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Illicit drug use among youth is a serious concern of
parents, schools, communities, and governments across the
country. Overall drug use among young people peaked in 1979,
then declined steadily throughout the 1980s before climbing
again between 1992 and 1997. Since then the rate of use among
youth has stabilized or decreased slightly. Specifically,
adolescent use of tobacco, alcohol (both illegal for youth),
inhalants, marijuana, LSD (lysergic acid diethylamide),
cocaine, heroin, and methamphetamine has remained stable.
Nonetheless today's levels are still well above those of the
1980s.
One exception to this overall trend is MDMA
(3,4-methylenedioxymethamphetamine), also known as ecstasy,
the use of which has spread rapidly throughout the country and
is still increasing. The consequences of high overall drug use
are increasing, too, evidenced in the growing numbers of
treatment admissions and emergency department visits,
particularly for the drugs most popular with young users such
as marijuana and the club drugs MDMA and GHB
(gamma-hydroxybutyrate).
Young people who use drugs appear to be negatively
influenced by many factors, including friends and family
members who may use or sell drugs or who do not actively
prohibit their use. But these same negative influences can be
overcome if parents, schools, communities, and governments
work in concert to educate young people regarding the dangers
of illicit substances, to effectively monitor their activities
and behaviors, and to actively encourage them to stay or
become drug free.
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The reduction of illicit drug use among the nation's youth
has long been a priority of the federal, state, and local
public health and law enforcement communities. To this end,
the U.S. Government tracks youth drug use via three nationally
representative surveys: the National Household Survey on Drug
Abuse (NHSDA), the Monitoring the Future (MTF) study, and the
Youth Risk Behavior Survey (YRBS). The NHSDA is a home-based
survey, while the MTF and YRBS are school-based. Also, while
the NHSDA and MTF are annual surveys that monitor drug use
only, the YRBS is biennial and monitors several health risk
behaviors, one of which is drug use. Despite these and other
differences in methodology, these national-level indicators
display remarkably similar drug use trends particularly
evident among youth.
As part of its efforts to research adolescent drug use and
to augment data derived from national-level reporting with
information at the local level, the National Drug Intelligence
Center (NDIC) developed a teen drug use questionnaire in 2001.
A directed research project, the questionnaire was
administered via telephone to 300 substance abuse counselors
across the nation. The questionnaire comprised approximately
30 questions that covered issues ranging from what drugs are
used and how they are acquired to the consequences of their
use. Responses to NDIC's questionnaire are not representative
of the population as a whole but provide anecdotal reporting
that, combined with demand and law enforcement sources, helps
illustrate adolescent drug use from several perspectives.
Age and use statistics indicate that young people typically
first experiment with tobacco, alcohol, inhalants, and
marijuana. The age of initiation for each of these substances
is lower than for any other illicit substance. According to
the latest data from NHSDA, the mean age at first use of
tobacco is 15.4; alcohol, 16.3; inhalants, 16.4; and
marijuana, 17.0. This higher onset age for marijuana is
consistent with research showing that most youth who initiate
marijuana use previously have used tobacco, alcohol, or both,
and that some have used inhalants. Moreover, rates of use for
these substances have been well above those for other specific
illicit substances tracked by prevalence studies. For example,
NHSDA data for 2000 show that lifetime use among those aged 12
to 17 was much higher for cigarettes (34.6%), alcohol (41.7%),
inhalants (8.9%), and marijuana/hashish (18.3%) than for the
next highest specific drug--LSD (3.6%).1
The MTF study, too, shows much higher rates of use for
these entry-level substances among eighth, tenth, and twelfth
graders, particularly noticeable among the youngest users. For
example, MTF data for 2001 show that lifetime use among eighth
graders for cigarettes (36.6%), alcohol (50.5%), inhalants
(17.1%), and marijuana/hashish (20.4%) was much higher than
for the next highest specific drug--MDMA (5.2%).
