Substance Abuse

Alcohol
Alcohol use among youth is more widespread than use of tobacco or illicit drugs. While alcohol use has been gradually declining among youth since the 1980s, and reached historically low levels in 2011, it continues to be a significant problem.1 According to the 2009 National Survey on Drug Use and Health (NSDUH), about 10.4 million youth ages 12 to 20 (27.2 percent) reported drinking alcohol in the past month.2

While findings suggest that youth drink less frequently than adults, they binge drink (defined as drinking five drinks or more in about two hours on at least one occasion) more than adults.3 According to the 2009 NSDUH, 6.9 million youth (18.1 percent of youth between the ages of 12 and 20) reported binge drinking and 2.1 million youth (5.4 percent of youth between the ages of 12 and 20) reported heavy drinking (defined as drinking five or more drinks on the same occasion on each of five or more days in the past 30 days).4 These rates are higher for youth and young adults than for any other age group and are higher for youth enrolled in college than their peers.5

Binge drinking and heavy drinking can lead to a number of health risks including overall development and specific effects on the brain, liver, and endocrine system. Individuals who reported starting to drink before the age of 15 were four times more likely to also report meeting the diagnostic criteria for alcohol dependence at some point in their lives. The younger youth are when they start to use alcohol, the more likely they will be to engage in harmful behaviors, such as using other drugs, having sex with six or more partners, and earning grades that are mostly Ds and Fs in school.6

Tobacco
Smoking cigarettes is the leading cause of preventable disease and death in the U.S and is most often initiated during adolescence. While the number of students reporting that “they had smoked within the past month” declined from 1972−2011, the number of youth who have tried cigarettes and those who reported daily use remains higher than the number of youth who have tried any other illicit drug. Also, teens report that it is “very easy” or “fairly easy” to get cigarettes. Among 8th, 10th, and12th graders in 2011, 27.8 percent had tried cigarettes in their lifetime and 11.7 percent reported that “they had smoked within the past month”.7

In addition to smoking cigarettes some youth, almost exclusively males, use smokeless tobacco, including snuff, snus, and chew, which can lead to disease, death, and dependence.8 The reported rate of smokeless tobacco use among youth has been declining, and 30-day prevalence is about half of the reported rate at peak levels in 1994 for all grades.
Illicit Drug Use and Prescription Drug Abuse
Illicit drugs include marijuana/hashish, cocaine (including crack), heroin, hallucinogens, inhalants, or prescription-type pain relievers, tranquilizers, stimulants, and sedatives used nonmedically.9 Learn more about commonly abused drugs.

While illicit drug use among youth is lower than tobacco and alcohol use, youth and young adults between the ages of 12 and 25 were more likely to be current illicit drug users than adults 26 and older.10 Marijuana is the most widely used of all illicit drugs among youth and many youth report that it is highly accessible.11 Studies report that the degree to which teens disapprove of marijuana use and the perceived risk associated with use, even regular use, has recently begun to decline. Changes in these beliefs and attitudes can be associated with driving changes in use.12 Painkillers are one of the most commonly used drugs by teens after tobacco, alcohol, and marijuana.13 The most popular prescription drugs are opioids and stimulants. Opioids, which include pain relievers such as OxyContin and Vicodin, are central nervous system depressants that are often used to treat anxiety and sleep disorders. Stimulants are often used to treat attention-deficit hyperactivity disorder and narcolepsy.14

Overlap Between Alcohol, Tobacco, and Illicit Drug Use and Abuse
Studies have found a connection between youth who use alcohol and tobacco, and those who use illicit drugs. Of the youth who reported heavy drinking (defined as drinking five or more drinks on the same occasion on each of five or more days in the past 30 days), 69.9 percent also reported they had used an illicit drug. In comparison, illicit drug use for those who were not current alcohol users (used alcohol within the past month) was reported at 5.2 percent.15 Youth who smoke tobacco are nine times more likely to meet the medical criteria for alcohol abuse and 13 times more likely to meet the medical criteria for illicit drug abuse and dependence. Neurological research suggests that nicotine can cause structural and chemical changes in teenage brains, increasing the risk of alcohol, marijuana, and opioid use.16

1 Johnston, O’Malley, Bachman, & Schulenberg, 2012
2 U.S. Department of Health and Human Services, 2010
3 National Institute on Alcohol Abuse and Alcoholism, 2007
4 U.S. Department of Health and Human Services, 2010
5 U.S. Department of Health and Human Services, 2010; SAMHSA, Center for Behavioral Health Statistics and Quality, 2012
6 Alcohol Alert, National Institute on Alcohol Abuse and Alcoholism, 2006
7 Johnston, O’Malley, Bachman, & Schulenberg, 2012
8 Johnston, O’Malley, Bachman, & Schulenberg, 2012
9 U.S. Department of Health and Human Services, 2010
10 U.S. Department of Health and Human Services, 2010
11 Johnston, O’Malley, Bachman, & Schulenberg, 2012
12 Johnston, O’Malley, Bachman, & Schulenberg, 2012
13 U.S. Department of Health and Human Services, 2010
14 National Institute on Drug Abuse, 2009
15 U.S. Department of Health and Human Services, 2010
16 National Center on Addiction and Substance Abuse, 2007

Risk and Protective Factors

Research shows that the risk for substance abuse and other adverse behaviors increases as the number of risk factors increases, and that protective factors may reduce the risk of youth engaging in substance use that can lead to substance abuse. This interactive effect of risk and protective factors has substantial implications for the design and implementation of successful preventive interventions. The more a program reduces risk factors and increases protective factors, the more it is likely to succeed in preventing substance abuse among children and youth.

Risk and Protective Factors
Early aggressive behavior, lack of parental supervision, academic problems, undiagnosed mental health problems, peer substance use, drug availability, poverty, peer rejection, and child abuse or neglect are risk factors associated with increased likelihood of youth substance use and abuse. Risk factors that occur during early childhood further increase the risk of youth substance abuse. Risk factors of prolonged duration, for example, those that continue on from childhood through adolescence, are also associated with increased likelihood of youth substance abuse. Risk factors frequently associated with substance abuse are common across multiple disorders.
Not all youth will develop substance abuse problems, even if they have experienced these risk factors. Some individuals are exposed to protective factors that may keep them from using substances. The presence of multiple protective factors can lessen the impact of a few risk factors. For example, strong protection, such as parental support and involvement, could diminish the influence of strong risks, such as having peers who abuse substances.

Warning Signs

Many youth may show behaviors in adolescence that are indicative of substance abuse, but can also be considered normal behaviors while growing up. It is important to take notice if there are several signs happening at the same time, if they occur suddenly, and if the behaviors are extreme. The following behaviors in a youth might indicate drug or alcohol abuse:
• Mood changes (temper flare-ups, irritability, defensiveness)
• Academic problems (poor attendance, low grades, disciplinary action)
• Changing friends and a reluctance to have parents/family get to know the new friends
• A “nothing matters” attitude (lack of involvement in former interests, general low energy)
• Finding substances (drug or alcohol) in youth’s room or personal effects
• Physical or mental changes (memory lapses, poor concentration, lack of coordination, slurred speech, etc.)

Warning signs indicate that there may be a problem that should be looked into—not that there is definitely a problem. If there is suspicion that a youth is abusing substances, it is important to first speak with the youth to get a better understanding of the situation. The next step would be to have the youth screened for substance use by a professional (e.g., school counselor, social worker, psychologist). If there is no clear evidence of abuse, families should contact their primary health care physician to rule out a physical problem. If formal intervention is necessary, local substance abuse professionals should be contacted.