The Results Are In: Adolescent Drug and Alcohol Use During the Pandemic

We wanted to take a look at the impact of the pandemic on adolescent drug and alcohol use.

During 2021, Did Teens Smoke, Drink, and Vape More Than in 2020?

In March of 2020, when the coronavirus pandemic swept across the United States, experts on adolescent development issued a series of dire warnings about the potential negative impact of the public health measures enacted in most states, cities, and communities.

Think back to that March and you’ll remember that everything on the following list was new to almost all of us:

• Shelter-in-place orders
• Social distancing
• Wearing surgical masks/other protective masks
• Virtual school (for most)
• Virtual work
• The idea of essential business
• The idea of essential travel
• COVID bubbles, i.e. the select group of people you could interact directly with, i.e. from less than 6 feet and without a mask

Educators, mental health professionals, and others warned the combination of all these changes would lead to problematic outcomes for teens. We’ll leave the impact on adults out of this article. Although we know the mental health of parents has a direct impact on the mental health of their children, that’s a topic for a separate article.

This article is about those warnings.

The experts warned virtual school would lead to learning loss. They warned social isolation and grief associated with the loss of milestone events like graduations, state championships, and proms would lead to an increase in mental health problems such as depression and anxiety. They warned the increase in mental health problems would lead to an increase in alcohol and substance use among teens.

The warnings were dire, and now that the results are in, we have a question:

Did the predictions come true?

Let’s take a look at the evidence.

COVID, Teens, and Substance Use: Increase or Decrease?

The first thing we’ll talk about is something we won’t focus on: learning loss due to virtual school. Here’s a quote from an article called “COVID-19 and the Education: The Lingering Effects of Unfinished Learning” from the well-known consulting firm McKinsey & Company, which is supported by data published the Brooking Institute in a study called “Test Score Patterns Across Three COVID-19-impacted School Years”:

“Our analysis shows that the impact of the pandemic on K–12 student learning was significant, leaving students on average five months behind in mathematics and four months behind in reading by the end of the school year.”

Now let’s look at the second major prediction: an increase in mental health among teens. We don’t have to go far to find the answers on this question. We’ve written dozens of articles about the impact of COVID-19 on adolescent mental health. The statistics presented by the Surgeon General’s publication “Protecting Youth Mental Health” on Teen Mental Health, which we discuss in our article “Surgeon General’s Advisory: Youth Mental Health in 2021” tell the story in a clear and concise manner.

Here’s the relevant data on youth mental health:

Worldwide Youth and Teen Mental Health: 2021 v. 2019

• General Mental Health:
  • Symptoms of anxiety and depression doubled
    • 20% of youth reported depressive symptoms
    • 25% of youth reported anxiety symptoms
  • Symptoms related to behavioral disorders such as ADHD increased moderately
• Psychiatric Emergencies (United States):
  • Visits to hospital emergency rooms for mental health issues for adolescents 12–17 increased 31%
  • Visits to hospital emergency rooms for suspected suicide attempts increased:
    • 51% for adolescent girls
    • 4% for adolescent boys

That’s the answer: the pandemic had an adverse effect on the mental health of individuals between 12-18 years old worldwide, not only in the U.S.

So, to recap:

Experts predicted learning loss for K-12 students, which evidence shows did, indeed, happen – more for math than for reading.

Experts predicted an increase in mental health issues among youth and teens, which evidence shows did, indeed, happen. Depression and anxiety increased for all demographics, and suicide attempts increased significantly for teenage girls.

All that information means our teens are in a tough spot. But what about that last prediction? Did the increase in mental health issues among teens lead to an increase in alcohol and substance use?

Let’s look at the data.

Alcohol and Drug Use Among Adolescents: 2019 Compared to 2021

We’ll cut to the chase, here:

Data published in the 2021 Monitoring the Future Survey (2021 MTF) does not support expert predictions about increased drug and alcohol use among teens during the pandemic.

That’s very good news, overall.

However, it’s still too early to reach a final judgment on the impact of the pandemic on teen drug use vis a vis an increase in pandemic-related mental health issues.

Why?

