This report is a wake-up call to every adult in America. If we could substantially improve the chances that our children would avoid accidents, injuries, a range of medical and mental health problems, unintended pregnancies, criminal involvement and even death, and that they would do better academically and professionally, would we do it? If we could help cut their chances of acquiring a lifetime chronic and debilitating health condition from one in four to one in 25 or less, would we do it? I suspect that every parent, health care provider, policymaker and other concerned adult would say, “of course – tell me how!”
This report tells you how...and why.
The ‘how’ is to prevent or delay the onset of substance use — be it tobacco, alcohol, controlled prescription or other drugs — as long as possible.
This is why: Adolescence is the critical period both for starting to smoke, drink or use other drugs and for experiencing more harmful consequences as a result. The teen brain is primed to take risks including experimenting with these substances and, because it is still developing, it is more vulnerable to their harmful effects. Some teens are at even greater risk because of genetics, family history, trauma and mental health or behavioral problem
Three-fourths of high school students (75.6 percent, 10.0 million) have smoked cigarettes, drunk alcohol or used another drug, and nearly half of high school students (46.1 percent, 6.1 million) are current users.
Teens who use these drugs greatly increase their risk of addiction, a complex brain disease affecting both the structure and function of the brain. One in eight high school students (11.9 percent, 1.6 million) has a diagnosable clinical substance use disorder involving nicotine, alcohol or other drugs. Nine out of 10 people who meet the clinical criteria for substance use disorders began smoking, drinking or using other drugs before they turned 18. For those who start using any of these substances before they are 18, one in four will become addicted, compared with one in 25 who first start to smoke, drink or use other drugs at age 21 or later.
The consequences of teen substance use are staggering in both financial and human terms. Teen use also threatens the health and lives of those who don’t use. And because teens who use these substances are likelier to become dependent than those who start as adults, the costs too often follow them for a lifetime--adding each year to the taxpayer bill for health care, developmental disabilities, criminal and family courts, prisons and jails, welfare and unemployment. At last count, this tab to government was almost $1,500 per year for every person in America.
The encouraging messages adolescents hear to smoke, drink and use other drugs help drive this problem and are created, in large part, by adults. Tobacco and alcohol advertisers and marketers ply teens with their wares. Many communities are dense with alcohol and tobacco outlets. Prescription drugs are advertised as a cure for every ill. Marijuana is marketed as medicine. The entertainment industry largely portrays teen substance use as fun and without adverse consequences. And, many parents shrug off teen substance use as a normal rite of passage or show by their own actions that it takes tobacco, alcohol or another drug to calm down, relax or socialize.
The combination of adolescence, American culture which glorifies and promotes substance use, and easy access to tobacco, alcohol and other drugs is the wellspring of our current public health epidemic. 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 consequences are too devastating and the costs are simply too high.
It is time to rethink teen substance use in the light of 21st century evidence. The problem is not that we don’t know what to do. The CASA report contains a full list of specific recommendations and includes the steps that we collectively must take to educate people about this health problem, help to delay substance use as long as possible, look for signs of trouble, and intervene as we would with any other health condition.
The problem is that we are failing to act. It is time to muster the motivation and will to recognize substance use as a public health problem and addiction as a treatable medical disease and respond accordingly. In these times of severe fiscal constraints, addressing this health problem is one extraordinary opportunity to both improve the future prospects for our children and significantly reduce the enormous costs this problem places on American taxpayers.
Susan E. Foster, MSW, CASA’s Vice President and Director of Policy Research and Analysis, was the principal investigator and staff director for this effort. The project manager was Emily Feinstein, JD, and the senior research manager was Linda Richter, PhD. The data analysis was conducted by CASA’s Substance Abuse and Data Analysis Center (SADACSM), headed by Roger Vaughan, DrPH, CASA Fellow and Professor of Clinical Biostatistics, Department of Biostatistics, Mailman School of Public Health at Columbia University, and associate editor for statistics and evaluation for the American Journal of Public Health. He was assisted by Elizabeth Peters and Sarah Tsai. Others who worked on the project are: Nina Lei and Mark Stovell, research assistants; Akiyo Kodera; and CASA’s librarian David Man, PhD, MLS. Jennie Hauser managed the bibliographic database and Jane Carlson handled administrative details.
For financial contributions toward this work, we thank Legacy®, the Conrad N. Hilton Foundation, the Carnegie Corporation of New York and the Michael Alan Rosen Foundation.
To guide its research, CASA assembled a distinguished panel of experts. The CASA National Advisory Commission on Substance Use among America’s High School Age Teens, which I chaired, advised CASA as they planned and conducted their research and shaped the recommendations for policy and practice. I want to thank the esteemed members of the Commission for volunteering their time and expertise to guide and help inform the work contained in this report.
While many individuals and institutions contributed to this effort, the findings and opinions expressed herein are the sole responsibility of CASA.