Rates of Teen Use

  • Teen substance use is not inevitable. A growing number of U.S. teens are choosing not to use alcohol or other drugs.

  • Although misperceptions that vaping (nicotine and marijuana/THC) is “safe and healthy” have resulted in increased use by teens, an analysis of data from the 2018 Monitoring the Future Survey showed that, overall, more U.S. teens didn’t use alcohol, tobacco, marijuana or other drugs than in prior decades. A driving factor has been the decline in smoking among U.S. teens; showing that prevention and intervention efforts can, and do, work.


Source: Adapted from Trends in Substance Nonuse by High School Seniors: 1975–201810

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Teen Brain Development

Building Blocks of the Brain
  • The neuron is the basic unit of communication in the brain.

  • Information between neurons is carried by chemical messengers (neurotransmitters) across gaps between neurons, called synapses.

  • Huge networks of neurons interact in this way to generate pathways for efficient communication among interconnected neurons.

Our Experiences Shape Our Brains
  • We are born with billions of neurons; nearly all the neurons we will ever have.

  • Connections between neurons, and the intricate pathways they form, are determined by our experiences; everything we think, feel, and do.

  • Through the process of synaptic pruning, synapses that are used a lot are strengthened, and ones that are not used are cut away.

  • Insulation of axons, by myelin, increases the speed and efficiency of communication between neurons in these established pathways that have been created through experiences.

  • The teen years are a unique time of opportunity for exploration, learning and memory.

  • During this time teens are training their brain with everything they experience, think, feel, and do, to help them become great at the things they are most interested in (e.g., academics, social relationships, activities).

  • The brain isn’t fully developed until approximately the age of 25.

Two Important Parts of the Brain
The Limbic System
  • The emotional brain

  • Deals with risk, reward, and feelings

  • One of the first parts of the brain to become fully developed, during the teen years

The Prefrontal Cortex
  • The rational brain

  • Thinks through decisions based on risk and reward

  • Not fully developed until 25-30 years old

  • The limbic system and prefrontal cortex are two of the brain areas involved in the natural reward pathway, responsible for communicating information about rewards necessary for survival (e.g., food, water, shelter, social relationships).

  • Dopamine is a neurotransmitter in the brain, which is released when “rewarding” experiences occur. Dopamine released in the “natural reward pathway” alerts other parts of the brain to “remember” what you did so that neural pathways can be established to repeat that “rewarding” feeling, again (e.g., eat that pizza, sink that shot, hang out with family and/or friends).

Substance Use & The Brain

  • Because of ongoing neurodevelopment, the teen brain is uniquely vulnerable to substance use.

  • Alcohol and other drugs act as “imposters” in the brain, mimicking natural neurotransmitters, and can hijack the natural reward pathway by causing the release of dopamine.

  • The amount of dopamine that is released with alcohol and other drugs is so intense that, when used repeatedly, the brain must turn down the signal by reducing the amount of dopamine receptors.

  • With fewer dopamine receptors, everyday activities become less enjoyable. Alcohol and other drugs can become the only way to feel good. This is addiction.

  • The teen brain is more susceptible to the effects of alcohol and other drugs. 9 out of 10 people who develop addiction, began using alcohol, nicotine, or marijuana before the age of 18.

  • Using alcohol, nicotine, marijuana, or other drugs during the teen years interferes with the natural brain development processes--- substances “trick the brain” into thinking that connections associated with using alcohol or other drugs are important and should be maintained. This is why people who start using alcohol or other drugs during the teen years are more likely to become addicted than adults.

  • Even if you don’t get addicted, alcohol and other drugs may disrupt the synaptic pruning process, making it harder for your brain to strengthen the synapses it needs to learn new things and develop new skills that help you become who you want to be.

  • Use of alcohol and/or other drugs by teens is associated with many other health and safety risks.11,12

Health Effects of The Most Commonly Used Substances by Teens and Young Adults

Alcohol graphic

Source: U.S. Department of Health and Human Services13

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Marijuana Graphic

Strength and Potency

THC graph

Source: Adapted from NIDA and data from the Potency Monitoring Program, Quarterly Report #14614

The amount of THC in marijuana has increased over the past few decades. In the early 1990s, the average THC content in marijuana was less than 4 percent. It is now about 15 percent and much higher in some products such as oils and other extracts (see below). Scientists do not yet know what this increase in potency means for a person’s health. Some people adjust how they consume marijuana (by smoking or eating less) to compensate for the greater potency; however, teens and young adults are less likely to make this adjustment. There have been reports of people seeking help in emergency rooms with symptoms of THC over ingestion including nervousness, shaking, psychosis (having false thoughts or seeing or hearing things that aren't there), nausea, and vomiting, after consuming high concentrations of THC. There is evidence that addiction to THC may occur more rapidly with the use of products containing higher levels of THC.

