TRENDS IN ADOLESCENT SUBSTANCE USE AND

PERCEPTION OF RISK FROM SUBSTANCE USE

AUTHORS

Rachel N. Lipari, Ph.D.

INTRODUCTION

An adolescent’s perception of the risks associated with substance use is an important

determinant of whether he or she engages in substance use. For example, youths who

perceive high risk of harm are less likely to use drugs than youths who perceive low risk of

harm.1 Thus, providing adolescents with credible, accurate, and age-appropriate information

about the harm associated with substance use is a key component in prevention

programming.2 Expanding upon research that shows the predictive nature of risk perceptions

to subsequent substance use among adolescents,3,4 the National Survey on Drug Use and

Health (NSDUH) provides an opportunity to conduct a cross-sectional analysis of the changes

over time in the prevalence of substance use and perceptions of risk. Although crosssectional analysis cannot confirm that increases in substance use are a direct result of

decreases in perceptions of risk, this report examines how rates of substance use and

perceived risk vary over time and in relation to each other. Understanding the relationship

between risk perception and substance use during adolescence may help to better target

health promotion messages and increase the effectiveness of prevention and intervention

programs.

NSDUH asks adolescents aged 12 to 17 how much people risk physical and other harm when

they drink five or more alcoholic drinks once or twice a week, use marijuana once or twice a

week, use cocaine once or twice a week, use LSD once or twice a week, and use heroin once

or twice a week. Response choices are (1) no risk, (2) slight risk, (3) moderate risk, and (4)

great risk. NSDUH also asks adolescents about their substance use in the 30 days before the

interview. This issue of The NSDUH Report focuses on trends in risk perception and

substance use among adolescents aged 12 to 17 between 2002 and 2011.

● The percentage of adolescents aged 12 to 17 who

perceived great risk from having five or more

alcoholic drinks once or twice a week increased

from 38.2 percent in 2002 to 40.7 percent in 2011;

during the same period, the rate of binge alcohol

use among adolescents decreased from 10.7 to 7.4

percent

● Between 2007 and 2011, the percentage of

adolescents who perceived great risk from

smoking marijuana once or twice a week

decreased from 54.6 to 44.8 percent, and the rate

of past month marijuana use among adolescents

increased from 6.7 to 7.9 percent

● In 2011, the percentages of adolescents reporting

substance use in the past month were generally

lower among those who perceived great risk from

using substances than among those who did not

perceive great risk

In Brief

Short Report January 03, 2013*

National Survey on Drug Use and Health
CHANGES IN ALCOHOL USE AND RISK PERCEPTION

The percentage of adolescents who perceived great risk from having five or more drinks of an alcoholic beverage once or twice a week increased

from 38.2 percent in 2002 to 40.7 percent in 2011 (Figure 1). Consistent with the increase in perceived risk, adolescents’ binge alcohol use

decreased from 10.7 in 2002 to 7.4 percent in 2011.5

Figure 1. Trends in Perception of Great Risk from Having Five or More Drinks

of Alcohol Once or Twice a Week and Past Month Binge Alcohol Use among

Adolescents Aged 12 to 17: 2002 to 2011

Difference between estimate and estimate for 2011 is statistically significant at the .05

level.

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Surveys

on Drug Use and Health (NSDUHs), 2002 to 2011 (revised March 2012).
Adolescents who perceived great risk from binge drinking—having five or more drinks of an alcoholic beverage once or twice a week—were less

likely than those who did not perceive great risk to report binge alcohol use in the past month (see Supporting Table S1). In 2011, 4.5 percent of

adolescents who perceived great risk from binge drinking once or twice a week reported they engaged in past month binge alcohol use,

compared with 9.5 percent of those who perceived moderate, slight, or no risk (Figure 2).

Figure 2. Past Month Binge Drinking and Marijuana Use among Adolescents

Aged 12 to 17, by Perceptions of Risk: 2011

Difference between those perceiving great risk and those perceiving moderate, slight,

or no risk is statistically significant at the .05 level.

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Surveys

on Drug Use and Health (NSDUHs), 2002 to 2011 (revised March 2012).
CHANGES IN MARIJUANA USE AND RISK PERCEPTION

The percentage of adolescents who perceived great risk of harm from smoking marijuana once or twice a week increased between 2002 and

2003 but remained relatively stable until 2007; the percentage then decreased each year from 54.6 percent in 2007 to 44.8 percent in 2011

(Figure 3). The rate of past month marijuana use among adolescents was relatively stable between 2002 and 2004, and then decreased between

2004 and 2005. The rate of past month marijuana use held steady at about 6.7 percent until 2008; it increased to 7.4 percent in 2009 and 2010

and to 7.9 percent in 2011.

Adolescents who perceived a great risk of harm from smoking marijuana had lower substance use rates than adolescents who did not perceive

great risk (see Supporting Table S1). In 2011, past month marijuana use was reported by 0.8 percent of adolescents who saw great risk in

smoking marijuana once or twice a week compared with 13.8 percent of those who saw moderate, slight, or no risk (Figure 2).

