Introduction

During stages of ongoing, yet incomplete, cognitive development, youth may be more inclined to take risks and experiment with drugs and alcohol, and are often heavily influenced by their peers.[1] Youth who use drugs and alcohol increase their risk of developing subsequent substance use disorders and other negative outcomes such as car accidents, unprotected sex, and interpersonal violence.[2] Youth substance use can also result in social, educational, and legal consequences. Punitive responses to youth substance abuse—by criminal justice officials, schools, and/or parents—may not lead to better outcomes.[3] However, there is evidence to suggest that protective factors, such as a sense of belonging at school or a positive adult presence, may exert a more powerful influence on youth and make them more responsive to treatment.[4]

This article examines the scope of the youth substance abuse problem and provides an overview of current issues and trends in youth substance use. Authority researchers used data on youth substance use from national and state data sources to help inform on youth substance use. Additionally, this article identifies some best practices to utilize in prevention and intervention efforts.

Risk Factors and Consequences of Substance Use Among Youth

It is important to monitor the prevalence of youth substance use due to potential negative consequences—both developmentally and legally. Between the ages of 12 and 22, the brain is still developing and hormone levels are rapidly changing, leading to an increased sensitivity among young people to the opinions of others, strengthening the effects of “peer pressure.”[5] Therefore, substance use initiation is more common among youth seeking approval and acceptance from their peers than adults.[6]

At particular risk for substance use disorders are youth who experience:

  • Poor caregiver relationships.
  • Minimal supervision.
  • Peer or family member substance use.
  • Academic failure.
  • Under-developed social skills.
  • Easy access to illicit substances.[7]

Youth with family histories of alcohol use disorders or who display aggressive, disruptive, or hyperactive behaviors are at higher risk of developing substance use disorders,[8] and this risk is particularly high for those who begin use before age 14.[9]

There are many negative effects of substance use during adolescence. Heavy drinking is associated with lowered ability to reason abstractly, impaired language skills, and reduced IQ,[10] which can be compounded by marijuana use.[11] However, if such impairments are caused by, or exist prior to, substance use has yet to be fully determined. In addition, youth substance use is associated with substance use later in life,[12] difficulty handling stress,[13] and negative peer relations.[14] Maintained recovery from substance use disorders has been shown to effectively reduce criminal activity.[15]

Data Sources of National and State Youth Substance Use Estimates

There are three main sources of national and state-level data on the prevalence of youth substance use which are described below. Authority researchers used these sources to examine the extent of youth substance use. The first two sources provide national- and state-level estimates of substance use among youth and the third offers only national estimates.

National survey on drug use and health. The Substance Abuse and Mental Health Services Administration’s (SAMHSA) National Survey on Drug Use and Health (NSDUH) annually surveys youth ages 12 to 17 years old about illicit substances used, including marijuana/hashish, cocaine/crack cocaine, heroin, hallucinogens, inhalants, and prescription-type psychotherapeutics used non-medically.

Youth Risk Behavior Surveillance System. The Youth Risk Behavior Surveillance System (YRBS), operated by the Centers for Disease Control and Prevention, surveys 9th to 12th graders every two years on violent, sexual, drug-use, dietary, and exercise behaviors.

Monitoring the Future. Monitoring the Future (MTF) is an annual survey of the behaviors, attitudes, and values of students in 8th, 10th and 12th grade. The program is conducted at the Survey Research Center in the Institute for Social Research at the University of Michigan.

Prevalence of Substance Use Among Youth

According to the 2014 NSDUH data, substance use among Illinois youth during the past year (2015) closely reflected Midwest and national rates (Figure 1) and marijuana was the most frequently used substance in the past year. The 2015 YRBS similarly indicated that Illinois mirrored the patterns measured in national samples.[16] YRBS estimates, which reflect lifetime use, revealed that 61 percent of high school students in Illinois had tried alcohol and 36 percent had tried marijuana. Other common substances used were prescription drugs (14 percent), inhalants (7 percent), and ecstasy (6 percent).

Figure 1

Percent youth reporting substance use in last year by substance type, 2014

Figure 2
Data source: 2014 NSDUH data for 12- to 17-year-olds (SAMHSA, 2015)
Note: Alcohol category includes alcohol abuse or dependence rather than use; prescription drugs includes non-medical use of pain relievers

Alcohol Use

In the 2014 National Survey on Drug Use and Health, 11 percent of 12- to 17-year-olds self-reported past-month alcohol use, which represented a statistically significant reduction from the 19 percent of 12- to 17-year-olds surveyed in 2003.[17] In addition, these data indicated that 2 percent of Illinois youth in 2014 had received a clinical diagnosis of alcohol dependence or abuse during the past year—down from 6 percent in 2003—compared to 2 percent of youth in the Midwest and 3 percent of U.S. youth.[18]

Marijuana Use

Of all illicit substances, cannabis is the most widely used by youth in Illinois—36 percent of 9th to 12th graders in Illinois and 50 percent of those in Chicago reported having tried it.[19] Higher use of marijuana compared to other substances may reflect general societal views on the less risky nature of marijuana use, but also greater accessibility.[20] According to MTF, since the mid-1970s, 80 to 90 percent of 12th graders have stated that marijuana was fairly easy to very easy to obtain.[21]

