Young People and Drugs

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The Drug Policy Alliance has a series of resources for educators and parents, including a drug education curriculum and tips for talking to teens about drugs.

Mothers Against Misuse and Abuse has been working since the early 1980s to provide honest, effective drug education for young people.

Page last updated Jan. 5, 2021 by Doug McVay, Editor.

41. Mortality Among High School Students in the US

"In 2016 in the United States, 74% of all deaths among persons aged 10–24 years resulted from four causes: motor vehicle crashes (22%), other unintentional injuries (20%), suicide (17%), and homicide (15%) (1). Among persons aged 15–19 years, 209,809 births (2); 488,700 cases of chlamydia, gonorrhea, and syphilis (3); and 1,652 diagnoses of human immunodeficiency virus (HIV) (4) were reported. Among persons aged ≥25 years, 54% of all deaths in the United States resulted from cardiovascular disease (31%) and cancer (23%) (1). These leading causes of mortality, morbidity, and social problems (e.g., academic failure, poverty, and crime) among youth and adults in the United States are associated with six categories of priority health-related behaviors: 1) behaviors that contribute to unintentional injuries and violence; 2) tobacco use; 3) alcohol and other drug use; 4) sexual behaviors that related to unintended pregnancy and sexually transmitted infections (STIs), including HIV infection; 5) unhealthy dietary behaviors; and 6) physical inactivity. These behaviors, as well as obesity, overweight, and asthma, frequently are related, are established during childhood and adolescence, and extend into adulthood.

"Significant health disparities exist among demographic subgroups of youth defined by sex, race/ethnicity, and grade in school, and especially between sexual minority and nonsexual minority youth (5–7). More specifically, violence, human immunodeficiency virus (HIV) infection, STIs, and pregnancy occur more frequently among sexual minority youth than nonsexual minority youth. In addition, some sexual minority youth struggle with stigma, discrimination, family disapproval, and social rejection. However, although differences based on sex, race/ethnicity, and grade in school have been well documented, not enough is known about health-related behaviors that contribute to negative health outcomes among sexual minority youth (5,7)."

Laura Kann, PhD; Tim McManus, MS; William A. Harris, MM; et al. "Youth Risk Behavior Surveillance — United States, 2017," Morbidity and Mortality Weekly Report Surveillance Summaries (Atlanta, GA: Centers for Disease Control, June 15, 2018), Vol. 67, No. 8.
https://www.ncbi.nlm.nih.gov/p...
https://www.cdc.gov/...

42. Marijuana Use and Educational Attainment

“Teen marijuana users are approximately twice as likely as non-users to drop out of high school.234 One study found that, compared to students who did not use marijuana at all in the past year, those who used marijuana less than weekly were 2.6 times as likely to be school dropouts (5.8 percent vs. 2.2 percent) and those who used marijuana at least weekly were 5.8 times as likely to be school dropouts (12.8 percent vs. 2.2 percent).235 Students who use marijuana before age 15 are twice as likely as other students to report frequent truancy and three times as likely to leave school before age 16.236 One study found that, by their 40s, individuals who used marijuana in adolescence and young adulthood had more than a third of a year’s less educational attainment than non-users. The more frequent the marijuana use in this age group, the fewer the number of years of educational attainment achieved.”

"Adolescent Substance Use: America's #1 Public Health Problem," The National Center on Addiction and Substance Abuse at Columbia University (New York, NY: National Center on Addiction and Substance Abuse at Columbia University, June 2011), p. 57.
http://www.casacolumbia.org/ad...

43. Impact of Parental Incarceration on Young Adults

"RESULTS: Positive, significant associations were found between parental incarceration and 8 of 16 health problems (depression, posttraumatic stress disorder, anxiety, cholesterol, asthma, migraines, HIV/AIDS, and fair/poor health) in adjusted logistic regression models. Those who reported paternal incarceration had increased odds of 8 mental and physical health problems, whereas those who reported maternal incarceration had increased odds of depression. For paternal incarceration, with the exception of HIV/AIDS, larger associations were found for mental health (odds ratios range 1.43–1.72) as compared with physical health (odds ratios range 1.26–1.31) problems. The association between paternal incarceration and HIV/AIDs should be interpreted with caution because of the low sample prevalence of HIV/AIDs."

Rosalyn D. Lee, Xiangming Fang and Feijun Luo, "The Impact of Parental Incarceration on the Physical and Mental Health of Young Adults." Pediatrics 2013;131;e1188; originally published online March 18, 2013; DOI: 10.1542/peds.2012-0627.
http://pediatrics.aappublicati...
http://pediatrics.aappublicati...

44. Early Drug Exposure and Later Drug Use

"The teen brain is a work in progress, making it more vulnerable than the mature brain to the physical effects of drugs. The potential for developing substance abuse and dependence is substantially greater when an individual’s first exposure to alcohol, nicotine and illicit drugs occurs during adolescence than in adulthood."

Steinberg, L., Distinguished University Professor and Laura H. Carnell Professor of Psychology, Department of Psychology, Temple University and author of "You and Your Adolescent: The Essential guide for ages 10 to 25" (personal communication, June 9, 2011), as quoted in "Adolescent Substance Use: America’s #1 Public Health Problem," The National Center on Addiction and Substance Abuse at Columbia University (New York, NY: National Center on Addiction and Substance Abuse at Columbia University, June 2011), p. 13.
http://www.casacolumbia.org/ad...

45. Likelihood That Young People with Diagnosed Mental Health Conditions Will be Put on Long Term Opioid Therapy

"Of the 1,000,453 opioid recipients (81.7%) with at least 6 months of follow-up, 51.1% were female, and the median age was 17 years (interquartile range, 16-18 years). Among these adolescents, the estimated cumulative incidence of LTOT [Long Term Opioid Therapy] after first opioid receipt was 1.1 (95% CI, 1.1-1.2) per 1000 recipients within 1 year, 3.0 (95% CI, 2.8-3.1) per 1000 recipients within 3 years, 8.2 (95% CI, 7.8-8.6) per 1000 recipients within 6 years, and 16.1 (95% CI, 14.2-18.0) per 1000 recipients within 10 years. The prevalence of mental health conditions and treatments in this sample is shown in eTable 3 in the Supplement.

