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Chapter 1: The Nature and Extent of Substance Abuse in the U.S.

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The consequences of illicit substance use extend to health problems, productivity losses, psychological problems, and crime and other social problems. The size of the problem is daunting. In 2002, the National Survey on Drug Use and Health (NSDUH) revealed that 8.3 percent of the American population — roughly 19.5 million people — were current users of an illegal drug, while countless more individuals used and abused legal substances. Moreover, almost one-half of the U.S. population 12 years of age and older have used an illegal drug at least once at some point in their lives.

While some solace may be taken from the fact that substance abuse rates are generally down from the levels reported in the late 1970s and early 1980s and seem to be on the decline after a rise in the mid- to late 1990s, it would be premature to claim a victory in the so-called "war against drugs." Evidence that our country continues to be deeply affected by substance abuse abounds.

Several key points regarding the nature and extent of the overall substance abuse problem in the United States and, more specifically, substance abuse among youth follow.

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"The prevention of adolescent drug and alcohol abuse is most likely to occur when parents, teachers, faith leaders and other individuals ... are well informed of the harmful effects of drugs, recognize behavioral changes that accompany drug use, and understand how drug use is encouraged and accepted in the social world of the child." (Parents Resource Institute for Drug Education [PRIDE], 2003).

Overview of the Nature and Extent of Substance Abuse in the U.S.

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Illicit Drug Use

View Figure 1: Substances of Choice for Illicit Users Aged 12 and Older

  • In 2002, 8.3 percent of the American population — 19.5 million people — were current users of an illegal drug.

  • Almost one-half (46 percent) of the U.S. population 12 years of age and older have ever used an illegal drug.

  • Marijuana:
    View Figure 2: Mean Age at First Use of Marijuana, 1965-2001

    • Approximately 2.6 million Americans used marijuana for the first time in 2001.

    • Researchers have determined that marijuana use can lead to addiction.

    • Approximately 9 percent of users will develop dependence, most likely in their first 5 years of use.

    • Today's marijuana is substantially more potent than that available in previous decades.

  • Cocaine:

    • An estimated 2 million Americans were current cocaine users, and an estimated 567,000 were current crack users in 2001.

    • Approximately 21 percent of those who ever use cocaine will develop dependence.

    • Cocaine use consistently accounts for the greatest proportion of drug-related emergency department admissions each year.

  • Heroin:

    • From 1995 to 2002, heroin use quadrupled among youth ages 12 to 17 and doubled among young adults ages 18 to 25.

    • Over half (53 percent) of heroin users are abusing or dependent on the drug.

    • Heroin use has been linked to fatal overdoses, spontaneous abortions, and infection with the human immunodeficiency virus (HIV) and hepatitis.

  • Methamphetamine:

    • Methamphetamine use doubled from 1990 (149,000 users) to 2002 (326,000 new users).

  • Inhalants:

    • Initiation of inhalant use more than doubled to 1.2 million in 2001.

    • Inhalants are inherently extremely toxic.

    • Use of inhalants can result in irregular heart rhythms, heart failure, asphyxiation, and death (NIDA, 2000).

  • MDMA/Ecstasy:
    View Figure 3: First Time Use of Ecstasy Among 18-25-Year-Olds, 1984-2000

    • There has been a rapid rise in use of Ecstacy, from 168,000 users in 1993 to 1.9 million in 2000 and 1.8 million in 2001.

    • Ecstasy has been associated with damage to brain cells, heart and kidney failure, and dangerous rises in body temperature.

    • Heavy use of MDMA has been shown to damage the brain, with resultant effects including confusion, memory problems, impulsivity, and psychological problems.

    • Reports suggest that pills sold as Ecstasy frequently contain other substances, including methamphetamine, ketamine, ephedrine, cocaine, and dextromethorphan.

Legal Drug Use

  • Tobacco:

    • In 2002, almost one-third (30.4 percent) of the U.S. population—71.5 million persons—reported current use of a tobacco product.

    • Cigarette smoking is the primary cause of preventable premature death in the United States, accounting for 1 in 5, or 440,000 deaths per year (CDC, 2003).

    • If smoking trends continue, 6.4 million people under the age of 18 will eventually die from a tobacco-related disease.

  • Alcohol:

    • In 2001, 54 million (22.9 percent of the population) persons reported binge drinking (defined as drinking 5 or more drinks on one occasion at least 1 day in the past 30 days).

