Adolescent Substance Use Disorders Are a Growing Health Concern in the United States

According to the 2014 National Survey on Drug Use and Health, nine percent of youth aged 12-17 years old reported that they were currently using an illicit drug. Moreover, 20.6 million persons—eight percent of the population aged 12 or older—needed treatment for an illicit drug or alcohol use problem but did not receive treatment at a specialty facility in the past year.1

Substance use has significant and longstanding health and academic consequences for young people, including increased injuries, school failure, mental health problems, criminal involvement, and dependence in adulthood.2, 3, 4

Adolescence is the critical period to prevent substance use disorders. When the use of addictive substances is initiated in adolescence, the risk of addiction is magnified.5 The chances of developing an addiction are nearly seven times higher for teens who begin using before age 15 than for those who delay use until age 21 or older, and 96 percent of adults with substance disorders began use before age 20.6 The propensity of youth to engage in high-risk behaviors underscores the importance of delaying the onset of use, identifying risky behaviors, and intervening early to address misuse and deter addiction. Underage drinking and drug use contribute to a wide range of costly health and social problems, including motor vehicle crashes (the greatest single mortality risk for underage drinkers); suicide; interpersonal violence (e.g., homicides, assaults, rapes); unintentional injuries such as burns, falls, and drowning; brain impairment; alcohol dependence; risky sexual activity; academic problems; and alcohol and drug poisoning.7 On average, alcohol is a factor in the deaths of approximately 4,700 youths in the United States per year, shortening their lives by an average of 60 years.8 Although screening, brief intervention, and referral to treatment (SBIRT) has proven successful among adults, its efficacy in adolescents has been poorly understood. There is a growing sense of urgency about adapting this proven method for substance abuse prevention for adolescents–especially in normative settings like school health programs.

SBHCs Provide Comprehensive Activities in the Areas of Alcohol, Tobacco, and Drug Use Prevention

SBHCs help increase the number of students exposed to programs and activities that discourage potentially harmful behaviors including alcohol, tobacco, and drug abuse, and violence and bullying. Many provide individual, small student group, and community activities to prevent alcohol, tobacco, and drug use. During the 2016-17 school year, eight percent of SBHCs had an alcohol or drug counselor as a member of their provider team.

Primary care and behavioral health providers in SBHCs, in consultation with national adolescent substance use prevention experts, can implement the following components of SBIRT using specific evidence-based tools and interventions:

Screening: The CRAFFT and the S2BI are the most commonly used screening tools for adolescents between the ages of 11 and 21. Recommended by the American Academy of Pediatrics, these validated tools can identify young people with substance use and possible substance use disorders. Providers may also choose to screen adolescent patients for depression and anxiety – two morbidities correlated with substance use – by using the PHQ9 Modified for Teens and GAD screening tools.

Brief Intervention: Providers conduct brief interventions with adolescents who use substances at least monthly, or have at least one consequence associated with their use. Brief interventions often employ motivational interviewing—an evidence based method easy to use in a school setting—to help adolescents explore their motivation to change. Through several three to fifteen minute sessions, providers encourage students to consider the consequences of substance use, understand why they use alcohol and/or drugs, and, when ready, set goals for changing their behaviors. A number of studies have shown that brief interventions can reduce adolescent substance use.10

Referral to Treatment: Motivational interviewing strategies can also be used when recommending an adolescent accept specialized treatment for a possible moderate or severe substance use disorder. Adolescents who voluntarily accept treatment are more likely to engage in care, which is an important factor in determining success. There are different levels of specialized treatment that range from support groups to medically managed intensive inpatient treatment.

School-Based Health Alliance Resources

For more information on the Alliance’s Substance Use Prevention initiative, visit this page.


(1) Substance Abuse and Mental Health Services Administration. Results from the 2012 National Survey on Drug Use and Health: Summary of National Findings, NSDUH Series H-46, HHS Publication No. (SMA) 13-4795. Rockville, MD2013.
(2) Hingson RW, Heeren T, Jamanka A, Howland J. Age of drinking onset and unintentional injury involvement after drinking. JAMA : the Journal of the American Medical Association. Sep 27 2000;284(12):1527-1533.
(3) Volkow ND, Li TK. Drugs and alcohol: treating and preventing abuse, addiction and their medical consequences. Pharmacology and Therapeutics. Oct 2005;108(1):3-17.
(4) Clark DB, Martin CS, Cornelius JR. Adolescent-onset substance use disorders predict young adult mortality. The Journal of Adolescent Health. Jun 2008;42(6):637-639.
(5) Chambers R, Taylor J, Potenza M. Developmental Neurocircuitry of Motivation in Adolescence: A Critical Period of Addiction Vulnerability. American Journal of Psychiatry. 2003;160(6):1041-1052.
(6) Ibid.
(7) Centers for Disease Control and Prevention. Alcohol-Related Disease Impact (ARDI). 2009;
(8) Ibid.
(9) Schelar, E., Lofink Love, H., Taylor, K., Schlitt, J., & Even, M. (2016). Trends and Opportunities for Investment in Student Health and Success: Findings from the 2013-2014 Census of School-Based Health Centers (SBHCs). Washington, D.C.: School-Based Health Alliance.
(10) Center for Substance Abuse Treatment. Definitions and Terms Relating to Co-Occurring Disorders. COCE Overview Paper 1.DHHS Publication No. (SMA) 06-4163. Rockville, MD: Substance Abuse and Mental Health Services Administration, and Center for Mental Health Services;2006.