U.S. Department of Justice

Office of Justice Programs

Office of Juvenile Justice and Delinquency Prevention 

used marijuana. By the 12th grade, about 80 percent have used

alcohol, 63 percent have smoked cigarettes, and 49 percent have

used marijuana. Young people account for the majority of new

users of many substances. The rising prevalence of marijuana use

during the first half of the 1990s was driven, in large part, by the

increasing rates of new use among youth ages 12–17. Between

1990 and 1997, declines in the mean age of first use of cocaine

and heroin were accompanied by an upward trend in the rate of

new cocaine and heroin users among 12- to 17-year-olds. Tobacco

use among adolescents, research shows, is a powerful predictor of

other drug use, especially among females. For adolescent males,

alcohol use is a strong predictor of progression into the use of

other drugs. The age when adolescents first start using alcohol,

tobacco, and illicit drugs is also a reliable predictor of later alcohol and drug problems, especially if that use begins before age

15. More than 40 percent of youth who start drinking at age 14 or

younger develop alcohol dependence, compared with 10 percent

of youth who begin drinking at age 20 or older.

Role of the Media 

The media play a critical role in shaping perceptions about the

risks of substance use. Increases in substance use among youth

between the early 1990s and 1996 were linked to a decline in the

prevalence of warning and antidrug messages from the media,

parents, and schools; the proliferation of pro-use messages from

the entertainment industry; and high levels of tobacco and alcohol

product advertising and promotion. Media research1 shows that in

the 200 most popular movie rentals in 1996 and 1997, alcohol

appeared in 93 percent, tobacco in 89 percent, and illicit drugs in

22 percent, with marijuana and cocaine depicted most often.

Analysis of the 1,000 most popular songs of 1996 and 1997

showed that 27 percent referred to either alcohol or illicit drugs.

In 1999, 44 percent of non-news programs aired by the four

Substance Abuse: The Nation’s 

Number One Health Problem

by Nels Ericson

Research has long shown that the abuse of alcohol, tobacco, and

illicit drugs is the single most serious health problem in the

United States, straining the health care system, burdening the

economy, and contributing to the health problems and death of

millions of Americans every year. Today, substance abuse causes

more deaths, illnesses, and disabilities than any other preventable

health condition. 

A new report, Substance Abuse: The Nation’s Number One

Health Problem, commissioned by the Robert Wood Johnson

Foundation and prepared by the Schneider Institute for Health

Policy at Brandeis University, tracks positive and negative trends

in adult and youth smoking, drinking, and illicit drug use over the

past three decades. The report contains data from several hundred

public and private sources, reporting snapshots and long-term

trends in patterns of adult and youth substance abuse, consequences to society, and approaches for combating the problem.

Among other findings, the report discusses the role the media

have played in influencing youth substance use and looks at how

treatment, though shown to be effective by numerous scientific

studies, is severely underutilized.

Research Findings

The findings of the report show that juveniles are experimenting

with drugs, alcohol, and tobacco at young ages. Indeed, the data

show that attitudes toward drug use and patterns of drug, alcohol,

and tobacco use are often established early in life. The research

suggests that significant changes in drug awareness take place

between the ages of 12 and 13. Thirteen-year-olds are three times

more likely to know how to obtain marijuana or to know someone

who uses illicit drugs than are 12-year-olds. Young adults (ages

18–25) are most likely to engage in heavy use of alcohol, drugs,

and tobacco than all other age groups. Other research findings are

discussed below.

Long-Term Implications of Early Substance Use 

By the eighth grade, 52 percent of adolescents have consumed

alcohol, 41 percent have smoked cigarettes, and 20 percent have

May 2001 #17

1 Roberts, D.F., Henricksen, C., and Christiansson, P.G. 1999. Substance

Use in Popular Movies and Music. Washington, DC: U.S. Department of

Health and Human Services, Substance Abuse and Mental Health

Administration, and Office of National Drug Control Policy.
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Washington, DC 20531

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major television networks portrayed tobacco use in at least one

episode. In 1998, the tobacco industry spent $6.7 billion on advertising and product promotions, and the alcohol industry spent

more than $1 billion on television, radio, print, and outdoor advertising in 1997.

Underutilization of Proven Treatment Options 

Research also shows that only a quarter of individuals who abuse

alcohol and illicit drugs get treatment. Recent studies have shown

that after 6 months, treatment for alcoholism is successful for 40

to 70 percent of patients, cocaine treatment is successful for 50 to

60 percent, and opiate treatment is successful for 50 to 80 percent,

with effectiveness defined as a 50-percent reduction in substance

use after 6 months. This research also shows that treatment, even

treatment for relapses into substance abuse, is less expensive than

incarceration and untreated addiction. 

Substance abuse can have an effect from earliest infancy to old

age. Some infants are born already affected by the substances

consumed by their mothers during pregnancy. Prenatal exposure

to alcohol, drugs, or tobacco in utero has been linked to psychological, cognitive, and physical problems in children. More than

2,000 infants are born every year in the United States with fetal

alcohol syndrome, a group of preventable birth defects and

developmental disabilities caused by alcohol consumption during

pregnancy. More than 6,000 children die each year of sudden

infant death syndrome and respiratory infections linked to parental smoking and low birth weights associated with a mother’s

smoking during pregnancy. Children can be affected by their parents’ substance abuse in a number of ways: from neglect and

abuse associated with alcohol and use of illicit drugs to chronic

respiratory problems caused by environmental tobacco smoke.

For Further Information

The Robert Wood Johnson Foundation, based in Princeton, NJ, is

the Nation’s largest philanthropy devoted exclusively to health

and health care. To obtain a copy of the report Substance Abuse:

The Nation’s Number One Health Problem, write to:

The Robert Wood Johnson Foundation

Attn: Substance Abuse Chartbook

Route 1 and College Road East

P.O. Box 2316

Princeton, NJ 08543–2316

Internet: www.rwjf.org, under the Resource Centers section. 

Nels Ericson is a Writer/Editor with the Office of Juvenile Justice and

Delinquency Prevention.

The Office of Juvenile Justice and Delinquency Prevention is a component 

of the Office of Justice Programs, which also includes the Bureau of Justice

Assistance, the Bureau of Justice Statistics, the National Institute of Justice,

and the Office for Victims of Crime.

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