Globally, an estimated 64 million people were suffering from drug use disorders in 2022, with cases of adolescent substance abuse evident in all regions of the world.
Adolescence describes the phase of life when people transition from childhood to adulthood (ages 10-19). During this period, a person experiences rapid biological, cognitive, physiological, and psychological change. It’s also when a person establishes both positive and negative patterns of behavior that can relate to physical activity, diet, sexual activity, and substance use. This vital stage of human development is crucial in building the foundations of good health as these learned behaviors can continue to influence a person for the rest of their lives. When adolescents are continuously exposed to substances before their brain can fully mature there is a much higher risk of developing a dependency and psychiatric complications.
Global Trends: Substance of Choice
Historically, mind altering substances known as psychoactive drugs were predominantly consumed in regions where they were derived from plants and were also traded and consumed along the common trade routes.
The cultivation and usage of these substances can be dated back millennia; heroin, produced from the seed pod of opium poppy plants, native to what is now Turkey, was used by the ancient Mesopotamians, Greeks and Chinese. It is now the poppy is mainly cultivated in Southeast and Southwest Asia, Mexico, and Colombia; cocaine has been derived from coca plants cultivated in South America for at least 4000 years. Colombia currently produces 70-80% of the world’s supply; and there are records of the cultivation and usage of cannabis across many ancient cultures in Asia and Europe, with cannabis now being cultivated in almost every country. A globalized market now sees these plant-based substances, despite them being illegal to import, available in all corners of the world. Not only are plant-based drugs more accessible to the world population, in the last 10 years there has been a global explosion in illicit synthetic drug production. Plant-based drugs require large areas of land in territories without strong law enforcement in order to cultivate the crop. Synthetic drugs can be produced using easily sourced cheap chemical inputs.
UNOCD Clandestine Synthetic Drugs: Evolution of a Problem
This boom has been facilitated by technological advancements; the rapid expansion of online platforms making information widely available on the internet and across social media; the proliferation of marketplaces on the dark web; and cryptocurrency which leaves an untraceable digital footprint, allowing anonymity for sellers and buyers.
Categorizing Substances
Substances are often categorized by their chemical makeup:
- Alcohol
- Opioids: heroin, fentanyl, oxycodone
- Benzodiazepines: Xanax, Ativan, Valium
- Cannabinoids: drugs chemically similar to tetrahydrocannabinol THC such as marijuana, hashish
- Barbiturates: amytal, luminal, phenobarbital
- Inhalants: gasses such as nitrous oxide (laughing gas); solvents, and aerosol sprays
They are also categorized according to their effects on a person:
- Depressants or ‘downers’ which create feelings of relaxation (ketamine, GHB, opiates, barbiturates)
- Stimulants or ‘uppers’ which are taken to increase wakefulness (cocaine, meth, ecstasy, amphetamines)
- Hallucinogens which alter the user’s perception of reality (LSD, psilocybin ‘magic mushrooms’, PCP)
Prescription psychotherapeutics include pain relievers, tranquilizers, stimulants, and sedatives obtained through a healthcare provider. Misuse of prescription drugs includes obtaining the drug without a valid prescription or using the drug contrary to the healthcare provider’s instructions.
Dominating Recent Trends in Adolescents
The United Nations World Drug Report 2024 shows that globally the most common substances abused by adolescents are alcohol, cannabis, and nicotine. Typically, these three potentially addictive substances are the first that youth will try.
In the U.S., approximately 8.5% of adolescents suffered from a substance use disorder in 2023; equating to around 2.2 million 12-17-year-olds, and the National Institute on Drug Abuse found that between 2010 and 2021 there was a dramatic rise in teenage deaths in the country due to substance overdoses. The regions reporting the highest proportions of young people in drug treatment are Africa, Central America and the Caribbean, and South America.
Most Common Substances Abused by Adolescents
Alcohol
Over a quarter of all people aged 15-19 years are current drinkers of alcohol, amounting to 155 million adolescents worldwide. In 2019, alcohol use among 15-19-year-olds was at a worldwide high of 22%, with little difference between genders.
