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Substance Use and Sexual Risk Behaviors Among Youth

U.S. Department of Health and Human Services (HHS), Office of the Surgeon General, Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health. Washington, DC: HHS, November 2016.
Clayton, H. B., Lowry, R., August, E., & Jones, S. E. (2016). Nonmedical use of prescription drugs and sexual risk behaviors. Pediatrics, 137(1), e20152480.
Cavazos-Rehg, P. A., Krauss, M. J., Spitznagel, E. L., Schootman, M., Cottler, L. B., & Bierut, L. J. (2011). Number of sexual partners and associations with initiation and intensity of substance use. AIDS and Behavior, 15(4), 869-874.
Lowry, R., Holtzman, D., Truman, B. I., Kann, L., Collins, J. L., & Kolbe, L. J. (1994). Substance use and HIV-related sexual behaviors among US high school students: are they related?. American Journal of Public Health, 84(7), 1116-1120.
Kann, L., McManus, T., Harris, W. A., et al. (2018). Youth risk behavior surveillance—United States, 2017. MMWR Surveillance Summary , 67(8), 1-479.
Hawkins, J. D., Catalano, R. F., & Miller, J. Y. (1992). Risk and protective factors for alcohol and other drug problems in adolescence and early adulthood: implications for substance abuse prevention. Psychological bulletin, 112(1), 64-105.
Cavazos-Rehg, P. A., Krauss, M. J., Spitznagel, E. L., Schootman, M., Cottler, L. B., & Bierut, L. J. (2012). Brief report: pregnant by age 15 years and substance use initiation among US adolescent girls. Journal of Adolescence, 35(5), 1393-1397.

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Basic Fact Sheet | Detailed Version
According to the Surgeon General’s Report Facing Addiction in America 1 , the misuse of substances such as alcohol and drugs is a growing problem in the United States. Although substance misuse can occur at any age, the teenage and young adult years are particularly critical at-risk periods. Research shows that the majority of adults who meet the criteria for having a substance use disorder started using substances during their teen and young adult years. Teen substance use is also associated with sexual risk behaviors that put young people at risk for HIV, sexually transmitted diseases (STDs), and pregnancy. 2 , 7 To address these issues, more needs to be done to lessen risks and increase protective factors for teens.
Studies conducted among teens have identified an association between substance use and sexual risk behaviors such as ever having sex, having multiple sex partners, not using a condom, and pregnancy before the age of 15 years of age. 2 , 7
Researchers have found that as the frequency of substance use increases, the likelihood of sex and the number of sex partners also increases. 3 In addition, studies show that sexual risk behaviors increase in teens who use alcohol, and are highest among students who use marijuana, cocaine, prescription drugs (such as sedatives, opioids, and stimulants), and other illicit drugs. Teens who reported no substance use are the least likely to engage in sexual risk-taking. 4
According to the 2017 National Youth Risk Behavior Survey (YRBS), 40% of high school students have ever had intercourse and 29% of high school students are currently sexually active. Of the students who are currently sexually active, 19% drank alcohol or used drugs before last sexual intercourse. 5
Of the students who are currently sexually active:
Substance use and sexual risk behaviors share some common underlying factors that may predispose teens to these behaviors. Because substance use clusters with other risk behaviors, it is important to learn whether precursors can be determined early to help identify youth who are most at risk.
Primary prevention approaches that are most effective are those that address common risk factors. Prevention programs for substance use and sexual risk behaviors should include a focus on individuals, peers, families, schools, and communities. When students’ school environments are supportive and their parents are engaged in their lives, they are less likely to use alcohol and drugs and engage in sexual behaviors that put them at risk for HIV, STDs, or pregnancy. 6
Common risk factors for substance use and sexual risk behaviors include:
For primary prevention activities targeting substance use and sexual risk behaviors to be effective, they should include: 6
CDC is engaging in a variety of efforts to develop strategies to combat substance use and sexual risk behaviors among teens. Some efforts include:
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Published on Sep 11, 2004 04:44 PM IST

