Historically speaking, it’s not a bad time to be a teenager’s liver. Or the lungs.
Regular use of alcohol, tobacco, and drugs among high school students has been on a long downward trend.
In 2023, 46 percent of seniors said they had one drink in the year before being interviewed. That’s a steep drop from 88 percent in 1979, when the behavior peaked, according to the annual Watch the Future survey, a closely watched national poll on youth substance use. A similar downward trend was observed among eighth and 10th graders for all three age groups in terms of smoking. In 2023, just 15 percent of seniors said they had smoked a cigarette in their lifetime, down from a peak of 76 percent in 1977.
Illicit drug use among teenagers 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 past year — up from 37 percent in 2017 and a peak of 51 percent in 1979.
There are some troubling caveats to the good news. One is that teen overdose deaths have risen sharply, with fentanyl-related deaths among teens doubling from 2019 to 2020 and remaining at that level in subsequent years.
Dr. Nora Volkow has dedicated her career to the study of drug and alcohol use. She has been the 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 changing trends in drug use.
What’s the big picture about teens 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 this is worth saying, too, about legal alcohol and tobacco.
What do you think about the change?
An important factor is education and prevention campaigns. Certainly, the smoking prevention campaign was one of the most effective we have ever seen.
Some of the policies implemented have also helped significantly, not just by making the legal age for alcohol and tobacco 21, but also by enforcing these laws. Then you stop the progression from more accessible drugs like tobacco and alcohol to illegal ones. And teenagers aren’t exposed to legal drug ads like they used to be. All these policies and interventions have had a subsequent impact on illicit drug use.
Does social media use play a role among teenagers?
Absolutely. Social media has displaced the opportunity to be in physical space with other teenagers. This makes it less likely that they will take drugs. And this became dramatically evident when schools were closed due to Covid-19. You saw a big jump down in the prevalence of poly-substance use during the pandemic. This may be because the teenagers could not be with each other.
The interesting thing is that despite the fact that schools are back, the prevalence of substance use has not risen to the pre-pandemic period. It remained stable or continued to decrease. It’s been a big jump down, a turnaround, and some drug use trends continue to slowly decline.
Is there any thought that the stimulation that comes from using a digital device might satisfy some of the same neurochemical experiences of drugs or provide a partial escape?
Yes, this is possible. There has been a change in the types of boosters available to teenagers. It’s not just social media, it’s video games, for example. Video games can be very reinforcing and can create compulsive patterns of use. So you trade one booster, one way of escape, for another. This may be another factor.
Is it too simplistic to see the decline in drug use as good news?
If you look at it objectively, yes, it is very good news. Why; Because we know that the earlier you use these drugs, the greater the risk of becoming addicted to them. It reduces the risk that these drugs will affect your mental health, your general health, your ability to complete an education, and your future job opportunities. This is absolutely good news.
But we don’t want to be complacent.
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 fallen, but use is still much higher than for cigarettes: In 2021, about a quarter of high school seniors said they had vaped nicotine in the previous year. Why do teens resist cigarettes and flock to vaping?
Most of the toxicity associated with tobacco has been attributed to the burning of the leaf. The burning of this tobacco was responsible for cancer and most of the other adverse effects, even though nicotine is the addictive element.
What we have come to understand is that vaping with nicotine has its own harms, but this is not as well understood as in the case of tobacco. The other aspect that made vaping so appealing to teenagers was that it was associated with all kinds of flavors – candy flavors. It wasn’t until the FDA made these flavors illegal that vaping became less affordable.
My argument would be that there is no reason to expose teenagers to nicotine. Because nicotine is very, very addictive.
Anything else you want to add?
We also have this whole interest in cannabis and psychedelic drugs. And there’s a lot of interest in the idea that psychedelic drugs might have therapeutic benefits. Preventing these new trends in drug use among teenagers requires different strategies than we used for alcohol or nicotine.
For example, we can say that if you take drugs like alcohol or nicotine, it can lead to addiction. This is supported by extensive research. But the warning about addiction to drugs like cannabis and psychedelics may not be as effective.
While cannabis can also be addictive, it is perhaps less addictive than nicotine or alcohol, and more research is needed in this area, especially on newer, higher-potency products. Psychedelics don’t usually lead to addiction, but they can create adverse mental experiences that can put you at risk for psychosis.