Data from the 1999 YRBS, which examines the initiation of
risk behaviors for tobacco, alcohol, and marijuana--but not
inhalants--support the NHSDA and MTF findings. Among students
in grades 9 through 12 nation-wide, 24.7 percent reported they
had smoked a cigarette, 32.2 percent had drunk alcohol, and
11.3 percent had tried marijuana before age 13. For all three
substances, males were significantly more likely than females
to have initiated these behaviors.
Support for the theory that the use of tobacco and alcohol
is an indicator of subsequent illicit drug use among youth is
demonstrated in NHSDA data for 2000. In that year, 42.7
percent of those aged 12 to 17 who smoked cigarettes reported
current use of illicit drugs, compared with just 4.6 percent
of nonsmokers. Also, 65.5 percent of heavy drinkers aged 12 to
17 reported current use of illicit drugs, while just 4.2
percent of nondrinkers reported current drug use.2
As young users age, rates of use generally increase,
peaking, according to 2000 NHSDA data, between 18 and 20 years
of age for current use. During this period, a number of youth
who use tobacco, alcohol, inhalants, or marijuana
progress to using other illicit substances, and the mean age
at first use for other drugs is as follows: hallucinogens,
18.6; cocaine, 19.5; pain relievers, 19.5; stimulants, 19.6;
heroin, 19.8; and methamphetamines, 20.0. 3
Anecdotal reporting from substance abuse counselors differs
somewhat from national-level data in terms of both drug and
age initiation. Respondents to NDIC's questionnaire
overwhelmingly answered "marijuana" when asked what
drug (other than alcohol) teenagers first use. Tobacco was
second, followed by inhalants and prescription drugs. Also,
the age of initiation reported by respondents was lower,
generally ranging between 10 and 14 years, and some
respondents noted use as young as 8 or 9, particularly of
marijuana or inhalants. Since substance abuse counselors tend
to see more youth who are in trouble because of drug use,
these initiation patterns may not be typical of youth in
general.
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National-level demand indicators show that the overall teen
drug use rate has stabilized or decreased slightly. According
to the 2000 NHSDA, past year use of any illicit drug among
youth aged 12 to 17 decreased from 1999 (19.8%) to 2000
(18.6%). But lifetime rates of use remain high. In 2000, 26.9
percent of 12 to 17 year olds reported using an illicit drug
in their lifetime, and of these, 18.3 percent had used
marijuana/hashish, 10.9 percent had abused prescription drugs,
and 5.8 percent had used hallucinogens. These figures changed
little from the previous year when 27.6 percent had used any
illicit drug, of which 18.7 percent had used
marijuana/hashish, 10.9 percent had abused prescription drugs,
and 5.7 percent had used hallucinogens.
Similarly, the MTF study indicates that the rate of past
year use of any drug by eighth, tenth, and twelfth graders
remained relatively stable between 2000 and 2001 (see Table).
Changes recorded for tenth and twelfth graders were not
significant, and lifetime use rates remain high overall. The
MTF study further indicates that 53.9 percent of twelfth
graders in 2001 had used an illicit drug at least once in
their lifetime. Nearly half (49.0%) reported lifetime
marijuana use, 11.7 percent reported lifetime MDMA use, 10.9
percent reported lifetime LSD use, 8.2 percent reported
lifetime cocaine use, and 6.9 percent reported lifetime
methamphetamine use.
Table. Past
Year Use of Any Illicit Drug for Eighth, Tenth, and Twelfth
Graders (%)
Source: The Monitoring the Future Study, 2001.
Lifetime use rates covered in the 1999 YRBS are somewhat
similar to those in the MTF study. Nationwide, 47.2 percent of
students in grades 9 through 12 had used marijuana at least
once in their lifetime, 9.5 percent had used cocaine, and 9.1
percent had used methamphetamine.
In agreement with the national-level demand indicators were
the substance abuse counselors responding to NDIC's
questionnaire who, when asked what drugs teens are using,
again overwhelmingly responded "marijuana."
Methamphetamine, MDMA, cocaine, hallucinogens, prescription
drugs (OxyContin, Valium, Xanax, other benzodiazepines), and
inhalants were reported as well.