"All mental health conditions and treatments were associated with higher rates of transitioning from a first opioid prescription to long-term therapy. Table 2 provides the estimated incidence of LTOT among those with and without mental health conditions and treatments.Adjusted relative increases in the rate of LTOT ranged from a factor of 1.73 for ADHD [Attention-Deficit/Hyperactivity Disorder] (hazard ratio [HR], 1.73; 95% CI, 1.54-1.95) to approximately 4-fold for benzodiazepines (HR, 3.88; 95%CI, 3.39-4.45) and nonopioid SUDs [Substance Use Disorders] (HR, 4.02;95%CI, 3.48-4.65) to 6-fold for non benzodiazepine hypnotics (HR, 6.15; 95%CI, 5.01-7.55) and to nearly 9-fold for OUD [Opioid Use Disorder] (HR, 8.90; 95%CI, 5.85-13.54). In addition, relative to no condition, the number of condition types was also associated with higher LTOT rates (1 condition: HR, 2.21; 95% CI, 2.01-2.43; 2 or more conditions: HR, 4.01; 95% CI, 3.62-4.46).

"Given the strong associations for OUD, we explored other mental health factors and opioid receipt among those with preexisting OUD. These adolescents were more likely than
adolescents without OUD to have other mental health conditions and treatments (eTable 4 in the Supplement). For example, 76.1% of adolescents with OUD had other SUDs, 61.0% had depressive disorders, and 52.6% had received an SSRI [Selective Serotonin Reuptake Inhibitor]. During follow-up, those with preexisting OUD received opioid drugs similar to those received by adolescents without OUD, although the former were more likely to receive certain opioids (eg, oxycodone and tramadol; eTable 5 in the Supplement). Of those with preexisting OUD, 15.5% filled a prescription for OUD medication treatment during follow-up."

Quinn PD, Hur K, Chang Z, et al. Association of Mental Health Conditions and Treatments With Long-term Opioid Analgesic Receipt Among Adolescents. JAMA Pediatr. 2018;172(5):423–430. doi:10.1001/jamapediatrics.2017.5641
https://jamanetwork.com/journa...
https://www.ncbi.nlm.nih.gov/p...

46. Importance of Family Dinners in Substance Use Prevention

"Compared to teens who have five to seven family dinners per week, those who have fewer than three family dinners per week are twice as likely to say they expect to try drugs (including marijuana and prescription drugs without a prescription to get high) in the future (17 percent vs. 8 percent)."

"The Importance of Family Dinners VIII: A CASAColumbia White Paper," The National Center on Addiction and Substance Abuse (New York, NY: September 2012), p. 7.
http://www.casacolumbia.org/ad...

47. Top Concerns Among Adolescents

"Every year teens tell us that tobacco, alcohol and other drugs are the biggest problem facing teens their age. This year, 26 percent of teens surveyed say that alcohol, drugs and tobacco are the most important issue teens face, followed by social pressures [18%] and academic pressures [11%]."

QEV Analytics, Ltd., "National Survey of American Attitudes on Substance Abuse XVII: Teens" (New York, NY: National Center on Addiction and Substance Abuse, August 2012), p. 25.
http://www.casacolumbia.org/ad...

48. Parental Incarceration and Adverse Childhood Experiences (ACEs)

"Children exposed to parental incarceration were more likely to have other ACEs than children not exposed to parental incarceration. For example, only 14.3% of children exposed to parental incarceration had no other ACEs, compared to 72.2% of children not exposed to parental incarceration. Further, among children exposed to parental incarceration, about 28.9% experienced one other ACE (compared to 19.4% of children not exposed to parental incarceration), 21.2% experienced two other ACEs (compared to 5.5%), 16.4% experienced three other ACEs (compared to 1.8%), and 19.3% experienced four or more other ACEs (compared to 1.2%).

"Table 2 presents descriptive statistics of ACEs for two groups of children: those who experienced parental incarceration and those who did not experience parental incarceration. Children exposed to parental incarceration had more ACEs than those not exposed to parental incarceration (2.06 compared to 0.41, p < 0.001). Children exposed to parental incarceration were also more likely to report any ACE (85.7% compared to 27.8%, p < 0.001). Children exposed to parental incarceration were nine times more likely to experience household member abuse (31.9% compared to 3.4%, p < 0.001) and violence exposure (20.3% compared to 2.3%, p < 0.001). They were eight times more likely to experience household member substance problems (45.5% compared to 5.8%, p < 0.001); five times more likely to experience parental death (11.8% compared to 2.5%, p < 0.001); and four times more likely to experience household member mental illness (24.1% compared to 6.4%, p < 0.001) and parental divorce or separation (72.7% compared to 20.5%, p < 0.001)."

Kristin Turney, Adverse childhood experiences among children of incarcerated parents, Children and Youth Services Review, Volume 89, 2018, Pages 218-225, ISSN 0190-7409, https://doi.org/10.1016/j.chil....
http://www.sciencedirect.com/s...

49. Illicit Use of Prescription Drugs

"Abuse of prescription medicine [by teens] remains high, but there are signs that it may be plateauing. Close to one in five teens (17 percent) say they have used a prescription medicine at least once in their lifetime to get high or change their mood. This is slightly, although not significantly, down from 22 percent in 2010 and from 20 percent in 2009. Use of prescription pain medicines, specifically Vicodin or OxyContin, is trending downward. One out of ten teens reports using pain medication to get high in the past year and six percent say they used in the past 30 days – down significantly from 2009 levels."

"The Partnership Attitude Tracking Study: 2011 Parents and Teens Full Report," MetLife Foundation and The Partnership at Drugfree.org (New York, NY: May 2, 2012), p. 13.
http://www.drugfree.org/wp-con...