    • Alcohol use accounted for almost 20,000 deaths from 1999 to 2001, nearly as many as for all illicit drugs combined.

Overall impact of substance abuse

  • Economic costs to society:

    • The projected economic cost of illicit drug use to U.S. society in 2002 was estimated at $160.7 billion.

    • Tobacco contributes an additional $75 billion in direct medical costs and $80 billion in costs associated with productivity losses.

    • The estimated cost of alcohol abuse totaled $148 billion in 1998, an increase of 25 percent over 1992 levels.

  • Death and disability:

    • There were 21,683 drug-induced deaths in 2003.

    • Approximately 22 million Americans—over 9 percent of the total population—were classified as substance dependent or abusive in 2002.

    • In 2002, 15 million, or over two-thirds of those who drank alcohol, abused or were dependent on it.

  • Criminal behavior:

    • In 2002, 64 percent of those arrested for a crime had recently used cocaine, marijuana, opiates, methamphetamine, and/or PCP.

    • Approximately 29 percent of the 1.8 million Americans on parole or supervised release from prison are current illicit drug users.

    • In 2002, nearly 1.5 million Americans were arrested for drug law violations.

    • Nearly two-thirds of prisoners in the U.S. Federal system in 1997 had been incarcerated for drug-related offenses.

    • Drug use was a contributing factor in 7 of 10 reported cases of child maltreatment.

  • Workplace effects:

    • Substance abusers are more than twice as likely to be unemployed.

    • Substance abusers are fired more frequently.

    • Substance abusers switch jobs more frequently.

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Substance Use Among Youth

For prevention efforts to succeed, it is important for prevention planners to examine substance usage, prevailing norms, and attitudes toward substance use, specifically among youth.
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Prevalence of use/abuse

  • Alcohol:
    View Figure 4: Lifetime Use of Alcohol by 8th-, 10th-, and 12th-Grade Students, 2003

    • While still the most commonly used drug; alcohol use has recently declined.

    • Even with recent declines, over half (55 percent) of 8th, 10th, and 12th graders reported alcohol use in the past 30 days in 2003.

    • Almost one-third of 12th graders reported binge drinking, defined as having 5 or more drinks on a single occasion in the past 30 days.

    • In 2002, 2.5 percent of teens aged 12 to 17 years were classified as heavy drinkers (i.e., reported having 5 or more drinks on the same occasion at least 5 different days in the past 30 days).

    • Slightly more than 25 percent of 6th and 8th graders reported drinking beer in the previous year.

    • Among 4th and 5th graders: 6.1 percent of 4th-grade and 6.7 percent of 5th-grade students reported drinking beer in the past year.

  • Tobacco:

    • Tobacco use has recently declined slightly, but it remains the second most commonly used drug.

    • Despite declines, almost 41 percent of teens reported lifetime cigarette use, with 17 percent reporting that they are current smokers in 2002.

    • In 1999, one-fourth (24.7 percent) of U.S. high school students reported that they had smoked a whole cigarette before age 13.

    • One-fifth (19.5 percent) of students in the 4th to 6th grades had smoked cigarettes.

  • Other drugs:
    View Figure 5: Lifetime Use of Drugs Other Than Alcohol and Tobacco by 12th Graders, 1993-2003

    • Illicit drug use among 8th, 10th, and 12th graders also underwent a decline from 2001 to 2003.

    • Illicit drug use among high school seniors declined from 66 percent in 1980 to 41 percent in 1992, when use rates began to rise sharply before declining to 53 percent in 2002.

      • Marijuana:
        View Figure 6: Lifetime Use of Marijuana by 8th-, 10th-, and 12th-Grade Students, 2003

        • Marijuana is the most commonly used illicit drug among young people.

        • Current use of marijuana by 8th, 10th, and 12th graders was reported in 2003 to be approximately 15 percent, down 11 percent from 2001.

        • Approximately 12 percent of 6th- and 8th-grade students had smoked marijuana in the previous year.

        • Risk of marijuana use among teens clearly increases with age, as well as with alcohol and/or tobacco use.

      • LSD:

        • Use of LSD has declined significantly in the past two years.

        • Current use of LSD and use over the past year dropped by almost two-thirds among 8th, 10th, and 12th graders.