The reasons for high alcohol usage among adolescents can be attributed to its relative ease of accessibility. It is legal to purchase and use in most countries (with most implementing the age limit of 18), and there’s an abundance of vendors, whether using physical shops, online, or via phone apps.
Within many societies, alcohol is also considered socially acceptable and associated with celebrations and events. Advertising campaigns for alcohol can be commonly displayed within sight of children and adolescents in many countries.
Historically, alcohol production and consumption has been deeply ingrained in many cultures and some even foster beliefs that alcohol can have positive effects on the body with myths such as: a glass of wine a day can prevent depression; or whisky being able to fight cancer, lower the risk of dementia and heart disease, and can help with weight loss; drinking has been said to reduce stress and anxiety; and a drink before bed can supposedly help you sleep. Even though many of these myths have been debunked, they can linger for generations in cultures, communities, and households.
Cigarettes
Nesster
From the 1940s, smoking was framed and promoted by tobacco industries as being associated with a strong masculine self-conception, being glamorous, being rebellious, a ‘rite of passage’ to adulthood, and socially acceptable. Endorsed by doctors and celebrities, many of these sentiments became ingrained in society, further perpetuated by popular culture. Still to this day, the biggest tobacco companies in the U.S. spend over $8 billion USD a year on advertising and promotional expenses.
Although cigarette use has declined amongst adolescents, e-cigarette use has become more prevalent.
Cannabis
Globally, cannabis use among adolescents was higher than that of adults in 2022, particularly in Oceania and Europe. It remains one of the most harmful drugs in regions such as Africa. In the UK, it is responsible for 87% of cases of young people seeking treatment for drug disorders. In Canada and the U.S., hospitalizations related to cannabis use disorders, as well as the proportion of people with psychiatric disorders and attempted suicide associated with regular use, have increased.
Even though studies show that the frequent use of cannabis during adolescence has been associated with psychiatric comorbidities and developmental issues, the perception of risk about cannabis usage is at the lowest point ever recorded.
Across Europe laws have been changing; Malta, Luxembourg and Germany have legalized cannabis for use in private. Switzerland and The Netherlands are also reviewing new laws and trial schemes in regards to sales and distribution . Canada, Uruguay, and 27 jurisdictions in the U.S. have legalized the production and sale of cannabis for non-medical use.
Notable New Trends
E-cigarettes / Vaping
The use of e-cigarettes among adolescents has skyrocketed over the last decade. These devices are not only used to deliver nicotine but can also be used with other chemicals such as THC and CBD.
In 2022, a survey was carried out in Europe, Central Asia, and Canada focused on adolescent substance use. It found that e-cigarette usage has increased dramatically in many regions with more than one in six adolescents (18%) reported having used an e-cigarette at least once in their life, and 10% having done so in the last 30 days. Across the EU, usage was more prevalent among adolescents from high-affluence families. A study in New Zealand revealed that e-cigarette use is spread across the socio-economic spectrum.
There are currently 88 countries that do not have a minimum age for purchasing e-cigarettes and 74 countries without regulations in place.
Worldwide reports are gradually revealing evidence that e-cigarettes are causing harm to adolescents: showing negative respiratory, neurological, and cardiovascular effects
Illicitly Manufactured Fentanyls (IMFs)
Fentanyl is a synthetic opioid that can be more than one hundred times more powerful than morphine and highly addictive. Clinically it’s used as a sedative and prescribed for acute short-term chronic pain.
Among adolescents in the U.S., overdose deaths increased 94% from 2019 to 2020, around 90% of deaths involved opioids and 84% involved IMFs . This rise is greater in adolescents than any other age group.
Many people do not realize they are taking fentanyl. Drug dealers are known to mix IMF with drugs such as heroin, cocaine, and MDMA because it provides a cheaper high and is very addictive.
Drug Enforcement Agency
Ketamine
In Western and Central Europe, Japan, Republic of Korea, and the U.S., illicit ketamine consumption is increasing. Notably, in Australia, the United Kingdom, and in Belgium, the use of the drug has increased in adolescents.
