6 assessment points (N=1,550), again integrating objective geospatial indicators, to test the model of these linkages again (Aims 1 and 2) and to determine the extent to which our model of these relationships differed in a time of enforced isolation and communal stress from a more ordinary time period post-pandemic (Aim 3). Importantly, the repeated measures design in both samples allows us to model trajectories of alcohol use and misuse and the complex relationships among social isolation, loneliness, stress, and adaptive/maladaptive coping processes over time. Closely aligned with the NIH Funding Opportunity Announcement PAR-21-350, our assessment of the impact of isolation and loneliness in the COVID-19 pandemic and post-pandemic periods on alcohol use/misuse has considerable implications for developing prevention and intervention efforts calibrated for the post-pandemic environment.

The ILLUMINATE study promises to produce a greater understanding of coping behavior as a key mechanism of action in the linkages between social isolation, loneliness, and alcohol use/misuse. Possessing greater understanding of this interplay will open important new avenues for developing and implementing more effective, contextually valid prevention and intervention efforts for substance use and misuse with the potential for substantial public health impacts.