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The Case for Nature-Based Prescriptions

Nearly one in four American adults reported drinking more alcohol during the COVID-19 pandemic, as previously discussed by the Center of Alcohol & Substance Use Studies. The increases in alcohol consumption are related to attempts of people to self-manage the stress of the pandemic, among other stressors, in their lives. This increase in substance use poses a number of concerns for the health and wellness of American adults. A 2019 study of alcohol consumption in Sweden found hazardous drinking (AUDIT scale score 8 or more) was associated with a higher risk of depression, indicative of the potential for substance use and mental health concerns among individuals with heavy alcohol use.

With growing concerns related to increased alcohol use, and the comorbidities associated with substance use, the Center of Alcohol & Substance Use Studies has a special interest in addressing these issues in ways that are strengths-based and wellness-focused in the 8 dimensions of wellness, including the environmental wellness dimension. One way we can support outcomes for people with mental health, trauma, and substance use challenges is helping people to plan time in nature and become more exposed to green spaces.

Published in March 2022, a recent article in PLOS ONE adds to the growing evidence that time in green spaces is associated with mental health benefits, including during the COVID-19 pandemic. The authors conducted a study in Denver, CO, where survey responses on the impact of COVID-19, exposure to green spaces, stress, and mental health were analyzed. Green space was defined as “any area with natural vegetation. This can include parks, yards, grassy areas, street trees, green roofs, cemeteries, etc.” (p. 6). It is important to point out that respondents to the measures were more likely to be older, white, college educated women. The authors found the green space measures were associated with lower scores on both the depression and anxiety measures, aligned with the literature that posits green spaces, nature, and time outdoors may have positive mental health impacts. Spending time outdoors in green spaces improves mood, which may serve as an alternative self-management or coping strategy for adults who have increased alcohol consumption, or a preventative measure for adults at risk for increasing alcohol consumption.

The positive impact of green spaces is emphasized by a 2021 publication out of the UK, A Handbook for Nature on Prescription to Promote Mental Health. Developed by the European Centre for Environment and Human Health, University of Exeter College of Medicine and Health, the Handbook details strategies for organizations and practitioners to provide “nature-based interventions.” Nature-based activities that can support well-being and overall health can include community gardening, outdoor walking groups, habitat restoration, and wilderness-focused activities, like bushcrafting (p. 9). The authors note, “Individual studies have indicated that craft activities, making things and acts of creation relate to wellbeing through self-management and empowerment, coping mechanisms, enjoyment and meaningful activities, performance and, for some populations, reaffirmation of identity” (p.25). The coping and self-management skills and capacities developed through such activities may be particularly valuable for individuals experiencing or at-risk for substance use, particularly when rates of drinking are increasing nationwide.

While Nature on Prescription is a complex intervention that integrates the healthcare and social prescribing systems in the UK, the tenets of the program can easily be adapted by behavioral health providers in the US seeking to improve outcomes for individuals recovering and healing from substance use, mental health conditions, or trauma exposure. A group-based process, Nature on Prescription can support collective efficacy and achievement among participants. Some people may benefit from structured group activities in nature. Providers may want to consider integrating the principles and practices of social prescribing from the UK into local practices to connect individuals receiving services to organizations that engage in structured outdoor activities, such as community clean-ups, community gardening, outdoor fitness or health classes, or even virtual outdoor programs.

It is important to be mindful that people may not have the same access to green spaces. People may benefit from finding ways to increase time outdoors as a habit and routine, as this can enhance wellness in all eight dimensions, including environmental wellness, improve mental health, and promote substance use recovery.

Disclaimer: The content is solely the responsibility of the authors and does not necessarily represent the official views of the Center of Alcohol & Substance Use Studies.


  • American Psychological Association (2022, March 10). Stress in America: Money, inflation, war pile on to nation stuck in COVID-19 survival mode.
  • Fullam, J., Hunt, H., Lovell, R., Husk, K., Byng, R., Richards, D., Bloomfield, D., Warber, S., Tarrant, M., Lloyd, J., Orr, N., Burns, L., & Garside, R. (2021) A handbook for Nature on Prescription to promote mental health. Version 1. Cornwall, UK: University of Exeter.
  • Gémes, K., Forsell, Y., Janszky, I., László, K. D., Lundin, A., Ponce De Leon, A., Mukamal, K. J., & Moller, J. (2019). Moderate alcohol consumption and depression – a longitudinal population‐based study in Sweden. Acta Psychiatrica Scandinavica, 139(6), 526-535.
  • Reid, C. E., Rieves, E. S., & Carlson, K. (2022). Perceptions of green space usage, abundance, and quality of green space were associated with better mental health during the COVID-19 pandemic among residents of Denver. PLOS ONE, 17(3), e0263779.