Prevent Teen Drug Use: One Choice for Health

There is a popular misconception that virtually all young people use alcohol, nicotine, marijuana and often other drugs; however, despite the dangerous societal normalization of substance use among teenagers and young adults, national epidemiological indicators show a surprising and important trend line in the prevalence of substance use among adolescents. An IBH study published in the journal Pediatrics showed that in increasing and significant numbers, adolescents are choosing not to use any of these addicting, and for adolescents, illegal, substances.  

IBH President Robert L. DuPont, MD and Sharon Levy, MD, Director of the Adolescent Substance Use and Addiction Program at Boston Children's Hospital discuss their study showing long-term trends in high school seniors who refrain from any alcohol, cigarettes, marijuana or other drugs.

To an important extent this striking trend reflects the steady decline in the past three decades of the use of alcohol and nicotine as well as of drugs that are illegal for adults. Over that time both alcohol and nicotine were been widely labeled “drugs” for the first time and thus come under the shadow of that worrisome term. This positive trend reflects the aging of the baby boom generation, a birth cohort that was more likely to abuse drugs than those who came before or after it, and as a cohort continues a pattern of use that is apparent in trend lines showing increasing substance use by older Americans. Read more about these changes in three IBH Commentaries: Reducing Future Rates of Adult Addiction Must Begin with Youth Prevention (2018), For a Healthy Brain Teens Make "One Choice" (2017) and It’s Time to Re-Think Prevention (2015).

An IBH study published in 2018 showed that there are three gateway drugs for youth: alcohol, nicotine and marijuana: 

After controlling for age, sex, and race/ethnicity, compared with youth without past-month marijuana use, youth with past-month marijuana use were 8.9 times more likely to report past-month cigarette use, 5.6, 7.9 and 15.8 times more likely to report past-month alcohol use, binge use, or heavy use (respectively), and 9.9 times more likely to report past-month use of other illicit drugs. The prevalence of past-month use of cigarettes, marijuana, and other illicit drugs was significantly higher among past-month alcohol users compared with youth without past-month alcohol use, and increased as intensity of alcohol use rose. Among past-month cigarette smokers, the prevalence of marijuana, other illicit drugs, and alcohol use were each significantly higher than youth without past-month cigarette use. Youth marijuana use, cigarette smoking, or alcohol consumption is associated with other substance use. This finding has importance for youth prevention, supporting a message no use by youth of any substance.

The following are two of a series of graphs of these data from the National Survey on Drug Use and Health (NSDUH) analyzed in DuPont, et al., 2018.


Substance use disorders are chronic, often lifelong, illnesses, which have behavioral and biologic components. These disorders are associated with many short- and long-term health problems. IBH is currently engaged in a project that promotes adolescent primary health care providers to encourage their patients to refrain from the use of all of these substances, all of them – including alcohol and nicotine – are illegal for adolescents.

For a number of years IBH has studied the link between academic performance and the use of marijuana and other substances, publishing a report in 2012, American’s Dropout Crises: The Unrecognized Connection to Adolescent Substance Use, coauthored by IBH President Robert L. DuPont, MD and Amelia Arria, PhD, Director of the Center for Young Adult Health and Development at the University of Maryland School of Public Health. 

There is no constituency that supports the use by teens of any alcohol, nicotine, marijuana or other drugs. Because nearly all substance use disorders can be traced to adolescence, the continuing decline in youth drug use holds great promise for reducing all of the later life problems resulting from use.

Robert L. DuPont, MD, President of the Institute for Behavior and Health and first Director of the National Institute on Drug Abuse speaks to parents about their important role in youth substance use prevention. Published by RyeTV (

For more information about the One Choice youth can make about substance use and prevention resources from IBH visit

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