50. Prevalence of Sadness or Hopelessness Among High School Students in the US, by Gender

"During the 12 months before the survey, 31.5% of students nationwide had felt so sad or hopeless almost every day for 2 or more weeks in a row that they stopped doing some usual activities (Supplementary Table 42). The prevalence of having felt sad or hopeless was higher among female (41.1%) than male (21.4%) students; higher among white female (38.2%), black female (40.7%), and Hispanic female (46.8%) than white male (21.4%), black male (17.3%), and Hispanic male (21.2%) students, respectively; and higher among 9th-grade female (40.0%), 10th-grade female (43.1%), 11th-grade female (43.6%), and 12th-grade female (37.5%) than 9th-grade male (19.5%), 10th-grade male (21.5%), 11th-grade male (20.9%), and 12th-grade male (24.1%) students, respectively. The prevalence of having felt sad or hopeless was higher among Hispanic (33.7%) than white (30.2%) and black (29.2%) students and higher among Hispanic female (46.8%) than white female (38.2%) students. The prevalence of having felt sad or hopeless was higher among 10th-grade female (43.1%) and 11th-grade female (43.6%) than 12th-grade female (37.5%) students and higher among 12th-grade male (24.1%) than 9th-grade male (19.5%) students.

"Analyses based on the question ascertaining sexual identity indicated that nationwide, 27.5% of heterosexual students; 63.0% of gay, lesbian, and bisexual students; and 46.4% of not sure students had felt sad or hopeless (Supplementary Table 42). The prevalence of having felt sad or hopeless was higher among gay, lesbian, and bisexual (63.0%) and not sure (46.4%) than heterosexual (27.5%) students and higher among gay, lesbian, and bisexual (63.0%) than not sure (46.4%) students. Among female students, the prevalence was higher among lesbian and bisexual (68.8%) and not sure (51.9%) than heterosexual (36.8%) students and higher among lesbian and bisexual (68.8%) than not sure (51.9%) students. Among male students, the prevalence was higher among gay and bisexual (45.5%) and not sure (36.4%) than heterosexual (19.5%) students. The prevalence also was higher among heterosexual female (36.8%) than heterosexual male (19.5%) students, higher among lesbian and bisexual female (68.8%) than gay and bisexual male (45.5%) students, and higher among not sure female (51.9%) than not sure male (36.4%) students."

Laura Kann, PhD; Tim McManus, MS; William A. Harris, MM; et al. "Youth Risk Behavior Surveillance — United States, 2017," Morbidity and Mortality Weekly Report Surveillance Summaries (Atlanta, GA: Centers for Disease Control, June 15, 2018), Vol. 67, No. 8.
https://www.ncbi.nlm.nih.gov/p...
https://www.cdc.gov/...

51. Estimated Number of Young Adults in the US With a Parent Who Has Ever Spent Time in Jail or Prison

"The prevalence of any PI [Parental Incarceration] was 12.5% with the 95% confidence interval (CI) of 11.3% to 13.8%. The distribution of incarceration status by category was: neither parent (87.5%, 95% CI: 86.2%–88.7%), father only (9.9%, 95% CI: 8.9%–10.9%), mother only (1.7%, 95% CI: 1.4%–2.0%), and both parents (0.9%, 95% CI: 0.7%–1.2%). A significant association was found between race and PI. Black and Hispanic individuals had the highest prevalence of PI, 20.6% and 14.8%, compared with 11.9% for white individuals and 11.6% for those classified as other. Pairwise comparison indicated the black and white prevalence rates were significantly different."

Note: Regarding study sample size: "The current study used data from the National Longitudinal Study of Adolescent Health (Add Health), a 4-wave longitudinal study following a nationally representative probability sample of adolescents in grades 7 through 12 in the 1994–1995 school year.46 The first 3 waves of Add Health data were collected from April to December 1995, from April to August 1996, and from August 2001 to April 2002. The fourth wave of data was collected in 2007 and 2008. The full sample for Wave 4 included 15 701 or 80.3% of the eligible participants from Wave 1. The response rates for Waves 1, 2, 3, and 4 were 79.0%, 88.6%, 77.4%, and 80.3%, respectively. The mean ages of participants during the 4 waves of data collection were 15.7 years, 16.2 years, 22.0 years, and 28.8 years, respectively.

"The current study was based on 14,800 participants who were interviewed during Wave 1 and Wave 4 and have a sampling weight. Of the 15,701 participants who participated in both Wave 1 and Wave 4 interviews, 14,800 participants have a sampling weight at Wave 4 interview that could be used to compute population estimates. For data analysis, data describing participants’ sociodemographic characteristics from Wave 1 of the Add Health study were combined with Wave 4 self-reported health outcomes and PI history."

Rosalyn D. Lee, Xiangming Fang and Feijun Luo, "The Impact of Parental Incarceration on the Physical and Mental Health of Young Adults." Pediatrics 2013;131;e1188; originally published online March 18, 2013; DOI: 10.1542/peds.2012-0627.
http://pediatrics.aappublicati...
http://pediatrics.aappublicati...

52. Depression and Marijuana Use

“High school students in CASA’s survey who report having ever used marijuana are more likely than students who never used marijuana to report that they feel alone or isolated (26.7 percent vs. 19.9 percent), that they often feel very sad or depressed (27.9 percent vs. 14.0 percent) and that they think they will develop depression during their lifetime (41.0 percent vs. 25.4 percent).7

Adolescent Substance Use: America’s #1 Public Health Problem," The National Center on Addiction and Substance Abuse at Columbia University (New York, NY: National Center on Addiction and Substance Abuse at Columbia University, June 2011), p. 46.
http://www.casacolumbia.org/ad...

53. Prescription Medicine Abuse

"It is important to note that the negative consequences of prescription medicine abuse remain extensive and troubling. Emergency room visits as a result of prescription medications increased 45 percent between 2004 and 2009 among children under 20 years of age1. Admissions to treatment for prescription medicine abuse among adolescents have also increased and deaths caused by drug overdoses, led by prescription medicines, now outnumber traffic fatalities in the United States2."

"The Partnership Attitude Tracking Study: 2011 Parents and Teens Full Report," MetLife Foundation and The Partnership at Drugfree.org (New York, NY: May 2, 2012), p. 14.
http://www.drugfree.org/wp-con...

54. Ease of Getting Drugs

"Younger teens (ages 12 to 13 and 14 to 15) are more likely to say that they can get prescription drugs in an hour, and within a day, compared to marijuana, while older teens (16- to 17) are more likely to be able to get to marijuana within a day."

QEV Analytics, LTD., "National Survey of American Attitudes on Substance Abuse XVII: Teens," The National Center on Addiction and Substance Abuse at Columbia University (New York, NY: National Center on Addiction and Substance Abuse at Columbia University, August 2012), p. 28.
http://www.casacolumbia.org/ad...