Figure 3. Trends in Perception of Great Risk from Smoking Marijuana Once or

Twice a Week and Past Month Marijuana Use among Adolescents Aged 12 to

17: 2002 to 2011

Difference between estimate and estimate for 2011 is statistically significant at the .05

level.

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Surveys

on Drug Use and Health (NSDUHs), 2002 to 2011 (revised March 2012).
CHANGES IN COCAINE, LSD, AND HEROIN USE AND RISK PERCEPTION

With roughly 78 percent of adolescents in 2011 perceiving great risk from using cocaine once or twice a week, the percentages have remained

stable since 2007 and are down only slightly since 2002 (Table 1). Despite the relatively stable trend in perception of great risk, the rate of past

month use of cocaine among adolescents decreased from 0.6 percent in 2002 to 0.3 percent in 2011. The percentage of adolescents who

perceived great risk from using LSD once or twice a week decreased from 76.2 percent in 2002 to 71.3 percent in 2010 and 70.4 percent in

2011; however, there was no change in the rate of past month use of LSD among adolescents during this period with roughly 0.1 percent of

youths using LSD.

Similarly, the percentage of adolescents who perceived great risk from using heroin once or twice a week decreased from 82.5 percent in 2002

to 80.4 percent in 2010 and 79.7 percent in 2011; however, there was no change in the rate of past month use of heroin among adolescents

during this period with up to 0.1 percent of youths using heroin. The association between perceived risk of using cocaine, LSD, and heroin and

the use of these substances was not as strong as it was for alcohol and marijuana (see Supporting Table S1).

Table 1. Trends in Perception of Great Risk from Using Selected Substances

Once or Twice a Week and Past Month Substance Use among Adolescents

Aged 12 to 17: Percentages, 2002 to 2011

Difference between estimate and estimate for 2011 is statistically significant at the .05

level.

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Surveys

on Drug Use and Health (NSDUHs), 2002 to 2011 (revised March 2012).

DEMOGRAPHIC DIFFERENCES IN RISK PERCEPTION IN 2011

In 2011, adolescent females were more likely than adolescent males to perceive great risk from having five or more alcoholic drinks once or

twice a week (44.9 vs. 36.6 percent) and from smoking marijuana once or twice a week (49.2 vs. 40.5 percent; Figure 4). There were no

differences between males and females in perceived risk from using cocaine once or twice a week, using heroin once or twice a week, or using

LSD once or twice a week.
Figure 4. Perception of Great Risk from Using Selected Substances Once or

Twice a Week among Adolescents Aged 12 to 17, by Gender: 2011

Difference between estimate for males and estimate for females is statistically

significant at the .05 level.

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Surveys

on Drug Use and Health (NSDUHs), 2002 to 2011 (revised March 2012).

Adolescents aged 12 to 14 were more likely than those aged 15 to 17 to perceive great risk from having five or more alcoholic drinks once or

twice a week (41.7 vs. 39.8 percent) and from smoking marijuana once or twice a week (54.7 vs. 35.6 percent; Figure 5). However, younger

adolescents were not consistently more wary than older adolescents of the risks of illegal substances. Adolescents aged 15 to 17 were more

likely than those aged 12 to 14 to perceive great risk from using cocaine once or twice a week (82.2 vs. 73.7 percent), using heroin once or twice

a week (86.3 vs. 72.5 percent), and using LSD once or twice a week (75.0 vs. 65.3 percent).

Figure 5. Perception of Great Risk from Using Selected Substances Once or

Twice a Week among Adolescents Aged 12 to 17, by Age Group: 2011

Difference between estimate for those aged 12 to 14 and the estimate for those aged

15 to 17 is statistically significant at the .05 level.

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Surveys

on Drug Use and Health (NSDUHs), 2002 to 2011 (revised March 2012).
DISCUSSION

As shown in this report, changes in perceived risk at the national level typically preceded or occurred simultaneously with changes in substance

use rates in the Nation. In the 10-year period between 2002 and 2011, trends in the perception of great risk from alcohol use increased while

binge alcohol use decreased. Rates of perception of great risk from smoking marijuana and marijuana use remained stable between 2004 and

2008; however, when rates of perception of risk decreased in 2007 through 2011, rates of smoking marijuana increased. This report also shows

that perceptions of risk from using alcohol and marijuana are lower for older adolescents, which may increase their risk of use in comparison with

younger adolescents. In contrast, older adolescents reported higher rates of perceived risk from using cocaine, heroin, and LSD than younger

adolescents. Notably, the vast majority of adolescents, regardless of age group, perceived great risk associated with use of cocaine, heroin, and

LSD.

Although this report provides details on the statistical associations between risk perception and substance use, it cannot be determined from

cross-sectional data if (1) perception of great risk from using a particular drug causes youths to abstain, (2) abstaining from drug use causes

youths to have perceptions of great risk from using, or (3) both. However, the findings reported here reinforce the importance of teaching youths

about the dangers associated with substance use. Understanding differences in the perception of risk for varying substances may be useful to

policymakers, educators, and prevention program staff in making decisions about deploying prevention messages and what segments of the

youth audience they should target.

