Nearly Half of U.S. Teens Smoke, Drink Alcohol, or Use Drugs

New Report Calls Teen Substance Abuse America’s No. 1 Public Health Problem

Medically Reviewed by Laura J. Martin, MD on June 29, 2011

June 29, 2011 -- Nearly half of all American high school students smoke, drink alcohol, or use illicit drugs, according to a new report. And one in four who started using these substances before they turned 18 may become addicts.

One-quarter of people in the U.S. who began using drugs or alcohol before age 18 meet the criteria for drug or alcohol addiction, compared with one of 25 Americans who started using drugs or alcohol when they were 21 or older, according to the report by the National Center on Addiction and Substance Abuse (CASA) at Columbia University in New York City.

“I was surprised at the prevalence of substance use disorders among young people,” says study author Susan E. Foster, CASA’s vice president and director of policy research and analysis. The new study opens a window of opportunity for providers and parents to intervene and prevent addiction, she says.

“Do everything you can to get young people through their teen years without using drugs or alcohol,” she says. “Every year they don’t use drugs or alcohol reduces their risk of negative consequences, such as addiction.”

According to information cited in the new report:

  • Ten million or 75% of high school students have tried tobacco, alcohol, marijuana, or cocaine; and one in five of them meet the medical criteria for addiction.
  • Of the 6.1 million or 46% of high school students who currently use addictive substances, one in three is addicted to these substances.
  • The most common drug of choice among high school students in the U.S. is alcohol, followed by cigarettes and marijuana.

The findings are based on surveys of 1,000 high school students, 1,000 parents of high school students, and 500 school officers, along with expert interviews, focus groups, a literature review of 2,000 scientific articles, and an analysis of seven data sets.

No. 1 Public Health Problem

“Health care providers need to integrate screening for substance abuse into their practice, and treat and refer patients,” Foster says. This may be easier said than done because there is a dearth of addiction treatment information and options available as well as insurance barriers, she says.

Parents need to know what their teens are up to and who they spend time with, she says.

Modeling good behavior is also important, Foster says. “Make sure they know that it doesn’t take a drink or drug to relax,” she says. And “if you do suspect there is a problem, get help fast because it won’t go away, and will probably exacerbate fast.”

Substance Abuse Not a Rite of Passage

Teen substance abuse is a huge problem,” says Stephen Grcevich, MD, a child and adolescent psychiatrist at Family Center by the fall in Chagrin Falls, Ohio. “The numbers in the new report are very consistent with what we see in context of our practice and surrounding areas.”

But teen substance abuse and addiction are not inevitable, he says. Preventing substance abuse starts with “intentional parenting” at an early age.

“You have to have a plan that allows you to be a positive influence on your children at a young age so that when they get to an age where they are exposed to drugs and alcohol, they will know how to say no,” he says.

“Kids who do well academically, are involved in religion, and/or are actively engaged in sports are less likely to get involved with these substances,” he says. “We need to look at giving kids something meaningful and important to do.”

The new findings mirror what Harold C. Urschel, MD, an addiction expert in Dallas, sees in practice “without question.”

He says that “we know that if you wait to drink alcohol until you are 21, you are 40% less likely to become addicted than if you drink alcohol at age 15,” he says.

From the age of 15 to 22, the adolescent brain is developing, Urschel says. “A complex layer of neural networks is being laid down and brain growth is exponential during these years, so even a little bit of injury from alcohol or drugs is greatly magnified,” he says.

Drinking alcohol or using drugs is not harmless fun or a rite of passage, he says.

Show Sources


CASA. Adolescent Substance Abuse: America’s #1 Health Problem. June 29, 2011.

Stephen Grcevich, MD, child and adolescent psychiatrist, Family Center by the Falls, Chagrin Falls, Ohio.

Susan E. Foster, vice president, director of policy research and analysis, CASA, New York City.

Harold C. Urschel, MD, addiction expert, Dallas.

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