Original Article

Substance Use Disorders among Adolescents in the United States: 2000–2019

Authors: Brook T. Alemu, PhD, MPH, Hind A. Baydoun, PhD, MPH, Olaniyi Olayinka, MD, MPH, Robyn M. Treadwell, MD, CDR MC, USN


Objectives: Substance use disorders (SUDs) are characterized by impairment caused by the recurrent use of alcohol, illicit drugs, or both. SUDs are pervasive and endemic among US adolescents, with potentially negative health and social consequences. Although the term experimentation normalizes adolescent substance abuse, the long-term consequences of this behavior beginning in adolescence can be detrimental to not only the adolescent but also the adult into which he or she develops. Our objective was to examine the epidemiology of SUD among hospitalized US adolescents, 13 to 19 years of age, during the time period 2000–2019.

Methods: A case-control study was conducted using 5,260,104 hospital discharge records (394,952 SUD and 4,865,152 non-SUD) from the 2000–2019 Kids’ Inpatient Database. SUD and clinical outcomes variables were identified based on the International Classification of Diseases, Ninth/Tenth Revisions, Clinical Modification, coding. SUD rates (per 1000 discharges) were calculated and adjusted odds ratios (aORs) with their 95% confidence intervals (CIs) were computed using logistic regression models for predictors of SUDs among hospitalized adolescents.

Results: The prevalence of SUDs was estimated to be 75.10 cases per 1000 discharges (95% CI 74.86–75.31). Demographically, the highest crude rates (per 1000 discharges) were seen among Native American (139.58) and White (91.97) patients. Adolescent patients who experienced SUD were twice as likely as nonusers to be 16 to 19 years of age (aOR 2.2, 95% CI 2.13–2.19) or to be male (aOR 2.2, 95% CI 2.22–2.27). SUD was significantly associated with cooccurring conditions, including anxiety (aOR 2.5, 95% CI 2.48–2.53), depression (aOR 2.3, 95% CI 2.30–2.35), mood disorder (aOR 2.17, 95% CI 2.14–2.20), schizophrenia (aOR 2.6, 95% CI 2.52–2.64), sexually transmitted infections (aOR 2.3, 95% CI 2.23–2.45), hepatitis (aOR 3.0, 95% CI 2.87–3.15), and suicide (aOR 1.33, 95% CI 1.30–1.35).

Conclusions: The study examined the epidemiology, risk factors, and common characteristics of hospitalized adolescent patients with SUDs. The high burden of psychiatric and medical comorbidities observed among this patient group warrants designing effective and comprehensive substance use prevention and treatment programs for youths.

