TEEN SUBSTANCE USE
STATISTICS ON TEEN SUBSTANCE USE
Teenagers in the U.S. are using some substances far less than previous generations did - cigarette smoking has reached historic lows, and underage drinking rates have dropped significantly. At the same time, vaping emerged as a dominant form of nicotine consumption, marijuana use remains common (though also showing signs of decline in certain surveys), and prescription medication misuse persists as a serious concern.
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According to a 2025 study by Addiction Group:
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Over 90% of adults with substance use disorders began using before age 18.
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Approximately 12–14% of teens have misused a prescription pain reliever at least once.
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36% of adolescents say they’ve tried vaping (nicotine or cannabis).
MENTAL HEALTH AND SUBSTANCE USE
In light of growing mental health concerns among adolescents in the United States, a National State of Emergency in Child and Adolescent Mental Health was issued in 2021, followed by advisories from the U.S. Surgeon General in 2021 and 2023. This comes at a time when many adolescents have reported adverse experiences, youth drug overdose deaths have spiked, and gun violence has increased. In 2021, 42% of adolescents reported feelings of sadness and hopelessness – which can be indicative of depressive disorder – up from 28% in 2011. Further, a recent KFF poll found that 55% of the public see youth mental health issues as a crisis in the U.S.; and that many children and teenagers are not able to get the mental health services they need.
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Data on youth mental health is limited and when it is available, parents or guardians often complete survey questionnaires on behalf of youth in their household. However, the recently released Teen National Health Interview Survey (NHIS-Teen) surveyed adolescents (ages 12-17) directly, which allows for a more direct representation of adolescent mental health. This brief uses the NHIS-Teen data – which was collected for an 18 month period from 2021 to 2022 – to provide an up-to-date analysis of adolescent mental health, utilization of mental health care, and unmet needs and how they vary across demographics, including sex and sexual identity.1 Other survey data collected directly from adolescent populations, including the Youth Risk Behavior Surveillance System (YRBSS) and the National Survey on Drug Use and Health (NSDUH), are included to supplement and provide more context. (Source)
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Key takeaways include:
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In 2021 and 2022, 21% of adolescents reported experiencing symptoms of anxiety in the past two weeks and 17% reported experiencing symptoms of depression. Female and LGBT+ adolescents were more likely than their counterparts to report experiencing anxiety or depression.
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Deaths due to drug overdose among adolescents more than doubled from 2018 (253 deaths) to 2022 (723 deaths). The largest increases in these deaths were among Hispanic and Black adolescents.
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Suicides are the second leading cause of death among adolescents. These deaths peaked in 2018 but have declined in recent years. In 2022, suicide death rates were highest among American Indian and Alaska Native adolescents (22.2 per 100,000) followed by White adolescents (7.2 per 100,000). Adolescent males had higher rates of suicide compared to their female peers (8.1 vs. 3.8 per 100,000) in 2022; however, thoughts of suicide and suicide attempts were higher (and increased faster) for females.
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In 2021 and 2022, 20% of adolescents reported receiving mental health therapy and 14% reported taking prescription medication.
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Many adolescents reported adverse experiences, including bullying (34%), emotional abuse by a parent (17%), and neighborhood violence (15%) in 2021 and 2022. Ninety-two percent of adolescents reported extended use of screens, which can also negatively impact mental health and well-being.
Substance Use among Adolescents with Moderate or Severe Anxiety Symptoms
In 2024, adolescents aged 12 to 17 who had moderate or severe symptoms of anxiety were more likely to have used some substances in the past year compared with their counterparts who had no or minimal symptoms of anxiety. Adolescents with moderate or severe symptoms were more likely than adolescents with no or minimal symptoms to have been past year illicit drug users (25.6 vs. 10.1 percent), past year marijuana users (17.5 vs. 6.7 percent), or past year misusers of opioids (i.e., heroin users or misusers of prescription opioids).
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Adolescents with moderate or severe symptoms of anxiety also were more likely than those with no or minimal symptoms to have been past year or past month users of most of the other substances. For example, 1.7 percent of adolescents with moderate or severe symptoms misused prescription tranquilizers or sedatives in the past year compared with 0.2 percent of adolescents with no or minimal symptoms; tranquilizers are commonly prescribed to relieve anxiety.
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Statistics provided by SAMHSA.gov's "Key Substance Use and Mental Health Indicators in the United States: Results from the 2024 National Survey on Drug Use and Health."
SOCIAL MEDIA AND PEER PRESSURE
The Influence of Social Media
For today’s digitally immersed youth, social media extends peer influence beyond the classroom or neighborhood:
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Content Exposure: Roughly a third of adolescents say they frequently see friends posting photos or videos involving alcohol or cannabis use.
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Peer Approval Metrics: Likes, positive comments, and shares can make risky behaviors seem accepted and even admired.
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Prevention Angle: Digital literacy programs aim to help teens critically evaluate substance-related posts and understand how curated online images differ from reality.
Peer Pressure
Peer pressure remains a defining factor in teen drug and alcohol experimentation. Adolescents are highly attuned to their friends’ behaviors - when substance use is normalized within a peer group, an individual teen’s likelihood of using climbs markedly.
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Direct Peer Pressure: Around one in five teens who try illicit drugs cite peer pressure as a primary motive.
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Perceived Approval: Simply believing that “most friends approve of drinking or smoking weed” can lower inhibitions. This effect is heightened by social media, where teens see posts of peers drinking or vaping, often flooded with likes and positive comments.
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Preventive Approaches: Peer-led programs (like student-led awareness campaigns) capitalize on the same social dynamics - if teens demonstrate that staying drug-free is valued, the group norm shifts toward healthier behavior.