Alcohol use among youth is more widespread than use of tobacco or illicit drugs. While alcohol use has been gradually declining among youth since the 1980s, and reached historically low levels in 2011, it continues to be a significant problem.¹ According to the 2009 National Survey on Drug Use and Health (NSDUH), about 10.4 million youth ages 12 to 20 (27.2 percent) reported drinking alcohol in the past month.²

While findings suggest that youth drink less frequently than adults, they binge drink (defined as drinking five drinks or more in about two hours on at least one occasion) more than adults.³ According to the 2009 NSDUH, 6.9 million youth (18.1 percent of youth between the ages of 12 and 20) reported binge drinking and 2.1 million youth (5.4 percent of youth between the ages of 12 and 20) reported heavy drinking (defined as drinking five or more drinks on the same occasion on each of five or more days in the past 30 days).⁴  These rates are higher for youth and young adults than for any other age group and are higher for youth enrolled in college than their peers.⁵

Binge drinking and heavy drinking can lead to a number of health risks including overall development and specific effects on the brain, liver, and endocrine system. Individuals who reported starting to drink before the age of 15 were four times more likely to also report meeting the diagnostic criteria for alcohol dependence at some point in their lives. The younger youth are when they start to use alcohol, the more likely they will be to engage in harmful behaviors, such as using other drugs, having sex with six or more partners, and earning grades that are mostly Ds and Fs in school.⁶

Smoking cigarettes is the leading cause of preventable disease and death in the U.S and is most often initiated during adolescence. While the number of students reporting that “they had smoked within the past month” declined from 1972−2011, the number of youth who have tried cigarettes and those who reported daily use remains higher than the number of youth who have tried any other illicit drug. Also, teens report that it is “very easy” or “fairly easy” to get cigarettes. Among 8th, 10th, and12th graders in 2011, 27.8 percent had tried cigarettes in their lifetime and 11.7 percent reported that “they had smoked within the past month”.⁷

In addition to smoking cigarettes some youth, almost exclusively males, use smokeless tobacco, including snuff, snus, and chew, which can lead to disease, death, and dependence.⁸ The reported rate of smokeless tobacco use among youth has been declining, and 30-day prevalence is about half of the reported rate at peak levels in 1994 for all grades. 

Illicit drugs include marijuana/hashish, cocaine (including crack), heroin, hallucinogens, inhalants, or prescription-type pain relievers, tranquilizers, stimulants, and sedatives used nonmedically.⁹ Learn more about commonly abused drugs.

While illicit drug use among youth is lower than tobacco and alcohol use, youth and young adults between the ages of 12 and 25 were more likely to be current illicit drug users than adults 26 and older.¹⁰ Marijuana is the most widely used of all illicit drugs among youth and many youth report that it is highly accessible.¹¹ Studies report that the degree to which teens disapprove of marijuana use and the perceived risk associated with use, even regular use, has recently begun to decline. Changes in these beliefs and attitudes can be associated with driving changes in use.¹² Painkillers are one of the most commonly used drugs by teens after tobacco, alcohol, and marijuana.¹³ The most popular prescription drugs are opioids and stimulants. Opioids, which include pain relievers such as OxyContin and Vicodin, are central nervous system depressants that are often used to treat anxiety and sleep disorders. Stimulants are often used to treat attention-deficit hyperactivity disorder and narcolepsy.¹⁴

Studies have found a connection between youth who use alcohol and tobacco, and those who use illicit drugs. Of the youth who reported heavy drinking (defined as drinking five or more drinks on the same occasion on each of five or more days in the past 30 days), 69.9 percent also reported they had used an illicit drug. In comparison, illicit drug use for those who were not current alcohol users (used alcohol within the past month) was reported at 5.2 percent.¹⁵  Youth who smoke tobacco are nine times more likely to meet the medical criteria for alcohol abuse and 13 times more likely to meet the medical criteria for illicit drug abuse and dependence. Neurological research suggests that nicotine can cause structural and chemical changes in teenage brains, increasing the risk of alcohol, marijuana, and opioid use.¹⁶