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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 \u201cmore acute\u201d concerns. Substance use providers emphasized \u201criskier\u201d 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.<\/jats:p>","DOI":"10.1177\/13591053261461883","type":"journal-article","created":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T17:10:04Z","timestamp":1783098604000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Behavioral health providers\u2019 prioritization of tobacco and marijuana concerns during the COVID-19 pandemic: A grounded theory analysis"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0894-3006","authenticated-orcid":false,"given":"Geoffrey J.","family":"Carney-Knisely","sequence":"first","affiliation":[{"name":"The Ohio State University College of Medicine, Columbus, OH, USA"},{"name":"University of Pittsburgh Medical Center, Pittsburgh, PA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amy K.","family":"Ferketich","sequence":"additional","affiliation":[{"name":"The Ohio State University College of Public Health, Columbus, OH, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Parvati","family":"Singh","sequence":"additional","affiliation":[{"name":"The Ohio State University College of Public Health, Columbus, OH, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tamar L.","family":"Gur","sequence":"additional","affiliation":[{"name":"The Ohio State University College of Medicine, Columbus, OH, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6644-8084","authenticated-orcid":false,"given":"Tasleem J.","family":"Padamsee","sequence":"additional","affiliation":[{"name":"The Ohio State University College of Public Health, Columbus, OH, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,7,3]]},"reference":[{"key":"e_1_3_3_2_1","doi-asserted-by":"publisher","DOI":"10.1080\/02791072.2017.1397304"},{"key":"e_1_3_3_3_1","volume-title":"Integrating Tobacco Use Disorder Interventions in Addiction Treatment: A Guide for Addiction Treatment Clinicians and Programs","author":"American Society of Addiction Medicine","year":"2022","unstructured":"American Society of Addiction Medicine (2022) Integrating Tobacco Use Disorder Interventions in Addiction Treatment: A Guide for Addiction Treatment Clinicians and Programs. 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