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Stress driving substance use in American teens, study finds

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

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

While most people reported using substances with friends, half of the included respondents were found to take pleasure 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 possible overdose may improve drug-related outcomes (especially mortality) in the longer term.

Why are adolescents the perfect goal group for SUD interventions?

Substance use disorder (SUD) is a growing mental disorder characterised by a person’s inability to regulate their consumption of medicine (legal or illegal), alcohol, and prescription medications. SUD is treatable normally, though intervention efficacy might be impacted by a lot of aspects, including the duration of the condition (the longer the person’s SUD, the harder it’s to treat).

Research has revealed that the majority cases of substance use begin in the course of 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 america of America (US) have found that the motivations behind substance use were predominantly stress-related, akin to “to feel mellow, calm, or relaxed” (73%), “to stop worrying a few 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 discover the people adolescents ‘get high with’ observed that 81% of adolescents eat substances in the corporate of friends, while 50% reported using alone. These findings highlight the potential of teaching this age group, each on the demerits of substance use and SUD and likewise on emergency responses within 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 reach, in turn saving lives.

Concerning the study

In the current study, researchers aimed to research the motivation and behavioral trends in substance use amongst 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.

Essentially the most recent CHAT assessment of people between Jan 2014 and September 2022 was included within the study dataset, with categories divided based on form of substance (alcohol, marijuana, or other prescription or non-prescription drugs; six categories), motivation (open-ended; six categories), and individuals with whom substances were consumed (open-ended; 4 categories). Moreover, ten categories describing substance-use-company were presented.

Study findings

Data analyses revealed a complete of 15,963 CHAT respondents, 9,557 (60%) of whom had indulged in substance use over the 30 days preceding the assessment. Of those, 9,543 reported motivations and individuals with whom substances were used and were hence included in downstream analyses. Results highlight that marijuana was probably 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, probably the most common reasons adolescents reported for using substances were to feel mellow, calm, or relaxed (73%), to rejoice or experiment (50%), to sleep higher or to go to sleep (44%), to stop worrying a few problem or to forget bad memories (44%), to make something less boring (41%), and to assist with depression or anxiety (40%).”

Surprisingly, these findings varied significantly by substance category, with alcohol and non-prescription drug use related to fun and experimentation (51 – 55%). As compared, marijuana and prescribed drugs were used for stress relief (76% and 61%, respectively). Alarmingly, 31% of respondents reported resorting to prescription stimulant misuse in an try and not sleep.

“Adolescents mostly used substances with friends (81%), a boyfriend or girlfriend (24%), anyone who has drugs (23%), and another person (17%); nevertheless, one-half (50%) reported using alone.”

As within the case of motivation, individuals with whom substances were used were also observed to differ substantially based on substance category – 80% of adolescents using marijuana, alcohol, or non-prescription drugs reported doing so in the corporate of friends. As compared, 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 mostly reported using substances with friends, which presents the chance for bystander intervention within the event of an overdose. Nearly 70% of fatal adolescent overdoses occurred with a possible bystander present, yet normally no bystander response was documented.”


The current study elucidates the motivations of adolescents indulging in substance misuse and the individuals with whom they eat these substances. Findings highlight that stress-related motivators outcompete fun and experimentation as the first reason for drug misuse, underscoring the necessity for higher mental health management strategies, policies, and interventions on this age group.

Analyses of individuals with whom substances were used reveal an alarming trend – greater than 50% of adolescents misusing prescription opioids did so alone, increasing the chance of fatal overdoses. While marijuana, alcohol, and non-prescription medication were normally consumed within the presence of friends (81%), the high observed rate of bystander non-responsiveness during fatal overdoses highlights the necessity for extensive adolescent education, each to tell individuals in regards to the harms and demerits of SUD, in addition to to show them the perfect practice (e.g., naloxone administration) within the event of an overdose of their vicinity.

Journal reference:

  • Connolly S, Govoni TD, Jiang X, et al. Characteristics of Alcohol, Marijuana, and Other Drug Use Amongst Individuals Aged 13–18 Years Being Assessed for Substance Use Disorder Treatment — United States, 2014–2022. MMWR Morb Mortal Wkly Rep 2024;73:93–98, DOI: 10.15585/mmwr.mm7305a1, https://www.cdc.gov/mmwr/volumes/73/wr/mm7305a1.htm?s_cid=mm7305a1_w
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