HV 5825 D783 1991 . c.2 f PUBL ‘ l"; ‘2 ! National Institute on Drug Abuse Di3ue USE AMONG YOUTH. Findings from the 1988 National Household Survey on Drug Abuse US. DEPARTMENT OF HEALTH AND HUMAN SERVICES C Public Health Service Alcohol, Drug Abuse, and Mental Health Administration PUBLIC Hi-‘lTH ULTRARY DRUG USE AMONG YOUTH: Findings from the 1988 National Household Survey on Drug Abuse National Institute on Drug Abuse Division of Epidemiology and Prevention Research 5600 Fishers Lane Rockville, Maryland 20857 U.S. Department of Health and Human Services Public Health Service Alcohol, Drug Abuse, and Mental Health Administration ACKNOWLEDGMENTS This publication was developed for the National Institute on Drug Abuse, Division of Epidemiology and Prevention Research, by the Research Triangle institute, Research Triangle Park, North Carolina, under Contract No. 271-89-8333. Significant contributors to the development, analysis, and writing of the report include Mary Ellen Marsden, Robert L. Flewelling, J. Valley Rachal, L. Lynn Guess, Susan L. Bailey, and James W. Cassell. Joseph Gfroerer, Lana Harrison, and Andrea Kopstein served as the NIDA project officers. Public Domain Notice All material appearing in this volume is in the public domain and may be reproduced or copied without permission from the National Institute on Drug Abuse. Citation of the source is appreciated. DHHS Publication No. (ADM) 91-1765 Printed 1991 Chapter VI. ,4 / /’ .r‘ I ' x / / \u 1 /'» ,1 n ,J , ,, l k, l / M ' / , sf / CONTENTS ~«/ / ‘ / / _ / / (Li //'- INTRODUCTION ................................................ f. ...... ’ .K. .......................... A. B. C. D. Importance Of Understanding Drug Use Among Youth ..................... The National Household Survey on Dmg Abuse ............................... Recent Trends in Dmg Use Among Youth ......................................... Overview of This Report ..................................................................... PREVALENCE AND TRENDS IN USE ...................................................... A. B. C. Prevalence Of Use, 1988 .................................................................... Trends in Current Use, 1972 to 1988 ................................................. Trends in Current Use by Age Group, 1972 to 1988 ......................... CORRELATES OF USE ............................................................................. mpow> Drug Use by Age ................................................................................ Drug Use by Sex and Race/Ethnicity ................................................. Drug Use by Region and Population Density .................................... Dmg Use by School Status and Living Arrangement ........................ Trends in Use by Demographic Characteristics ................................. PATTERNS OF USE .................................................................................. A. B. C. Frequency and Level of Drug Use ...................................................... Multiple Drug Use ............................................................................... Age at First Use .................................................................................. PROBLEMS ASSOCIATED WITH USE .................................................... A. B. C. D. Problems Related tO Drug Use ........................................................... Dependency Symptoms Related to Drug Use ................................... Negative Experiences Related to Alcohol Use .................................. Perceived Risks Of Drug Use .............................................................. SUMMARY .................................................................................................. A. B. C. D. Prevalence and Trends ....................................................................... Correlates Of Use ................................................................................. Patterns Of Use .................................................................................... Problems and Perceived Risks Associated with Drug Use ................ REFERENCES ............................................................................................................... APPENDIX A B Selected Data Tables .................................................................................. Key Definitions ............................................................................................. Page Number 1 1O 11 12 13 LIST OF FIGURES Page Percentage of Youth Aged 12 to 17 Reporting Use of Illicit Drugs, Alcohol, and Cigarettes in Lifetime, Past Year, and Past Month: 1988 ................... 8 Trends in Percentage of Youth Aged 12 to 17 Reporting Use of Illicit Drugs, Alcohol, and Cigarettes in Past Month: 1972-1988 ........................ 10 Trends in Percentage Reporting Use of Marijuana, Alcohol, and Cigarettes in Past Month, by Age Group: 1972-1988 ................................. 13 Percentage of Youth and Young Adults Reporting Use of Any Illicit Drug, Marijuana, Alcohol, and Cigarettes in Lifetime, Past Year, and Past Month, by Age Category: 1988 .................................................................... 16 Percentage of Youth Aged 12 to 17 Reporting Use of Illicit Drugs, Alcohol, and Cigarettes in Past Month, by Sex and by Race/Ethnicity: 1988 .......... 18 Percentage of Youth Aged 12 to 17 Reporting Use of Illicit Drugs, Alcohol, and Cigarettes in Past Month, by Region: 1988 ......................................... 20 Percentage of Youth Aged 12 to 17 Reporting Use of Illicit Drugs, Alcohol, and Cigarettes in Past Month, by Population Density: 1988 ...................... 21 Percentage of Youth Aged 16 and 17 Reporting Use of Illicit Dmgs, Alcohol, and Cigarettes in Past Month, by School Status: 1988 ................ 23 Percentage of Young Adults Aged 21 to 25 Reporting Use of Illicit Drugs, Alcohol, and Cigarettes in Past Month, by High School Graduation Status: 1988 .............................................................................. 24 Percentage of Youth Aged 12 to 17 Reporting Use of Illicit Drugs, Alcohol, and Cigarettes in Past Month, by Living Arrangement: 1988 ..................... 25 Percentage of Youth Aged 12 to 17 Reporting Patterns of Lifetime Use of Alcohol, Cigarettes, Marijuana, and Other Illicit Drugs: 1988 ................. 33 Average Age at First Use of Alcohol, Cigarettes, and Other Drugs for Youth Aged 16 and 17: 1988 ...................................................................... 35 Percentage of Youth Aged 12 to 17 Reporting Drug Use and Symptoms of Dependency in Past Year, by Type of Drug: 1988 ................................. 40 LIST OF FIGURES (continued) Number Page 14 Percentage of Past Month Drinkers Aged 12 to 17 Reporting Negative Drinking-Related Experiences in the Past Year, by Frequency of Alcohol Use in Past 30 Days: 1988 ...................................... 43 vi Number 10 11 12 LIST OF TABLES Page Estimated Percentages and Numbers (in Thousands) of Youth Aged 12 to 17 in the U.S. Household Population Who Have Used Illicit Dmgs, Alcohol, and Cigarettes in Lifetime, Past Year, and Past Month: 1988 ......................................................................................... 9 Trends in Percentage of Youth Aged 12 to 17 Reporting Drug Use in Past Month: 1972-1988 ............................................................................... 11 Trends in Percentage of Youth Aged 12 to 17 Reporting Any Illicit Dmg Use in Lifetime, Past Year, and Past Month, by Demographic Characteristics: 1985 and 1988 ................................................................... 27 Percentage of Youth Aged 12 to 17 Reporting Days of Use of Marijuana, Cocaine, and Alcohol in Past Month: 1988 ................................................. 29 Percentage of Youth Aged 12 to 17 Reporting Days of Alcohol Use in Past Month, by Demographic Characteristics: 1988 .................................. 30 Percentage of Youth Aged 12 to 17 Reporting Levels of Cigarette Use in Past Month, by Demographic Characteristics: 1988 ............................... 31 Percentage of Youth Aged 12 to 17 Reporting Patterns of Lifetime Use of Alcohol, Cigarettes, Marijuana, and Other Illicit Drugs, by Age Category: 1988 ............................................................................................ 33 Percentage of Youth Aged 12 to 17 Reporting Problems Resulting from Their Use of Alcohol, Cigarettes, or Other Drugs in Past Year, by Age Category: 1988 ................................................................................ 37 Percentage of Youth Drug Users Aged 12 to 17 Reporting Drug-Related Problems in Past Year, by Type of Drug to Which Problems Were Attributed: 1988 ........................................................................................... 