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A new study published in the 'American Journal of Preventive Medicine' has revealed that teenagers engaging in high-risk behaviours involving sex and drugs are at greater risk of depression, suicidal thoughts and suicide attempts than teens who say no to sex and drugs.
"These results suggest that healthcare professionals who identify adolescent patients reporting sexual intercourse or drug use should strongly consider screening for depression and risk of suicide," said Denise D. Hallfors, lead author of the study and a senior research Scientist at the Pacific Institute for Research and Evaluation in Chapel Hill, North Carolina.
Hallfors along with his colleagues analyzed various sex and drug behavior patterns via data from a survey of nearly 19,000 teenagers.
The researchers clustered the teens in 16 groups according to their behaviors. Groups included the abstainers, who eschewed sex and drugs; sex dabblers; alcohol and sex dabblers; teens with multiple sexual partners; and illegal drug users.
Abstainers had the lowest levels of depression, suicidal thoughts and suicide attempts, while teens in groups associated with sex and drugs, and heavy use of illegal drugs such as marijuana had the highest levels. In between were the dabblers in sex, drugs, alcohol and tobacco.
The researchers also found that girls were less likely than boys to pursue high-risk behaviours, but girls who did were more vulnerable than boys to the constellation of depression, suicidal thoughts and suicide attempts.
The study also showed the link between the socio-economic status with depression. While higher socio-economic status reduced the likelihood of depression by about half, it increased the risk of suicidal thoughts. Hallfors and colleagues have, therefore, called for more research to examine this phenomenon.
Meanwhile, Hallfors and his colleagues have advised healthcare professionals to screen all teens for sexual behaviours and drug use and those who engage in such behaviours should be screened for depression and suicide risk also.
"It is particularly important not to miss opportunities to diagnose depression because effective treatments are available, or to overlook suicide risk because suicide can be prevented," concluded Hallfors.
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Medically reviewed by Drugs.com. Last updated on Sep 7, 2022.
Sex education basics may be covered in health class. But teens might not hear — or understand — everything they need to know to make tough choices about sex. That's where you come in.
It can be awkward, but sex education is a parent's job. By connecting with your teen early and often, you can set the stage for a lifetime of healthy sexuality.
Sex might be hard to talk about. But it's even harder to avoid. Sex seems to be everywhere — news, entertainment, social media, advertising. But you can use that to get the talk going and keep it going.
Sex education for teens includes not having sex (abstinence), date rape, gender identity, sexual orientation and other hard topics. Be ready for questions such as:
What if my partner wants to have sex, but I don't? Be clear that no always means no. Sex should never be pressured or forced. Any form of forced sex is rape, whether it's done by a stranger or someone your teen has been dating.
Point out to your teen that alcohol and drugs can weaken peoples' decisions. And they can make people think less clearly. Date rape and other dangerous situations become more likely when alcohol and drugs are involved.
What if I'm questioning whether I'm lesbian, gay, bisexual, transgender or queer (LGBTQ)? Many teens wonder about their sexual orientation, gender identity or expression. Help your teen understand that teens are just beginning to explore sexual attraction. These feelings may change as time goes on. And if they don't, that's fine.
A negative answer to your teen's sexual orientation, gender identity or expression can have negative effects. LGBTQ youth have a higher risk of STIs, substance abuse, depression and attempted suicide. Family acceptance can protect against these risks.
Above all, let your teen know that your love is unconditional. Praise your teen for sharing their feelings. Listen more than you speak.
Dating violence occurs more often than many teens or adults may think. About 1 in 12 teens has reported facing physical or sexual dating violence. So it's important to get the facts and share them with your teen.
Watch for warning signs of dating violence, such as:
Teens in abusive relationships have a higher risk of long-term effects. These include poor grades, binge drinking and suicide attempts. The emotional impact of early unhealthy relationships may also set the stage for future unhappy, violent relationships.
Talk with your teen now about the importance of healthy relationships. Model healthy relationships through the way you connect with your teen and others. The lessons your teen learns today about respect, boundaries, and understanding what is right and wrong will carry over into future relationships.
If your teen is sexually active, it may be more important than ever to keep the conversation going. Even if you don't think your teen is ready, be open yet honest in your approach. Remind your teen that you expect sex and its responsibilities to be taken seriously.
Your teen's health care provider can help too. A routine checkup can give your teen the chance to talk about sexual health to only the provider in private. The provider can help your teen learn about contraception and safe sex. The provider can also help you build your skills to teach your teen about safe sex.
The provider may also stress the importance of routine human papillomavirus (HPV) vaccination. This vaccine protects people of all genders against genital warts and cancers of the cervix, anus, mouth and throat, and penis. People can usually get the vaccine between ages 9 and 26. But it is sometimes available for people older than age 26.
Your guidance is key to helping your teen become a sexually responsible adult. Be honest and speak from the heart. If your teen doesn't seem interested in what you have to say about sex, say it anyway. Your teen is probably listening.
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