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Top Risk Factors for Teen Substance Abuse
Verywell Mind's content is for informational and educational purposes only. Our website is not intended to be a substitute for professional medical advice, diagnosis, or treatment.
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Buddy T is an anonymous writer and founding member of the Online Al-Anon Outreach Committee with decades of experience writing about alcoholism.
Medically reviewed by Steven Gans, MD on November 02, 2015
Steven Gans, MD is board-certified in psychiatry and is an active supervisor, teacher, and mentor at Massachusetts General Hospital.
Why do some teens get involved in substance abuse while others do not? What factors or influences increase the risks that adolescents will smoke cigarettes, drink alcohol, get drunk and use illegal and prescription drugs, while others go all the way through high school abstinent?
To answer these questions, The National Center on Addiction and Substance Abuse (CASA) at Columbia University conducts a "back-to-school" study otherwise known as "The National Survey of American Attitudes on Substance Abuse."
Since 1995, this survey has attempted to identify characteristics, situations, and circumstances that increase or decrease the likelihood of teen substance abuse.
From the results of several of CASA's 17 published studies, the following risk factors for increased likelihood that teens will smoke, drink or use drugs have emerged.
In one of CASA's early studies (2003), the survey found that highly stressed teens, compared to low-stressed teens are much more likely to become involved in substance abuse:
Teens being influenced to smoke, drink, and use drugs begins much earlier in their lives than parents would like to think, according to later CASA survey results.
The survey found that between age 12 and age 17, the likelihood that a teen will smoke, drink or use illegal drugs increases seven times. During the same time, from age 12 to 17, the percentage of teens who report having friends who smoke marijuana increases 14 times.
The CASA survey has repeatedly found that teens who attend religious services at least once a week are at significantly at lower risk of becoming involved in substance abuse.
Teens who have seen pictures on Facebook or other social networking sites of other kids getting drunk, passed out, or using drugs are more likely to become involved in substance abuse themselves, compared to kids who have not seen such pictures. They are:
In addition, teens who spend significant time on social networking are:
Teens involved in social networks are much more likely to have friends and classmates who use illegal drugs and abuse controlled prescription drugs.
Compared to teens who reported being under low stress (5 or less on a scale of 1 to 10), teens under high stress (6 or higher on a scale of 1 to 10) are significantly more likely to abuse substances:
Teens who are sometimes left home alone overnight without adult supervision are more likely to be substance abusers, compared to teens who are never left home alone at night.
CASA's surveys reveal that teens that experience cyberbullying are more than twice as likely to smoke, drink and use marijuana compared with teens who are not bullied.
In each instance, if teens taking the survey said they agreed with the statements below, they were three times more likely to use marijuana, about twice as likely to drink alcohol, and many times more likely to smoke cigarettes:
Throughout the years, the CASA survey found that strong parental disapproval of substance abuse is a factor in teens' attitudes and behavior. Teens who say their parents would be "extremely upset" to find out they smoked, drank, or used marijuana were must less likely to use substances themselves or to think it is okay for their peers to use them.
When children reported that their parents would not be extremely upset, however, the survey found that the parents:
The surveys find that it is important for parents to send a consistent and unified message to their teens about drugs and alcohol. Compared to teens whose parents completely agree with each other about substance abuse, teens whose parents don't completely agree are:
Time after time, the CASA survey has found that parental involvement in their teens lives can play an important role in whether are not they become involved in substance abuse, especially if the parents are sensitive to the stress in their children's lives, understand when and why they are bored, and limit and monitor their spending money.
According to the National Center on Addiction and Substance Abuse, these are five ways that parents can reduce the possibility that their children will smoke, drink, get drunk or use illegal drunks before age 18:
CASA suggests that parents can become more involved with their teens by helping them with their homework, attend their extra-curricular events, plan activities that you can do together, and talk to them about drugs, alcohol, and tobacco.
Learn the best ways to manage stress and negativity in your life.
Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
The National Center on Addiction and Substance Abuse. National Survey of American Attitudes on Substance Abuse XVII: Teens. Addiction Research August 2012.
The National Center on Addiction and Substance Abuse. National Survey of American Attitudes on Substance Abuse VIII: Teens and Parents. Addiction Research August 2003.
The National Center on Addiction and Substance Abuse. National Survey of American Attitudes on Substance Abuse VI: Teens and Parents. Addiction Research August 2011.
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Verywell Mind's content is for informational and educational purposes only. Our website is not intended to be a substitute for professional medical advice, diagnosis, or treatment.
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CENTERS FOR DISEASE CONTROL AND PREVENTION
High school students who smoke, drink, use drugs, carry a weapon to school, get involved in fights or engage in other risky behaviors also are more likely to become pregnant or to impregnate a sexual partner, according to a new study from psychiatry researchers at Washington University School of Medicine in St. Louis.
