Historically speaking, it's not a bad time to be a teenage liver. Or lungs.
Regular drinking, tobacco and drug use among high school students has been trending downward for a long time.
In 2023, 46% of older adults said they had consumed alcohol in the year prior to the interview. That's a sharp decline from 88 percent in 1979, when the behavior was at its peak, according to the annual Monitoring the Future survey, a national poll on youth substance abuse. A similar downward trend in smoking rates was observed between 8th and 10th grade, and across these three age groups. By 2023, only 15% of older adults said they had ever smoked in their lifetime. This is a decrease from 76% in 1977.
Illegal drug use among teens has remained low and fairly steady over the past three decades, with a notable decline during the COVID-19 pandemic.
In 2023, 29% of high school students reported using marijuana in the previous year. This is a decrease from 37% in 2017 and a decrease from the peak of 51% in 1979.
The good news comes with some sobering caveats. One is that overdose deaths among youth have increased dramatically. Fentanyl-related deaths among youth doubled from 2019 to 2020 and remained at that level in subsequent years.
Dr. Nora Volkow has devoted her career to studying drug and alcohol use. She has served as director of the National Institute on Drug Abuse since 2003. She sat down with The New York Times to discuss the changing patterns and reasons for changing drug use trends.
What's the big picture about teens and drug use?
People don't really realize that rates of drug use among young people, especially teenagers, are at their lowest risk we've seen in decades. And this is worth saying about legal alcohol and cigarettes too.
What do you credit for the change?
One of the key factors is education and prevention campaigns. Certainly, the cigarette smoking prevention campaign was one of the most effective campaigns we have ever seen.
Some of the policies implemented not only set the legal age for drinking and smoking at 21, but also went a long way toward enforcing those laws. This can help you stop the progression from easy-to-access drugs like cigarettes and alcohol to illicit drugs. And teenagers aren't as exposed to legal drug ads as they used to be. All of these policies and interventions have had downstream effects on illicit drug use.
Does teens’ social media use play a role?
totally. Social media has transformed opportunities to be in a physical space with other teens. This will make you less likely to take the drug. And this was dramatically revealed when schools closed due to COVID-19. We have seen significant declines in the use of many substances during the pandemic. Maybe it's because teenagers can't be with each other.
An interesting issue is that even with schools back, rates of substance abuse have not risen to pre-pandemic levels. Either it remains stable or continues to decline. It was a big leap and change, and some drug use trends continue to slowly decline.
Is there any idea that stimulation from digital device use might satisfy some of the same neurochemical experiences as drugs or provide some escapism?
Yes, it is possible. There has been a change in the types of reinforcers available to teens. This applies to video games as well as social media, for example. Video games can be very reinforcing and can create compulsive patterns of use. So you are transferring one reinforcer, one method of escape, to another reinforcer. That could be another factor.
Is it too simplistic to see the decline in drug use as good news?
Objectively speaking, yes, this is very good news. why? Because we know that the earlier you start using these drugs, the greater your risk of becoming addicted. This lowers the risk that these drugs will interfere with your mental health, overall health, ability to complete education, and future career opportunities. That's really good news.
But we don't want to be complacent.
As drug supply becomes more dangerous, deaths from overdose are increasing. We are not exaggerating. What I mean is, taking one of these drugs could kill you.
What about vaping? Although it is decreasing, its usage is still significantly higher than that of cigarettes. In 2021 About a quarter of high school students said they had vaped nicotine in the previous year.. Why are teenagers rejecting cigarettes and flocking to vaping?
Most of the toxicity associated with tobacco comes from burning the leaves. Even though nicotine is an addictive factor, smoking cigarettes has been linked to cancer and most other adverse health effects.
What we have come to understand is that nicotine vaping is harmful in and of itself. However, this is not as well understood as for tobacco. Another aspect of vaping that is so attractive to teens is that it is associated with all kinds of flavors, namely candy flavors. It wasn't until the FDA made these flavors illegal that vaping became less accessible.
My argument is that there is no reason why we should expose teenagers to nicotine. This is because nicotine is highly addictive.
Is there anything you'd like to add?
We are also interested in cannabis and psychedelics. And there is a lot of interest in the idea that psychedelics may have therapeutic benefits. Preventing this new trend of drug use among teens requires a different strategy than that used for alcohol or nicotine.
For example, we can say that taking drugs such as alcohol or nicotine can lead to addiction. This is supported by extensive research. However, warnings about addiction to drugs such as cannabis or hallucinogens may not be very effective.
Cannabis can also be addictive, but less so than nicotine or alcohol. More research is needed in this area, especially for newer, more effective products. Psychedelics do not typically lead to addiction, but they can cause negative mental experiences that can put you at risk for psychosis.