The Social Determinants of Adolescent Drug Use

Adolescence marks a formative period for students, when they gain independence, experience social pressure, and prepare for adulthood. While experimenting with drugs seems like a rite of passage to many teens, the opioid epidemic — a 165% increase in adolescent hospitalizations since 19972 — has thrust it into the spotlight of urgent health threats.

Adolescent Drug Use in the U.S.

Teens use alcohol more than any illicit drug.3 For children younger than 21, it results in:

  • 200,000 annual ER visits
  • 4,300 annual deaths

By 12th grade, 31.5 percent of students have tried marijuana, and nearly 25% use at least one other illicit drug.1

When it comes to access:

  • 81% of 12th graders say it is easy to get marijuana.3
  • 68% of 12th graders have tried alcohol.1
  • 43% of high school students know a classmate who sells drugs.3

Drug use impairs mental and physical development, but influence comes from more than just peer pressure. Let’s look at the social determinants that contribute to drug use to find areas for intervention and prevention.

The Social Determinants of Drug Use

1. Parental Influence

Health literacy

  • 29% of parents believe ADHD medication can improve a child’s performance, even if they do not have ADHD.4


  • 14% of teens say their parents have talked to them about prescription drug use.5

Health care access

  • 56% of teens say it is easy to get prescription drugs from a parent’s medicine cabinet.4

2. Geographic Location

  • In one study, teens living in rural communities were 35% more likely than teens in urban areas to have used prescription painkillers.6
  • A federal study found that patients in rural treatment facilities were 20% more likely to use substances at an earlier age than urban patients.7

3. Socioeconomic Status

Income level

  • In one study, residents of high income neighborhoods were prescribed painkillers roughly 25% more than those in low-income neighborhoods.8

Health care coverage

  • In a 2011 study, 37% of respondents who didn’t get treatment for substance use cited an inability to pay or lack of insurance.9

4. Ethnicity

  • Prescription drug use among high school students, by ethnicity, according to a 2010 CDC survey 10:

23% of caucasians

17% – of Hispanics

12% of African-Americans

  • In 2013, SAMHSA found 38.7% of Native American adolescents had a lifelong prevalence of illicit drug use.11
  • Illicit drug use among teens, by ethnicity, according to a 2013 study by the Partnership for Drug-Free Kids:12
    • 54% of Hispanics
    • 45% – of African-Americans
    • 43% – of caucasians

5. Academic Achievement


  • Compared to low-stress teens, high-stressed teens with grades of mostly Bs or lower are more than:13
    • 7x likelier to have used marijuana.
    • 3x likelier to have used alcohol.
    • 3x likelier to have used tobacco.


  • 63% of 12th grade students read below a proficient level. Low literacy is linked to low health literacy over time.14

6. Social Setting

  • 75% of 12- to 17-year-olds said seeing pictures of teens partying with drugs on social networking sites encourages them to party similarly.15

7. School Funding

Drug prevention education

  • Students from rural communities with access to community-based prevention programs are 20% to 65% less likely to use prescription medications.16

Presence of school nurse

No matter which of these social determinants are at play, teens are still vulnerable to substance abuse and addiction. If you or someone you know is at risk of substance use, visit for support.


1Sixty percent of 12th graders do not view regular marijuana use as harmful” NIDA, December 18, 2013. 12/14/16.
2National Trends in Hospitalizations for Opioid Poisonings Among Children and Adolescents, 1997 to 2012.” JAMA Pediatrics, December 2016. 12/14/16. com/journals/jamapediatrics/article-abstract/2571466
3Drug Use in High School” Teen Rehab Center, September 16, 2016. 12/14/16.
4Goldberg, Cas “National Study: Teen Misuse and Abuse of Prescription Drugs Up 33 Percent Since 2008, Stimulants Contributing to Sustained Rx Epidemic,” Partnership for Drug-Free Kids, April 22, 2013. 12/14/16.
5Willmer, Rebecca. “Infographic: When Parents Talk about Prescription Drug Abuse, Kids Listen (Even If They Pretend Not To),” Education Development Center, December 3, 2013. 12/14/16.
6Detour: Teens in Rural Areas More Likely to Abuse Painkillers,” 12/14/16
7he TEDS Report: A Comparison of Rural and Urban Substance Abuse Treatment Admissions, Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. July 31, 2012. 12/14/16
8Michael Joynt, M.D., and Meghan Train, D.O. “Socioeconomic Status Plays Major Role in Opioid Pain Control,” University of Rochester Department of Medicine. June 26, 2013. 12/14/16
9Economic Status and Abuse,”, 2016. 12/14/16.
10Reinberg, Steven. “20% of U.S. High Schoolers Abuse Prescription Drugs,” U.S. News & World Report, June 3, 2010. 12/14/16.
11SAMHSA American Indian/Alaska Native Data,” Substance Abuse and Mental Health Services Administration, 2013. 12/14/16.
12Goldberg, Cassie. “New Survey: Hispanic Teen Drug Use Significantly Higher Than Other Ethnic Groups, Substance Abuse Becoming Normalized Behavior Among Latino Youth,” Partnership for Drug-Free Kids, August 20, 2013. 12/14/16. new-survey-hispanic-teen-drug-use-significantly-higher-than-other-ethnic-groups-substance-abuse-becoming-normalized-behavior-among-latino-youth
13“National Survey on American Attitudes on Substance Abuse XVII: Teens,” National Center on Addiction and Substance Abuse, August 2012. 12/14/16.
14The Nation’s Report Card,” National Assessment of Educational Progress, 2016. 12/14/16.
15Jaslow, Ryan. “Survey: “Digital peer pressure” fueling drug, alcohol use in high school students,” CBS News, August 12, 2012. 12/14/16.
16Prevention efforts focused on youth reduce prescription abuse into adulthood,” National Institute on Drug Abuse, February 14. 2013. 12/14/16.
17Camera, Lauren. “Many School Districts Don’t Have Enough School Nurses,” U.S. News & World Report, March 23, 2016. 12/14/16.

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