38 Percentage of Youth Drug Users Aged 12 to 17 Reporting Symptoms of Dependency in Past Year, by Type of Drug to Which Symptoms Were Attributed: 1988 ........................................................................................... 41 Percentage of Past Year Drinkers Aged 12 to 17 Reporting Negative Experiences Associated with Their Drinking: 1988 ..................................... 44 Percentage of Youth Perceiving Great Risk of Using Cigarettes, Drugs, or Alcohol, by Age Category: 1988 ............................................................. 45 vii LIST OF TABLES (continued) Number Page A-1 Number of Interviewed Youth Aged 12 to 17 and Estimated Number in Household Population, by Demographic Characteristics: 1988 ................. 53 A-2 Estimated Percentages and Numbers of Users (Thousands) of Alcohol, Tobacco, and Selected Drugs in US. Household Population, Aged 12 or Older, in Lifetime, Past Year, and Past Month: 1988 ........................ 54 A-3 Trends in Percentage Reporting Use of Marijuana, Alcohol, and Cigarettes in Past Month, by Age Group: 1972-1988 ................................. 55 A-4 Percentage of Youth and Young Adults Reporting Use of Any illicit Drug, Marijuana, Alcohol, and Cigarettes in Lifetime, Past Year, and Past Month, by Age Category: 1988 ................................... 56 viii I. INTRODUCTION This report provides information about the use of illicit drugs, alcohol, and tobacco among our Nation's youth aged 12 to 17. For comparative purposes, some data are also presented for older age groups. Information is presented about the prevalence and trends in use, correlates of use, patterns of use, and problems associated with use. Most data are drawn from the 1988 National Household Survey on Drug Abuse (NHSDA), although data concerning trends are drawn from NHSDA surveys conducted from 1972 to 1985. A. Importance of Understanding Drug Use Among Youth Youth is a period during which use of many drugs begins and patterns of use that may continue into adulthood develop (Johnston, O’Malley, & Bachman, 1988; Kandel, 1980; Kandel & Logan, 1984; Kandel & Yamaguchi, 1985; answick, Merzer, & Messen‘, 1985). Drug use during these years is predictive of use during young adulthood as well as problems in development (Newcomb & Bentler, 1988), and use of dmgs during youth may be related to problem use of illicit drugs and alcohol in later life (Kandel, Davies, Karus, & Yamaguchi, 1986; Kandel, Simcha-Fagan, & Davies, 1986; O’Donnell, Voss, Clayton, Slatin, & Room, 1976). For these reasons, the study of drug use among youth is a critical undertaking. This report provides information to aid in understanding the nature and extent of drug use among youth. Epidemiologic research as reported here provides an understanding of the types of youth at risk of beginning use of illicit dmgs, alcohol, and tobacco and the extent and nature of problems associated with use. This information can be used to more effectively design and target prevention, intervention, and treatment efforts for youth. Information about trends in drug use may be used to gauge the overall effectiveness of these efforts and the need for additional services. B. The National Household Survey on Drug Abuse The 1988 NHSDA is the ninth in a series of studies designed to measure the prevalence and correlates of drug use in the United States. The survey is sponsored by the National Institute on Drug Abuse (NIDA), with additional support for the 1988 survey provided by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) and the US. Department of Education. A description of the 1988 survey, including information on sampling, data collection, and a more detailed presentation of prevalence estimates and correlates, is found in three other volumes from the study: - National Household Survey on Drug Abuse: Highlights 1988. This report provides an overview of findings from the survey, including information on the prevalence of use, trends in use, demographic characteristics of users, patterns of use, and perceptions of risk of use of illicit drugs, alcohol, and tobacco (NIDA, 1990a) 0 National Household Survey on Drug Abuse: Main Findings 1988. This report provides detailed information on the prevalence of use and trends in use and information on demographic correlates of use, frequency of use, patterns of use, problems from use, and perceptions of risk of using illicit dmgs, alcohol, and tobacco (NIDA, 1990b). 0 National Household Survey on Drug Abuse: Population Estimates 1988. This report provides estimates of the percentages and numbers of people in the U.S. household population who have ever used illicit drugs, alcohol, and tobacco as well as estimates of use in the past year and past month (NIDA, 1990c). The methodology used for the 1988 NHSDA was essentially the same as that used for each of the eight previous National Household Surveys. A national probability sample of households in the coterminous United States was selected from 100 primary sampling units. Since 1972, Alaska and Hawaii have not been included in the NHSDA sample because of logistic and cost considerations. In each selected household, a roster recording the age, race/ethnicity, and sex of all household members aged 12 and older was completed. Using a random sampling procedure, either two, one, or no respondents were selected to be interviewed. (Selection probabilities were based on the race/ethnicity of the head of household and the ages of household members.) The procedure was designed to control the sample sizes for age and raciaVethnic groups of interest. After selection, respondents were interviewed in person in their homes by trained interviewers. The interview process included use of self- administered answer sheets and other procedures designed to assure respondents that their responses to sensitive questions would be kept confidential and anonymous. The 1988 NHSDA surveyed a representative sample of 8,814 individuals from the 1988 household population aged 12 and older in the coterminous United States. The sample design ensured adequate sample sizes for four age groups (12 to 17, 18 to 25, 26 to 34, and 35 or older) and three racial/ethnic groups (Hispanic in origin, regardless of race; white, not of Hispanic origin; and black, not of Hispanic origin). The youth population aged 12 to 17 was oversampled to allow detailed analyses of drug use among youth. Although this report focuses on youth aged 12 to 17, some comparisons are made to other age groups. Table A-1 in Appendix A presents the numbers of youth interviewed and the estimated number of youth in the household population. Estimates are provided for the total sample and for specific subgroups defined by age, sex, race/ethnicity, population density, geographic region, school status, and living arrangement. All percentages presented in the report are based on weighted data, and thus represent estimates of population values. Prevalence estimates that were considered to be unreliable are not shown in the tables and figures, but have been replaced with an asterisk (*) and noted as "low precision."1 Although the NHSDA data are useful to estimate drug use among virtually the entire population of the United States, the data have certain limitations. First, the data are obtained from self-reports of drug use, and their value depends on respondents’ truthfulness and accuracy of recall. Experimental studies have established the validity of self-report data in similar contexts, and the NHSDA procedures were designed to encourage honesty and recall; however, some under- and overreporting may have taken place. Second, the survey is cross-sectional rather than longitudinal. That is, individuals were interviewed only once and were not followed for additional interviews. The survey therefore provides an overview of drug use prevalence at one point in time rather than a view of changes in drug usage over time for groups of individuals. Third, because the survey's target population is defined as the household population of the continental United States, a small proportion (less than 2 percent) of the population is excluded. The subpopulations excluded are those in group quarters (military installations, correctional institutions, college dormitories, and hospitals) and those without a permanent residence (homeless people and residents of single rooms in hotels). To the extent that some of these groups (9.9., prisoners or transients) have higher rates of use than the household population, the NHSDA may yield somewhat conservative estimates of drug use in the total population. This may be particularly true for prevalence estimates of rarely used drugs such as heroin. C. Recent Trends in Drug Use Among Youth Recent surveys of the nature and extent of drug use among youth show that drug use during the 19805 declined from a peak in the late 19703. Still, many youth use illicit drugs, alcohol, and tobacco. The 1979 NHSDA found that about one-third (34.3 percent) of youth aged 12 to 17 reported that they had ever used one or more illicit drugs; by 1985, this percentage had decreased to 29.5 percent. As presented in this report, the percentage of lifetime users among youth decreased further between 1985 and 1988, to 24.7 percent. Similar decreases in lifetime use of alcohol and cigarettes were found. The percentage of youth who had used drugs in the past month also decreased since the late 1970s, from 17.6 percent in 1979 to 14.9 percent in 1985 and 9.2 percent in 1988. The percentage of youth using alcohol or cigarettes in the past month has also decreased in recent years (NlDA, 1990a). 