Nine out of 10 Americans who meet the medical criteria for addiction1 started smoking, drinking, or using other drugs before age 18, according to a national study released by The National Center on Addiction and Substance Abuse (CASA) at Columbia University.
The study, Adolescent Substance Use: America’s #1 Public Health Problem, reveals that adolescence is the critical period for the initiation of substance use and its consequences. The CASA report finds 1 in 4 Americans who began using any addictive substance before age 18 are addicted, compared to 1 in 25 Americans who started using at age 21 or older.
Adolescent substance use at “epidemic” levels
The CASA report underscores the fact that addiction is a disease with adolescent origins. The underdeveloped teen brain makes it likelier that teens will take risks, including using addictive substances that interfere with brain development, impair judgment and heighten their risk of addiction.
The CASA report reveals that:
75 percent (10 million) of all high school students have used addictive substances including tobacco, alcohol, marijuana or cocaine; 1 in 5 of them meets the medical criteria for addiction.
46 percent (6.1 million) of all high school students currently use addictive substances; 1 in 3 of them meets the medical criteria for addiction.
“Teen substance use is our nation’s number one public health problem. Smoking, drinking and using other drugs while the brain is still developing dramatically hikes the risk of addiction and other devastating consequences,” said Jim Ramstad, Former Member of Congress (MN-3) and a CASA board member who also chaired the report’s National Advisory Commission.
The CASA report noted that alcohol is the preferred addictive substance among high school students:
- 72.5 percent have drunk alcohol;
- 46.3 percent have smoked cigarettes;
- 36.8 percent have used marijuana;
- 14.8 percent have misused controlled prescription drugs; and
- 65.1 percent have used more than one substance.
“Addiction is a disease that in most cases begins in adolescence so preventing or delaying teens from using alcohol, tobacco or other drugs for as long as possible is crucial to their health and safety,” said Susan Foster, CASA’s Vice President and Director of Policy Research and Analysis. “We rightfully worry about other teen health problems like obesity, depression or bullying, but we turn a blind eye to a more common and deadly epidemic that we can in fact prevent.”
American culture drives teen substance use
The report finds that American culture, broadly defined, actually increases the risk that teens will use addictive substances. A wide range of social influences subtly condone or more overtly encourage use, including acceptance of substance use by parents, schools and communities; pervasive advertising of these products; and media portrayals of substance use as benign or glamorous, fun and relaxing. These cultural messages and the widespread availability of tobacco, alcohol, marijuana and controlled prescription drugs normalize substance use, undermining the health and futures of our teens.
Forty-six percent of children under age 18 (34.4 million) live in a household where someone 18 or older is smoking, drinking excessively, misusing prescription drugs or using illegal drugs.
Less than half (42.6 percent) of parents list refraining from smoking cigarettes, drinking alcohol, using marijuana, misusing prescription drugs or using other illicit drugs as one of their top three concerns for their teens; almost 21 percent say that marijuana is a harmless drug.
The report also finds that many teens with other challenges such as a family history including a genetic predisposition, a co-occurring health problem, or a victim of trauma are at even higher risk of substance use and addiction.
A costly epidemic
The CASA report declares teen smoking, drinking, misusing prescription drugs and using illegal drugs to be a public health epidemic presenting clear and present dangers to millions of American teens, and severe and expensive long range consequences for our nation.
In addition to the heightened risk of addiction, consequences of teen substance use include accidents and injuries; unintended pregnancies; medical conditions such as asthma, depression, anxiety, psychosis and impaired brain function; reduced academic performance and educational achievement; criminal involvement and even death.
The report finds teen substance use is the origin of the largest preventable and most costly public health problem in America today. Immediate costs per year of teen use include an estimated $68 billion associated with underage drinking and $14 billion in substance-related juvenile justice costs. Total costs to federal, state and local governments of substance use, which has its roots in adolescence, are at least $468 billion per year-almost $1,500 for every person in America (2).
“The combination of adolescence, an American culture that glorifies and promotes substance use, and easy access to tobacco, alcohol and other drugs creates a perfect storm for our teens and for taxpayers,” said Ramstad. “We no longer can justify writing off adolescent substance use as bad behavior, as a rite of passage or as kids just being kids. The science is too clear, the facts are too compelling, the health and social consequences are too devastating and the costs are simply too high.”
The CASA report contains a full list of recommendations that include:
- Educating the public that teen substance use is a public health problem and addiction a medical problem that in most cases originates in adolescence.
- Preventing or delaying the onset of substance use through effective public health measures.
- Identifying teens most at risk through routine screenings.
- Intervening early to prevent further use and consequences as with any other public health problem.
- Providing appropriate medical treatment to teens for substance use disorders.
“The problem is not that we don’t know what to do, it’s that we are failing to act,” noted Foster. “It is time to recognize teen substance use as a preventable public health problem and addiction as a treatable medical disease, and to respond to it as fiercely as we would to any other public health epidemic threatening the safety of our children.”
The report was funded by grants from Legacy®, the Conrad N. Hilton Foundation, the Carnegie Corporation of New York and the Michael Alan Rosen Foundation.
CASA is the only national organization that brings together under one roof all the professional disciplines needed to study and address use of all substances – alcohol, nicotine, illegal, prescription and performance enhancing drugs – in all sectors of society. Founded in 1992 by former U.S. Secretary of Health, Education, and Welfare, Joseph A. Califano, Jr., CASA and its staff of some 60 professionals aim to inform Americans of the economic and social costs of substance use and its impact on their lives, find out what works in prevention and treatment of this disease, and remove the stigma of addiction and replace shame and despair with hope.