Data on where and when young people use drugs is somewhat
harder to come by than data on the number of users and the
frequency of use. But youth surveys and law enforcement
sources suggest that drugs continue to have a strong presence
in schools across the country. For example, results of the
1999 YRBS indicate that 30.2 percent of students in grades 9
through 12 had been offered, sold, or given an illegal drug on
school property within the 12 months preceding the survey.
Male students (34.7%) were significantly more likely then
female students (25.7%) to experience these situations.
More recently, a 2001 report from the National Center on
Addiction and Substance Abuse (CASA) at Columbia University
indicates that 60 percent of high school students and 30
percent of middle school students report that drugs are used,
kept, or sold at their schools. Also, according to responses
to NDIC's National Drug Threat Survey 2001, some state and
local law enforcement agencies in Arizona, California,
Connecticut, Kentucky, Maine, Maryland, Minnesota, New York,
Pennsylvania, Rhode Island, Texas, and Utah report an increase
in drug presence at schools in their areas.
Despite the apparent availability of drugs in schools, most
data indicate that young people generally use on weekends and
in the late afternoon or early evening after school on
weekdays. Data for the 2000-2001 school year from the Parents'
Resource Institute on Drug Education (PRIDE) indicate that
drug use rates among youth generally are higher during
weekends and after school. Drug use among sixth through
twelfth graders responding to the PRIDE survey was most
prevalent during the weekends for marijuana, cocaine, and
hallucinogens. For example, 28.5 percent of the twelfth
graders reported using marijuana during weekends, compared
with 12.4 percent reporting use after school and 7.9 percent
reporting use before school. The time of use for inhalants was
more evenly distributed than that of the three drugs mentioned
above. In fact, students reported equal or heavier use of
inhalants during school hours than after school.
Most substance abuse counselors responding to NDIC's
questionnaire also indicated that teens use drugs in the
afternoons and evenings after school and on weekends. But
several indicated that drug use frequently occurs before
school and during lunch as well.
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One of the more notable trends over the past few years
concerns the rate of MDMA use, which rose sharply among
eighth, tenth, and twelfth graders between 1998 and 2000,
according to the MTF study. Past year use of MDMA among
twelfth graders, for example, rose from 3.6 to 8.2 percent
during that period. While the increase in use slowed between
2000 and 2001 (to 9.2% for twelfth graders), MTF data further
indicate that teens' perceive MDMA as increasingly available
(see Chart 1). While an increase in
actual prevalence of the drug may or may not be true,
perceived prevalence could persuade some teens that MDMA use
is the norm and thereby increase the likelihood they will try
it. Data from MTF further indicate that for the second
straight year MDMA use is more prevalent among teenagers than
cocaine use.
Chart 1.
Long-Term Trends in Perceived Availability of MDMA by
Twelfth Graders (%)
Source: The Monitoring the
Future Study, 2001.
Likewise, information from the 2001 Partnership Attitude
Tracking Study (PATS) shows that teens' lifetime use of MDMA
more than doubled from 1995 (5.0%) to 2001 (12.0%) and is now
equal with that of cocaine, crack, and LSD and higher than
that of heroin. According to the Partnership for a Drug-Free
America, one factor contributing to the rising use of MDMA is
the perception among teens that the drug is "only
slightly more dangerous" than tobacco, alcohol,
inhalants, and marijuana.
Illustrating the rapid growth of the drug across the
country, "ecstasy," or MDMA, was the overwhelming
response from substance abuse counselors responding to NDIC's
questionnaire when asked what drugs teens currently use that
were previously unavailable in their communities. Heroin,
prescription drugs (primarily OxyContin), GHB, methamphetamine
(including crystal meth-amphetamine), crack cocaine, and
hallucinogens were reported as well. Also, some state and
local law enforcement agencies in Colorado, Connecticut,
Georgia, Kansas, Minnesota, Montana, North Dakota, Nebraska,
New Jersey, South Dakota, Tennessee, and Wisconsin reported
through the National Drug Threat Survey 2001 that MDMA either
was just emerging in their areas or had emerged within the
previous year.