1 For purposes of this report, low precision is defined as a standard error equal to or greater than 50% of the prevalence estimate. The annual survey of high school seniors (the Monitoring the Future study) has shown similar decreases in the prevalence of drug use (University of Michigan, 1990). In 1979, for example, some 65.1 percent of high school seniors reported having ever used any illicit drug, compared to 50.9 percent in 1989; comparable percentages for use in the past month were 38.9 percent in 1979 and 19.7 percent in 1989. Use of alcohol during the past month has also decreased, from 68.2 percent in 1975 to 60.0 percent in 1989, with higher percentages of users in the late 19705. Similar overall decreases in use of cigarettes in the past month were also found, despite a leveling off in the decline during the early and mid- 19803. These recent decreases in the use of illicit drugs, alcohol, and cigarettes among youth suggest a continuing downward trend in the use of drugs by youth. D. Overview of This Report The major objective of this report is to examine the nature and extent of use of illicit drugs, alcohol, and tobacco among youth, including differences in the extent of involvement during the years from ages 12 to 17. More specifically, the report examines the: a prevalence of use of any illicit drug, specific illicit drugs, alcohol, and tobacco among youth aged 12 to 17; - trends in use from 1972 to 1988; . comparison of drug use among youth with use by young adults and older adults; 0 correlates of use; . frequency and level of use; . patterns of use of illicit drugs and alcohol; . problems associated with the use of illicit drugs, alcohol, and cigarettes; and a perceived risks of drug use. The following drugs or classes of drugs were examined in the 1988 NHSDA and most of the preceding surveys in the series: marijuana (including hashish), cocaine (including crack), inhalants, hallucinogens (including PCP), heroin, nonmedical use of prescription- type psychotherapeutic drugs (including stimulants, sedatives, tranquilizers, and analgesics), alcohol, cigarettes, and smokeless tobacco. For most of these drugs, the reported prevalence of use in the lifetime, past year, and past month is examined. Definitions of drug use levels are provided in Appendix B. Use in the past month is also referred to as current use. Differences in rates of use between the 1985 and 1988 NHSDA surveys and between demographic groups in 1988 that are statistically significant are noted in the text. Demographic characteristics examined in this report are age, sex, race/ethnicity, population density, geographic region, school status, and living arrangement. Definitions of these demographic characteristics are presented in Appendix B. Findings for school status are presented only for those youth aged 16 to 17 because dropout status may not be applicable to younger persons. Findings are presented separately for each of these demographic characteristics in this report. However, it is recognized that this presentation may yield misleading conclusions if the effects of a particular characteristic are confounded with another characteristic such as age. The reader is cautioned about the possible confounding of results for demographic characteristics. Where possible, data are presented graphically in this report. Additional information about the sample and supplementary tables that provide sample sizes and percentages for figures are presented in the appendixes. The reader is referred to the 1988 Main Findings report (NIDA, 1990b) for more detailed information about the survey and research findings for other age groups. At the time of publication, more recent data are available from the 1990 National Household Survey on Drug Abuse. However, these data were not available when the detailed tabulations on youthful patterns of drug use were prepared and analyzed for this report. Readers are referred to the 1990 Population Estimates and Highlights reports for summary information on drug use among the 12 to 17 year old cohort in 1990. (The Main Findings Report should be available in late 1991 .) The findings from 1990 show a continuation of the downward trends in illicit drug use patterns among youth. II. PREVALENCE AND TRENDS IN USE This chapter provides an overview of the prevalence of use of illicit dmgs, alcohol, and tobacco among youth aged 12 to 17 in 1988 and trends in current use from 1972 to 1988. It also provides estimates of the number of youth who have ever used drugs or used them in the past year or past month. Comparable percentages and estimates for the total household population aged 12 and older are presented in Appendix A in Table A-2. A. Prevalence of Use, 1988 (Figure 1 and Table 1) In 1988, alcohol was the drug used most commonly by youth aged 12 to 17 in the household population. Approximately 50 percent of youth reported ever using alcohol, and about 25 percent reported use within the month before the survey. Cigarettes were the next most commonly used drug. Some 42 percent of youth reported lifetime use of cigarettes, and 11.8 percent reported use in the past month. Approximately one-fourth of youth reported having ever used one or more illicit dmgs, 16.8 percent used them in the past year, and 9.2 percent used them in the past month. Illicit drugs include marijuana and hashish, cocaine and crack, inhalants, hallucinogens, heroin, and prescription-type psychotherapeu- tic drugs used for nonmedical purposes (Figure 1 and Table 1). Marijuana was the most commonly used illicit drug among youth in 1988. Some 17.4 percent of youth reported having ever used marijuana, 12.6 percent used it in the past year, and 6.4 percent used it in the past month. Comparatively few youth reported having ever used cocaine. The prevalence of cocaine use among youth was 3.4 percent for lifetime use and 1.1 percent for use in the past month. About one-third of cocaine users reported having used crack cocaine. After marijuana, inhalants had the highest prevalence of lifetime use by youth. Inhalants include gasoline, spray paints, aerosol sprays, glue, lacquer thinners, amyl nitrites, ether, nitrous oxide, and correction fluids. The percentage of youth who reported they had ever used any of these substances for "kicks" or to "get high" was 8.8 percent. Two percent of youth reported current use of inhalants (Table 1). Almost 8 percent of youth reported having ever used prescription-type psychothera- peutic dmgs for nonmedical reasons, and approximately 2 percent reported having done so in the past month. Psychotherapeutic drugs include stimulants, sedatives, tranquilizers, and analgesics. Among these drugs, stimulants and analgesics were the most commonly used. Stimulants had been used by 4.2 percent of youth in their lifetimes and analgesics by 4.1 percent. Sedatives and tranquilizers had ever been used by 2.3 percent and 2.0 percent of youth, respectively. Current use of stimulants and analgesics was reported by Figure 1. Percentage of Youth Aged 12 to 17 Reporting Use of llllclt Drugs, Alcohol, and Cigarettes In LIfetlme, Past Year, and Past Month: 1988 [Ahfilr‘rfit’fifbfié ' " " " w— “Lifetime Past Year Past Month Marijuana Use Lifetime 17.4 Past Year _ 12.8 Past Month 6.4 CEcZThSUEe ' WM—Iiritiif Past Year Past Month Amiga. a . ._ Llfetlme Past Year Past Month (EEEQEWUSB I'Iria‘tTnTéw Past Year Past Month 3.4 2.9 1.1 ‘ 50.2 25.2 ‘ 42.3 0.0 10.0 20.0 30.0 40.0 50.0 60.0 Percent Source: NIDA, National Household Survey on Drug Abuse, 1988. approximately 1 percent of youth, and current use of sedatives and tranquilizers by fewer than 1 percent (Table 1). Compared to other drugs, heroin use was uncommon among youth in 1988 (Table 1). The reported lifetime prevalence of heroin use was 0.6 percent. Nevertheless, heroin use among youth is a serious social and public health concern. Heroin is an extremely addictive drug, and overdoses may be life threatening. The sharing of needles used to inject heroin may result in the transmission of acquired immune deficiency syndrome (AIDS), hepatitis, and other infectious diseases. Heroin use among youth may be more common than these figures indicate because homeless and runaway youth, among whom drug use may be higher, were not included in the sample. Relative to the total population of about 20 million youth aged 12 to 17, these 1988 prevalence figures translate to approximately 5 million youth who had ever used illicit dmgs, more than 10 million who had ever used alcohol, and about 8.6 million who had ever Table 1. Estimated Percentages and Numbers (in Thousands) of Youth Aged 12 to 17 in the US. Household Population Who Have Used Illicit Drugs, Alcohol, and Cigarettes in Lifetime, Past Year, and Past Month: 1988 Youth Aged 12 to 17 Lifetime Past Year Past Month Number Number Number of Users of Users of Users Drug Percent (Thousands) Percent (Thousands) Percent (Thousands) Any Illicit Drug Use1 24.7 5,005 16.8 3,404 9.2 1,866 Marijuana/Hashish 17.4 3,516 12.6 2,545 6.4 1,296 Cocaine 3.4 683 2.9 591 1 .1 225 Crack 0.9 188 0.7 132 0.3 56 Inhalants2 8.8 1,773 3.9 780 2.0 410 Hallucinogens 3.5 704 2.8 565 0.8 168 PCP 1.2 234 0.6 124 0.2 34 Heroin 0.6 118 0.4 85 * * Nonmedical Use of any Psychotherapeutics 7.7 1 ,557 5.4 1,085 2.4 485 Stimulants 4.2 852 2.8 568 1 .2 245 Sedatives 2.3 475 1.7 346 0.6 123 Tranquilizers 2.0 413 1.5 313 0.2 44 Analgesics 4.1 840 3.0 606 0.9 182 Alcohol 50.2 10,161 44.6 9,021 25.2 5,097 Cigarettes 42.3 8,564 22.8 4,614 1 1.8 2,389 Smokeless Tobacco 14.9 3,021 7.0 1,413 3.6 722 *Low precision; no estimated reported. 1Any illicit drug use includes nonmedical use of marijuana or hashish, cocaine (including crack), inhalants, hallucinogens (including PCP), heroin, or psychotherapeutics at least once. 2Inhalants include gasoline, spray paints, aerosol sprays, glue, lacquer thinners, amyl nitrites, ether, nitrous oxide, and correction fluids. 3Nonmedical use of any prescription-type stimulant, sedative, tranquilizer, or analgesic; does not include over-the-counter drugs. Source: NIDA, National Household Survey on Drug Abuse, 1988. smoked cigarettes. Among youth, approximately 1.9 million were current users of illicit dmgs, 5 million were current alcohol users, and 2.4 million were current smokers (Table 1). B. Trends in Current Use, 1972 to 1988 (Figure 2 and Table 2) As shown in Figure 2 and Table 2, the use of most drugs by youth peaked in the late 19705 and has since declined. For example, 7.0 percent of youth used marijuana in the past month in 1972, 16.7 percent in 1979, and 6.4 percent in 1988. Some 34.0 percent of youth were current alcohol users in 1974, 37.2 percent in 1979, and 25.2 percent in 1988. The exception to this pattern is the percentage of current users of cigarettes among youth, Figure 2. Trends in Percentage of Youth Aged 12 to 17 Reporting Use of Illicit Drugs, Alcohol, and Cigarettes in Past Month: 1972-1988 40.0 20.0 Percent 10.0 0.0 Year —/\— Any Illicit Drug % l- Marijuana «fj- Cocaine —.— Alcohol —.- Cigarettes *Data are not available for some years. Note: In 1979, cigarette users included only persons who ever smoked at least five packs. Source: NIDA, National Household Survey on Drug Abuse, 1972-1988. 10 Table 2. Trends In Percentage of Youth Aged 12 to 17 Reporting Drug Use In Past Month: 1972-1988 Drug 1972 1974 1976 1977 1979 1982 1985 1988 (Unweighted u) (880) (952) (986) (1,272) (2,165) (1,581) (2,246) (3,095) Any Illicit Drug Use1 -- -- -- -- 17.6 1271‘ 14.9 9.2+++ Marijuana/Hashish 7.0 12.0 12.3 16.6 16.7 11.5 12.0 6.4+++ Cocaine 0.6 1.0 1.0 0.8 1.4 1.6 1.5 1.1 Inhalantsz 1.0 0.7 0.9 0.7 2.0 -- 3.4 2.0+ Hallucinogens 1.4 1.3 0.9 1.6 2.2 1.4 1.2 0.8 Heroin . . . . . . . . Nonmedical Use of Ary Psychotherapeuticszv -- -- -- -- 2.3 3.8 3.0 2.4 Stimulants -- 1.0 1.2 1.3 1.2 2.6 1.6 1.2 Sedatives -- 1.0 * 0.8 1.1 1.3 1.0 0.6 Tranquilizers -- 1.0 1.1 0.7 0.6 0.9 0.6 0.2 Analgesics -- -- -- -- 0.6 0.7 1 .6 0.9 Alcohol3 -- 34.0 32.4 31.2 37.2 30.2 31.0 25.2++ Cigarettes4 -- 25.0 23.4 22.3 12.1 14.7 15.3 11.8++ -- Estimate not available. ‘Low precision; no estimate reported. 1Nonmedical use of marijuana or hashish, cocaine (including crack), inhalants, hallucinogens (including PCP), heroin, or psychotherapeutics at least once. 2Nonmedical use of any prescription-type stimulant, sedative, tranquilizer, or analgesic; does not include over-the-counter drugs. 3Estimates prior to 1979 for alcohol, and 1982 for psychotherapeutics, may not be comparable to those for later years due to a change in methodology. See Appendix B, Definitions of Demographic Characteristics, tor explanation. 4For 1979, includes only persons who ever smoked at least five packs. 1'The exclusion of inhalants in 1982 is believed to have resulted in underestimates in any illicit use for that year, especially for 12— to 17-year-olds. +Difterence between 1985 and 1988 statistically significant at the .05 level. ++Difference between 1985 and 1988 statistically significant at the .01 level. +++Difterence between 1985 and 1988 statistically significant at the .001 level. Source: NIDA, National Household Survey on Drug Abuse, 1972-1988. 11 which was highest in 1974 (25.0 percent), decreased to 12.1 percent in 1979, increased slightly to 15.3 percent in 1985, but decreased to 11.8 percent in 1988. However, the prevalence of current cigarette use in 1979 may have been slightly underestimated due to a difference in the definition of smoker for that year (only those who smoked at least five packs in their lifetime were defined as smokers). Between 1985 and 1988, the prevalence of current use of all types of drugs decreased among youth. The decreases in current use of any illicit drug, marijuana, inhalants, alcohol, and cigarettes were statistically significant (only the 1985/1988 differences were tested for statistical significance). Trends in current use of any illicit dmg, marijuana, cocaine, alcohol, and cigarettes are shown in Figure 2, and trend data for more specific categories of dmgs are provided in Table 2. For most illicit drugs, the percentage of current users in 1988 was lower than or similar to that during the early to mid-1970s. Rates of current use of alcohol and cigarettes were substantially lower in 1988 than in the early to mid-19703. C. Trends in Current Use by Age Group, 1972 to 1988 (Figure 3) Figure 3 presents trends in current use by youth (aged 12 to 17), young adults (aged 18 to 25), and older adults (aged 26 and older) for each of the three most commonly used drugs: marijuana, alcohol, and cigarettes. (Percentages for this figure are presented in Appendix A in Table A-3.) This figure permits the examination of trends among youth relative to those for the older age groups. For all three drugs, young adults have the highest rates of use in all survey years. Youth are the least likely of the three age groups to have been current users of alcohol or cigarettes, but they are intermediate to young adults and older adults in their use of marijuana in all survey years. The trends in use for all three drugs during the 19703 and 19805 are generally parallel across the three age groups. This similarity suggests that there may be broad, societal-level influences on dmg and alcohol use trends that cut across age groups. For both youth and young adults, current marijuana use was highest in the late 19705 and has declined substantially since then (Figure 3a). Since 1979, the prevalence of current marijuana use among youth decreased from 16.7 percent to 6.4 percent, and among young adults from 35.4 percent to 15.5 percent. The percentage of current users among older adults is somewhat more constant, although there was also a decrease between 1985 and 1988. Between 1985 and 1988, current use of marijuana decreased significantly for all three age groups. The prevalence of current alcohol use was highest for all three age groups in 1979 (Figure 3b). Between 1979 and 1988, the percentage reporting current use of alcohol has declined 32 percent among youth, 14 percent among young adults, and 11 percent among 12 Figure 3. Trends In Percentage Reporting Use of Marijuana, Alcohol, and Cigarettes In Past Month, By Age Group: 1972-1988 3a. Marijuana eo.o .__,, -- w — ~ - 60.0 ‘52 g 400 6'; 20.0 1‘ 72 74 7677 79 32 as as Your 3b.Aioohol eo.o —— ——~ — —~~ Percent 8 O 20.0.»...... . 0,0 LH47++7+— 4~ 4—4 ~+ v+A is «l 74— 4—4—4 72 74 76 77 79 82 85 88 Year Sc. Cigarettes soo]~—~fi— , ~ _, — — ‘1 60.0 7:7 2 40.0 g l 20-0 ‘ ' M , -. 12.0 7 7- 6‘ d\9°‘ Drug *Low precision; no estimate reported. Note: The number of lifetime users (unweighted E) are given in parentheses. Source: NIDA, National Household Survey on Drug Abuse, 1988. 