55. Impact of State-Legal Medical Marijuana on Adolescent Marijuana Use

"In conclusion, our study of self-reported marijuana use by adolescents in states with a medical marijuana policy compared with a sample of geographically similar states without a policy does not demonstrate increases in marijuana use among high school students that may be attributed to the policies."

Choo, Esther K. et al., "The Impact of State Medical Marijuana Legislation on Adolescent Marijuana Use," Journal of Adolescent Health, August 2014, Volume 55, Issue 2, p. 160 - 166.
http://www.jahonline.org/...
http://www.jahonline.org/...

56. Alcohol and Tobacco Use by Young People as Gateway Factors for Eventual Use of Other Drugs

"• In 2013, the rate of current illicit drug use among youths aged 12 to 17 who smoked cigarettes in the past month was approximately 9 times the rate among youths who did not smoke cigarettes in the past month (53.9 vs. 6.1 percent). Also, the rate of current marijuana use in 2013 among youths aged 12 to 17 who smoked cigarettes in the past month was about 11 times the rate among youths who did not smoke cigarettes (49.5 vs. 4.6 percent).
"• In 2013, the rate of current illicit drug use was associated with the level of past month alcohol use. Among youths aged 12 to 17 who were heavy drinkers (i.e., consumed five or more drinks on the same occasion on each of 5 or more days in the past 30 days), 62.3 percent were current illicit drug users and 57.9 percent were current marijuana users. These rates were higher than the rates among youths who were not current alcohol users (4.9 percent for current illicit drug use and 3.3 percent for current marijuana use). Additionally, among youths aged 12 to 17 who were binge but not heavy alcohol users (i.e., consumed five or more drinks on the same occasion on 1 to 4 days in the past 30 days), 46.6 percent were current illicit drug users and 43.2 percent were current marijuana users (with the marijuana use rate being higher than the 2012 rate of 37.8 percent).
"• In 2013, the rate of current illicit drug use among youths aged 12 to 17 who both smoked cigarettes and drank alcohol in the past month was approximately 16 times the rate among those who neither smoked cigarettes nor drank alcohol in the past month (64.5 vs. 3.9 percent). Additionally, the rate of current marijuana use among youths aged 12 to 17 who both smoked cigarettes and drank alcohol in the past month was about 25 times the rate among those who neither smoked cigarettes nor drank alcohol in the past month (59.7 vs. 2.4 percent)."

Substance Abuse and Mental Health Services Administration, Results from the 2013 National Survey on Drug Use and Health: Summary of National Findings, NSDUH Series H-48, HHS Publication No. (SMA) 14-4863. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2014, p. 31.
http://www.samhsa.gov/data/NSD...
http://www.samhsa.gov/data/NSD...

57. Importance of Relationship with Parents

"Teens who have high-quality relationships with Mom and Dad are less likely to use drugs, drink or smoke.
"Compared to teens who say they have an excellent relationship with Dad,* teens who have a less than very good relationship with their father are:
• Almost four times likelier to have used marijuana (23 percent vs. 6 percent);
• Twice as likely to have used alcohol (35 percent vs. 16 percent); and
• Two and a half times as likely to have used tobacco (15 percent vs. 6 percent).
"Compared to teens who say they have an excellent relationship with Mom,† teens who have a less than very good relationship with their mother are:
• Almost three times likelier to have used marijuana (26 percent vs. 9 percent);
• Two and a half times as likely to have used alcohol (45 percent vs.18 percent); and
• Two and a half times likelier to have used tobacco (16 percent vs. 6 percent)."

"The Importance of Family Dinners VIII: A CASAColumbia White Paper," The National Center on Addiction and Substance Abuse (New York, NY: September 2012), p. 3.
http://www.casacolumbia.org/ad...

58. Social Networking and Drug Use

"Compared to teens who have never seen pictures on Facebook, MySpace or another social networking site of kids getting drunk, passed out, or using drugs, teens who have seen such pictures are:

• Four times likelier to have used marijuana (25 percent vs. 6 percent);
• More than three times likelier to have used alcohol (43 percent vs. 13 percent); and
• Almost three times likelier to have used tobacco (16 percent vs. 6 percent)."

QEV Analytics, LTD., "National Survey of American Attitudes on Substance Abuse XVII: Teens," The National Center on Addiction and Substance Abuse at Columbia University (New York, NY: National Center on Addiction and Substance Abuse at Columbia University, August 2012), p. 3.
http://www.casacolumbia.org/ad...

59. Gangs in Schools

"• Forty-five percent of high school students say that there are gangs or students who consider themselves to be part of a gang in their school.
"• Thirty-five percent of middle school students say that there are gangs or students who consider themselves to be part of a gang in their school.
"Compared to teens in schools without gangs, those in schools that have gangs are nearly twice as likely to report that their school is drug infected, meaning drugs are used, kept or sold on school grounds (30 percent vs. 58 percent).
"A quarter of public school students (27 percent) say that their school is both drug infected and has gangs."

Knowledge Networks and QEV Analytics, "National Survey of American Attitudes on Substance Abuse XV: Teens and Parents" (New York, NY: National Center on Addiction and Substance Abuse at Columbia University, August 2010), p. 2.
http://www.casacolumbia.org/ad...

60. Drug-Related ER Visits

"Patients aged 20 or younger accounted for 18.8 percent (922,953 visits) of all drug-related ED visits in 2010. About one half (45.3 percent, or 417,856 visits) of these visits involved drug misuse or abuse, representing a rate of 476.1 ED visits per 100,000 population aged 20 or younger."

Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. "The DAWN Report: Highlights of the 2010 Drug Abuse Warning Network (DAWN) Findings on Drug-Related Emergency Department Visits," (Rockville, MD: July 2, 2012), p. 2.
http://www.samhsa.gov/data/2k1...

61. Early Initiation of Substance Use

“When initiation of substance use occurs in preadolescence or early in adolescence, the risk of addiction is magnified.8 CASA’s analysis of national data finds that individuals‡ who first used any addictive substance before age 15 are six and a half times as likely to have a substance use disorder as those who did not use any addictive substance until age 21 or older (28.1 percent vs. 4.3 percent).”

"Adolescent Substance Use: America’s #1 Public Health Problem," The National Center on Addiction and Substance Abuse at Columbia University (New York, NY: National Center on Addiction and Substance Abuse at Columbia University, June 2011), p. 38
http://www.casacolumbia.org...