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The consequences of early drug use are shown in the numbers
of young people requiring drug-related treatment and emergency
health care or exposing themselves to health risks. For
example, the 1999 Treatment Episode Data Set (TEDS) indicates
that 47 percent of admissions to publicly funded treatment
facilities for marijuana abuse were under the age of 20.
Moreover, among primary marijuana admissions, more than half
(57%) first used the drug by age 14, and 92 percent by age 18.
Teens also accounted for more than half of admissions for
hallucinogens in 1999: 53 percent were between the ages of 15
and 19.
Data for 2000 indicate that 31 percent of all Drug Abuse
Warning Network (DAWN) emergency department cases involved
patients aged 25 and under. At least 80 percent of LSD, MDMA,
and Rohypnol mentions, more than 70 percent of ketamine
mentions, and 60 percent of GHB mentions involved patients
aged 25 and under. DAWN data further show that
marijuana/hashish mentions among those aged 12 to 17 increased
622 percent between 1990 and 2000.
The use of any drug or alcohol can lower inhibitions and
lead to riskier behavior and, subsequently, to potential harm
to the user such as exposure to sexually transmitted diseases.
The 1999 YRBS results indicate that 24.8 percent of students
nationwide who were sexually active at the time of the survey
had used drugs or alcohol at the time of their last sexual
intercourse. Male students (31.2%) were significantly more
likely than female students (18.5%) to engage in this
behavior.
A 1999 CASA study that analyzed the YRBS sample from 1997
indicated that 63 percent of high school teens who used
alcohol reported having sex compared with 26 percent of those
who never used alcohol. Also, 72 percent of teens who used
drugs reported having sex compared with 36 percent of those
who never used drugs. The CASA study further suggests that
teens who use drugs or alcohol are more likely to have sex at
younger ages, to have multiple partners, and to be at greater
risk of sexually transmitted diseases and pregnancy.
Substance abuse counselors responding to NDIC's
questionnaire, when asked what, in their experience, were the
consequences of teen drug use, frequently mentioned legal
(arrests, violence, criminal activity) and health (emergency
room visits, pregnancy, suicides) problems as well as poor
family or social relationships. The most commonly reported
consequence, however, was poor school performance comprising
truancy, cheating, poor grades, disciplinary problems, and
expulsions or dropouts.
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Young peoples knowledge and perceptions of illicit drugs
are affected, both negatively and positively, by many
influences including friends, peers, family members, and
television and other media. For example, NHSDA data show that
significantly more young people (17%) were likely to be
current users of marijuana when a few, some, or all of their
friends used marijuana than those reporting none of their
friends used marijuana (0.5%). Also, those who knew adults
that used marijuana were nine times more likely to be current
marijuana users than those who did not know adults that used
the drug.
What is more, responses to NDIC's questionnaire indicate
that many teens learn how to use drugs--and often acquire
them--from their friends, peers, and family members, including
parents. Various forms of media also were implicated. For
example, some respondents specifically mentioned prime-time
news programs that present drug information in such detail
that they teach young people how to administer drugs.
Unfortunately many parents are unaware or remain
unconvinced of the positive influence they might have in
preventing their children from using drugs. According to a
2001 report from the Office of National Drug Control Policy (ONDCP),
only 52.0 percent of parents of 12 to 13 year olds believe
that monitoring would decrease the likelihood of their
children using drugs. Information from the 2001 PATS, however,
indicates that one of the biggest risks that teens associate
with marijuana use is upsetting their parents. More than
two-thirds (66.0%) of teens mentioned this risk in 2001, and
this percentage has been relatively stable over the last few
years.
PRIDE data for the 2000-2001 school year also support the
contention that parents can positively influence drug use
rates among their children. Use rates were lower among sixth
through twelfth graders reporting their parents talked with
them "a lot" about illicit drugs (18.8%) than among
those whose parents seldom (28.4%) or never (34.5%) discussed
illicit drugs.