35 V. PROBLEMS ASSOCIATED WITH USE Many youth who reported having begun to use illicit drugs, alcohol, or cigarettes also reported experiencing problems related to their use. These problems ranged from psychological depression, to decreased productivity at work or school, to feelings of dependency, and to certain negative experiences with drinking. This chapter describes the prevalence of drug-related problems among youth and also reports the percentage of youth who perceived great risk for using various drugs. A. Problems Related to Drug Use (Tables 8 and 9) Respondents to the 1988 NHSDA were asked whether they had experienced each of 1 1 problems in the past year because of their use of cigarettes, alcohol, or other drugs; they were then asked to attribute these problems to one or more of these drugs. These problems include feelings of anxiety or depression, arguments and fights with family and friends, and decreased productivity at work or school. The percentage of youth who experienced any of these problems by age category is presented in Table 8. The Table 8. Percentage of Youth Aged 12 to 17 Reporting Problems Resulting from Their Use of Alcohol, Cigarettes, or Other Drugs in Past Year, by Age Category: 1988 Age Category Number of Alcohol, Cigarette, Total or Dmg-Related Problems1 12—13 14-15 16-17 (12-17) One or more problems 2.2 15.3 24.4 14.8 Two or more problems 1.2 10.1 15.1 9.4 Three or more problems 0.7 6.8 10.3 6.3 1 Respondents were asked whether they had experienced each of 11 problems in the past year because of their use of alcohol, cigarettes, or other drugs; they were then asked to identify the specific drugs that caused each problem. The problems include feelings of anxiety or depression, problems with family or friends, and decreased productivity at work or school. Source: NlDA, National Household Survey on Drug Abuse, 1988. 37 Table 9. Percentage of Youth Drug Users Aged 12 to 17 Reporting Drug-Related Problems in Past Year, by Type of Drug to Which Problems Were Attributed: 1 988 Drug Used in Past Year Mari- Ciga- Problems in Past Year juana Cocaine Alcohol rettes (Unweighted [\l_) (387) (97) (1,300) (607) Became depressed or lost interest in things 11.3 13.8 7.6 2.2 Had arguments and fights with family or friends 7.0 13.1 9.8 3.1 Felt completely alone and isolated 4.9 8.8 4.2 1.2 Felt very nervous and anxious 7.4 20.1 5.7 5.2 Had health problems 2.4 8.3 1.8 3.6 Found it difficult to think clearly 14.0 8.8 11.2 0.4 Felt irritable and upset 3.6 6.3 5.5 1.6 Got less work done than usual at school or on the job 7.7 6.2 3.8 1.1 Felt suspicious and distrustful of people 5.6 9.8 4.0 * Found it harder to handle my problems 4.3 3.9 3.0 1.0 Had to get emergency medical help * * 0.8 ‘ One or more of the problems above 28.8 26.8 20.7 12.6 Two or more of the problems above 16.4 22.8 12.0 3.7 Three or more of the problems above 1 1.1 13.7 8.2 2.1 'Low precision; no estimate reported. Source: NIDA, National Household Survey on Drug Abuse, 1988. 38 percentage who reported each specific problem, by type of drug to which the problem was attributed, is presented in Table 9.3 As shown in Table 8, 14.8 percent of all youth reported one or more problems in the past year because of their use of cigarettes, alcohol, or other drugs. Two or more problems were reported by 9.4 percent, and three or more problems by 6.3 percent. The prevalence of drug-related problems was highly associated with age. Only 2.2 percent of 12- and 13- year-olds reported any drug-related problems, compared to 24.4 percent of 16- and 17- year-olds. Table 9 shows the percentages of past year users of marijuana, cocaine, alcohol, and cigarettes who reported problems due to their use of these drugs. For example, of those who reported using marijuana in the past year, 11.3 percent reported becoming depressed or losing interest in things because of their use of marijuana. The problem most frequently attributed to marijuana use was difficulty in thinking clearly, reported by 14 percent of the past year users of marijuana. This was also the most common problem attributed to alcohol, reported by 11 percent of those who had used alcohol in the past year. Feeling nervous and anxious was the most frequently mentioned problem related to the use of both cocaine (20.1 percent) and cigarettes (5.2 percent). Overall, the percentage of users of each of these four drugs who reported one or more problems due to those drugs was slightly higher for marijuana use than cocaine use, and it was higher for these illicit dmgs than for use of alcohol or cigarettes. B. Dependency Symptoms Related to Drug Use (Figure 13 and Table 10) Youth, as well as adults, may begin to feel dependent on their use of illicit drugs, alcohol, or tobacco. The symptoms of dependency investigated here include (1) attempts to cut down on use of a drug, (2) tolerance or using larger amounts of the drug to experience the same effect, (3) daily use of the drug, (4) feelings of dependence on the drug, and (5) withdrawal symptoms such as sickness upon cessation of use or decreased use. Respondents to the 1988 NHSDA were asked whether they had experienced each of these symptoms related to their use of marijuana, cocaine, alcohol, and cigarettes in the past 3As discussed more fully in the 1988 Main Findings report (NIDA, 1990b), because of nonresponse the numbers presented in Tables 8 and 9 may be underestimates of the percentages experiencing problems. If respondents had never used alcohol or illicit drugs, they were instructed to skip those items; however, many users skipped these items as well. In addition, respondents were first asked whether they had experienced each of the problems in the past year, then they were asked which drug or drugs had caused the problem. The use of two separate questions may have been an additional source of nonresponse because respondents could answer the first question but refuse to answer the second. Comparisons of data resulting from two different assumptions regarding missing data suggest that the estimates presented here may underestimate the true percentage by up to 2 percentage points. 39 Flgure 13. Percent [- Used Dmg in Past Year Note: Percentage of Youth Aged 12 to 17 Reportlng Drug Use and Symptoms of Dependency in Past Year, by Type of Drug: 1988 50.0 40.0 30.0 20.0 10.0 0.0 12.6 ‘ :2;2;I 2:2 ,7 , "W 7, , ‘ Marijuana Cocaine Alcohol Clgarettes . Any Symptoms of Dependency on Thatlirug Respondents were asked whether they had experienced each of five dependency symptoms in the past year related to their use of marijuana, cocaine, alcohol, and cigarettes. The symptoms of dependency include (1) attempts to cut down on use of a drug, (2) tolerance or using larger amounts of the drug to experience the same effect, (3) daily use of the drug, (4) feelings of dependence on the drug, and (5) withdrawal symptoms such as sickness upon cessation or decreased use. Source: NIDA, National Household Survey on Drug Abuse, 1988. 40 Table 10. Percentage of Youth Drug Users Aged 12 to 17 Reporting Symptoms of Dependency in Past Year, by Type of Drug to Which Symptoms Were Attributed: 1988 Drug Used in Past Year Symptoms of Dependency Marijuana Cocaine Alcohol Cigarettes (Unweighted E) (387) (97) (1,300) (607) Tried to cut down 35.2 31.1 31.6 63.8 Used larger amounts 18.9 22.2 12.3 13.1 Used every day 20.0 12.8 5.3 44.7 Needed, dependent 12.4 14.7 5.3 35.0 Withdrawal symptoms 6.1 12.1 3.9 12.2 Any of the above symptoms of dependency 46.4 40.2 38.2 71.2 Source: NIDA, National Household Survey on Drug Abuse, 1988. year. The percentage of youth who reported use of each of the four drugs and symptoms of dependency on those drugs is presented in Figure 13. The percentage of users of each drug who had experienced specific dependency symptoms associated with that drug in the past year is presented in Table 10. As shown in Figure 13, many youth who reported having used marijuana, cocaine, alcohol, or cigarettes in the past year had also experienced symptoms of dependency because of use of those drugs. For instance, 12.6 percent of youth reported having used marijuana in the past year, and 5.8 percent reported one or more symptoms of dependency associated with marijuana use. As shown in Table 10, this 5.8 percent of youth who had experienced dependency symptoms associated with marijuana use constitutes 46.4 percent of marijuana users. Approximately 16 percent of all youth reported having experienced dependency symptoms because of cigarette use and 17 percent because of alcohol use; smaller percentages had experienced problems associated with marijuana use or cocaine use (Figure 13). Fully 71 percent of youth who had used cigarettes in the past year experienced dependency symptoms because of such use, which was higher than for other drugs (Table 10). For all drugs, the most prevalent symptom of dependency was trying to cut down on its use. 41 C. Negative Experiences Related to Alcohol Use (Figure 14 and Table 11) Respondents were also asked whether they had any of 18 negative experiences in the past year because of their drinking. The percentage