Stress driving substance use in American teens, study finds

In a recent study published in the journal Morbidity and Mortality Weekly Report (MMWR), researchers aimed to guide the development and subsequent implementation of anti-substance use policies. To this end, this study investigated the motivations of substance use amongst American adolescents and the persons with whom they use these substances. Results reveal that stress-related motivators, including seeking to feel ‘calm’ or ‘mellow’ and experimentation, were the most often reported triggers for substance use in adolescents aged 13 to 18 years.

​​​​​​​Study: Characteristics of Alcohol, Marijuana, and Other Drug Use Among Persons Aged 13–18 Years Being Assessed for Substance Use Disorder Treatment — United States, 2014–2022. ​​​​​​​Image Credit: Antonio Guillem / Shutterstock

While most individuals reported using substances with friends, half of the included respondents were found to indulge in prescription drug misuse alone. These findings suggest that effective stress and mental health management amongst adolescents and youth may significantly reduce first-time drug use. Educating these individuals on the cons of substance use and emergency procedures when faced with a potential overdose may improve drug-related outcomes (especially mortality) in the future.

Why are adolescents the ideal target group for SUD interventions?

Substance use disorder (SUD) is a growing mental disorder characterized by an individual’s inability to control their consumption of drugs (legal or illegal), alcohol, and prescription medications. SUD is treatable in most cases, though intervention efficacy can be impacted by a number of factors, including the duration of the condition (the longer the individual’s SUD, the harder it is to treat).

Research has revealed that most cases of substance use begin during the adolescent years (13 to 18), putting this age group at high risk of SUD, stunted or otherwise negatively impacted brain development, and fatal overdose risk. Results of cross-sectional studies in the United States of America (US) have found that the motivations behind substance use were predominantly stress-related, such as “to feel mellow, calm, or relaxed” (73%), “to stop worrying about a problem or to forget bad memories” (44%), and to combat depressed or anxiety (40%). The secondary motivation was ‘having fun or experimenting’ (44%).

Attempts to identify the people adolescents ‘get high with’ observed that 81% of adolescents consume substances in the company of friends, while 50% reported using alone. These findings highlight the potential of educating this age group, both on the demerits of substance use and SUD and also on emergency responses in the event of an opioid overdose. Naloxone, a Food and Drug Administration (FDA)-approved opioid antagonist, has been shown to be effective in reversing opioid overdoses, thereby buying time for emergency medical personnel to arrive, in turn saving lives.

About the study

In the present study, researchers aimed to investigate the motivation and behavioral trends in substance use among adolescents aged 13 to 18. Data was acquired from the National Addictions Vigilance Intervention and Prevention Program’s Comprehensive Health Assessment for Teens (CHAT), a self-reported online questionnaire targeting adolescents currently undergoing SUD interventions.

The most recent CHAT assessment of individuals between Jan 2014 and September 2022 was included in the study dataset, with categories divided based on type of substance (alcohol, marijuana, or other prescription or non-prescription drugs; six categories), motivation (open-ended; six categories), and persons with whom substances were consumed (open-ended; four categories). Additionally, ten categories describing substance-use-company were presented.

Study findings

Data analyses revealed a total of 15,963 CHAT respondents, 9,557 (60%) of whom had indulged in substance use over the 30 days preceding the assessment. Of these, 9,543 reported motivations and persons with whom substances were used and were hence included in downstream analyses. Results highlight that marijuana was the most commonly used substance (84%), followed by alcohol (49%).

Non-prescription and prescription drug use comprised 21% (n = 2,032) and 19% (n = 1,812) of assessments, respectively, with methamphetamine (8%) and pain medication (13%) dominating their respective category.

“Overall, the most common reasons adolescents reported for using substances were to feel mellow, calm, or relaxed (73%), to have fun or experiment (50%), to sleep better or to fall asleep (44%), to stop worrying about a problem or to forget bad memories (44%), to make something less boring (41%), and to help with depression or anxiety (40%).”

Surprisingly, these findings varied significantly by substance category, with alcohol and non-prescription drug use associated with fun and experimentation (51 – 55%). In comparison, marijuana and prescription drugs were used for stress relief (76% and 61%, respectively). Alarmingly, 31% of respondents reported resorting to prescription stimulant misuse in an attempt to stay awake.

“Adolescents most commonly used substances with friends (81%), a boyfriend or girlfriend (24%), anyone who has drugs (23%), and someone else (17%); however, one-half (50%) reported using alone.”

As in the case of motivation, persons with whom substances were used were also observed to vary substantially based on substance category – 80% of adolescents using marijuana, alcohol, or non-prescription drugs reported doing so in the company of friends. In comparison, only 64% of respondents used prescription medication with friends. This trend was reversed in individuals using alone, with 51% of respondents using prescription medication alone, while only 26% used alcohol alone.

“Adolescents most commonly reported using substances with friends, which presents the opportunity for bystander intervention in the event of an overdose. Nearly 70% of fatal adolescent overdoses occurred with a potential bystander present, yet in most cases no bystander response was documented.”

Conclusions

The present study elucidates the motivations of adolescents indulging in substance misuse and the persons with whom they consume these substances. Findings highlight that stress-related motivators outcompete fun and experimentation as the primary reason for drug misuse, underscoring the need for better mental health management strategies, policies, and interventions in this age group.

Analyses of persons with whom substances were used reveal an alarming trend – more than 50% of adolescents misusing prescription opioids did so alone, increasing the risk of fatal overdoses. While marijuana, alcohol, and non-prescription medication were usually consumed in the presence of friends (81%), the high observed rate of bystander non-responsiveness during fatal overdoses highlights the need for extensive adolescent education, both to inform individuals about the harms and demerits of SUD, as well as to teach them the ideal practice (e.g., naloxone administration) in the event of an overdose in their vicinity.