Complementing these findings are results of a 2000 CASA
survey. The survey correlated teens' risk of substance abuse
with 12 possible actions the teens attributed to their
parents. Some of the parental actions included monitoring
media exposure, monitoring school performance, knowing where
teens are after school and on weekends, and expressing
disapproval of drug use. Results of the CASA survey indicate
that teens whose parents monitor such activities are at
one-quarter the risk of smoking, drinking, and using illegal
drugs.
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Attitudes drive behavior, and national drug education
campaigns over the years may have had an effect on the
attitudes of youth toward drug use. Overall drug use declined
from the mid-1980s to the early 1990s, a period marked by
campaigns such as the D.A.R.E. (Drug Abuse Resistance
Education) and "Just Say No" programs. Drug use then
increased from the early to mid-1990s, a time of conflicting
drug-related messages, some of which glamorized the use of
drugs.
The National Youth Anti-Drug Media Campaign implemented by
ONDCP in January 1998 appears to have influenced attitudes
especially toward marijuana use, an area the campaign
principally targeted. Although the prevalence studies are not
designed to evaluate the campaign's effectiveness and
definitive evaluation is not yet complete, some data suggest a
positive impact. For example, NHSDA data for 2000 show that
81.9 percent of those aged 12 to 17 had either seen or heard a
drug prevention message outside of school in the previous
year. Moreover, the 2001 PATS suggests that frequent exposure
to antidrug messages correlates to fewer teens reporting
lifetime (38%), past year (30%), and current (19%) use of
marijuana than less frequent exposure (see Chart
2).
Chart 2.
Marijuana Use Among Teens Who Report Seeing or Hearing
Antidrug Messages (%)
Source: 2001 Partnership
Attitude Tracking Study Key Findings.
Conversely, use rates for MDMA, a drug not specifically
addressed in the original media campaign, have risen since
1998. In response, the first national education campaign
focusing on MDMA was initiated in February 2002. The campaign
has been designed to educate parents as well as teenagers and
consists of both television and print advertisements that
deliver messages about the very real dangers associated with
MDMA use in an effort to change the perception that it is a
harmless drug.
The D.A.R.E. program also launched a new curriculum that
began in limited areas in fall 2001. The new curriculum
targets older students by shifting from fifth to seventh
graders and incorporating a supplementary program for ninth
graders. To counter the theory that some education programs
make drug use seem more prevalent than it is and thus
encourage youth to see it as a social norm, the revamped
D.A.R.E. program allows students to challenge perceived norms
through peer discussion groups.
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Despite relatively stable to slightly declining overall
drug use among young people, rates of use are still relatively
high. Moreover, the consequences of drug use to the nation's
youth and the ever-present threat of emerging drugs, such as
MDMA, demand constant attention.
As long as drugs remain available to young people, antidrug
education must be a priority for policymakers and law
enforcement as well as for parents and schools. Only through
consistent and ongoing antidrug messages from family, friends,
schools, and governments--and the supported efforts of youth
themselves to remain drug free--can adolescent drug use be
substantially reduced.
Centers for Disease Control
Youth Risk Behavior Survey
University of Michigan
Monitoring the Future Study
National Center on Addiction and Substance Abuse at
Columbia University
NDIC National Drug Threat Survey responses
NDIC Teen Drug Use Questionnaire responses
Office of National Drug Control Policy
Parents' Resource Institute on Drug Education
Partnership for a Drug-Free America
Partnership Attitude Tracking Study
Substance Abuse and Mental Health Services Administration
Drug Abuse Warning Network
National Household Survey on Drug Abuse
Treatment Episode Data Set
1. Lifetime use is
defined as use of a drug at least once in a user's life; past
year use, at least once in the preceding 365 days; current
use, at least once in the preceding 30 days.
2. The NHSDA defines
"heavy" alcohol use as drinking five or more drinks
on the same occasion on each of 5 or more days in the past 30
days.
3. Includes
nonmedical use of any prescription-type pain reliever or
stimulant; does not include over-the-counter drugs.
Program