Historically speaking, it’s not a bad time to be a teenager’s liver. Or the lungs.
Regular alcohol, tobacco and drug use among high school students has followed a long downward trend.
In 2023, 46 percent of seniors said they had had a drink in the year before being interviewed; that’s a precipitous drop from 88 percent in 1979, when the behavior peaked, according to the annual Monitoring the Future survey, a closely watched national survey of substance use among youth. A similar downward trend was seen among eighth and 10th graders, and in those three age groups, when it came to smoking. In 2023, only 15 percent of older people said they had smoked a cigarette in their lives, down from a high of 76 percent in 1977.
Illicit drug use among adolescents has remained low and fairly stable over the past three decades, with some notable declines during the Covid-19 pandemic.
In 2023, 29 percent of high school seniors reported using marijuana in the previous year, up from 37 percent in 2017 and from a high of 51 percent in 1979.
There are some sobering warnings about the good news. One is that teen overdose deaths have increased dramatically: Fentanyl-related teen deaths doubled from 2019 to 2020 and remained at that level in subsequent years.
Dr. Nora Volkow has dedicated her career to the study of drug and alcohol use. She has been 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 behind the changing trends in drug use.
What is the general picture about adolescents and drug use?
People don’t really realize that among young people, especially teenagers, the rate of drug use is at the lowest risk we’ve seen in decades. And it is worth saying also in the case of legal alcohol and tobacco.
To what do you attribute the change?
An important factor is education and prevention campaigns. Without a doubt, the tobacco prevention campaign has been one of the most effective we have ever seen.
Some of the policies that were implemented also helped significantly, not only in setting the legal age for alcohol and tobacco consumption at 21, but also in enforcing those laws. Then the advance of drugs that are more accessible, such as tobacco and alcohol, to illicit ones stops. And teens aren’t exposed to legal drug ads like they were in the past. All of these policies and interventions have had a subsequent impact on illicit drug use.
Does the use of social networks among adolescents influence?
Absolutely. Social media has changed the opportunity to be in physical space with other teens. This reduces the likelihood that they will use drugs. And this became dramatically evident when schools closed due to Covid-19. A large downward jump was seen in the prevalence of many substance use during the pandemic. This could be because the teenagers couldn’t be together.
What’s interesting is that even though schools are back, the prevalence of substance use has not increased until the pre-pandemic period. It has remained stable or continued to decline. It was a big jump down, a change, and some trends in drug use continue to slowly decline.
Is there any idea that the stimulation that comes from using a digital device might satisfy some of the same neurochemical experiences of drugs or provide some escapism?
If that’s possible. There has been a change in the types of reinforcers available to adolescents. It’s not just about social media, but also about video games, for example. Video games can be very stimulating and can produce compulsive usage patterns. So, you are trading one reinforcer, one way of escape, for another. That may be another factor.
Is it too simplistic to consider the decline in drug use as good news?
If you look at it objectively, yes, it is very good news. Because? Because we know that the sooner these drugs are used, the greater the risk of becoming addicted to them. It reduces the risk that these medications will interfere with your mental health, your general health, your ability to complete an education, and your future job opportunities. That is absolutely good news.
But we don’t want to become complacent.
The drug supply is more dangerous, leading to an increase in overdose deaths. We are not exaggerating. I mean, taking one of these drugs can kill you.
What about vaping? It has been decreasing, but consumption is still considerably higher than that of cigarettes: in 2021, About a quarter of high school seniors said they had vaped nicotine in the past year.. Why would teenagers resist cigarettes and flock to vaping?
Most of the toxicity associated with tobacco has been attributed to burning the leaf. The burning of that tobacco was responsible for the cancer and most of the other adverse effects, even though nicotine is the addictive element.
What we have come to understand is that vaping nicotine has its own harms, but this has not been understood as well as in the case of tobacco. The other thing that made vaping so appealing to teens was that it was associated with all kinds of flavors: candy flavors. It wasn’t until the FDA made those flavors illegal that vaping became less accessible.
My argument would be that there is no reason we should expose teenagers to nicotine. Because nicotine is very, very addictive.
Anything else you want to add?
We also have all this interest in cannabis and psychedelic drugs. And there is a lot of interest in the idea that psychedelic drugs may have therapeutic benefits. To prevent these new trends in drug use among adolescents, different strategies are required than those we have used with alcohol or nicotine.
For example, we can say that if drugs such as alcohol or nicotine are consumed, this can cause addiction. This is backed by extensive research. But warning about addiction to drugs like cannabis and psychedelics may not be as effective.
While cannabis can also be addictive, it may be less so than nicotine or alcohol, and more research is needed in this area, especially on newer, higher potency products. Psychedelics are not typically addictive, but they can produce adverse mental experiences that can put you at risk for psychosis.
