Trends in Substance Use, Approaches to Preventing Substance Abuse
Adolescent substance abuse and its resulting harms are major concerns of parents, policymakers, teachers, and public health officials. Nevertheless, experimentation with substances, particularly alcohol and tobacco, is progressively more common behavior from pre- to late adolescence. When adolescents try substances a few times, with peers, this experimentation is generally not associated with any long-term impairment of functioning. Experimentation is considered problematic when substance use occurs at a very young age, with increasing frequency, while the child is alone, or in the context of behavioral or emotional difficulties. If use becomes more frequent, negative consequences can develop, including impairment at school or work, legal problems, accidents, and interpersonal difficulties. Substance use becomes abuse when an adolescent suffers negative and harmful consequences because of the use of substances—and yet continues using. Substance abuse has been strongly linked to risky sexual behavior, delinquent behavior, and low school achievement. Heavy and prolonged substance use can result in drug dependence, with a syndrome of significant distress if the drug use is stopped or reduced.
Adolescents tend to follow a particular pattern of involvement with drugs. Typically, the first substance an adolescent uses is one that is legal for adults (tobacco or alcohol). The next stage is often experimentation with marijuana. Tobacco, alcohol, and marijuana have been labeled "gateway drugs" because they precede the use of other harder drugs. High frequency of use and early age of initiation are both associated with movement to higher stages of substance use.
Early initiation of substance use is linked to substance abuse and dependence. A 1997 study by Bridget Grant and Deborah Dawson found that more than 40 percent of individuals who began drinking before age fourteen developed a dependence on alcohol. In comparison, only 10 percent of those who began drinking at age twenty or older developed alcohol dependence. Similarly, individuals who began using drugs at an early age tend to experience greater drug problems. A 1993 study conducted by Denise Kandel and Kazuo Yamaguchi found that adolescents who use harder drugs, such as cocaine or crack, began using one of the gateway drugs (cigarettes, alcohol, or marijuana) two years earlier than adolescents who did not advance to harder drugs. Most smokers begin smoking as teenagers. More than 90 percent of individuals who become regular smokers begin before the age of nineteen.
The Monitoring the Future study, conducted by Lloyd Johnston, Patrick O'Malley, and Jerald Bachman, tracked the prevalence of adolescent substance use among American eighth, tenth, and twelfth grade students each year from the mid-1970s into the twenty-first century. The study focused on three categories of substances: illicit drugs, alcohol, and cigarettes. It also examined gender and racial/ethnic differences in substance use.
Illicit drug use peaked in the 1970s, decreased steadily until the early 1990s, and then increased during the 1990s, with a slight decline and leveling off at the close of the decade. Marijuana is the most common illicit drug used. In 2000, more than half (54%) of American high school seniors reported using some type of illicit drug in their lifetimes. Reported prevalence rates among tenth and eighth grade students that year were lower (46% and 27%, respectively). In 2000, one-quarter of twelfth grade students reported using an illicit drug during the previous month, followed by 23 percent of tenth graders and 12 percent of eighth grade students.
Alcohol use increased throughout the 1970s, peaking at the end of the decade; it then steadily decreased in the 1980s and remained fairly stable during the 1990s. In the 2000 survey, 80 percent of twelfth grade students reported having tried alcohol at least once, and 62 percent reported having been drunk at least once. Seventy-one percent of tenth grade students had tried alcohol (49 percent had been drunk at least once), and 52 percent of eighth grade students had tried alcohol (25 percent had been drunk at least once). One-half of high school seniors, 41 percent of tenth graders, and 22 percent of eighth graders reported drinking alcohol in the previous thirty days.
Cigarette use peaked in the mid-1970s, declined substantially for a few years, remained relatively stable in the mid-1980s and early 1990s, increased during the mid-1990s, and experienced a slight decrease in the last few years of the twentieth century for eighth and tenth graders. According to results from 2000, over half of twelfth graders (63%) and tenth graders (55%) reported smoking a cigarette in their lifetimes, while 41 percent of eighth graders had smoked. The reported prevalence rates for smoking during the previous thirty days were 31 percent of twelfth grade students, 24 percent of tenth graders, and 15 percent of eighth graders.
Gender and Racial/Ethnic Differences
Male students have higher lifetime and thirty-day prevalence rates than their female counterparts for marijuana use for all grades reported. Senior males report more illicit drug use of other types in the previous thirty days than females, but there is little gender difference in tenth or eighth grade. Males also tend to use alcohol more than females, which becomes more apparent by twelfth grade. Across all grades, males and females seem to have almost equal rates of daily cigarette smoking. African-American students report lower lifetime, annual, thirty-day, and daily illicit drug use prevalence rates than white and Hispanic students. African-American students also have the lowest prevalence rates of alcohol use, being drunk, and binge drinking.