of youth drinkers who reported having any negative experiences with drinking, by frequency of drinking in past month, is presented in Figure 14. The percentage of youth who reported having experienced each of the negative experiences with drinking is reported in Table 11. The negative experiences with drinking range from feeling aggressive or cross while drinking, to getting into a heated argument while drinking, to being unable to remember what happened while drinking. As shown in Figure 14, more than two-thirds of youth who drank in the past month experienced one or more negative experiences with their drinking within the previous year. Approximately 54 percent of those who drank on 1 or 2 days reported one or more negative experiences, compared with more than 90 percent of those who drank on more than 10 days. The likelihood of negative drinking experiences was thus closely tied to the frequency of consumption. As Table 11 indicates, a wide variety of drinking-related problems were reported by youth who stated that they had consumed alcohol in the past year. Most common among these were tossing drinks down fast to get an effect and being unable to remember what happened. Three or more problems were reported by 28.6 percent of those who had drunk alcohol in the past year. D. Perceived Risks of Drug Use (Table 12) The perceived likelihood of harmful effects may be an important deterrent to the use of alcohol, cigarettes, and illicit drugs. Table 12 reports the percentage of youth who perceived a great risk of harm for various levels and types of substance use. For the entire sample of youth aged 12 to 17, this percentage ranged from approximately 26 percent for having one or two drinks nearly every day to more than 90 percent for using either cocaine or heroin regularly. The majority of respondents perceived great risk for many of the drug use categories. Ironically, despite all the scientific evidence available on the health consequences of smoking, fewer than half of the respondents perceived a great risk for smoking one or more packs of cigarettes per day. Overall, use of illicit dmgs was more likely to be viewed as risky than was use of alcohol or cigarettes, and regular use of dmgs was more likely to be perceived as risky than was occasional use or use of drugs only once or twice. The percentage of youth who perceived great risk for most types of drug use was remarkably similar across age groups. However, the percentage who perceived great risk of using most illicit drugs was slightly higher among older youth. The major exception to this pattern was for smoking marijuana occasionally, for which perceived great risk was 53.4 percent among 12— and 13-year-olds and 37.7 percent among 16- and 17-year-olds. 42 Figure 14. Percentage of Past Month Drinkers Aged 12 to 17 Reporting Negative Drinking-Related Experiences in the Past Year, by Frequency of Alcohol Use in Past 30 Days: 1988 100.0 ~L W Wfiii‘m N 80.0 .0—0 : 60.0 — (D 0 h <1) 1 40.0 — 20.0 — 0.0 — ~ Any Use 1-2 Days 3-5 Days 6-10 Days 11-30 Days Frequency of Alcohol Use in the Past 30 Days Note: Respondents were also asked whether they had one or more of 18 negative experiences with their drinking during the past year. The negative experiences included feeling aggressive or cross while drinking, getting into a heated argument while drinking, and being unable to remember what happened while drinking. The number of respondents (unweighted E) in each category is given in parentheses. Only respondents who reported having at least one drink in the past month are included in this figure. Source: NIDA, National Household Survey on Drug Abuse, 1988. Table 11. Percentage of Past Year Drlnkers Aged 12 to 17 Reporting Negatlve Experlences Associated with Their Drinking: 1988 1 Problems Associated with Drinking During Past Year Percent (Unweighted 3) (1,300) Aggressive or cross while drinking 19.1 Heated argument while drinking 12.7 Stayed away from work or school 4.5 High or tight on job or at school 9.5 Lost or nearly lost job * Partner told me I should cut down 10.6 Relative told me I should cut down 7.4 Friend told me I should cut down 8.4 Tossed down drinks fast to get effect 25.0 Afraid I might be or become alcoholic 15.5 Stayed drunk for more than one day 4.6 Difficult for me to stop drinking 10.1 Unable to remember what happened 23.9 Quick drink when no one was looking 16.6 Drink first thing in morning 2.3 Hands shook after drinking day before 3.7 Get high or tight while drinking alone 12.2 Kept on drinking after promising myself not to 10.7 Any of the above problems 54.2 Three or more of the above problems 28.6 Note: Only respondents who reported having at least one drink in the past 12 months are included in this table. *Low precision; no estimate reported. 1Respondents with missing data on problems are coded as not having problems. Compared with estimates based on coding missing data for nonusers or light users of alcohol as not having problems, the figures are somewhat conservative estimates of the prevalence of problems. Source: NIDA. National Household Survey on Drug Abuse, 1988. Table 12. Percentage of Youth Perceiving Great Risk of Using Cigarettes, Drugs, or Alcohol by Age Category: 1988 Age Category (years) Total Risk Behavior 12-13 14-15 16—1 7 12-17 Smoke one or more packs of cigarettes per day 47.8 44.5 48.9 47.1 Smoke marijuana occasionally 53.4 42.8 37.7 44.1 Smoke marijuana regularly 84.4 79.7 78.5 80.7 Try PCP once or twice 48.3 47.4 51.1 49.0 Use PCP regularly 86.2 88.1 92.6 89.2 Try heroin once or twice 44.2 47.4 53.2 48.5 Use heroin regularly 88.8 89.5 94.3 91.0 Use cocaine occasionally 75.5 75.7 81.3 77.7 Try cocaine once or twice 52.0 49.6 56.4 52.8 Use cocaine regularly 90.1 93.1 95.3 93.0 Use "crack" occasionally 76.0 75.5 84.6 78.9 Take one or two drinks nearly every day 27.0 25.6 24.1 25.5 Take four or five drinks nearly every day 62.3 61.3 65.9 63.3 Have five or more drinks once or twice a week 54.0 49.9 51.3 51.6 Note: Questions asked were: How much do you think people risk harming themselves physically, and in other ways, when they do each of the following activities? Response choices for each of 14 activities were: (1) no risk, (2) slight risk, (3) moderate risk, and (4) great risk. Source: NIDA, National Household Survey on Drug Abuse, 1988. 45 VI. SUMMARY The prevalence of drug use among youth decreased during the 19805, but many youth reported use of illicit drugs, alcohol, and cigarettes and experienced problems with their use. A. Prevalence and Trends In 1988, one-fourth of youth aged 12 to 17 reported they had used one or more illicit drugs in their lifetimes, one-half had used alcohol, and more than 40 percent had used cigarettes. These rates translate to approximately 5 million youth who have used one or more illicit drugs in their lifetimes, more than 10 million who used alcohol, and 8.6 million who used cigarettes. Some 9 percent of youth reported that they were current users of illicit dmgs; that is, they had used one or more illicit drugs in the past month. Approximately 25 percent were current alcohol users, and 12 percent were current cigarette smokers. Reported use of most illicit drugs, alcohol, and cigarettes by youth aged 12 to 17 peaked during the late 19705 and declined since then. Between 1985 and 1988, significant decreases in the prevalence of use of any illicit drug, marijuana, inhalants, alcohol, and cigarettes in the past month were found for all youth. The prevalence of use of cocaine, hallucinogens, and prescription—type psychotherapeutic drugs in the past month was similar in 1985 and 1988. Between 1985 and 1988, significant decreases in the prevalence of use of any illicit drug in the past month were found for males and females, all racial/ethnic groups, and residents of the Northeast and West. Marijuana was the illicit drug most commonly used by youth; lifetime use was reported by 17 percent of youth, with 6 percent reporting use in the past month. Other illicit drugs were used by 2 percent or fewer youth in the past month. Compared with older age groups, youth were least likely to be current users of alcohol or cigarettes, but were more likely than those aged 26 and older to be current marijuana users. Young adults aged 18 to 25 were more likely than youth or older adults to be current users of marijuana, alcohol, and cigarettes. B. Correlates of Use Among youth, use of illicit drugs, alcohol, and cigarettes increased with age. For alcohol and tobacco, the percentages of lifetime users were only slightly higher from the late teens to midtwenties, indicating that most initial use of these substances occurs during adolescence. Past year and past month use of any illicit drug, marijuana, and cigarettes peaked at ages 18 to 20 and was slightly lower for the 21 - to 25-year-old age group. 