A recent report by the British Association of Urological Surgeons states that ketamine misuse can trigger liver and bladder abnormalities. In a recent interview with the BBC, Dr. Mohammed Belal stated: “we’ve seen a huge explosion of young people taking ketamine throughout the [United Kingdom]… Ketamine destroys the lining of the bladder, and that can have very serious consequences”.
Risks and Consequences
Journal of Adolescent Health
As alcohol and marijuana are the two most commonly used substances during adolescence, most larger scale research programs have focused on their damaging effects. Some notable studies include: the IMAGEN study (started 2007) which is following 2,000 young people from the age of 14 from England, Ireland, France, and Germany, collecting data from brain imaging, cognitive and behavioral assessments, questionnaires, and blood sampling. Another is the Adolescent Brain Cognitive Development (ABCD) Study which is tracking the biological and behavioral development of 11,880 U.S. children from the ages 9-10 through adolescence into young adulthood.
| Short-term individual risks | Long-term individual risks | Community consequences |
|---|---|---|
| Injury Violence Self-harm and suicide Teenage pregnancy Sexually Transmitted Diseases Sexual exploitation Adverse mental health issues Overdose Gateway to ‘harder’ substances Antisocial behavior Poor educational attainment Exclusion from school, work, social activities Involvement in criminal activities | Addiction Organ damage Continued mental health issues Housing and employment problems Impaired chances of social reintegration | Crime Pressures on healthcare Generational cycle of substance abuse Loss to workforce and economy |
Why Do Adolescents Turn to Substance Abuse?
In many cultures, the transition from nonuse to use of some substances (such as alcohol or nicotine) can be considered a normative part of adolescent development. However, the transition from user to substance abuser is gradual and complex. It is rarely a conscious choice made by the individual.
Attitudes and use patterns tend to evolve over time, and are informed by the behaviors of peers, informed by adults, substance availability, public policy, and messages from the media . The dependency on substances evolves from a dynamic interaction between psychological, social, and biological factors.
The Role of Law Enforcement Officers in Drug Use Prevention within School Settings, UNODC
Although the reasons for turning to substance abuse vary between countries and different economic classes, there are similar themes. One common reason given by adolescents from both the developed world and middle classes in developing countries was boredom. Another common theme was feeling a lack of control over their life and sought ‘freedom’ in substances.
The main factors can be broken down into four categories: family and home environment, individual factors, peer influence, and community factors.
Key Factors Fueling the Problem
What are the main factors that are facilitating and fueling the increase in substance abuse amongst adolescents?
Obtaining Substances Has Become Easier
Adolescents usually obtain substances via a friend, older sibling, or even a parent. However, it has become increasingly easier for young people to directly access substances themselves online. The growth of the internet, social media, and other means of digital communication has facilitated access to a wider variety of substances including new emerging synthetics.
According to the U.S. Drug Enforcement Administration (DEA), traffickers have turned social media and smartphones into a ‘one-stop shop’ to market, sell, buy, and deliver substances. Adverts on social media platforms such as Facebook, Snapchat, and TikTok can be uploaded and disappear within 24-hours. By using slang, key words, and emojis posts can evade detection. Buyers respond using direct messaging either using apps like WhatsApp, Signal, and Telegram, and pay using an app available in their country. In 2021, the DEA investigated more than 80 cases of online drug trafficking in the U.S., across urban, suburban, and rural communities.
In 2023, a 19-year-old drug dealer was arrested and charged with running a social media drug distribution service that targeted minors in Oregon, U.S. Using Instagram, Snapchat, and Telegram she promoted illicit substances via the name “Kiki’s Delivery Service” – after the family-friendly animated movie. The service had been run for around three years and was responsible for several drug overdoses in young people. 50% of her clientele were minors.
Marketing and Advertising
It’s not only illegal substances that are being advertised on online. The popularity of legal substances such as vaping has been facilitated by social media increasing the exposure and accessibility of vaping devices exponentially. Children and adolescents are exposed to targeted online marketing campaigns for products that are potentially harmful. Meanwhile popular culture continues to glorify and normalize them.