Marijuana Extracts

Smoking/vaping/dabbing extracts and resins from the marijuana plant with high levels of THC is on the rise. There are several forms of these extracts, such as hash oil, budder, wax, and shatter. These resins have 3 to 6 times more THC than the plant itself. Smoking, vaping, or dabbing it can deliver dangerous amounts of THC and has led some people to seek treatment in the emergency room. There have also been reports of people injured in fires and explosions caused by attempts to extract hash oil from marijuana leaves using butane (lighter fluid).

nicotine graphic

The Centers for Disease Control and Prevention reports that there is no risk-free level of exposure to secondhand smoke. Each year, an estimated 58 million Americans are regularly exposed to secondhand smoke and more than 42,000 nonsmokers die from diseases caused by secondhand smoke exposure. Since the 1964 Surgeon General’s Report, 2.5 million adults who were nonsmokers died because they breathed secondhand smoke.

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Nicotine or THC from vaping products activates the brain’s reward circuits and increases levels of an important chemical messenger in the brain, called dopamine. Dopamine causes the brain to remember the behavior associated with that increase and reinforces the desire to vape nicotine or THC. This can cause a person to seek out nicotine or THC and use it again and again, despite the risks to their health.12


It is important to recognize that in addition to the negative health effects caused by nicotine and THC, vaping has its own risks, which include addiction and other potentially harmful health effects. Health experts have raised many questions about the safety of vaping devices, particularly for teens:

  • Testing of some vaping products found the aerosol (vapor) to contain known cancer-causing and toxic chemicals. The health effects of repeated exposure to these chemicals are not yet clear.

  • Some research suggests that nicotine vaping may increase the likelihood that teens will try other tobacco products, including cigarettes. A study showed that students who have vaped nicotine by the time they start 9th grade are more likely than others to start smoking traditional cigarettes and other smoked tobacco products within the next year. Another study has also shown a connection between vaping nicotine and smoking traditional cigarettes. These studies suggest that using vaping products can lead to cigarette smoking in adolescents.

  • Some research suggests that certain vaping products contain metals like nickel and chromium, possibly coming from the heating of coils, that may be harmful when inhaled.

For More Information about the effects of other drugs including depressants, stimulants, hallucinogens, and opioids:

Signs and Symptoms of Addiction

Addiction can happen at any age, but it usually starts when a person is young. Teens who continue to use drugs despite harmful consequences could be addicted.

When adolescents start behaving differently for no apparent reason—such as acting withdrawn, frequently tired or depressed, or hostile—it could be a sign they are developing a drug-related problem. Parents and others may overlook such signs, believing them to be a normal part of puberty. Other signs include:

  • a change in peer group

  • carelessness with grooming

  • decline in academic performance

  • missing classes or skipping school

  • loss of interest in favorite activities

  • trouble in school or with the law

  • changes in eating or sleeping habits

  • deteriorating relationships with family members and friends15

For teens seeking help for substance use, or for parents, teachers and other trusted, caring adults seeking to help a teen they know is struggling with substance use, visit our Resource page or the SAMHSA National Helpline website for their free, confidential, treatment referral and information services line.

Industry Influence

industry graphic

Sources: Stanford Research Into the Impact of Tobacco Advertising,16 & Centers for Disease Control and Prevention17

Industries and street dealers that sell alcohol, marijuana, tobacco, other drugs, and/or vape devices know that teens who get hooked early, become life-long sources of profit. For this reason, teens and young adults are often targeted for advertising and marketing of substances with addiction potential.

What role does industry play in teen substance use?
  • Industries that sell alcohol, marijuana, tobacco and vaping products, profit from consumers who use their products daily or near daily.

  • In fact, the Pareto principle states that 80% of profits are derived from the top 20% of consumers. When the product has addiction potential, the top 10-20% of consumers most often represent those who have a substance use disorder. For this reason, these industries are sometimes called addiction-for-profit industries.

  • These industries know that the teen brain is more susceptible to addiction, thus products are often designed to appeal to young people, who will then become lifelong customers. These include products that are sweet, cheap, and easy to disguise or hide.

  • Key advertising and marketing tactics include making their products seem “healthy”, “cool”, and “fun” while denying the science that shows the significant risks to health and safety.

How can we, as a society, better address substance use?


Universal prevention

  • Age-appropriate youth substance use prevention efforts, beginning at a young age, are our best chance of “vaccinating” young people against future addiction. If first use of alcohol or other drugs is delayed until the brain is fully developed (~25 years old) the risk of addiction is dramatically reduced.