47 However, past year and past month use of alcohol was steadily higher throughout the entire age range from 12 to 25. Some differences in drug use by youth among demographic groups were found. Males and females were equally likely to report current use of any illicit drug, marijuana, and cigarettes, but males were more likely than females to report current alcohol use. Whites were more likely than were blacks and Hispanics to be current users of most dmgs. Youth living with both natural parents were less likely than were those living in other situations to use drugs. There were few differences in the prevalence of drug use by geographic region, population density (metropolitan/nonmetropolitan), and school status (currently enrolled in school or dropped out). However, high school dropouts were significantly more likely to smoke cigarettes than were those remaining in school. C. Patterns of Use Most youth who had used marijuana, cocaine, or alcohol in the past month reported that they were infrequent users. However, approximately 3.4 percent of youth drank alcohol on more than 5 days in the past month and about 2 percent smoked a pack or more of cigarettes a day in the past month. Almost 40 percent of youth reported that they had never used alcohol, cigarettes, or illicit dmgs; 36 percent had used either alcohol or cigarettes but not illicit drugs; and almost one-fourth had used illicit drugs. Relatively few youth had used illicit drugs who had not also used either cigarettes or alcohol. Among those aged 16 and 17, the average age at first use ranged from 12.4 for cigarettes to 15.5 for cocaine. D. Problems and Perceived Risks Associated with Drug Use Approximately 15 percent of youth reported problems in the past year resulting from the use of alcohol, drugs, or cigarettes. Users of cocaine and marijuana were more likely to report problems from their drug use than were users of alcohol and cigarettes. Some 6 percent of youth reported experiencing one or more symptoms of dependency for marijuana use, while 17 percent reported one or more dependency symptoms for alcohol and 16 percent for cigarettes. Of those who used alcohol, cigarettes, marijuana, or cocaine in the past year, the percentage who experienced one or more symptoms of dependency was highest for cigarette users (71 percent). More than two—thirds of the youth who drank in the past month reported negative experiences with their drinking during the previous year, and the percentage who reported such experiences increased with the frequency with which alcohol was consumed. The percentage of youth who attributed great risk from using drugs ranged from 25 percent for having one or two drinks nearly every day to more than 90 percent for using alcohol or cocaine regularly. The perception of risk for most categories of dmg use was similar across age categories. REFERENCES answick, A. F., Merzer, C. R., & Messeri, P. A. (1985). Dmg use initiation among urban black youth: A seven-year followup of developmental and secular influences. Youth and Society, 17(2), 189-216. Johnston, L. D., O'Malley, P. M., & Bachman, G. G. (1988). Illicit dnJg use, smoking, and drinking by America ’s high school students, college students, and young adults 1975- 1987. Rockville, MD: National Institute on Drug Abuse. Kandel, D. B. (1980). Drug and drinking behavior among youth. Annual Review of Sociology, 6, 235-285. Kandel, D. B., & Logan, J. A. (1984). Patterns of dmg use from adolescence to young adulthood: I. Periods of risk for initiation, continued use, and discontinuation. American Journal of Public Health, 74(7), 660-666. Kandel, D. B., & Yamaguchi, K. (1985). Developmental patterns of the use of legal, illegal, and medically prescribed psychotropic drugs from adolescence to young adulthood. In Jones, C. L., & Battjes, R. J. (Eds.), Etiology of drug abuse: Implications for prevention (pp. 193-235). (NIDA Research Monograph 56. A RAUS Review Report). Rockville, MD: National Institute on Drug Abuse. Kandel, D. B., Davies, M., Karus, D., & Yamaguchi, K. (1986). The consequences in young adulthood of adolescent drug involvement. Archives of General Psychiatry, 43, 746- 754. Kandel, D. B., Simcha-Fagan, 0., & Davies, M. (1986). Risk factors for delinquency and illicit drug use from adolescence to young adulthood. Journal of Drug Issues, Winter, 67-90. Newcomb, M. D., & Bentler, P. M. (1988). Consequences of adolescent dmg use: Impact on the lives of young adults. Newbury Park, CA: SAGE Publications, Inc. NIDA (National Institute on Dmg Abuse). (1990a). National Household Survey on Drug Abuse: Highlights 1988. Rockville, MD: Author. NIDA (National Institute on DnJg Abuse). (1990b). National Household Survey on Drug Abuse: Main Findings 1988. Rockville, MD: Author. NIDA (National Institute on DnJg Abuse). (1990c). National Household Survey on Drug Abuse: Population Estimates 1988. Rockville, MD: Author. O’Donnell, J. A., Voss, H. L., Clayton, R. R., Slatin, G. F., & Room, R. G. W. (1976). Young men and drugs—a nationwide survey (NIDA Research Monograph 5). Rockville, MD: National Institute on Drug Abuse. Rachal, J. V., Williams, J. R., Brehm, M. L., Cavanaugh, E. R., Moore, R. P., & Eckerman, W. C. (1975). A national study of adolescent drinking behavior, attitudes, and correlates. Research Triangle Park, NC: Research Triangle Institute. 49 U.S. DHHS (United States Department of Health and Human Services). (1990). Press conference to release the National Household Survey on Drug Abuse, December 19, 1990. Washington, DC: Author. University of Michigan. (1990, February 9). Drug use continues to decline. Ann Arbor, MI: News and Information Services, University of Michigan. 50 APPENDIX A SELECTED DATA TABLES 51 Table A-1. Number of lntervlewed Youth Aged 12 to 17 and Estimated Number In Household Population, by Demographic Characteristics: 1988 Interviewed Youth Estimated Number in Household Population Demographic Characteristic Number % (in thousands) Total 3,095 1 00.0 20,250 Age 12 and 13 925 29.1 5,900 14 and 15 1,060 34.8 7,043 16 and17 1,110 36.1 7,308 Sex Male 1,557 51.1 10,354 Female 1 ,538 48.9 9,896 Race/Ethnicity White 1,518 71.8 14,533 Black 747 15.3 3,102 Hispanic 763 10.5 2,118 Other 67 2.5 498 Population Density Large Metropolitan 1,485 39.5 7,993 Small Metropolitan 899 32.5 6,581 Nonmetropolitan 71 1 28.0 5,676 Region Northeast 568 18.5 3,753 North Central 648 26.3 5,318 South 1,214 39.2 7,943 West 665 1 6.0 3,237 School Status1 Enrolled 986 90.8 6,588 Dropped out 72 5.9 427 High school graduate 42 3.3 241 Living Arrangement Living with both natural parents 1,827 65.1 13,047 Living with one natural and one stepparent 229 8.7 1,735 Living with single parent 839 22.4 4,479 Other 162 3.8 770 1"School Status" applies only to ages 16 and 17. Source: NIDA, National Household Survey on Drug Abuse, 1988. 53 Table A-2. Estlmated Percentages and Numbers of Users (Thousands) of Alcohol, Tobacco, and Selected Drugs In US. Household Populatlon, Aged 12 or Older, In Llfetlme, Past Year, and Past Month: 1988 Time Period Lifetime Past Year Past Month Number of Number of Number of Users Users Users Drug Percent (Thousands) Percent (Thousands) Percent (Thousands) Any Illicit Drug Use1 36.6 72,496 14.1 27,971 7.3 14,479 Marijuana/Hashish 33.1 65,748 10.6 21 ,099 5.9 1 1,616 Cocaine 10.7 21,171 4.1 8,208 1.5 2,923 Crack 1.3 2,483 0.5 1,026 0.2 484 lnhalants 5.7 11,261 1.3 2,632 0.6 1,223 Hallucinogens 7.4 14,607 1.6 3,085 0.4 776 PCP 3.1 6,133 0.2 377 ‘ * Heroin 1.0 1,907 0.3 539 " * Nonmedical Use of ny Psychotherapeutics 1 1 .9 23,526 5.7 1 1 ,399 1 .7 3,393 Stimulants 7.1 14,068 2.5 4,957 0.9 1,755 Sedatives 3.5 6,975 1 .6 3,099 0.4 784 Tranquilizers 4.8 9,482 2.2 4,407 0.6 1,174 Analgesics 5.2 10,257 2.7 5,342 0.6 1,151 Alcohol 85.0 168,498 68.1 135,071 53.4 105,845 Cigarettes 75.1 149,005 34.2 67,831 28.8 57,121 Smokeless Tobacco 14.9 29,467 5.0 10,016 3.6 7,073 ‘Low precision; no estimate reported. 1Nonmedical use of marijuana or hashish, cocaine (including crack), inhalants, hallucinogens (including PCP), heroin, or psychotherapeutics at least once. 2Nonmedical use of any prescription—type stimulant, sedative, tranquilizer, or analgesic; does not include over-the-counter drugs. Source: NIDA, National Household Survey on Drug Abuse, 1988. 54 Table A-3. Trends In Percentage Reporting Use of Marijuana, Alcohol, and Cigarettes In Past Month, by Age Group: 1972-1988 Dmg 1972 1974 1976 1977 1979 1982 1985 1988 Marijuana/Hashish 12 to 17 7.0 12.0 12.3 16.6 16.7 11.5 12.0 6.4 18 to 25 27.8 25.2 25.0 27.4 35.4 27.4 21.8 15.5 226 2.5 2.0 3.5 3.3 6.0 6.6 6.1 3.9 Alcohol 12 to 17 -- 34.0 32.4 31.2 37.2 30.2 31.0 25.2 18 to 25 -- 69.3 69.0 70.0 75.9 70.9 71.4 65.3 226 -- 54.5 56.0 54.9 61.3 59.8 60.6 54.8 Cigarettes1 12 to 17 -- 25.0 23.4 22.3 12.1 14.7 15.3 11.8 18 to 25 -- 48.8 49.4 47.3 42.6 39.5 36.8 35.2 226 -- 39.1 38.4 38.7 36.9 34.6 32.8 29.8 -- Not available. 