Jaggery
A study published in 2024, showed that Australian youth are being exposed to a high frequency of alcohol adverts via social media. On average, users from the study were seeing an alcohol advert every three minutes. Most of these adverts contained call to action features (Facebook 78.80% and Instagram 71.17%) which promote use and ease of access to adolescents . In the U.S., data from 2018 found that youths were being exposed to an average of three alcohol advertisements a day . In the UK, a study in 2021 showed that 82% of 11–17-year-olds were exposed to alcohol advertising in the past month.
While the World Health Organization recommends regulation of alcohol advertising by governments to reduce substance abuse, especially in adolescents, it’s still prevalent online, on TV, and on billboards. Alcohol brands also commonly sponsor sporting events and teams followed by young fans; Heineken has been the sponsor for Formula 1 and the UEFA Champions League; for the 2024/25 season Guinness will be the official sponsor of the Premier League; and the U.S. open is sponsored by Grey Goose Vodka.
Prevention and Intervention
Effective prevention programs need to incorporate and address issues in the individual, at home, school, and the wider community. By approaching every aspect of an adolescent’s lifestyle and environment, important messages can be reinforced and a long-term strategy of prevention and intervention can be implemented. As every situation is different depending on a person’s personality, home life, culture, and country; a bespoke approach is required at each level, incorporating strong communication and cooperation between each.
Addressing substance abuse issues at a community level requires: adequate funding; mobilizing community leaders to identifying substance abuse related problems in the area; identifying the causes of the problems unique to their community; changing local community environmental conditions tied to substance use; and implementing a process of evaluation to judge the effectiveness of the program.
The Role of Government, Law Enforcement and Experts
Governments, law enforcement, and experts are required to monitor trends in trafficking, selling, and consumption of substances in each specific region. This also involves creating and implementing protective laws; effective policing; and collecting, analyzing, and providing data that can inform schools and communities, that in turn can inform guardians. Adequate political and financial support of a government is required across sectors (health care, law enforcement, education) to implement coordinated strategies in the prevention of substance abuse and provide effective and timely intervention systems.
Effective substance abuse prevention programs, whether delivered at school or within a community, should be developed using research and evidence-based methodologies – considering the structure, content, and delivery. Early intervention is critical. Tackling substance abuse becomes harder in high school years (14-18 years old); therefore the topic should be approached before this point.
Specialist substance abuse support for adolescents requires a different approach to adult support. Often the substance abuse is not the main issue but a symptom of an underlying cause that may include neglect, abuse, or other safeguarding concerns. Effective communication training in the professionals who interact with and influence youth is essential.
Law enforcement officers who interact with adolescents, especially those visiting community centers or schools to deliver talks, must be trained effectively in communicating with the youth within that region. Implementing evidence-based communication strategies and approaching substance abuse as a public health issue rather than a crime is more effective with young people. For example, scientific evidence shows that using scare tactics and fear arousal can lead adolescents to believe the message is exaggerated and not truthful, leading them to ignore the message. Focusing on science-based language – clear, logical and factual – as well as being accessible and relevant, has been proven to be an effective method of communication.
Every country has its own referral system. In the UK the most common route for young people to access specialist treatment services is via the education services. There is also a big difference in drug treatment coverage between regions: in 2022, Europe and Oceania reported the highest treatment coverage with 26% and 14% respectively of people receiving treatment for drug use disorders; in Africa and Asia, drug treatment coverage was low with 2.8% and 5.1% respectively in the same year .
In every region, effective prevention and intervention requires close collaboration between civil society, law enforcement, the criminal justice system, health and social care sectors, the community, schools, and families. Trust must be built between adolescents and professionals with an understanding that although there are common behavioral patterns in youth, every case of substance abuse requires an individual approach. Whether interventions come from the family, school, or community – addressing substance abuse early on is key to preventing long term damage to the individual and wider society.
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