Use of synthetic marijuana—herbal matter sprayed with lab-synthesized chemicals—has decreased significantly in the last five years, most dramatically among 12th graders. The percent of 12th graders reporting use in the last year dropped from 11 to 5 percent between 2011 and 2015.[22]

Prescription Drug Use

Prescription drugs include many different types of substances but most commonly refer to pain relievers (OxyContin and Vicodin), tranquilizers (Xanax, Valium, and Klonopin), stimulants (Ritalin and Adderall), and sedatives (Amytal, Seconal, and Ambien).[23] YRBS found that 10 percent of White and 13 percent of Hispanic U.S. high school students had tried prescription drugs in their lives compared to 12 percent of Black students—a statistically significant difference.[24] Fourteen percent of Illinois high school students and 11 percent of Chicago students tried prescription drugs compared to 17 percent in the national sample.[25] The 2015 MTF survey found that less than 3 percent of U.S. high school students had used OxyContin, Vicodin, Ritalin, or Adderall in the past year.[26]

Heroin Use

The recent nationwide increase in heroin use and overdose is linked to the availability of prescription opioid drugs.[27] In 2013, there were over 207 million opioid prescriptions filled in the United States.[28] The rise of prescription opioid use can be attributed in part to ineffective prescription drug monitoring, lack of understanding of prescription pain killer addiction, and aggressive prescription drug sales strategies.[29]

When users can no longer afford or obtain prescription drugs, they may turn to heroin as a replacement, as it has similar effects, is inexpensive, and is widely available.[30] A study of 1,200 people with heroin use disorders found 39 percent of those whom had initial dependence to prescription opioids and then transitioned to heroin were more likely to be young and White.[31] Those introduced to prescription drugs between the ages of 10 and 12 are more likely to transition to heroin.[32]

The YRBS found that 3 percent of high school students in Illinois and 4 percent of high school students in Chicago had tried heroin in their life, compared to 2 percent nationally.[33] In terms of perceived risk associated with heroin use, 78 percent of U.S. 12th graders believed that those who used heroin occasionally were at great risk of harming themselves and 95 percent disapproved of people who used heroin—a higher disapproval rate than that for any other drug.

Substance Use Among Illinois Youth by Race and Ethnicity

Some differences in youth substance use by race and ethnicity exist when examining particular drugs (Figure 2).[34] For example, Hispanic and Black youth were more likely to ever report marijuana use (48 and 44 percent, respectively) compared to 30 percent of White youth, while White and Hispanic youth (62 and 67 percent, respectively) were more likely to report ever using alcohol than Black youth (54 percent).

Figure 2

Percent of Illinois high school students reporting ever using substance by race and ethnicity, 2015

Figure 2
Data source: Youth Risk Behavior Surveillance Survey

Treatment Options for Substance-Using Youth

Almost none of the 35,000 Illinois youth between age 12 and 17 years who self-reported misuse of drugs, —3.4 percent of all Illinois youth—received treatment.[35] In addition, Black and Hispanic youth received treatment at significantly lower rates than members of other racial and ethnic groups.[36]

To examine the relationship between race and the primary substance of use while in treatment, Authority researchers further examined Illinois SAMHSA treatment episode dataset (TEDS) (Table 1).[37] A statistically significant overrepresentation of White youth was seen in treatment for every drug category except marijuana, χ2 (75, 3,179) = 185.42, p < .001.[38]

Table 1

Number of Youth in Treatment by Race and Substance Type

Alcohol Cocaine Marijuana Heroin Other Total
n n n n n n
White 276 9 1,285 43 111 1,613
Non-White 99 6 1,327 6 17 1,566
Total 375 15 2,612 49 128 3,179
Data source: SAMHSA TEDS 2011

Youth alcohol and drug experimentation and misuse occurs at all socioeconomic levels in all communities, but treatment options may vary by community.[39] Under-representation of Black youth in treatment likely reflects disparities in access and the quality of care that are due to factors like societal and institutional racism, poverty (the consequences of which include residence in neighborhoods far from quality treatment facilities and lack of appropriate insurance coverage), and fewer treatment referrals.[40] In addition, stigma surrounding treatment for substance use disorders and a lack of understanding of substance use disorders as a disease may impede treatment access.[41] Youth may also be unable to access treatment because of harsh discipline/punishment by parents in response to drug use or beliefs that seeking assistance and treatment denotes weakness.[42]

Implications for Policy and Practice

Overall, the data analyzed indicate that alcohol and marijuana continue to be the most frequently used substances by youth, while methamphetamine and heroin use was less common of drug types. Any substance use by youth, however, is cause for concern because brain development is still occurring during adolescence and into young adulthood. Researchers continue to examine prevalence of youth substance use, factors associated with successful recovery, and effective prevention and intervention efforts in order to improve understanding and reduce substance use disorders and related negative consequences. The following are some suggested implications based on research and literature.