        • The decline in LSD use is attributed to improved law enforcement, resulting in the perception of decreased availability.

      • Ecstacy:

        • Use of Ecstacy has also decreased significantly.

        • Use of Ecstasy in the past year declined in 2003 by 50 percent to 3.1 percent among 8th, 10th, and 12th graders.

        • Decreases in use were attributed to increasing perceptions among youth of the drug's harmfulness.

      • Inhalants:

        • Use of inhalants has followed a similar declining trend.

        • In 2003, approximately 6 percent of teens reported inhalant use.

        • An exception is the increase in inhalant use among 8th graders: from 8 to about 9 percent reporting use in the past year.

        • Among 4th to 5th graders: Approximately 4 percent of students in 4th grade reported inhalant use during the past year.

      • Cocaine and heroin:

        • Teen use of heroin and cocaine is uncommon. Levels remained unchanged from 2001 to 2003 but were lower than in the late 1990s.

  • Gender considerations:

    • Male teens were more likely than female teens to use almost all illicit substances.

    • Male teens were 50 percent more likely than female teens (3.1 percent compared with 1.9 percent) to meet the criteria for heavy drinking.

    • Female youth were more likely than their male peers to report that obtaining crack, cocaine, or LSD would be easy.

    • Female teens have exceeded male teens in cigarette use.

  • Race/ethnicity considerations:

    • Race/ethnicity appears to play an important role in substance abuse among youth.

      • Example: Lifetime cigarette use varies greatly by ethnicity.

        Use is highest among American Indian/Alaskan Native populations (27.7 percent), followed by white teens (15.6 percent), teens of two or more races (12.6 percent), Hispanic/Latino teens (10.0 percent), African-American teens (6.6 percent), and Asian teens (3.8 percent).

    • Race/ethnicity in combination with gender also has effects on substance abuse.

      • Example: Heavy drinking patterns are influenced by both race/ethnicity and gender

        White male teens are the most likely to be heavy drinkers (4.0 percent), followed by white female teens and Hispanic male teens (2.5 percent and 2.6 percent, respectively), Hispanic female teens (1.8 percent), African-American male teens (.8 percent) and African-American female teens (.4 percent).

Impact of substance abuse on youth

  • Likelihood of continued use/abuse:

    • Of youth who report ever having smoked, the vast majority (85.7 percent) are still smoking in the 12th grade.

    • Of youth who report ever having been drunk, 83 percent are still getting drunk in the 12th grade.

    • Many teens are already dependent on nicotine and will likely require significant motivation and skills to quit.

    • Of youth who report ever having tried marijuana, over three-fourths (76.4 percent) are still using marijuana in the 12th grade.

  • Progression to more serious use/abuse:

    • Teens who smoke tobacco are 14 times more likely to try marijuana than their nonsmoking peers.

    • Alcohol and tobacco use results in a greater likelihood of progression to other substance use.

    • Early use of marijuana has been repeatedly associated with a greater likelihood of other illicit drug use, perhaps in part because youth who smoke marijuana have greater access to and opportunities to try other substances.

  • Negative outcomes:

    • Alcohol-related car accidents are a leading cause of death among 15 to 19 year olds.

    • Substance abuse among youth predicts lower educational achievement, job instability, early pregnancy, and infection with HIV and other sexually transmitted diseases.

  • Antisocial and criminal behavior:

    • Possession and/or use of drugs can lead to a variety of legal sanctions and a permanent criminal record.

    • Delinquent behavior among youth has been found to increase in direct proportion to frequency of marijuana use.

    • A study of Maryland juvenile detainees revealed that 40 percent were in need of treatment for substance abuse.

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What Now?

  • Efforts toward reducing the extent of these problems should be encouraged and supported.

  • Downward trends in use of alcohol, tobacco, and other drugs among youth are encouraging.

  • The Handbook and Curriculum Guide provide additional tools to allow those in the important position of planning and implementing substance abuse prevention curricula to do so effectively and efficiently.

Previous Chapter: Preface Next Chapter: Chapter 2
  Handbook Preface
Chapter 1: The Nature and Extent of Substance Abuse in the U.S.
Chapter 2: Foundations of Substance Abuse Prevention Curricula
Chapter 3: Needs Assessment and Curriculum Development
Chapter 4
Chapter 5
Chapter 6
Chapter 7: Curriculum Implementation
Practical Points

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