If we assume alcohol and drug use related to mental health issues is a function of self-medication – i.e. the use of intoxicants to mitigate the negative emotions related to mental illness – then it’s logical to assume that many teens will try to manage their symptoms without drugs at first. Therefore, there may be a subset of teens with untreated mental health issues who will turn to self-medication if their symptoms reach a critical point.

That’s a big hypothetical, but it’s realistic.

And before we get to the statistics that prove the news is good, so far, we’ll give you the not-so-good-news that’s also in the 2021 MTF: the use of amphetamines, cough syrup as an intoxicant, and inhalants among 8^th graders increased.

Here’s that data.

Amphetamines, Cough Syrup, and Inhalants: 8^th Graders, 2019-2021

• Amphetamines:
  • 2019: 4.1%
  • 2020: 5.3%
  • 2021: 3.0%
• Cough syrup:
  • 2019: 3.2%
  • 2020: 4.6%
  • 2021: 3.5%
• Inhalants:
  • 2019: 4.77%
  • 2020: 6.1%
  • 2021: 4.8%

As you can see, those numbers increased significantly for 8^th graders for all three substances from 2019-2020, then decreased significantly from 2020-2021. For amphetamines and cough syrup, the 2021 values are significantly below the 2019 values, which is positive. We’ll keep an eye on the inhalant data, because inhalants are dangerous: use can lead to permanent brain damage.

Now it’s time for the meat and potatoes of this article: the data on drug use among 8^th, 10^th, and 12^th graders. We’ll share data for a 10-year period spanning 2011-2021, starting with the numbers from 2011-2019. This will give you the big-picture context for the changes that occurred during the pandemic. The numbers show a stable trend, some variation, but no major changes.

Here’s that data:

Any Illicit Drug Use in the Past Year: 2011-2019

• 8^th graders:
  • 2011: 14.7%, 2012: 13.4%, 2013: 15.2%, 2014: 14.6%, 2015: 14.8%, 2016: 12.0%, 2017: 12.9%, 2018: 13.4%, 2019: 14.8%

With minor increases and decrease between 2011 and 2019, that’s a net increase of 0.01%, which is small, and statistically insignificant.

• 10^th graders:
  • 2011: 31.1%, 2012: 30.1%, 2013: 32.1%, 2014: 29.9%, 2015: 27.9%, 2016: 26.8%, 2017: 27.8%, 2018: 29.9%, 2019: 31.0%

Despite decreases and increases between 2013 and 2019, that’s a net decrease of 0.01%, which is small, and statistically insignificant.

• 12^th graders:
  • 2011: 40%, 2012: 39.7%, 2013: 40.1%, 2014: 38.7%, 2015: 38.6%, 2016: 38.3%, 2017: 39.9%, 2018: 38.8%, 2019: 36.8%

This number remained relatively stable from 2011-2018, then dropped in 2019, making the net decrease 3.2%, which seems large in comparison to the other changes in this list, but is not statistically significant.

The takeaway for the data from 2011-2019 is that, with some exceptions, illicit drug use did not rise or fall dramatically for 8^th, 10^th, or 12^th graders. Now let’s take a look at the change from 2019-2020, and you’ll understand why we included all that data above: it’s a setup for what you’re about to read.

Any Illicit Drug Use in the Past Year: 2020-2021

• 8^th graders:
  • 2020: 15.6%
  • 2021: 10.2%

For 8^th graders, that’s a decrease of 34%, larger than any one year change the previous 9 years.

• 10^th graders:
  • 2020: 30.4%
  • 2021: 18.7%

Among 10^th graders, that’s a decrease of 38%, larger than any one year change the previous 9 years.

• 12^th graders:
  • 2020: 36.8%
  • 2021: 32.0%

For 12^th graders, that’s a decrease of 13%, which is far smaller than the decreases for 8^th and 10^th graders, but still the largest one-year change in the previous 9 years.

Now let’s look at the data on specific intoxicants and substances of use and misuse: alcohol, marijuana, nicotine vaping, and illicit drugs other than marijuana.

