Yes, We Have A Teen Drug Problem

The headline is tragic.  A teen uses what they think is a prescription drug that will help late night study.   A “fake” pill, built with fentanyl, results in a fatal overdose.  A teen living in a society where the use of drugs is tolerated if not promoted, meets a fatal outcome.  Yet, like much in the arena of alcohol and drug abuse, this tragic event does not tell the full story of teen drug use, abuse and addiction in America.  Yes, we have a teen alcohol and drug problem, but with empathy for the families who experience this specific loss, this headline does not tell the whole story.

We argued elsewhere that a free press dramatizes substance use in a way that masks the real nature of the problem.  Of the 40 million people who suffer from substance use disorder the homeless population, often cited in the press, is likely about 1% of the total problem.  Certainly, there is a problem in the homeless population, but that common image, fueled by a well-intentioned press, is misleading.  The same is true about teen drug use; it is a serious problem, but one we have mischaracterized.

The Monitoring the Future Survey reports that drug use by adolescents has declined steadily since 1975 (www.nih.gov/news-events/news-releases/percentage-adolescents-reporting-drug-use-decreased-significantly-2021).  That is wonderful news. However, drug and alcohol use remain prevalent among American teens.  A 2022 report from the National Center for Drug Abuse Statistics (https://drugabusestatistics.org/teen-drug-use/) reported these data on teen drug use:

• 2.08 million or 8.33% of 12- to 17-year-olds nationwide report using drugs in the previous month

• 21.3% of 8th graders have tried illicit drugs

• By 12th grade 46.6% of teens have tried illicit drugs

• 11.89 million 18- to 25-year-olds used drugs in the last month

• 11.2% of overdose deaths in America occur to people aged 15 to 24 years

• 1.19 million 12- to 17-year-and 11.7 million 18-25 year olds report binge drinking in the last month

• 7.1 million 12- to 20-year-olds report drinking in the last month

• 61.5% of teens have abused alcohol by 12th grade

• Overdose deaths due to opioids have increased 500% among 15- to 24-year-olds since 1999

• 5.3% of 12th graders have abused opioids other than heroin at least once.

The Monitoring the Future Survey displayed dismaying data for the increased use of vaping in 2021 as well.  In the past year 12.1% of 8th graders, 19.5% of 10th graders, and 26.6% of 12th graders reported vaping nicotine

Startlingly, a study by the Geffen School of Medicine at UCLA (https://www.uclahealth.org/news/adolescent-drug-overdose-deaths-rose-exponentially-first) found that overdose deaths among teenagers nearly doubled in 2020 and rose another 20% in the first half of 2021 even as drug use remained steady or declined. While overdose deaths among teens remained steady at 492 from 2010 to 2019 the number in 2021 was 1,146.  That is a rate of 5.49 per 100,000.

It is often remarked that teen alcohol and drug use results from “peer pressure” and no doubt those influences are very real and powerful. This thought begs the question of where teens get the sense that alcohol and drug use is a fun and social thing to do. It does not take much thought to realize that like most teen behaviors they are acquired in the home. We know from the data we reported previously that the vast majority of those behaviors observed in the home are responsible and model responsible use. When it comes to problematic use by teens, however, there are negative influences from the home that are likely far more influential than peer pressure.

A 2019 study conducted at North Dakota State University (https://www.ndsu.edu/agriculture/extension/publications/parents-role-substance-use-prevention-tips-talking-youth-all-ages) listed the critical factors that contributed to teen alcohol and drug use and abuse. Those were:

• Lack of parental supervision

• Poor attachment with caregivers

• Academic problems

• Undiagnosed mental health conditions

• Substance using parents, siblings, friends

• Peer Rejection

• Child abuse and neglect

Strikingly, four of the seven causative factors related to parental or caregiver behavior – - supervision, attachment, abuse/neglect, and parental drug use. 

Several studies have reported that among all parents they underestimate the use and breadth of alcohol and drugs by their teen children.  The C.S. Mott Children’s Hospital National Poll on Children’s Health 2020 survey of child health concerns (http://mottpoll.org/sites/default/files/documents/122120_Top10.pdf) asked a national sample of parents to rate the top health concerns for US children and teens. The 2020 top child health concerns were:

1. Overuse of social media (72%)

2. Bullying/cyberbullying (62%)

3. Internet safety (62%)

4. Unhealthy eating (59%)

5. Depression/suicide (54%)

6. Lack of physical activity (54%)

7. Stress/anxiety (54%)

8. Smoking/vaping (52%)

9. Drinking or using drugs (50%)

10. COVID (48%)

The list is influenced by a wide range of developmental issues among young children through adolescents.  A survey solely for teens might look different.  Yet, while admirable that drug use including nicotine, alcohol and narcotics attracts the attention of 50% of the parents, it is also remarkable that 50% of the parents did not rank these issues among their top ten concerns. 

It is heartening to know that adolescent alcohol and drug use has been declining steadily and for many years. Yet, the breadth of teen use of alcohol and drugs is much broader and many times more serious an issue yet today.  Of course, the death of even one teen from use of fake pills is tragic. Considering causes of teen alcohol and drug use, parents underestimate the relative seriousness of this problem.  Worse yet, in far too many cases parental behaviors are among the top reasons why alcohol and drug use and abuse occur in the first instance.

Parenting is joyous but sometimes hard.  Yet, parenting may never be as crucial to the current and future health of their children as in theses teen years and especially around alcohol and other drug use.  The guidance from the American Addiction Centers sums up the parental role:

“Parents underestimate that they have a positive influence on their teen’s choices, and that includes drug use. Being open to tackling tough subjects, setting clear expectations and modeling responsible behaviors all play an important role in developing a healthy parent-child relationship. When it comes to drugs, believe it or not, your child is listening. It’s never too soon to start a two-way conversation about drugs. The conversations you have today can and do have a positive impact on your child’s future.”

Gene Gilchrist