Adolescent Substance Use: America’s #1 Public Health Problem


CASAColumbia’s work for this report involved:

  • National surveys of 1,000 high school students, 1,000 parents of high school students and 500 school personnel (including teachers, principals, counselors and coaches)
  • Analyses of 7 national data sets
  • Interviews with approximately 50 leading experts in a broad range of fields related to this report
  • 5 focus groups with students, parents and school personnel
  • A review of more than 2,000 publications


The report finds that:

  • Three-quarters of high school students have used addictive substances, including cigarettes, alcohol, marijuana or cocaine
  • 46% of all high school students currently use addictive substances, and 12% meet the clinical criteria for addiction
  • 90% of Americans who meet the medical criteria for addiction started smoking, drinking or using other drugs before age 18
  • 1 in 4 Americans who began using any addictive substance before age 18 are addicted, compared to 1 in 25 who started using at age 21 or older

This study also identified the risk factors for teen substance use and addiction, including genetics, family history, psychological factors and environmental factors, and examined how American culture—specifically, messages sent by adults, as well as the media’s glamorization of smoking, drinking and other drug use—normalizes teen substance use and ultimately undermines the health and future of teens nationwide.

Teen substance use or addiction is the origin of the largest preventable and most costly public health problem in America today.

  • Immediate costs per year of teen use include an estimated $68 billion associated with underage drinking and $14.4 billion in substance-related juvenile justice programs each year
  • Total costs to federal, state and local governments of substance use, which usually has its roots in adolescence, are at least $468 billion per year—almost $1,500 for every person in America


It is essential to educate the public that teen substance use is a public health problem and that addiction is a complex brain disease that, in most cases, originates in adolescence. Our health systems must work to prevent or delay the onset of substance use through effective public health measures. Routine screenings should be conducted by health care providers to identify at-risk teens. Once these teens are identified, health care providers must intervene to reduce risky use and provide appropriate treatment if needed.

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