Secondhand harms from alcohol—also called alcohol’s harms to others—negatively affect users’ children, partners, extended families, friends, neighbors, and communities. In contrast to alcohol-related harms, a comprehensive empirical inventory of types, rates and impacts of secondhand harm from drugs in the US has been entirely lacking. As states and communities grapple with challenges posed by legalization of recreational marijuana, the worsening opioid crisis and the COVID-19 pandemic, understanding how use of different drugs (alone and in combination with alcohol) impacts families and communities takes on new importance to inform policies and programs to minimize harm. This study, Secondhand Harms from Alcohol & Drugs: Impacts on Families and Communities across the US, will build upon a prior NIAAA-funded study of alcohol’s harm to others (R01AA022791) to fill this gap. We propose to develop, field and analyze the 2023 US Alcohol and Drug Harm to Others Survey, a representative adult population survey focused on a key set of harms experienced by victims of others’ use of prevalent substances including alcohol, tobacco, marijuana, opioid painkillers, heroin, cocaine and methamphetamine. Using geocoded self-report data, we will assess prevalence of secondhand impacts of each substance and of multiple substance use; rates and severity of harms from different types of “others” (spouses/partners, family members, co-workers, friends and strangers); mental and physical health impacts; and risk factors including victims’ personal characteristics and own substance use, as well as their neighborhood, community and state contexts. The Aims are to: (1) document prevalence, overlap and trends in secondhand harms from alcohol and drugs, (2) examine contexts contributing to secondhand harms, and (3) assess impacts of secondhand harms from alcohol and drugs on mental and physical health and quality of life. Based on our experience designing and analyzing national surveys, we propose to conduct a comprehensive survey to collect detailed data on secondhand alcohol and drug harms, and analyze these using advanced strategies, including some co-analysis with existing data on secondhand harms collected before and during the COVID-19 pandemic. Major project innovations will be to generate comprehensive US population estimates of specific secondhand drug harms, collect new longitudinal data, and study trends in alcohol and marijuana harms. A conceptual innovation is to investigate the role of both macro (neighborhoods, state contexts) and micro (drinking contexts, social relationships) environments vis a vis secondhand harms from alcohol and specific drugs. Despite importance for prevention, few studies have identified environmental contexts in which secondhand harms from alcohol and various drugs occur. We will examine how environments may contribute to (or minimize) specific harms for women and other high-priority groups (racial/ethnic minorities and sexual/gender minorities). Documenting types, overlap and severity of secondhand harms from alcohol and drugs has great practical utility for prevention and promises to inform future development of effective public health policies.

The proposed study is highly relevant to public health, as data from the planned US population survey would allow more accurate estimation of negative impacts of alcohol, tobacco and drugs like marijuana, opioids and methamphetamine on people other than users themselves. The study will identify relevant risk factors of individuals, their social environments, and their neighborhoods and communities, which will be useful for planning targeted interventions and prevention programs to protect people at risk of harm. Results also will provide evidence to inform debates on effective policy strategies to reduce alcohol- and drug-related harm.