Teen drug habits are changing for the better. With warnings.

Historically speaking, it's not a bad time to be a teenager's liver. Or the lungs.

Regular alcohol, tobacco, and drug use among high school students has seen a long downward trend.

In 2023, 46% of older adults said they had had a drink in the year before being surveyed; that's a steep decline from 88% in 1979, when the behavior peaked, according to the annual Monitoring the Future survey, a closely watched national survey of youth substance use. A similar downward trend was observed among eighth and tenth graders and for these three age groups regarding cigarette smoking. In 2023, only 15% of older adults reported having smoked a cigarette in their lifetime, compared to a peak of 76% in 1977.

Illicit drug use among adolescents has remained low and fairly stable over the past three decades, with some notable declines during the Covid-19 pandemic.

In 2023, 29% of high school students reported using marijuana in the previous year, down from 37% in 2017 and a peak of 51% in 1979.

There are some sobering caveats to the good news. The first is that overdose deaths among adolescents have increased dramatically, with fentanyl-related deaths among adolescents doubling from 2019 to 2020 and remaining at that level in subsequent years.

Dr. Nora Volkow has dedicated her career to studying drug and alcohol use. She has been director of the National Institute on Drug Abuse since 2003. She met with the New York Times to discuss changing patterns and the reasons behind changing trends in drug use.

What's the big picture about teens and drug use?

People don't realize that among young people, particularly adolescents, the rate of drug use is the lowest we've seen in decades. And it's worth saying this for legal alcohol and tobacco too.

To what do you attribute the change?

An important factor are education and prevention campaigns. Certainly the prevention campaign against cigarette smoking was one of the most effective we have ever seen.

Some of the policies implemented have also contributed significantly, not only raising the legal age for alcohol and tobacco to 21, but also enforcing those laws. So the progression from more accessible drugs, such as tobacco and alcohol, to illicit ones stops. And teenagers are no longer exposed to advertising for legal drugs as they were in the past. All of these policies and interventions have had a downstream impact on illicit drug use.

Does social media use among teens play a role?

Absolutely. Social media has displaced the opportunity to be in physical space with other teens. This makes them less likely to take medications. And this became dramatically evident when schools closed due to Covid-19. There has been a large downward jump in the prevalence of many substance use during the pandemic. This may have been due to the fact that the teenagers could not be together.

What's interesting is that even though schools have been reinstated, the prevalence of substance use has not reached pre-pandemic levels. It remained stable or continued to decline. It's been a big leap down, a shift, and some drug use trends continue to slowly decline.

Is it thought that stimulation from the use of a digital device could fulfill some of the same neurochemical experiences as drugs or provide some of the escapism?

Yes, it is possible. There has been a change in the types of reinforcers available to adolescents. It's not just about social media, it's about, for example, video games. Video games can be very reinforcing and can produce patterns of compulsive use. So you're moving one reinforcement, one way of escape, to another. This could be another factor.

Is it too simplistic to view the decline in drug use as good news?

If you look at it objectively, yes, that's great news. Why? Because we know that the earlier you take these drugs, the greater the risk of becoming dependent on them. It reduces the risk that these drugs will interfere with your mental health, your overall health, your ability to complete an education, and your future job opportunities. This is absolutely good news.

But we don't want to become complacent.

The supply of drugs is more dangerous and leads to an increase in overdose deaths. We're not exaggerating. I mean, taking one of these drugs can kill you.

What about vaping? It is declining, but consumption is still significantly higher than that of cigarettes: in 2021, About a quarter of high school seniors said they had vaped nicotine in the previous year. Why should teenagers resist cigarettes and prefer vaping?

Most of the toxicity associated with tobacco has been attributed to burning of the leaves. Burning that tobacco was responsible for cancer and most other adverse effects, even though nicotine is the addictive element.

What we have come to understand is that vaping nicotine itself carries harm, but this has not been as well understood as in the case of tobacco. The other thing that made vaping so appealing to teens 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 accessible.

My argument would be that there is no reason why we should expose teenagers to nicotine. Because nicotine is very, very addictive.

Anything else to add?

We also have all this interest in cannabis and psychedelic drugs. And there's a lot of interest in the idea that psychedelic drugs could have therapeutic benefits. To prevent these new trends in drug use among adolescents, strategies different from those used for alcohol or nicotine are needed.

For example, we can say that if you take drugs such as alcohol or nicotine, this can lead to addiction. This is supported by extensive research. But warnings about addiction to drugs like cannabis and psychedelics may not be as effective.

While cannabis can be addictive, it is perhaps less so than nicotine or alcohol, and more research is needed in this area, especially on newer, higher-potency products. Psychedelics do not usually lead to addiction, but they can produce adverse mental experiences that can put you at risk for psychosis.

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