Why Teens Being Assessed for Treatment Use Alcohol and Drugs, 2014–2022

Substance use often starts in adolescence, and it puts young people at risk of fatal overdose and of substance use disorder (SUD) later in life. Knowing why teenagers use alcohol, marijuana and other drugs, and who they use them with, can point to ways of preventing use and its harms. CDC researchers looked at what adolescents being assessed for SUD treatment in the United States said on both counts between 2014 and 2022.

The data

The study used the Comprehensive Health Assessment for Teens (CHAT), a self-reported online assessment for people aged 13–18 being evaluated for SUD treatment, run by the National Addictions Vigilance Intervention and Prevention Program. It covered assessments from January 1, 2014, to September 28, 2022, dropping repeat assessments by the same person within 60 days.

Teens reported what they had used in six categories — alcohol; marijuana, hashish or THC; other nonprescription drugs; and misuse of prescription pain medications, prescription stimulants, or prescription sedatives or tranquilizers. For each category they could tick any of 15 reasons for using, and any of 10 options for who they used with, including using alone. Because more than one answer was allowed, percentages add up to more than 100.

What they used

Of 15,963 assessments, 9,557 (60%) reported using alcohol, marijuana or other drugs in the past 30 days, and 9,543 of those answered the questions on reasons or company.

Why they used

Overall, the reasons most often given were:

• to feel mellow, calm or relaxed — 73%;
• to have fun or experiment — 50%;
• to sleep better or fall asleep — 44%;
• to stop worrying about a problem or forget bad memories — 44%;
• to make something less boring — 41%;
• to help with depression or anxiety — 40%.

The leading reason differed by substance. Having fun or experimenting led for alcohol (51%) and nonprescription drugs (55%). Feeling mellow, calm or relaxed led for marijuana (76%), misused prescription pain medications (61%) and misused sedatives or tranquilizers (55%). For misused prescription stimulants, the top reason was to stay awake (31%).

Who they used with

Most teens used with friends (81%); others named a boyfriend or girlfriend (24%), anyone who has drugs (23%) or someone else (17%). But half (50%) said they used alone.

Friends and being alone were the two most common answers for every kind of substance, in different proportions. About 80% of those using alcohol, marijuana or nonprescription drugs used them with friends, compared with 64% of those misusing prescription drugs. Using alone was most common with prescription drug misuse, at 51%, against 44% for marijuana, 39% for nonprescription drugs and 26% for alcohol.

What it means

Many of these teens used substances for fun, or to find relief — mental, emotional or physical. That matches a 2020 study of young adults misusing prescription drugs, which found both recreational and self-treatment motives. Anxiety and traumatic life events are linked to substance use in adolescents, and reasons such as forgetting bad memories or easing depression and anxiety suggest that better mental health support could directly reduce use.

Using alone is the most worrying finding. When no one else is there, no one can respond to an overdose, and misusing prescription drugs alone is especially dangerous now that counterfeit pills made to look like prescription medicines may contain illegal drugs such as illegally manufactured fentanyl. Encouraging people not to use alone, and making naloxone — which reverses opioid overdoses — available to everyone who uses drugs, could lower that risk.

Using with friends, on the other hand, means someone could step in. Nearly 70% of fatal adolescent overdoses happened with a potential bystander present, yet in most cases no response by a bystander was recorded. Education designed for teenagers can teach them to recognise an overdose and respond, including giving naloxone, and can raise awareness of local Good Samaritan laws that protect people who give emergency help. Access to effective treatment for SUD and mental health conditions may also lower the risk of overdose.

The authors' recommendations:

• harm reduction education tailored to adolescents — discouraging using alone, and teaching how to recognise and respond to an overdose in others;
• access to treatment and support for mental health and stress, to address the reasons many teens gave for using.

Limits

These teens were a convenience sample of adolescents already being assessed for SUD treatment, so the results do not describe all U.S. adolescents. Answers were self-reported and open to recall and social desirability bias. And some questions asked about categories rather than specific drugs, so where a teen used several drugs in one category it is not possible to tell which one an answer referred to.

Sources

Based on "Characteristics of Alcohol, Marijuana, and Other Drug Use Among Persons Aged 13–18 Years Being Assessed for Substance Use Disorder Treatment — United States, 2014–2022," by Sarah Connolly and colleagues (CDC; Inflexxion), Morbidity and Mortality Weekly Report 73(5), published by the Centers for Disease Control and Prevention; rewritten in hubnx's own words.

• The report's figure and social media graphic are not reproduced.