April 29, 2010

A Day in the Life of American Adolescents: Substance Use Facts Update

In the United States in 2008, almost one third of adolescents aged 12 to 17 drank alcohol in the past year, around one fifth used an illicit drug, and almost one sixth smoked cigarettes.¹ Although the percentage of adolescents using alcohol, cigarettes, and illicit drugs declined between 2002 and 2008, the percentage of persons aged 12 to 17 receiving substance abuse treatment remained relatively stable.² In addition, the number of adolescents seen in an emergency department (ED) for the use of illicit drugs or the misuse or abuse of pharmaceuticals remained stable from 2004 to 2008.³ In 2008, 7.5 percent of all persons admitted to publicly funded treatment facilities were aged 12 to 17.⁴

The Office of Applied Studies (OAS) in the Substance Abuse and Mental Health Services Administration (SAMHSA) collects, analyzes, and disseminates critical public health data. OAS manages four national data collections that offer insight into adolescent substance use and treatment: the National Survey on Drug Use and Health (NSDUH), the Treatment Episode Data Set (TEDS), the National Survey of Substance Abuse Treatment Services (N-SSATS), and the Drug Abuse Warning Network (DAWN).^5,6,7,8

This issue of The OAS Report presents facts about adolescent substance use, including initiation, receipt of treatment, and emergency department visits for substance use "on an average day."⁹ Data presented in this report from NSDUH, TEDS, and DAWN are for adolescents aged 12 to 17; data presented from N-SSATS are for youths under 18 years old.

According to the 2008 NSDUH, 10.2 percent of adolescents aged 12 to 17 drank alcohol for the first time in the past year, and 6.0 percent used an illicit drug¹⁰ for the first time. The 2008 NSDUH indicates that, on an average day during the past year, the following numbers of adolescents used the indicated substances for the first time (Figure 1):

• 7,540 drank alcohol for the first time;
  
• 3,845 smoked cigarettes for the first time;
  
• 4,365 used an illicit drug for the first time;
  
• 3,695 used marijuana for the first time;
  
• 2,466 used prescription pain relievers nonmedically for the first time;
  
• 1,406 used hallucinogens for the first time;
  
• 1,310 used inhalants for the first time;
  
• 653 used cocaine for the first time;
  
• 628 used licit or illicit stimulants nonmedically for the first time;
  
• 127 used methamphetamine for the first time; and
  
• 93 used heroin for the first time.
  

Figure 1. Number of Adolescents Aged 12 to 17 Who Used Cigarettes, Alcohol, or Illicit Drugs for the First Time on an Average Day: 2008 NSDUH

According to the 2008 NSDUH, 8 million adolescents aged 12 to 17 drank alcohol in the past year, nearly 5 million used an illicit drug, and nearly 4 million smoked cigarettes. In addition, on an average day during the past year, the following number of adolescents aged 12 to 17 used the indicated substances (Figure 2):

• 1,021,853 smoked cigarettes;
  
• 508,329 drank alcohol;
  
• 563,182 used marijuana;
  
• 36,572 used inhalants;
  
• 24,737 used hallucinogens;
  
• 16,622 used cocaine; and
  
• 2,866 used heroin.
  

Figure 2. Number of Adolescents Aged 12 to 17 Who Used Cigarettes, Alcohol, or Illicit Drugs on an Average Day: 2008 NSDUH

The 2008 NSDUH indicates that

• adolescents who used alcohol in the past month drank an average of 4.6 drinks per day on the days they drank; and
• adolescents who smoked cigarettes in the past month smoked an average of 4.4 cigarettes per day on the days they smoked.

TEDS reported that, in 2008, there were 141,683 admissions for adolescents aged 12 to 17 to substance abuse treatment programs (TEDS data come primarily from facilities that receive some public funding). TEDS indicates that, on an average day in 2008, adolescent admissions to treatment presented with the following substances as the primary substance of abuse¹¹ (Figure 3):

• 263 presented with marijuana;
  
• 76 presented with alcohol;
  
• 10 presented with stimulants;
  
• 9 presented with heroin or other opiates;
  
• 6 presented with cocaine; and
  
• 8 presented with other drugs.
  

Figure 3. Number of Adolescents Aged 12 to 17 Admitted to Publicly Funded Substance Abuse Treatment Facilities on an Average Day, by Primary Substance of Abuse: TEDS 2008

TEDS indicates that, on an average day in 2008, adolescent admissions to substance abuse treatment were referred by the following principal sources of referral¹² (Figure 4):

• 184 by the criminal justice system;
  
• 63 by self-referral or referral from other individuals;
  
• 46 by community organizations;
  
• 43 by schools;
  
• 28 by treatment providers; and
  
• 18 by other health care professionals.
  

Figure 4. Number of Adolescents Aged 12 to 17 Admitted to Publicly Funded Substance Abuse Treatment Facilities on an Average Day, by Principal Source of Referral: TEDS 2008

In addition, N-SSATS, which collects information on substance abuse treatment at both publicly and privately funded facilities, reports how many active clients¹³ under age 18 received the following types of substance abuse treatment on an average day in 2008 (Figure 5):

• 76,484 were clients in outpatient treatment;
  
• 9,219 were clients in nonhospital residential treatment; and
  
• 762 were clients in hospital inpatient treatment.
  

Figure 5. Number of Clients under Age 18 Who Were Clients in Publicly or Privately Funded Substance Abuse Treatment Facilities on an Average Day, by Service Type: 2008 N-SSATS

DAWN estimates that in 2008 there were about a quarter of a million drug-related ED visits by adolescents aged 12 to 17, of which 169,600 visits involved the use of illicit drugs, alcohol, or intentional misuse or abuse of pharmaceuticals (e.g., prescription medicines, over-the-counter remedies, dietary supplements).¹⁴ On an average day in 2008, there were 723 drug-related ED visits for adolescents aged 12 to 17, of which 465 involved the use of illegal drugs or the misuse or abuse of pharmaceuticals. Various substances were involved in ED visits at the following levels (Figure 6):¹⁵

• 151 involved alcohol and no other drug;
  
• 54 involved alcohol taken together with other drugs;
  
• 129 involved marijuana;
  
• 18 involved MDMA (i.e., Ecstasy), LSD, PCP, or other hallucinogens;
  
• 17 involved cocaine;
  
• 12 involved illicit amphetamines or methamphetamines;
  
• 6 involved inhalants;
  
• 5 involved heroin;
  
• 86 involved prescription or nonprescription pain relievers;
  
• 31 involved prescription narcotic pain relievers (e.g., hydrocodone, oxycodone);
  
• 39 involved benzodiazepines;
  
• 34 involved antidepressants or antipsychotics; and
  
• 5 involved attention-deficit/hyperactivity disorder (ADHD) medications.
  

Figure 6. Number of Emergency Department (ED) Visits for Drug Misuse or Abuse on an Average Day for Patients Aged 12 to 17, by Selected Types of Drugs: 2008 DAWN

DAWN estimates that, on any given day in 2008, there were 63 ED visits for drug-related suicide attempts among adolescents.