In order to prevent substance abuse among young people, both supply and demand reduction strategies are critical. Supply reduction strategies include any method used to reduce the availability of drugs, such as border patrols, confiscation of drug shipments, and penalties for drug use and drug dealing. In recent years, "community" police officers have been increasingly used in neighborhood and secondary school settings to prevent the local sale and distribution of drugs. Within the realm of legal substances, such as alcohol and tobacco, effective supply reduction strategies include increasing taxes, increasing the legal age of use, increasing law enforcement, reducing product advertising, reducing the number of sales outlets, and imposing penalties for sales of these products to minors.
Demand reduction strategies are designed to reduce the demand for drugs. Prevention and treatment are part of demand reduction. Prevention attempts to reduce demand by decreasing risk factors and increasing protective factors associated with substance abuse, while treatment is designed to decrease demand by stopping substance abuse in addicted or abusing individuals.
Prevention programs are organized along a targeted audience continuum—that is, the degree to which any person is identified as an individual at risk for substance abuse. Universal prevention strategies address the entire population (e.g., national, local community, school neighborhood) with messages and programs aimed at preventing or delaying the use of alcohol, tobacco, and other drugs. Selective prevention strategies target subsets of the total population that are deemed to be at risk for substance abuse by virtue of their membership in a particular population segment—for example, children of adult alcoholics, dropouts, or students who are failing academically. Indicated prevention strategies are designed to prevent the onset of substance abuse in individuals who do not meet medical criteria for addiction but who are showing early danger signs, such as truancy, falling grades, and cigarette smoking.
Research shows that there are many risk factors for drug abuse, each having a different impact depending on the phase of development. Risk factors can be associated with individual characteristics as well as social contexts. Individual risk factors include: genetic susceptibility to addiction, high sensation seeking, impulsive decision making, conduct problems, shyness coupled with aggression in boys, rebelliousness, alienation, academic failure, and low commitment to school.
Family risk factors include: substance abusing or emotionally disturbed parents; perceived parent permissiveness toward drug/alcohol use; lack of or inconsistent parental discipline; negative communication patterns and conflict; stress and dysfunction caused by death, divorce, incarceration of parents or low income; parental rejection; lack of adult supervision; poor family management and communication; and physical and/or sexual abuse. School risk factors include: ineffective classroom management, failure in school performance, truancy, affiliations with deviant peers, peers around deviant behaviors, and perceptions of approval of drug using behaviors in the school, peer, and community environments.
Certain protective factors have also been identified. These factors are not always the opposite of risk factors, and their impact varies along the developmental process. The most salient protective factors include: strong bonds with the family; experience of parental monitoring with clear rules of conduct within the family unit and involvement of parents in the lives of their children; success in school performance; and strong bonds with prosocial institutions such as the family, school, and religious organizations. Other factors—such as the availability of drugs, alcohol, and tobacco, and beliefs that substance use by young people is generally tolerated—also influence a number of youth who start to use drugs.
During the 1990s, the federal government made a concerted effort to test and disseminate prevention programs that met rigorous scientific standards for effectiveness. For example, school districts had to select effective programs and evaluate their progress toward specific goals for reduction of substance use by students, in order to receive funding through the Safe and Drug Free Schools program. Agencies such as the National Institute on Drug Abuse and the Center for Substance Abuse Prevention funded national and local studies to test whether youth who participate in prevention programs actually experience a reduction in risk factors, an increase in protective factors, and/or reductions in substance use. Federal agencies, scientific societies, and private foundations developed criteria for assessing the evidence about the effectiveness of various approaches and programs, and many provided recommendations to the public about particular programs and approaches through web sites and print media. Changing behavior is exceedingly complex, but informed efforts by parents, schools, and communities can help protect young people from the harms of substance abuse.
Grant, Bridget F., and Deborah A. Dawson. "Age at Onset of Alcohol Use and Its Association with DSM-IV Alcohol Abuse and Dependence: Results from the National Longitudinal Alcohol Epidemiologic Survey." Journal of Substance Abuse 9 (1997):103-110.
Johnston, Lloyd D., Patrick M. O'Malley, and Jerald G. Bachman. Monitoring the Future National Survey Results on Drug Use, 1975-1999, Vol. 1: Secondary Students. Bethesda, MD: National Institute on Drug Abuse, 1999.
Johnston, Lloyd D., Patrick M. O'Malley, and Jerald G. Bachman."Monitoring the Future National Results on Adolescent Drug Use: Overview of Key Findings, 2000." Available from http://www.monitoringthefuture.org; INTERNET.
Kandel, Denise B., and Kazuo Yamaguchi. "From Beer to Crack:Developmental Patterns of Drug Involvement." American Journal of Public Health 83 (1993):851-855.
Kandel, Denise B., Kazuo Yamaguchi, and Kevin Chen. "Stages of Progression in Drug Involvement from Adolescence to Adulthood: Further Evidence for the Gateway Theory." Journal of Studies on Alcohol 53 (1992):447-457.
Denise E. Hallfors
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