Context: Comprehensive descriptions of substance use and abuse trajectories have been lacking in nationally representative samples of adolescents.
Objective: To examine the prevalence, age at onset, and sociodemographic correlates of alcohol and illicit drug use and abuse among US adolescents.
Design: Cross-sectional survey of adolescents using a modified version of the Composite International Diagnostic Interview.
Setting: Combined household and school adolescent samples.
Participants: Nationally representative sample of 10 123 adolescents aged 13 to 18 years.
Main Outcome Measures: Lifetime estimates of alcohol and illicit substance use and DSM-IV diagnoses of abuse, with or without dependence.
Results: By late adolescence, 78.2% of US adolescents had consumed alcohol, 47.1% had reached regular drinking levels defined by at least 12 drinks within a given year, and 15.1% met criteria for lifetime abuse. The opportunity to use illicit drugs was reported by 81.4% of the oldest adolescents, drug use by 42.5%, and drug abuse by 16.4%. The median age at onset was 14 years for alcohol abuse with or without dependence, 14 years for drug abuse with dependence, and 15 years for drug abuse without dependence. The associations observed by age, sex, and race/ethnicity often varied significantly by previous stage of use.
Conclusions: Alcohol and drug use is common in US adolescents, and the findings of this study indicate that most cases of abuse have their initial onset in this important period of development. Prevention and treatment efforts would benefit from careful attention to the correlates and risk factors that are specific to the stage of substance use in adolescents.