62. Delay in Onset of Substance Use

“Each year that the onset of substance use is delayed until the mid-20s - about the time when the human brain is more fully developed10 — the risk of developing a substance use disorder is reduced.11 Among people who used any of these substances before age 18, one in four have a substance disorder, compared with one in 25 who started to smoke, drink or use other drugs at age 21 or later.”12

Adolescent Substance Use: America’s #1 Public Health Problem," The National Center on Addiction and Substance Abuse at Columbia University (New York, NY: National Center on Addiction and Substance Abuse at Columbia University, June 2011), p. 39.
http://www.casacolumbia.org/up...

63. Inhalants

"In 2011, there were 719,000 persons aged 12 or older who had used inhalants for the first time within the past 12 months, which was lower than the numbers in prior years from 2002 to 2005 (ranging from 849,000 to 877,000). An estimated 67.1 percent of past year initiates of inhalants in 2011 were under age 18 when they first used. The average age at first use among recent initiates aged 12 to 49 was similar in 2010 and 2011 (16.3 and 16.4 years, respectively)."

Substance Abuse and Mental Health Services Administration, Results from the 2011 National Survey on Drug Use and Health: Summary of National Findings, NSDUH Series H-44, HHS Publication No. (SMA) 12-4713. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2012, p. 58.
http://www.samhsa.gov/data/NSD...

64. Prevalence of Inhalant Use Among US Youth

"Inhalants rank second among the illicit drugs in lifetime prevalence for 8th graders (8.9%) and third for 10th graders (6.1%); but they rank seventh for 12th graders (4.9%). Inhalants also rank second-highest in 30-day prevalence among the illicit drugs for 8th (2.1%) and third (1.1%) among 10th graders, but they rank much lower for 12th graders (0.8%). Note that the youngest respondents report the highest levels of use; this is the only class of drugs for which current use declines with age during adolescence.3"

3: The results also indicate declining lifetime inhalant prevalence at higher grades, which could be due to various factors. There might be lower lifetime prevalence at older ages because the eventual school dropout segment is included only in the lower grades. If those who will become dropouts are unusually likely to use inhalants, lifetime use rates could decline with grade level. That would lead to a relatively stable difference between the grades in lifetime use (because dropout rates have been fairly stable in recent years); however, the degree of difference has changed some over time, with larger differences emerging in the mid-1990s. Another possible factor is changing validity of reporting with age; but in order to account for the trend data, one would have to hypothesize that this tendency became stronger in the 1990s, and we have no reason to believe that it did. Cohort differences may be a factor, but cannot completely explain the large changes in lifetime prevalence. It seems likely that all of these factors contribute to the differences observed in the retrospective reporting by different ages, and possibly some additional factors as well.

Miech, R. A., Johnston, L. D., O’Malley, P. M., Bachman, J. G., Schulenberg, J. E., & Patrick, M. E. (2018). Monitoring the Future national survey results on drug use, 1975–2017: Volume I, Secondary school students. Ann Arbor: Institute for Social Research, The University of Michigan. Available at
http://monitoringthefuture.org...
http://monitoringthefuture.org...

65. Inhalants

"• The percentage of adolescents (i.e., youths aged 12 to 17) who used inhalants in the past year was lower in 2007 (3.9 percent) than in 2003, 2004, and 2005 (4.5, 4.6, and 4.5 percent, respectively)
"• Among adolescents who used inhalants for the first time in the past year (i.e., past year initiates), the rate of use of nitrous oxide or “whippits” declined between 2002 and 2007 among both genders (males: 40.2 to 20.2 percent; females: 22.3 to 12.2 percent)
"• In 2007, 17.2 percent of adolescents who initiated illicit drug use during the past year indicated that inhalants were the first drug that they used; this rate remained relatively stable between 2002 and 2007
(Note: "Inhalants" are defined as: "Aerosol sprays other than spray paint include products such as aerosol air fresheners, aerosol spray, and aerosol cleaning products (e.g., dusting sprays, furniture polish). The aerosol propellants in these products are commonly chlorofluorocarbons. By contrast, nitrous oxide is used as a propellant for whipped cream and is available in 2-inch tapered cylinders called “whippits” that are used to pressurize home whipped-cream charging bottles.")

Substance Abuse and Mental Health Services Administration, Office of Applied Studies. (March 16, 2009). "The NSDUH Report: Trends in Adolescent Inhalant Use: 2002 to 2007." Rockville, MD, pp. 1 and 3.
http://oas.samhsa.gov/2k9/inha...

66. Impact on Young People of Incarceration of Their Fathers

"Paternal incarceration, however, was found associated with a greater number of health outcomes than maternal incarceration. Also, paternal incarceration was found to be associated with both physical and mental health problems, whereas maternal incarceration was found associated only with poor mental health.
"For paternal incarceration, with the exception of HIV/AIDS, larger associations were found for mental health as compared with physical health outcomes. Caution should be taken in understanding the significance of the finding related to HIV/AIDS, given its low overall sample prevalence and wide CI. If this is a true association, it may be related to paternal HIV/AIDS status and other risk factors related to father absence. Given the high correlation between HIV/AIDS and incarceration, increased odds of HIV/AIDS in offspring could come from perinatal transmission. However, social factors may also explain this relationship."

Rosalyn D. Lee, Xiangming Fang and Feijun Luo, "The Impact of Parental Incarceration on the Physical and Mental Health of Young Adults." Pediatrics 2013;131;e1188; originally published online March 18, 2013; DOI: 10.1542/peds.2012-0627.
http://pediatrics.aappublicati...
http://pediatrics.aappublicati...

67. Physical and Mental Health Impact of Parental Incarceration on Their Children

"As shown in Table 2, bivariate analyses indicate PI [Parental Incarceration] was significantly associated with 8 of the 16 health conditions (heart disease, asthma, migraines, depression, anxiety, posttraumatic stress disorder [PTSD], HIV/AIDS, and fair/poor health). With the exception of heart disease and HIV/AIDS, individuals who reported neither parent had an incarceration history had the lowest prevalence rates of these 8 health conditions. Individuals who reported father incarceration only had the highest prevalence rates of 3 of the 8 health conditions (heart disease, HIV/AIDS, and fair/poor health); whereas individuals who reported mother incarceration only were highest on 2 conditions (depression and anxiety) and individuals who reported incarceration of both parents were highest on 3 conditions (asthma, migraine, and PTSD)."