1For 1979, includes only persons who ever smoked at least five packs. Source: NIDA, National Household Survey on Drug Abuse, 1972-1988. 55 99 Table A-4. Percentage of Youth and Young Adults Reporting Use of Any Illicit Drug, Marijuana, Alcohol, and Cigarettes in Lifetime, Past Year, and Past Month, by Age Category: 1988 Any Illicit Drug Marijuana Alcohol Cigarettes Past Past Past Past Past Past Past Past Age (Unweighted 3) Lifetime Year Month Lifetime Year Month Lifetime Year Month Lifetime Year Month 12 and 13 (925) 8.4 4.9 2.4 4.2 2.8 1.5 22.2 16.2 6.5 22.6 10.3 3.3 14 and 15 (1,060) 23.1 15.7 8.7 15.0 10.6 4.9 49.3 43.6 23.2 43.9 24.1 10.5 16 and 17 (1,110) 39.4 27.5 15.2 30.3 22.4 11.8 73.6 68.4 42.2 56.6 31.6 19.9 18 to 20 (592) 52.7 30.3 18.9 49.1 32.0 16.3 85.2 77.8 52.9 72.0 49.3 35.5 21 to 25 (913) 62.6 29.9 17.2 60.7 25.5 15.0 93.3 84.1 69.7 76.7 42.0 35.0 Source: NlDA, National Household Survey on Drug Abuse, 1988. APPENDIX B KEY DEFINITIONS 57 Definitions of Drug Use The following definitions of drug use, as well as those for demographic characteristics, are based on the instruments used to administer the 1988 NHSDA. In this report, the prevalence of use of illicit drugs, alcohol, and tobacco is examined for three time periods, defined as: Lifetime use: used one or more times in the individual’s lifetime. Past year use: used one or more times in the year before the survey. Past month use: used one or more times in the month (30 days) before (also referred to the survey. as current use) The following dmgs or classes of drugs were examined in the 1988 NHSDA: marijuana (including hashish), cocaine (including crack), inhalants, hallucinogens (including PCP), heroin, nonmedical use of prescription psychotherapeutic drugs (stimulants, sedatives, tranquilizers, and analgesics), alcohol, cigarettes, and smokeless tobacco. Because drug users may use several different substances, it is impossible to determine the total proportion of the population using illicit drugs by adding together the proportion using each individual drug. Therefore, a composite measure, "any illicit drug use,” was also constructed for purposes of analysis. Throughout this report, both "(any) illicit drugs" and "illicit use of dmgs" refer to the use of any illegal drugs such as marijuana, cocaine, inhalants, hallucinogens, or heroin, as well as nonmedical use of prescription stimulants, sedatives, tranquilizers, or analgesics. 59 Definitions of Demographic Characteristics Demographic characteristics of drug users examined in this report are age, sex, race/ethnicity, population density, region, school status, and living arrangement. These terms are defined below, and estimates are given of the numbers of individuals with such characteristics in the US. household population aged 12 and older and, where appropriate, for youth. The estimated numbers of youth in each demographic group in the household population are presented in Table A-1 in Appendix A. Age Age Category Age Group High School Graduation Status Living Arrange- ment Age of respondents was defined as age at the time of interview. The discussion in most of this report centers on "youth," those aged 12 to 17. Some comparisons are made to ”young adults," those aged 18 to 25, and "older adults," aged 26 or older. The estimated numbers of individuals in the household population in these four groups are: youth, 20 million; young adults, 30 million; and older adults, 149 million. A categorization of ages for youth and young adults into five levels: ages 12 and 13, 14 and 15, 16 and 17, 18to 20, and 21 to 25. A categorization of ages for all National Household Survey respondents into three levels: ages 12 to 17 (youth), 18 to 25 (young adults), and 26 and above (older adults). This variable was defined for respondents aged 21 to 25. It was determined by examining the last grade completed in school and whether the respond- ent was enrolled in school at the time of the survey. Persons aged 21 to 25 who had completed the twelfth grade or higher were classified as graduates. Those who had not completed twelfth grade and were not currently enrolled were classified as dropouts. Approximately 2 percent of the respondents aged 21 to 25 had not completed twelfth grade, but were currently enrolled. These persons were not assigned a high school graduation status. "Living arrangement" concerns the presence of parents in the youth’s household and was defined for all respondents aged 12 to 17. Based on their reports of persons living in the household, respondents were classified as living with "both natural parents," “one natural parent and one stepparent," ”living with a single (natural or step) parent, or "other." Slightly more than 13 million youth in the household population reported living with both natural parents. Almost 2 million reported living with one natural and one stepparent, while around 4.5 million live with a single parent. Approximately 770,000 reported living in other situations, including with other relatives or unrelated individuals. 60 Population Density Race/ Ethnicity Region School Status Individuals in the U.S. household population were divided into three categories based on the density of the population in which they lived. Two of the categories were considered urban: large metropolitan and small metropolitan. "Large metro" includes metropolitan areas with a population of 1,000,000 or more; approximately 84 million reported living in large metropolitan areas. "Small metro" includes metropolitan areas with populations of 50,000 to 999,999; approximately 64 million individuals reported living in small metropolitan areas. The third category is "nonmetro" and includes small towns and mral nonfarm and farm areas outside the large and small metropolitan areas; approximately 50 million individuals reported living in these areas. In line with the current Census classification, individuals were grouped into four racial/ethnic groups. Individuals referred to as "white" were those who stated that they are "white," but "not of Hispanic origin." Approximately 157 million people in the U.S. household population aged 12 or older met this definition. Individuals referred to as "black" were those who reported being "black," but "not of Hispanic origin." This included approximately 22 million people in the United States household population aged 12 and older. "Hispanic" included anyone of Hispanic on'gin--whether racially black, white, or other; this category included approximately 15 million individuals. The category "other" included all other individuals, of which there were approximately 4 million in the U.S. household population aged 12 and older. Because the NHSDA included very few individuals classified as "other," separate prevalence estimates were not developed for this group, although they were included in the prevalence rates for the total population. "Region" corresponded to the Census categorization of the coterminous U.S. into four areas. Exhibit 1 presents the locations of these regions and the U.S. Postal Service abbreviations for each State included in that region. For the 1988 NHSDA, the Northeast comprised approximately 40 million individuals in the U.S. household population aged 12 and older; the North Central, the South, and the West included 47 million, 73 million, and 38 million individuals, respectively. "School status" indicated whether respondents were currently enrolled in school, had dropped out of school, or had graduated from high school. This variable was defined for 16- and 17-year-olds only. School status was determined by examining the last grade completed in school and whether the respondent was enrolled in school at the time of the survey. Persons aged 16 and 17 who had completed the 11th grade or lower and were currently enrolled were classified as "enrolled." Approximately 6.6 million persons in the household population aged 16 and 17 fell into this category. Persons in this age group who had completed the 11th or some lower grade, but were not enrolled at the time of the interview, were classified as "dropped out." Slightly more than 400,000 persons in the household population aged 16 and 17 met this definition. Finally, persons who had completed the 12th grade were classified as "high school graduates," regardless of enrollment status. 61 Sex Approximately 240,000 persons in the household population aged 16 and 17 met this definition. Males constituted approximately 95 million of the U.S. population aged 12 and older and females approximately 103 million. Exhibit 1. Census Regions of the United States North Central Northeast 62 A75? 125 1992 UL. BERKELEY LIBRARIES \\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\ DDDDDDDDDD DIIIlS Publication No. (ADM) 91-1765 Alcohol Drug Abuse and Mental Health Administration Printed 1991 fun-r—v-aw-“I