LAUSR

Abstract Introduction Before COVID‐19, Native Hawaiians/Pacific Islanders (NH/PI) endured a heavy burden of alcohol, tobacco and other drug (ATOD) use in prior US data. Responding to reports that many NH/PI communities experienced severe COVID‐19 disparities that could exacerbate their ATOD burden, we partnered with NH/PI communities to assess the substance use patterns and treatment needs of diverse NH/PIs during COVID‐19. Methods Collaborating with NH/PI community organisations across five states with large NH/PI populations, we conducted a large‐scale investigation of NH/PI ATOD use, mental health and treatment need during COVID‐19. Between April and November 2021, NH/PI‐heritage research staff from our community partners collected data involving 306 NH/PI adults using several community‐based recruitment methods (e‐mail, telephone, in‐person) and two survey approaches: online and paper‐and‐pencil. Multivariate regressions were conducted to examine potential predictors of NH/PI alcohol use disorder and need for behavioural health treatment. Results During COVID‐19, 47% and 22% of NH/PI adults reported current alcohol and cigarette use, while 35% reported lifetime illicit substance use (e.g., cannabis, opioid). Depression and anxiety were high, and alcohol use disorder, major depression and generalised anxiety disorder prevalence were 27%, 27% and 19%, respectively. One‐third of participants reported past‐year treatment need with lifetime illicit substance use, COVID‐19 distress and major depression respectively associating with 3.0, 1.2, and 5.3 times greater adjusted odds for needing treatment. Conclusions NH/PI adults reported heavy ATOD use, depression, anxiety and treatment need during COVID‐19. Targeted research and treatment services may be warranted to mitigate COVID‐19's negative behavioural health impact on NH/PI communities.