Rosalyn D. Lee, Xiangming Fang and Feijun Luo, "The Impact of Parental Incarceration on the Physical and Mental Health of Young Adults." Pediatrics 2013;131;e1188; originally published online March 18, 2013; DOI: 10.1542/peds.2012-0627.
http://pediatrics.aappublicati...
http://pediatrics.aappublicati...

68. Alcohol Use v Marijuana Use - US Youth and "The Displacement Hypothesis"

"Alcohol and marijuana are the two most commonly used substances by teenagers to get high, and a question that is often asked is to what extent does change in one lead to a change in the other. If the substances co-vary negatively (an increase in one is accompanied by a decrease in the other) they are said to be substitutes; if they co-vary positively, they are said to be complements. Note that there is no evidence that the 13-year decline in marijuana use observed between 1979 and 1992 led to any accompanying increase in alcohol use; in fact, through 1992 there was some parallel decline in annual, monthly, and daily alcohol use, as well as in occasions of heavy drinking among 12th graders, suggesting that the two substances are complements. Earlier, when marijuana use increased in the late 1970s, alcohol use also increased. As marijuana use increased again in the 1990s, alcohol use again increased with it, although not as sharply. In sum, there has been little evidence from MTF over the years that supports what we have termed 'the displacement hypothesis,' which asserts that an increase in marijuana use will somehow lead to a decline in alcohol use, or vice versa.8 Instead, both substances appear to move more in harmony, perhaps both reflecting changes in a more general construct, such as the tendency to use psychoactive substances, whether licit or illicit, or in the frequency with which teens party. However, with alcohol use decreasing and marijuana use increasing over the past few years, it is possible that the displacement hypothesis is gaining some support. As a number of states are changing their policies regarding marijuana, our continued monitoring will provide the needed evidence concerning whether alcohol and marijuana are substitutes or complements."

Miech, R. A., Johnston, L. D., O’Malley, P. M., Bachman, J. G., & Schulenberg, J. E. (2015). Monitoring the Future national survey results on drug use, 1975–2014: Volume I, Secondary school students. Ann Arbor: Institute for Social Research, The University of Michigan, pp. 161-162.
http://monitoringthefuture.org...
http://monitoringthefuture.org...

69. Reasons for Non-Prescription Use of Prescription Opioids by US High School Seniors

"Approximately 12.3% of the respondents -- high school seniors in the United States -- reported lifetime nonmedical use of prescription opioids and 8.0% reported past-year nonmedical use. Table 1 shows the prevalence of motives for nonmedical use of prescription opioids among high school seniors in the United States. The leading motives included 'to relax or relieve tension' (56.4%), 'to feel good or get high' (53.5%), 'to experiment-see what it's like' (52.4%), 'to relieve physical pain' (44.8%), and 'to have a good time with friends' (29.5%).

Sean Esteban McCabe, Phd, et al., "Motives for Nonmedical Use of Prescription Opioids among High School Seniors in the United States: Self-Treatment and Beyond," Archives of Pediatric and Adolescent Medicine, 2009 August; 163(8): 739-744. doi:10.1001/archpediatrics.2009.120.
http://www.ncbi.nlm.nih.gov/pu...
http://www.ncbi.nlm.nih.gov/pm...

70. Attitudes of Young People Toward Legalization of Marijuana

"• Table 8-8 lists the proportions of 12th graders in 2018 who favor various legal consequences for marijuana use. The proportion who believe it should be entirely legal was 48%, near the record high set the previous year of 49%. As the percentage favoring legality increased, the percentage believing marijuana use should be a crime decreased and in 2018 was 11%, the lowest level recorded by the survey, having fallen from a peak of 53% in 1990.

"• Asked whether they thought it should be legal to sell marijuana if it were legal to use it, about two in three (66%) said “yes,” very near the historic high of 67% set the previous year. However, about 83% of those answering “yes” (55% of all respondents) would permit sale only to adults. A small minority (11%) favored the sale to anyone, regardless of age, while 19% said that sale should not be legal even if use were made legal, and 15% said they “don’t know.” Thus, while the majority subscribe to the idea of legal sale, if use is allowed, the great majority agree with the notion that sale to underage people should not be legal.

"• Most 12th graders felt that they would be little affected personally by the legalization of either the sale or the use of marijuana. Nearly half (45%) of the respondents said that they would not use the drug even if it were legal to buy and use, while others indicated that they would use it about as often as they do now (16%) or less often (1%). Only 9% said they would use it more often than they do at present, while 16% thought they would try it. Another 13% said they did not know how their behavior would be affected if marijuana were legalized. Still, this amounts to 25% of all 12th graders, or about one in four, who thought that they would try marijuana, or that their use would increase, if marijuana were legalized.

"• A study of the effects of decriminalization by several states during the late 1970s, based on MTF data, found no evidence of any impact on the use of marijuana among young people, nor on attitudes and beliefs concerning its use.18 However, it should be noted that decriminalization falls well short of the full legalization posited in the questions here. Moreover, the situation today is very different from the one in the late 1970s, with more peer disapproval and more rigorous enforcement of drug laws, at least until recently. Some more recent studies suggest that there might be an impact of decriminalization, because “youths living in decriminalized states are significantly more likely to report currently using marijuana.”19 One study using MTF data shows that prevalence of marijuana use among 12th grade Californian students significantly increased in the two years after decriminalization went into effect in 2011, and youth attitudes also became significantly more permissive.20 As more states approve full legalization of recreational use for adults (as has occurred in California, Massachusetts, Michigan, Nevada, Maine, Colorado, Washington, Oregon, Alaska, Vermont, and Washington, DC), it seems quite possible that attitudes about, and use of, marijuana will change. Declines in perceived risk and disapproval of marijuana would seem the most likely attitudinal changes, and such changes may well lead to increased use among youth."

Miech, R. A., Johnston, L. D., O’Malley, P. M., Bachman, J. G., Schulenberg, J. E., & Patrick, M. E. (2019). Monitoring the Future national survey results on drug use, 1975–2018: Volume I, Secondary school students. Ann Arbor: Institute for Social Research, The University of Michigan. Available at
http://monitoringthefuture.org...
http://monitoringthefuture.org...