Past Year Alcohol Use: 8^th, 10^th, and 12^th Graders

• 8^th graders:

• • 2020: 20.5%
  • 2021: 17.2%

• 10^thgraders:

• • 2020: 40.7%
  • 2021: 28.5%
• 12^th graders:
  • 2020: 55.3%
  • 2021: 46.5%

Between the first and second years of the pandemic, alcohol use decreased significantly for 10^th and 12^th graders, and remained stable for 8^th graders.

Past Year Marijuana Use: 8^th, 10^th, and 12^th Graders

• 8^th graders:
  • 2020: 11.4%
  • 2021: 7.1%
• 10^thgraders:
  • 2020: 28.0%
  • 2021: 17.3%
• 12^thgraders:
  • 2020: 35.2%
  • 2021: 30.5%

Between the first and second years of the pandemic, marijuana smoking and vaping decreased significantly for eighth, 10^th, and 12^th graders.

Past Year Nicotine Vaping: 8^th, 10^th, and 12^th Graders

• 8th graders:
  • 2020: 16.6%
  • 20219: 12.1%
• 10^thgraders:
  • 2020:30.7%
  • 2021: 19.5%
• 12^thgraders:
  • 2020: 34.5%
  • 2021: 26.6%

Between the first and second years of the pandemic, the percentage of students who reported vaping nicotine vaping decreased significantly for eighth, 10th, and 12th graders.

Any illicit drug, other than marijuana: 8^th, 10^th, and 12^th Graders

• 8^th graders:
  • 2020: 7.7%
  • 2021: 4.6%
• 10^thgraders:
  • 2020: 8.6%
  • 2021: 5.1%
• 12^thgraders:
  • 2020: 11.4%
  • 2021: 7.2%

Between the first and second years of the pandemic, use of any illicit drug other than marijuana decreased significantly for eighth, 10^th, and 12^th graders.

In addition, the MTF reported significant decreases in use in some grade levels for cocaine, prescription opioids, hallucinogens, nonmedical use of amphetamines, and tranquilizers.

What Does This Report Mean?

To quote a headline from the online journal Science Daily, one thing the data might mean is this:

“No peers, no beers.”

That’s a catchy way of saying this:

The data from 2020-2021 may indicate that adolescent drug us is driven in large part by freedom of movement, attending in-person school, and peer proximity.

We’ll leave the MTF data for a moment before we conclude to talk for a moment about the research that led to that quote. A meta-analysis of 49 studies from 23 countries showed that youth substance use declined significantly worldwide during the pandemic. Here’s how one of the study authors assesses their results:

“One of the driving factors for youth substance use is access to substances. With stay-at-home orders, virtual schooling and social distancing, children have been spending more time with family and are more socially isolated from peers than before. Although social isolation from peers may have a negative impact on their mental health, it may just be one of the desirable outcomes of the pandemic when considering substance use in children.”

Let’s be clear: there’s no real way to quantify a theoretical trade-off between the negative mental health outcomes of social isolation and the reduction in substance use as a result of shelter-in-place orders, school closures, and social distancing guidelines. Both cause real problems in the lives of teens and families. Substance use and mental illness, in extreme cases, can result in death. That’s the hard truth. That’s true for teens or any other demographic. The kernel of wisdom we find here is the connection between peers and access to alcohol and other substances.

Over the next several years, as our teens return to school and rediscover the new rhythms of daily life in a world where COVID-19 is a reality, we can apply this knowledge – and the 2021 MTF data – in a manner that helps our teens.

Here’s a simple way to think about it.

We now know that alcohol and drug use decreases when our teens don’t go to school and don’t go out. Therefore, we can increase our awareness and engagement around what they do when they go to school and go out with friends.

This will look different for every family, because each family creates its own culture and each teen lives in their own set of circumstances.

We can say, however, that the best way to find out what’s going on with your teen is to talk to your teen. Teens need to know the facts about alcohol and drugs. When they do go out with friends and encounter access, they need real knowledge in order to make responsible decisions. It may be a difficult conversation to initiate, but we believe in you. If you’re uncomfortable talking to your teen about the dangers of alcohol and drugs, you they can read these two articles:

National Drug and Alcohol Facts Week: The Effects of Alcohol on The Major Organs

National Drug and Alcohol Facts Week: The Effects of Illicit Drugs on The Major Organs of Teens