Trends in Adolescent Substance Use and Perception of Risk from Substance Use

An adolescent's perception of the risks associated with substance use is an important determinant of whether he or she engages in substance use. For example, youths who perceive high risk of harm are less likely to use drugs than youths who perceive low risk of harm.¹ Thus, providing adolescents with credible, accurate, and age-appropriate information about the harm associated with substance use is a key component in prevention programming.² Expanding upon research that shows the predictive nature of risk perceptions to subsequent substance use among adolescents,^3,4 the National Survey on Drug Use and Health (NSDUH) provides an opportunity to conduct a cross-sectional analysis of the changes over time in the prevalence of substance use and perceptions of risk. Although cross-sectional analysis cannot confirm that increases in substance use are a direct result of decreases in perceptions of risk, this report examines how rates of substance use and perceived risk vary over time and in relation to each other. Understanding the relationship between risk perception and substance use during adolescence may help to better target health promotion messages and increase the effectiveness of prevention and intervention programs.

NSDUH asks adolescents aged 12 to 17 how much people risk physical and other harm when they drink five or more alcoholic drinks once or twice a week, use marijuana once or twice a week, use cocaine once or twice a week, use LSD once or twice a week, and use heroin once or twice a week. Response choices are (1) no risk, (2) slight risk, (3) moderate risk, and (4) great risk. NSDUH also asks adolescents about their substance use in the 30 days before the interview. This issue of The NSDUH Report focuses on trends in risk perception and substance use among adolescents aged 12 to 17 between 2002 and 2011.

The percentage of adolescents who perceived great risk from having five or more drinks of an alcoholic beverage once or twice a week increased from 38.2 percent in 2002 to 40.7 percent in 2011 (Figure 1). Consistent with the increase in perceived risk, adolescents' binge alcohol use decreased from 10.7 in 2002 to 7.4 percent in 2011.⁵

Adolescents who perceived great risk from binge drinking—having five or more drinks of an alcoholic beverage once or twice a week—were less likely than those who did not perceive great risk to report binge alcohol use in the past month (click here to see a supplemental table). In 2011, 4.5 percent of adolescents who perceived great risk from binge drinking once or twice a week reported they engaged in past month binge alcohol use, compared with 9.5 percent of those who perceived moderate, slight, or no risk (Figure 2).

The percentage of adolescents who perceived great risk of harm from smoking marijuana once or twice a week increased between 2002 and 2003 but remained relatively stable until 2007; the percentage then decreased each year from 54.6 percent in 2007 to 44.8 percent in 2011 (Figure 3). The rate of past month marijuana use among adolescents was relatively stable between 2002 and 2004, and then decreased between 2004 and 2005. The rate of past month marijuana use held steady at about 6.7 percent until 2008; it increased to 7.4 percent in 2009 and 2010 and to 7.9 percent in 2011.

Adolescents who perceived a great risk of harm from smoking marijuana had lower substance use rates than adolescents who did not perceive great risk (click here to see a supplemental table). In 2011, past month marijuana use was reported by 0.8 percent of adolescents who saw great risk in smoking marijuana once or twice a week compared with 13.8 percent of those who saw moderate, slight, or no risk (Figure 2).

With roughly 78 percent of adolescents in 2011 perceiving great risk from using cocaine once or twice a week, the percentages have remained stable since 2007 and are down only slightly since 2002 (Table 1). Despite the relatively stable trend in perception of great risk, the rate of past month use of cocaine among adolescents decreased from 0.6 percent in 2002 to 0.3 percent in 2011. The percentage of adolescents who perceived great risk from using LSD once or twice a week decreased from 76.2 percent in 2002 to 71.3 percent in 2010 and 70.4 percent in 2011; however, there was no change in the rate of past month use of LSD among adolescents during this period with roughly 0.1 percent of youths using LSD.

Similarly, the percentage of adolescents who perceived great risk from using heroin once or twice a week decreased from 82.5 percent in 2002 to 80.4 percent in 2010 and 79.7 percent in 2011; however, there was no change in the rate of past month use of heroin among adolescents during this period with up to 0.1 percent of youths using heroin. The association between perceived risk of using cocaine, LSD, and heroin and the use of these substances was not as strong as it was for alcohol and marijuana (click here to see a supplemental table).

In 2011, adolescent females were more likely than adolescent males to perceive great risk from having five or more alcoholic drinks once or twice a week (44.9 vs. 36.6 percent) and from smoking marijuana once or twice a week (49.2 vs. 40.5 percent; Figure 4). There were no differences between males and females in perceived risk from using cocaine once or twice a week, using heroin once or twice a week, or using LSD once or twice a week.

Adolescents aged 12 to 14 were more likely than those aged 15 to 17 to perceive great risk from having five or more alcoholic drinks once or twice a week (41.7 vs. 39.8 percent) and from smoking marijuana once or twice a week (54.7 vs. 35.6 percent; Figure 5). However, younger adolescents were not consistently more wary than older adolescents of the risks of illegal substances. Adolescents aged 15 to 17 were more likely than those aged 12 to 14 to perceive great risk from using cocaine once or twice a week (82.2 vs. 73.7 percent), using heroin once or twice a week (86.3 vs. 72.5 percent), and using LSD once or twice a week (75.0 vs. 65.3 percent).

As shown in this report, changes in perceived risk at the national level typically preceded or occurred simultaneously with changes in substance use rates in the Nation. In the 10-year period between 2002 and 2011, trends in the perception of great risk from alcohol use increased while binge alcohol use decreased. Rates of perception of great risk from smoking marijuana and marijuana use remained stable between 2004 and 2008; however, when rates of perception of risk decreased in 2007 through 2011, rates of smoking marijuana increased. This report also shows that perceptions of risk from using alcohol and marijuana are lower for older adolescents, which may increase their risk of use in comparison with younger adolescents. In contrast, older adolescents reported higher rates of perceived risk from using cocaine, heroin, and LSD than younger adolescents. Notably, the vast majority of adolescents, regardless of age group, perceived great risk associated with use of cocaine, heroin, and LSD.

Although this report provides details on the statistical associations between risk perception and substance use, it cannot be determined from cross-sectional data if (1) perception of great risk from using a particular drug causes youths to abstain, (2) abstaining from drug use causes youths to have perceptions of great risk from using, or (3) both. However, the findings reported here reinforce the importance of teaching youths about the dangers associated with substance use. Understanding differences in the perception of risk for varying substances may be useful to policymakers, educators, and prevention program staff in making decisions about deploying prevention messages and what segments of the youth audience they should target.

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