What teens think they know about substances (and what they don’t)

There’s a lot to learn in adolescence, including important lessons about substance misuse. Teens’ perceptions of substances are often shaped by their peers. Leading causes cited by students for consuming drugs and alcohol include the expectation of pleasure, curiosity/experimentation, and media endorsement of the practices.

But many teens who think they understand the safety of these substances should think again.

The perceived harm of substances

Students’ expectations of the harm substances cause do not always align with the documented risks of use. The 2020 Substance Abuse and Mental Health Services Administration (SAMHSA) survey found as many as one-third of adolescents aged 12 to 17 surveyed did not see having four or five alcoholic drinks nearly every day or smoking one or more packs of cigarettes per day as harmful. More than 75% of the age group also reported not perceiving great risk of harm from taking marijuana monthly.

More findings from the 2021 Monitoring the Future study across adolescent grade levels:

• Over 30% of 8th graders surveyed considered taking cocaine or heroin occasionally to be unharmful.
• More than half of 10th graders surveyed deemed vaping marijuana regularly safe.
• Approximately 65% of 12th graders surveyed did not see having five or more drinks once or twice each weekend as dangerous to their health.

Due to their age, decision-making ability, and underage legal status, any and all substance use among teens is defined as misuse. The costs to adolescents’ health from partaking in drugs or alcohol can be serious, and even deadly.

The real health risks

The outcome of teen substance misuse can vary by type & quantity consumed. Some key health risks attached to different substance types include:

Alcohol misuse - The National Institute on Alcohol Abuse and Alcoholism (NIAAA) explains that underage drinking can pose the dangers of altered brain development, impaired judgement, injury, death, and more. They identify consuming four or five alcoholic drinks within two hours as binge drinking. The practice accounts for 90% of all alcoholic drinks consumed by young people. In recent years, adolescent girls have taken the lead in alcohol misuse.

Underage binge drinking is often involved in hazing incidents at college campuses and can lead to life-altering consequences for all students involved, as seen recently from the alcohol poisoning of a University of Missouri student.

Tobacco misuse - The Centers for Disease Control and Prevention (CDC) names cigarette smoking as the leading cause of preventable death in the United States. Cigarette smoking harms nearly every organ of the body, and is connected to increased risk of strokes, heart disease, and lung cancer. Tobacco misuse can involve cigarettes, electronic cigarettes used for vaping (the most common nicotine source among youth) and other products.

The CDC estimates about one of every 13 Americans currently aged 17 years or younger will die from a smoking-related illness.

Illicit or prescription drug misuse - The 2021 Monitoring the Future study found drug misuse among students declined drastically across drug categories in 2021. Yet illicit or prescription drug misuse still reaches thousands of teens in their sample alone, and even more nationwide.

The CDC classifies misuse of prescription drugs, illegal drugs, and injection drugs all as creating a high risk of adverse outcomes for adolescents. This includes dropping out of school, criminal justice involvement, injury, and loss of life, among other consequences. Opioids as prescription drugs in particular remain misused at epidemic proportions in the U.S.

Explore the signs of teen substance misuse here

Seeking in-the-moment thrills, finding life-long consequences

Many teens find their way to substance misuse when seeking a thrill. According to the NIAAA, the impulse often serves not only as rebellion but also as a result of youths’ brains developing well into their twenties. When brain development is still in progress, the full consequences of having drugs or alcohol as adolescents may not be clear.

This includes immediate negative reactions that can follow substance misuse. According to the National Institute on Drug Abuse (NIDA), these reactions may involve experiencing anxiety, fear, distrust, or panic from drugs instead of the anticipated “high.” The NIAAA further shares that alcohol misuse is not always arousing. Rather, it can lead to loss of coordination, drowsiness, and withdrawal or hangover effects.

Even more concerning are the outcomes of teen substance misuse that build over time, such as addiction and other forms of Substance Use Disorder (SUD). Most students who begin abusing substances as adolescents experience SUD symptoms throughout adulthood. This means adolescents' substance misuse that grows into abuse can affect the full scope of their lives. In this sense, the consequences of teen substance misuse stretch long after the initial thrill has passed.

The impact on mental health

Like some adults, many adolescents may view substances as solutions to their mental health concerns. Yet substance misuse is likely to only increase their issues and treatment needs.

The NIAAA identifies teens who experience depression or anxiety as among those with the greatest risk of alcohol problems. These increased risks carry across substances. In 2020, SAMHSA found 2.7% (644,000) of adolescents aged 12 to 17 surveyed had both a major depressive episode (MDE) and an SUD in the past year. This included Illicit Drug Use Disorder, Alcohol Use Disorder, or both.

When students engage in substance misuse, they only damage their wellbeing. Teaching teens to recognize that substances provide harm rather than help is key to supporting their mental health.

Learn how to recognize depression and anxiety among teens

Managing teen substance misuse

Teens never have to be alone in managing their substance misuse. Many resources can help, such as:

• The NIDA for Teens
• SAMHSA’s Substance Abuse Facility Locator
• The NIAAA’s Rethinking Drinking website
• The CDC’s Health Resources for Teens

Schools, parents, and families can help address teen substance misuse using the prevention strategies offered by the CDC. The strategies involve the following protective factors:

• Parent or family engagement
• Family support
• Parental disapproval of substance use
• Parental monitoring
• School connectedness, among others