Substance Use and Mental Health Concerns

Learn about the different mental health and substance use issues that can disrupt the healthy development and education of students.

Alcohol Abuse and Underage Drinking

Alcohol remains the most widely abused substance among America’s youth, with a higher percentage of youth ages 12 to 20 using more alcohol in the past month (25.1%) than tobacco (19.6%) or illicit drugs (14.9%). The extent of alcohol consumption by those younger than the legal drinking age of 21 is a serious threat to both public health and public safety.

Underage drinking and associated problems have profound negative consequences for underage drinkers, their families, their communities, and society. Underage drinking contributes 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 (for example, homicides, assaults, rapes)
  • Unintentional injuries, such as burns, falls, and drowning
  • Brain impairment
  • Alcohol dependence
  • Risky sexual activity
  • Academic problems
  • Alcohol and drug poisoning

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.

Research shows that parents are the leading influence on their child’s decisions about alcohol. Many parents make efforts to ensure that their children understand that underage drinking is illegal and can carry negative health and academic consequences. Alcohol use among college students, including among those who are under age 21, is common and can have serious negative consequences.

According to the 2007 Surgeon General’s Call to Action to Prevent and Reduce Underage Drinking, parents, schools, and colleges and universities have an active role to play in prevention efforts.

Parents can:

  • Show they disapprove of underage drinking
  • Show they care about their child’s happiness and well-being
  • Show they are a good source of information about alcohol
  • Show they are paying attention and they will notice if their child drinks
  • Build their child’s skills and strategies to avoid underage drinking

Schools can:

  • Provide an environment that allows students to explore and develop their individual talents
  • Inform parents and students about the consequences of underage drinking
  • Implement evidence-based programs aimed at preventing underage drinking
  • Provide and promote venues where adolescents can gather with friends where alcohol is not available

Colleges and universities can:

  • Provide appealing, alcohol-free places for students to gather
  • Establish and enforce rules against underage alcohol use
  • Restrict the sale of alcoholic beverages on campus and at campus events
  • Educate parents, students, and faculty about the consequences of underage drinking on college campuses, including secondhand effects, such as receiving poor grades or becoming the victim of an alcohol-related assault or accident

Find more information on underage drinking and what parents, schools, and universities can do at the Underage Drinking topic.

Illegal and Prescription Drug Use

In 2012, the estimated 1.4 million first-time marijuana users within the past year ages 12 or older initiated drug use before the age of 18. These youth represented the majority (57.3%) of the 2.4 million total first-time marijuana users. Other SAMHSA research shows that in 2012, 5.3% of youth between the ages of 12 and 17 used a pain reliever for nonmedical use in the past year. For more information, visit the Alcohol, Tobacco, and Other Drugs and the Prescription Drug Misuse and Abuse topics.

Although several states have decriminalized marijuana (for recreational or medical use), it remains an illegal substance under federal law. As state laws change, they are likely to create issues for substance abuse service delivery. To provide guidelines, the Department of Justice issued new guidance regarding marijuana enforcement – 2013 (PDF | 525 KB) for federal prosecutors regarding eight factors for consideration in marijuana enforcement. In addition, SAMHSA participates on the Department of Health and Human Services’ (HHS) Behavioral Health Coordinating Council (BHCC) to ensure that all of the mental health and substance use projects and programs that HHS operating and staff divisions lead are synchronized. The BHCC has various standing subcommittees, including one that addresses marijuana issues.

Tobacco Use

Tobacco use among adolescents remains a serious public health concern. Among 12- to 17-year-olds, 6.6% (an estimated 1.6 million youths) in 2012 reported using cigarettes within the month prior to being surveyed, though use is steadily declining. Research has attributed the decline, in part, to the Synar Amendment of 1992. The law requires states to prohibit the sale and distribution of tobacco products to people under the age of 18. Learn more about SAMHSA’s work supporting the enforcement of the Synar Amendment.

Bullying and Peer Pressure

Many children and youth want to feel well liked and included in a group, which can sometimes make them susceptible to bullying and peer pressure. Both behaviors can start as early as preschool and become an even greater risk as young people transition into middle school, high school, college, and beyond. According to the Center for Disease Control and Prevention’s (CDC’s) Youth Risk Behavior Surveillance System (YRBSS), in 2013, 20% of U.S. high school students were bullied on school property and 15% were bullied electronically during 12 months before the survey.

There are a number of actions school staff can take to make schools safer and prevent bullying and bullying-like behavior. These include assessing bullying behavior within a school; engaging parents, legal guardians, and youth in all efforts; creating school-wide policies and rules; building a safe environment for students and teachers; and educating students and school staff. For more information on preventing and addressing bullying in schools, visit

SAMHSA offers the KnowBullying app to empower parents with the tools they need to start the conversation with their children about bullying. The app describes strategies to prevent bullying and explains how to recognize warning signs that a child is bullying or being bullied. It also includes a section for educators.


In the United States, 10.7% of adolescents aged 12 to 17 (around 2.6 million) in 2013 had at least one major depressive episode within the year prior to being surveyed. Of those 2.6 million adolescents, 61.9% did not receive treatment. The rate of a major depressive episode among U.S. youths in 2012 was about three times higher among females (13.7%) than among males (4.7%).


CDC's YRBSS also showed, in 2013 17% of students in grades 9 to 12 reported having seriously considered suicide, more than 13% had made a plan for how they would attempt suicide, and 8% reported having attempted suicide one or more times in the past 12 months. Learn more at the Suicide Prevention topic.

Last Updated: 08/21/2017