71. Pain Relief and Non-Prescription Use of Prescription Opioids by US High School Seniors

"The lifetime medical use of prescription opioids was reported by approximately 14.0% of those who did not engage in past-year nonmedical use of prescription opioids, 76.1% of nonmedical users of prescription opioids motivated only by pain relief, 71.4% of those motivated by pain relief and other motives, and 46.7% of those who reported non-pain relief motives only (p < 0.001). Among past-year nonmedical users of prescription opioids, approximately 56.5% of those motivated only by pain relief as compared to 23.1% of those who reported pain relief and other motives, and 14.2% of those who reported only non-pain relief motives had initiated medical use of prescription opioids before nonmedical use of prescription opioids. In contrast, approximately 19.6% of those motivated only by pain relief as compared to 48.3% of those who reported pain relief and other motives, and 32.5% of those who reported only non-pain relief motives initiated nonmedical use of prescription opioids before medical use of prescription opioids."

Sean Esteban McCabe, Phd, et al., "Motives for Nonmedical Use of Prescription Opioids among High School Seniors in the United States: Self-Treatment and Beyond," Archives of Pediatric and Adolescent Medicine, 2009 August; 163(8): 739-744. doi:10.1001/archpediatrics.2009.120.
http://www.ncbi.nlm.nih.gov/pu...
http://www.ncbi.nlm.nih.gov/pm...

72. Opioids Do Not Have Potential To Cause Malformations To An Embryo Or Fetus

"It is important to note that, contrary to alcohol, benzodiazepines and nicotine, opioids do not have teratogenic potential (3). Thus, special attention needs to be paid to dependence and abuse of legal substances and prescription drugs that can have severe consequences for the foetus and newborn, such as foetal developmental disorders or sudden infant death syndrome (Fetal Alcohol Spectrum Disorders Center for Excellence, 2013; McDonnell-Naughton et al., 2012)."

European Monitoring Centre for Drugs and Drug Addiction, "Pregnancy and opioid use: strategies for treatment," EMCDDA Papers (Publications Office of the European Union: Luxembourg, 2014), p. 3.
http://www.emcdda.europa.eu/pu...
http://www.emcdda.europa.eu/at...

73. Children with Parents in Prison

"Since 1991, the number of children with a mother in prison has more than doubled, up 131%. The number of children with a father in prison has grown by 77%. This finding reflects a faster rate of growth in the number of mothers held in state and federal prisons (up 122%), compared to the number of fathers (up 76%) between 1991 and midyear 2007.
"Of the estimated 74 million children in the U.S. resident population who were under age 18 on July 1, 2007, 2.3% had a parent in prison (table 2). Black children (6.7%) were seven and a half times more likely than white children (0.9%) to have a parent in prison. Hispanic children (2.4%) were more than two and a half times more likely than white children to have a parent in prison."

Glaze, Lauren E., and Maruschak, Laura M., "Parents in Prison and Their Minor Children" (Washington, DC: US Dept. of Justice Bureau of Justice Statistics, Aug. 2008), NCJ222984, p. 2.
http://www.bjs.gov/content/pub...

74. Estimated Prevalence of and Attitudes Toward Marijuana Use Among Youth in the US in 2015

"Marijuana, the most widely used of the illicit drugs, did not show any significant change in annual prevalence this year in any of the three grades, nor in the three grades combined. After rising for several years, the annual prevalence of marijuana has more or less leveled out since about 2010.
"This year, 12 percent of 8th ­graders, 25 percent of 10th ­graders and 35 percent of 12th ­graders reported using marijuana at least once in the prior 12 months. Of more importance, perhaps, is their daily or near-­daily marijuana use (defined as smoking marijuana on 20 or more occasions in the past 30 days). These rates stand at 1.1 percent, 3.0 percent and 6.0 percent in 8th, 10th and 12th grades, respectively.
"In other words, one in every 16 or 17 high school seniors is smoking marijuana daily or near daily. These rates have changed rather little since 2010, but are from three-­to-­six times higher than they were at their low point in 1991.
"'The proportion of our young people smoking marijuana this frequently remains a matter of concern,' Johnston said.[2],[3]
"He notes that the percent of students who see regular marijuana use as carrying a great risk of harm has declined substantially since about 2005, and is still declining. Over the past 10 years, the percent seeing a great risk in regular marijuana use has fallen among 8th ­graders from 74 percent to 58 percent, among 10th ­graders from 66 percent to 43 percent and among 12th­graders from 58 percent to 32 percent."

Johnston, L. D., O'Malley, P. M., Miech, R.A., Bachman, J. G., & Schulenberg, J. E. (December 16, 2015). "Use of ecstasy, heroin, synthetic marijuana, alcohol, cigarettes declined among US teens in 2015," University of Michigan News Service: Ann Arbor, MI, p. 5.
http://www.monitoringthefuture...

75. Trends in Attitudes of US 12th Graders Toward Legalization of Any Illegal Drugs

"• In 2018 for the first time in the history of the survey the majority of 12th grade students did not favor legally prohibiting marijuana use in public places. The proportion of 12th graders who favor legally prohibiting marijuana use in public places decreased by 2 percentage points to 48% in 2018, continuing a long decline since 2008, when 70% favored prohibition. The percentage favoring legal prohibitions against use in private was also at a historic low of 22% in 2018, down from 82% in 1990.

"• The majority of 12th graders agree that people should be prohibited by law from using illicit drugs other than marijuana in public. (The questions specified people age 18 or older; presumably proportions would be even higher for those under 18.) For example, in 2018 the percentages agreeing to prohibition are 60% for amphetamines or sedatives (barbiturates), 65% for LSD, and 75% for heroin. Even use in private is opposed by substantial proportions; for example, 42% believe that use in private of amphetamines or sedatives (barbiturates) should be illegal, while 44% believe the same for LSD, and 66% believe it about heroin use.

"• In 2018, 38% of 12th graders believe that cigarette smoking in “certain specified public places” should be prohibited by law. Were the question more specific as to the types of public places in which smoking might be prohibited (e.g., restaurants or hospitals), quite different results might have emerged.