And it wasn’t just one pregnancy, according to the study, published in the Journal of Adolescent Health.
“Teen pregnancies have been declining, but it’s not because teens aren’t engaging in as much sex, it’s that more have been using condoms and other contraceptive methods,” says first author Patricia A. Cavazos-Rehg, PhD. “Yet there’s still this high-risk group of adolescents putting themselves at increased risk for pregnancy and sexually transmitted infections.”
Cavazos-Rehg, research assistant professor of psychiatry, analyzed data gathered in 1999, 2001 and 2003 as part of the National Youth Risk Behavior Survey, a project that collected information from more than 14,000 high school students, who answered questions about smoking, drug use, drinking and driving, sexual activity and other risky behaviors.
Adolescents were asked if they were involved in 10 risky health behaviors, Cavazos-Rehg explains. Almost 20 percent of the boys reported that they engaged in at least seven of those 10, and about 10 percent of the girls also were engaging in the majority of these risky behaviors.
“We found that those involved in risky activities had not only an elevated risk for pregnancy but also an even greater risk for multiple pregnancies, and as risky health behaviors occurred more frequently, so did pregnancies,” she says.
Because some 750,000 teens get pregnant the United States each year, Cavazos-Rehg says she wasn’t surprised that almost 8 percent of adolescent males had impregnated a partner and about 13 percent of females reported that they had experienced a pregnancy. What did surprise her, she says, was that so many had the experience more than once.
“I did expect some of this, but it was so much more pronounced than I would have thought,” she says. “I would have expected an adolescent would learn a lesson and then try to prevent another pregnancy from occurring in the future. But it appears that many of those most at risk are not attempting to modify their behavior after that initial pregnancy.”
Part of the explanation is revealed in data from a second study led by Cavazos-Rehg and published in the journal Contraception. In that study, her team found that substance-using males and females who had numerous sexual partners were the least likely to use contraceptives, putting them at risk for pregnancy and for sexually transmitted infections.
That study looked at substance use among teens and its relationship to contraceptive choices. The team correlated findings about smoking, drinking, marijuana and cocaine use with information about contraceptive use and found that adolescent males using all four substances were the least likely to use any contraceptive method.
Among girls in the study, those who reported having had six or more sex partners were more likely to use no contraception or to rely upon withdrawal as a way to prevent pregnancy.
These two studies probably underestimate the extent of the problem among adolescents because the surveys don’t include information from teens who dropped out of high school, according to Cavazos-Rehg. She says information from those who quit school almost certainly would inflate the numbers related to teen pregnancy and risky health behaviors.
Currently, her team is analyzing more information from teens to determine whether some pregnancies involving high-risk teenagers might be intentional rather than accidental, asking those adolescents whether they would be pleased or upset by a pregnancy.
Intentional teen pregnancies would be difficult to prevent, Cavazos-Rehg says, but better understanding the link between pregnancies and risky health behaviors could provide teachers, administrators and parents with a way to target adolescents most at risk for pregnancies and sexually transmitted infections.
“If a child is smoking or drinking or engaging in other risky behaviors, school counselors, educators and parents should not only target that particular behavior but also talk to the teen about sex,” Cavazos-Rehg says. “If a teen is engaging in these risky behaviors, he or she probably isn’t quite ready to be a parent yet, but those same teens appear to be the most likely to have a child.”
Cavazos-Rehg PA, Krauss MJ, Spitznagel EL, Schootman M, Cottler LB, Bierut LJ. Associations between multiple pregnancies and health risk behaviors among U.S. adolescents, Journal of Adolescent Health, vol. 47(6), Dec., 2010. pp. 600-603.
Cavazos-Rehg PA, Krauss MJ, Spitznagel EL, Schootman M, Peipert JF, Cottler LB, Bierut LJ. Type of contraception method used at last intercourse and associations with health risk behaviors among U.S. adolescents, Contraception, vol. 82(6), Dec., 2010. pp. 549-555.
This work was supported by grants from the National Center for Research Resources and the National Institute on Drug Abuse of the National Institutes of Health.
Washington University School of Medicine’s 2,100 employed and volunteer faculty physicians also are the medical staff of Barnes-Jewish and St. Louis Children’s hospitals. The School of Medicine is one of the leading medical research, teaching and patient care institutions in the nation, currently ranked fourth in the nation by U.S. News & World Report. Through its affiliations with Barnes-Jewish and St. Louis Children’s hospitals, the School of Medicine is linked to BJC HealthCare.
February 5, 2015
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October 1, 2014
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©2021 Washington University in St. Louis

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