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1. Silvers JA, Squeglia LM, Rømer KT, et al. Hunting for what works: adolescents in addiction treatment. Alcohol Clin Exp Res 2019;43:578–592.
2. Patterson DA. Addiction treatment: a strengths perspective. Health Soc Work 2004;29:345. .
3. National Center for Drug Abuse Statistics. Drug use among youth: facts & statistics. https://drugabusestatistics.org/teen-drug-use/. Accessed December 15, 2022.
4. Levy S, Weiss R, Sherritt L, et al. An electronic screen for triaging adolescent substance use by risk levels. JAMA Pediatr 2014;168:822–828.
5. Khan L. Substance use in adolescents: latest trends. Pediatr Ann 2019;48: e418–e422.
6. Kwan LY, Eaton DL, Andersen SL, et al. This is your teen brain on drugs: in search of biological factors unique to dependence toxicity in adolescence. Neurotoxicol Teratol 2020;81:106916.
7. Centers for Disease Control and Prevention. Adolescent and school health, 2019. https://www.cdc.gov/healthyyouth/index.htm. Accessed January 6, 2023.
8. National Institute on Drug Abuse. Stats & trends in teen drug use with interactive chart, 2021. https://nida.nih.gov/research-topics/trends-statistics. Accessed January 5, 2023.
9. Jones, CM, Clayton, HB, Deputy NP, et al. Prescription opioid misuse and use of alcohol and other substances among high school students - Youth Risk Behavior Survey, United States, 2019. MMWR Morb Mortal Wkly Rep 2020;69:38–46.
10. National Institute on Drug Abuse. Principles of adolescent substance use disorder treatment: a research-based guide. https://archives.nida.nih.gov/sites/default/files/podat-guide-adolescents-508.pdf. Published January 2014. Accessed December 19, 2022.
11. Substance Abuse and Mental Health Services Administration (SAMHSA). Preventing Marijuana Use Among Youth. SAMHSA Publication No. PEP21-06-01-001. Rockville, MD: National Mental Health and Substance Use Policy Laboratory. Substance Abuse and Mental Health Services Administration, 2021. https://store.samhsa.gov/sites/default/files/pep21-06-01-001.pdf.
12. Miech R, Johnston L, O’Malley MP, et al. Trends in adolescent vaping, 2017–2019. N Engl J Med 2019;381:1490–1491.
13. Farzal Z., Perry MF, Yarbrough WG, et al. The adolescent vaping epidemic in the United States—how it happened and where we go from here. JAMA Otolaryngol Head Neck Surg 2019;145:885–886.
14. Centers for Disease Control and Prevention. Alcohol and public health: underage drinking. https://www.cdc.gov/alcohol/fact-sheets/underage-drinking.htm. Accessed January 3, 2023.
15. Johnston L, O’Malley P, Miech R, et al. Monitoring the Future National Survey Results on Drug Use: 1975-2015: Overview: Key Findings on Adolescent Drug Use, Ann Arbor: Institute for Social Research, University of Michigan; 2016.
16. Jackson NJ, Isen JD, Khoddam R et al. Impact of adolescent marijuana use on intelligence: results from two longitudinal twin studies. Proc Natl Acad Sci USA 2016;113:E500–E508.
17. Substance Abuse and Mental Health Services Administration. Key substance use and mental health indicators in the United States: Results from the 2019 National Survey on Drug Use and Health. https://www.samhsa.gov/data/. Accessed November 14, 2022.
18. Healthcare Cost and Utilization Project. KID database documentation. https://hcup-us.ahrq.gov/db/nation/kid/kiddbdocumentation.jsp. Accessed January 9, 2023.
19. Healthcare Cost and Utilization Project. HCUP summary statistics report. https://hcup-us.ahrq.gov/db/nation/kid/kidsummarystats.jsp. Accessed June 21, 2023.
20. Sebastiao YV, Metzger GA, Chisolm DJ, et al. Impact of ICD-9-CM to ICD10-CM coding transition on trauma hospitalization trends among young adults in 12 states. Inj Epidemiol, 2021;8:1–13.
21. Healthcare Cost and Utilization Project. Clinical Classifications Software (CCS) for ICD-9-CM. https://hcup-us.ahrq.gov/toolssoftware/ccs/ccs.jsp. Accessed June 1 , 2023.
22. Healthcare Cost and Utilization Project. Clinical Classifications Software Refined (CCSR) for ICD-10-CM diagnoses. https://hcup-us.ahrq.gov/toolssoftware/ccsr/dxccsr.jsp. Accessed June 17, 2023.
23. Volkown ND, Han B, Einstein EB, et al. Prevalence of substance use disorders by time since first substance use among young people in the US. JAMA Pediatr 2021;175:640–643.
24. Levy S, Weiss R, Sherritt L, et al. An electronic screen for triaging adolescent substance use by risk levels. JAMA Pediatr 2014;168:822–828.
25. Swaim RC, Stanley LR. Substance use among American Indian youths on reservations compared with a national sample of US adolescents. JAMA Netw Open 2018;1:e180382.
26. Bertrand K, Richer I, Brunelle N, et al. Substance abuse treatment for adolescents: how are family factors related to substance use change? J Psychoactive Drugs 2013;45:28–38.
27. Von Diemen L, Bassani DG, Fuchs SC, et al. Impulsivity, age of first alcohol use and substance use disorders among male adolescents: a population-based case-control study. Addiction 2008;103:1198–1205.
28. Whitesell M, Bachand A, Peel J, et al (2013). Familial, social, and individual factors contributing to risk for adolescent substance use. J Addict 2013;2013: 579310.
29. Patrick ME, Wightman P, Schoeni RF, et al. Socioeconomic status and substance use among young adults: a comparison across constructs and drugs. J Stud Alcohol Drugs 2012;73:772–782.
30. Goodman E, Huang B. Socioeconomic status, depressive symptoms, and adolescent substance use. Arch Pediatr Adolesc Med 2002;156:448–453.
31. Hanson MD, Chen E. Socioeconomic status and substance use behaviors in adolescents: the role of family resources versus family social status. J Health Psychol 2007;12:32–35.
32. Humensky, JL. Are adolescents with high socioeconomic status more likely to engage in alcohol and illicit drug use in early adulthood? Subst Abuse Treat Prev Policy 2010;5:19–29.
33. Couwenbergh C, Van Den Brink W, Zwart K, et al. Comorbid psychopathology in adolescents and young adults treated for substance use disorders. Eur Child Adolesc Psychiatry 2006;15:319–328.
34. Roberts RE, Roberts CR, Xing Y. Comorbidity of substance use disorders and other psychiatric disorders among adolescents: evidence from an epidemiologic survey. Drug Alcohol Depend 2007;88:S4–S13.
35. Shrier LA, Harris SK, Kurland M, et al. Substance use problems and associated psychiatric symptoms among adolescents in primary care. Pediatrics 2003;111:e699–e705.
36. Danielson ML, Bitsko RH, Ghandour RM, et al. Prevalence of parent-reported ADHD diagnosis and associated treatment among US children and adolescents. J Clin Child Adolesc Psychol 2018,47:199–212.
37. Wilens TE, Martelon M, Joshi G, et al. Does ADHD predict substance-use disorders? A 10-year follow-up study of young adults with ADHD. J Am Acad Child Adolesc Psychiatry 2011;50:543–553.
38. Heslin KC, Elixhauser A. Mental and substance use disorders among hospitalized teenagers, 2012: statistical brief 202. https://hcup-us.ahrq.gov/reports/statbriefs/sb202-Mental-Substance-Use-Teenagers.pdf. Accessed January 5, 2023.
39. Grella CE, Hser YI, Joshi V, et al. Drug treatment outcomes for adolescents with comorbid mental and substance use disorders. J Nerv Ment Dis 2001; 189:84–92.
40. O’Malley KJ, Cook KF, Price MD, et al. Measuring diagnoses: ICD code accuracy. Health Serv Res 2005;40:1620–1639.
41. Agency for Healthcare Research and Quality. KID’s inpatient databases, 2019. https://hcup-us.ahrq.gov/news/announcements/kid2019.jsp. Accessed December 12, 2022.