"• Less than half (42%) of 12th graders in 2018 think that getting drunk in public should be prohibited.

"• For all drugs included in the question, fewer 12th graders believe that use in private settings should be illegal, as compared with use in public settings. This is particularly true for getting drunk in private (which only 20% think should be illegal vs. 42% for getting drunk in public) and for smoking marijuana in private (which only 22% think should be illegal vs. 48% for smoking marijuana in public places)."

Miech, R. A., Johnston, L. D., O’Malley, P. M., Bachman, J. G., Schulenberg, J. E., & Patrick, M. E. (2019). Monitoring the Future national survey results on drug use, 1975–2018: Volume I, Secondary school students. Ann Arbor: Institute for Social Research, The University of Michigan. Available at
http://monitoringthefuture.org...
http://monitoringthefuture.org...

76. Effectiveness of Federal Prevention Messages, 1998

"Youths who used illicit drugs in the past year were significantly less likely than youths who had not used drugs to report that they received prevention messages in a special class about alcohol or other drugs at school or as part of another regular class, such as a health class, although these differences were not large. Nearly half of youths who used illicit drugs in the past year reported that they received education or information about alcohol or other drugs as part of a regular class at school, and nearly 30% of youths who used illicit drugs reported being in a special class about alcohol or other drugs at their schools. Youths who were drunk on 51 or more days in the past year did not differ significantly from their counterparts with regard to receipt of alcohol or other drug education as part of a special class.
"In addition, findings from Table 13.8 suggest that youths’ exposure to prevention messages outside school, such as through the media, was fairly widespread but appeared to be unrelated to illicit drug use or being drunk on 51 or more days in the past year. Nearly 80% of youths who used illicit drugs and more than three-fourths of youths who were drunk on 51 or more days in the past year reported being exposed to prevention messages outside school."

Office of Applied Studies, National Institute on Drug Abuse, "National Household Survey on Drug Abuse: Main Findings 1998" (Rockville, MD: SAMHSA, US Department of Health and Human Services, March 2000), p. 174.
http://www.icpsr.umich.edu/icp...
http://eric.ed.gov/?id=ED442033
http://files.eric.ed.gov/fullt...

77. Substance Use and Nonfatal Violent Victimization

"Juveniles using drugs or alcohol committed 1 in 10 of the nonfatal violent victimizations against older teens. This was 2-1/2 times higher than the percentage of victimizations against younger teens perceived to be committed by a juvenile who was using drugs or alcohol.
"Younger teens were more likely than older teens to report that their juvenile offender was not using drugs or alcohol. In about 4 in 10 victimizations against younger and older teens committed by juveniles, the victim could not ascertain whether or not the offender was using drugs or alcohol."

Baum, Katrina, PhD, "Juvenile Victimization and Offending, 1993-2003" (Washington, DC: US Dept. of Justice, Bureau of Justice Statistics, Aug. 2005), p. 8.
http://www.bjs.gov/content/pub...

78. Past Year Marijuana Use and Exposure to Prevention Messages, by Race/Ethnicity

"• Exposure to prevention messages in the media was significantly associated with lower odds of past year marijuana use for whites and Hispanics, but not for blacks or youths in the 'other' category.
"• Higher levels of parental communication about substance use were significantly associated with lower odds of past year marijuana use among Hispanic youths, but not among youths of other racial/ethnic groups.
"• Within the school domain, strong sanctions against illegal drug use were significantly associated with lower odds of past year youth marijuana use among whites, Hispanics, and youths in the "other" category, but not for blacks.
"• Exposure to prevention messages in school was associated with lower odds of past year marijuana use for whites and Hispanics, but not for blacks or youths in the 'other' category."

Wright, D., & Pemberton, M. (2004). Risk and Protective Factors for Adolescent Drug Use: Findings from the 1999 National Household Survey on Drug Abuse (DHHS Publication No. SMA 04-3874, Analytic Series A-19). Rockville, MD: Substance Abuse and Mental Health Services Administration, Office of Applied Studies, p. 6.
https://www.ncjrs.gov/App/publ...

79. Characteristics of Cannabis Users, Other Drug Users, and Abstainers

"Zambon et al also found that having a good relationship with a best friend was related to increased use of cannabis, alcohol, and tobacco. Similarly, Hoel et al39 reported that although abstainers are successful in many social arenas, they socialize less frequently with friends than youth who drink, while a Finnish study40 indicated that moderate use of alcohol among adolescents was associated with a positive self-image in social relationships. Another
study,41 performed in New Zealand, also indicated an association between a high level of connectedness to friends and an increased level of smoking and use of cannabis in the previous month.
"In addition, and contrary to previous research,23 our study does not confirm the negative effect of cannabis on academic performance among COG youth. In our case, they are more likely to be high school students and they report similar grades as abstainers, even though they skip class more often."

Suris, J. C.; Akre, Christina; Berchtold, Andre´; Jeannin, Andre´; Michaud, Pierre-Andre´, "Some Go Without a Cigarette: Characteristics of Cannabis Users Who Have Never Smoked Tobacco," Archives of Pediatric Adolescent Medicine (Chicago, IL: American Medical Association, November 2007) Vol. 161, No. 11, p. 1046.
http://archpedi.jamanetwork.co...

80. Cannabis Users Compared With Abstainers

"Interestingly, our results do not confirm our hypothesis of better overall functioning among abstainers. In fact, what our research indicates is that the main difference between COG [cannabis use only group] youth and abstainers [those abstaining from all drugs] is that the former are more socially driven: they are significantly more likely to practice sports, and they have a better relationship with their peers. Moreover, even though they are more likely to skip class, they have the same level of good grades; and although they have a worse relationship with their parents, they are not more likely to be depressed. Nevertheless, our results seem to indicate that, although typical of the adolescence process, having good support from friends together with a less solid relationship with parents is a risk factor for occasional cannabis use."

Suris, J. C.; Akre, Christina; Berchtold, Andre´; Jeannin, Andre´; Michaud, Pierre-Andre´, "Some Go Without a Cigarette: Characteristics of Cannabis Users Who Have Never Smoked Tobacco," Archives of Pediatric Adolescent Medicine (Chicago, IL: American Medical Association, November 2007) Vol. 161, No. 11, p. 1046.
http://archpedi.jamanetwork.co...

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