  • Addiction is now considered a pediatric disease, with 9 out of 10 people who develop an addiction first using alcohol or another drug before the age of 18.

  • A comprehensive community-based approach to youth substance use prevention includes multiple strategies in multiple domains. Some of these strategies include:

    • Environmental strategies, including policies, that reduce access and availability of alcohol and other drugs to young people are important elements of youth substance use prevention.

    • Community, school, and family norms that model healthy, substance-free, ways to cope with stress and have fun help to reduce teen substance use.

    • Universal age-appropriate prevention education. At an early age, this can include age-appropriate lessons on brain science and social-emotional learning skill development. As children approach middle school, information regarding the impact of alcohol, nicotine, and other drugs on the brain and body helps to increase the perception of harm and reduce teen substance use.

    • Strong perception of parental and peer disapproval of teen substance use are among the most important factors that decrease the likelihood of teen substance use.18


Reducing stigma

  • The experience of addiction can feel scary and isolating. Negative stereotypes about addicted people may worsen their sense of shame, fear, and guilt. While conversations about addiction should be honest and heartfelt, it’s crucial to refrain from using judgmental language when describing those with substance use disorders.

  • Insensitive language contributes to stigma, which prevents many from seeking the treatment they need – and deserve. Here are some harmful terms to avoid: “Addict”, “Alcoholic”, “Abuser”, “Clean”, and “Relapse”.

  • Quality and compassionate care of those struggling with addiction, as with any other health condition, is critical to short and long-term recovery.22


Early detection

  • As with other physical and mental health issues, early detection of substance use, behavioral assessment, and appropriate intervention measures are important to ensure the best possible health and safety outcomes for young people.

  • In the wake of COVID-19, youth are facing unprecedented mental health challenges. Early detection has the potential to mitigate the mental health crisis19 by minimizing interruptions to education, delaying or preventing onset of serious psychiatric illness, and decreasing the need for utilization of already limited adolescent behavioral health services and resources.

  • Parents, teachers, and healthcare professionals can learn about risk factors for substance use and common warning signs indicative of substance use, thus creating an opportunity for early intervention.

    • Risk factors increase the likelihood that adolescents will use substances or develop addiction. They should be taken into consideration with protective factors, which decrease the likelihood that adolescents will use substances or develop addiction.

      • Common risk factors include: alcohol and/or other drug availability in the community; exposure to ads for alcohol and/or other drugs; neighborhood poverty and/or violence; family history of alcohol and/or other drug use; family or personal history of mental illness (e.g., depression, anxiety, ADHD, bipolar disorder, psychosis); friends who use alcohol and/or other drugs; childhood trauma (e.g., abuse, neglect); lack of strong, healthy bonds with caregivers, parents, or trusted adults; aggressive behavior; high levels of risk taking or impulsivity; being caught using alcohol and/or other substances at school or a school sanctioned event; belief that most teens use alcohol and/or other drugs; and belief that alcohol and/or other drugs are not harmful for teens. To learn more about risk and protective factors, click here.

    • Common warning signs of drug use in adolescents are changes to behavior and mannerisms. 20 See Signs and Symptoms under “Substance Use 101” for common warning signs in adolescents. When warning signs go unnoticed or confused with a normal part of adolescent development, an opportunity for early intervention may be missed. Communication and developing trusted relationships with adolescents are not only powerful protective factors, but also provide an opportunity to flag these behaviors and mannerisms early on. For tips on how to communicate with children and adolescents about substance use, click here and here.

    • Early intervention that is effective and appropriate ensures the best possible health and safety outcomes for adolescents using substances.

      • iDECIDE has been developed to provide early intervention to adolescents caught using substances in school, and may also be used as a drug education curriculum. iDECIDE is an alternative to punitive responses to substance use and is adolescent-focused, supportive, empowering, equitable, and science-based.

      • If you are a teen seeking help for substance use, or for parents, teachers and other trusted, caring adults that have noticed warning signs or are concerned a teen is struggling with substance use, visit our Resource page or the SAMHSA National Helpline website for their free, confidential, treatment referral and information services line.

Please note, material on this site should never be used as a substitute for direct advice or medical care from your doctor or other qualified clinician.


Attention to comorbidities

  • Substance use is often co-occurring with mental health issues such as anxiety and depression, which sometimes may be associated with prior or existing trauma.

  • According to the National Institute on Drug Abuse, approximately 50% of adults with a substance use disorder also have a mental illness and over 60% of adolescents in community-based substance use disorder treatment programs also meet diagnostic criteria for another mental illness.

  • When it is found that a young person is using alcohol or other drugs, an assessment for co-occurring mental health issues (and vice versa) is important to develop the most appropriate plan for each individual young person.21