Use Promising Practices to Prevent and Treat Youth Substance Use

Ideally, substance use prevention programs can reach youth with practical information before they are confronted with decisions about drug use. The most effective programs target risk and protective factors at the individual, family, and community levels and are guided by psycho-social theories.[43]

School-based substance use prevention. School-based programs are commonly used and accessible to large numbers of students. The three overarching categories of school-based prevention programs are:

  • Social resistance skills training programs. These programs promote awareness of high-risk situations and social influences that encourage substance use and teach skills to recognize, respond, and resist pressure from peers and the media.[44]
  • Normative education programs. These programs aim to alter the inaccurate popular perception that substance use is widespread, socially acceptable, and relatively harmless.[45]
  • Competence enhancement skills training programs. These programs teach general personal and social skills that can be applied to a wide range of life situations including when faced with high-risk situations related to substance use.[46]

There are two promising competence enhancement skills training programs. Research has found that LifeSkills Training, a three-year, classroom-based curriculum, reduced youth violence and substance use.[47] Research suggested Project Towards No Drug Abuse, a school-based program for high school students at high-risk for substance use, reduced cigarette smoking, drug use, victimization risk, and weapon-carrying.[48]

Family-based substance use prevention. The most effective family-based prevention and intervention programs focus on parenting skills and family bonding.[49] Research has found that Family Matters, a prevention program for parents to use at home with youth age 12 to 14, reduced smoking and drinking among youth.[50]

Creating Lasting Family Connections, a substance use and violent behavior prevention program, has been shown to reduce substance use, as well as increase use of community services, and parental knowledge and beliefs about substance use.[51] The program aims to enhance family bonding and improving parent-child communication skills and can be offered in a variety of settings, including schools, churches, and community centers.[52]

Brief Strategic Family Therapy is a prevention program for families with youth age 6 to 17 years old who exhibit rebellious, truant, or delinquent behaviors, such as early substance use or negative peer association. Research has suggested the program significantly reduces substance abuse, as well as improves family functioning, engagement in therapy, and aggression and conduct problems.[53]

Community-based substance use prevention. Community-based programs often include multiple components, including public policy initiatives, mass media campaigns, and other forms of community organization. While community-based programs require more resources and coordination than programs with a narrower scope, these programs can be effective in preventing youth substance when implemented well.[54]

Community Trials Intervention to Reduce High-Risk Drinking is a community-based program that employs multiple environmental intervention strategies to reduce alcohol use through community awareness, obstructing minor’s access to alcohol, and enforcing laws related to alcohol consumption and sales.[55] Research has suggested that reduced community member consumption of alcohol, rates of driving under the influence, and alcohol-related assaults and car accidents.[56]

Reduce Youth Misuse of Prescription Medications

Prescription drugs can be beneficial to youth who are prescribed them for physical and mental health conditions. However, these medications are dangerous when misused and may threaten the safety of youth at-risk for depression.[57] A 15-year study of a nationally representative sample found hospitalizations related to prescription opioid poisonings among youth nearly doubled.[58] In addition, many of the hospitalizations of youth over 10 years old were due to self-harm or suicide attempts.[59] Public health interventions, such as parental education, should be employed in addition to policy initiatives, consumer product regulations, and national clinical practice guidelines with recommendations on prescribing opioids to treat pain among youth.[60]

The increase in youth misuse of prescription medications necessitates an effective response to limit accessibility and raise awareness on the dangerous consequences resulting from prescription medication abuse.[61] First, parents should store medications in a secure location, keep track of which medications are in the home, and dispose of unused medications in a secure manner. Second, medical professionals should be sure to carefully document and monitor patients’ prescription histories and refill requests.[62] Finally, evidence-based substance use disorder training that is culturally-competent and trauma-informed is recommended for juvenile justice system officials, so that they may better refer and assist youth and families.[63]

Offer Evidence-Based Treatment for Delinquent Youth

The juvenile justice system may be the first to respond to cases of youth substance use, but community-based treatment may be more effective at reducing harmful drug use. As the first point of contact with the legal system, law enforcement acts as a gatekeeper, with discretion to filter out cases that may be more effectively handled by professionals in the community. Some law enforcement departments are training officers on how to divert youth from arrest to treatment for substance use disorders and mental health services.[64] A meta-analysis of juvenile diversion programs indicated that pre-charge diversion is more effective at reducing recidivism than judicial post-charge interventions.[65] A comparative review of best practices for programs that divert drug offenders found that the most successful programs tended to provide broad access to treatment, continuous evaluation, extensive training, and healthcare and criminal justice partnership opportunities, while also addressing mental health issues related to drug use.[66]

In conclusion, nationally and in Illinois, traditionally high drug use categories of marijuana and alcohol appear to be stable or falling and youth use of other drugs remains relatively low. To prevent and intervene in youth substance use, the literature recommends training for public health and justice system professions, identifying an reducing risk factors, and employing evidence-based programs and practices to positively impact and save young lives.

Note: Dependence and abuse are defined by the DSM-V, the American Psychological Association’s Diagnostic and Statistical Manual of Mental Disorders.

Note: Chicago estimates are based on the 2013 YBRS data; data from 2015 were unavailable.

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