END NOTES

1. Johnston, L. D., O’Malley, P. M., Bachman, J. G., & Schulenberg, J. E. (2012). Monitoring the Future national survey results on drug use, 1975-2011: Volume

I, secondary school students. Ann Arbor, MI: Institute for Social Research, the University of Michigan. Retrieved from

http://monitoringthefuture.org/pubs/monographs/mtf-vol1_2011.pdf

2. Palmgreen, P., & Donohew, L. (2006). Effective mass media strategies for drug abuse prevention campaigns. In Z. Sloboda & W. J. Bukoski (Eds.),

Handbook of drug abuse prevention (pp. 27-43; Part II, Handbooks of Sociology and Social Research). New York, NY: Springer US.

3. Hawkins, J. D., Catalano, R. F., & Miller, J. Y. (1992). Risk and protective factors for alcohol and other drug problems in adolescence and early childhood:

Implications for substance abuse prevention. Psychological Bulletin, 112(1), 64-105.

4. Bauman, K. E. (1980). Research methods for community health and welfare: An introduction. New York, NY: Oxford University Press.

5. Binge alcohol use is defined as drinking five or more drinks on the same occasion (i.e., at the same time or within a couple of hours of each other) on at

least 1 day in the past 30 days. 

SUGGESTED CITATION

Lipari, R.N. Trends in Adolescent Substance Use and Perception of Risk from Substance Use. The CBHSQ Report: January 3, 2013. Center for

Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration, Rockville, MD.
SUPPORTING TABLE

Table S1. Past Month Use of Selected Substances, by Risk Perceptions of

Substance Use Behaviors among Persons Aged 12 to 17: Numbers in

Thousands, Percentages, and Standard Errors of Percentages, 2002-2011

NOTE: Respondents with unknown data were excluded.

1 Binge Alcohol Use is defined as drinking five or more drinks on the same occasion

(i.e., at the same time or within a couple of hours of each other) on at least 1 day in

the past 30 days.

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey

on Drug Use and Health, 2002-2011.
SUMMARY

Background: An adolescent's perception of the risks associated with substance use is an important determinant of whether he or she engages

in substance use. Methods: NSDUH asks adolescents aged 12 to 17 how much people risk physical and other harm when they drink five or more

alcoholic drinks once or twice a week, use marijuana once or twice a week, use cocaine once or twice a week, use LSD once or twice a week, and

use heroin once or twice a week. This report presents estimates of youth aged 12 to 17 perceptions of great risk associated with substance use

and past month use of associated substances. Results: The percentage of adolescents aged 12 to 17 who perceived great risk from having five

or more alcoholic drinks once or twice a week increased from 38.2 percent in 2002 to 40.7 percent in 2011; during the same period, the rate of

binge alcohol use among adolescents decreased from 10.7 to 7.4 percent. Between 2007 and 2011, the percentage of adolescents who

perceived great risk from smoking marijuana once or twice a week decreased from 54.6 to 44.8 percent, and the rate of past month marijuana

use among adolescents increased from 6.7 to 7.9 percent. The percentages of adolescents reporting substance use in the past month were

generally lower among those who perceived great risk from using substances than among those who did not perceive great risk. Conclusion:

Understanding differences in the perception of risk for varying substances may be useful to policymakers, educators, and prevention program

staff in making decisions about deploying prevention messages and what segments of the youth audience they should target.

Key words: risk perception, substance use, adolescents, National Survey on Drug Use and Health, NSDUH 

AUTHOR INFORMATION

cbhsqrequest@samhsa.hhs.gov

KEYWORDS

Short Report, Population Data, Researchers

The Substance Abuse and Mental Health Services Administration (SAMHSA) is the agency within the U.S. Department of Health and Human Services that leads public health efforts to advance

the behavioral health of the nation. SAMHSA's mission is to reduce the impact of substance abuse and mental illness on America's communities.

The National Survey on Drug Use and Health (NSDUH) is an annual survey sponsored by The Substance Abuse and Mental Health Services Administration (SAMHSA). The survey collects data

by administering questionnaires to a representative sample of the population through face-to-face interviews at their place of residence.

The NSDUH Report is prepared by The Center for Behavioral Health Statistics and Quality (CBHSQ), SAMHSA, and by RTI International in Research Triangle Park, North Carolina. (RTI

International is a trade name of Research Triangle Institute.)

Information on the most recent NSDUH is available in the following publication:

Center for Behavioral Health Statistics and Quality. (2012). Results from the 2011 National Survey on Drug Use and Health: Summary of national findings (HHS Publication No. SMA 12-4713,

NSDUH Series H-44). Rockville, MD: Substance Abuse and Mental Health Services Administration.

Also available online: http://www.samhsa.gov/data/.