Behavioral health providers' prioritization of tobacco and marijuana concerns during the COVID-19 pandemic: A grounded theory analysis.

Given the high co-occurrence of tobacco, marijuana use, and mental health disorders, we explored behavioral health providers' perceptions of patient mental health and substance use during the COVID-19 pandemic. We conducted semi-structured interviews with 21 Ohio providers randomly sampled from state licensure records, analyzing data using constructivist grounded theory. Providers perceived broad increases in substance use and mental health symptoms, attributing these to isolation, reduced support access, and pandemic-related stress. Providers consciously de-prioritized tobacco and marijuana to focus on "more acute" concerns. Substance use providers emphasized "riskier" substances while mental health providers prioritized severe psychiatric symptoms. Tobacco was often excluded from abstinence frameworks due to its normalization in recovery settings. These findings highlight the need for targeted provider training, organizational policy reform, and educational interventions to address the systematic deprioritization of tobacco and marijuana in behavioral health settings, with implications extending beyond the COVID-19 pandemic to future public health crises.