A Decade of Research using the NSDUH Adolescent Sample: What Have We Learned?

By Christopher P. Salas-Wright and Michael G. Vaughn


Over the last decade, we have spent several thousand hours carefully examining data from SAMHSA’s National Survey on Drug Use and Health (NSDUH). The NSDUH is a data source of broad scope designed to provide national drug use estimates for the US civilian, noninstitutionalized population ages 12 and older. Critically, it is a survey with great relevance to alcohol and drug use prevention as it includes data on nearly 300,000 youth ages 12 to 17, and includes many questions related to substance use risk, prevention, and treatment.

Our long-standing research with the NSDUH has yielded more than 75 peer-reviewed articles in an array of scientific journals, but our work in this area can be boiled down to several core questions:

  • Are today’s American youth more or less likely to use alcohol and drugs, or about as likely as before?
  • What are the characteristics of youth who use alcohol and drugs compared to those who do not? 
  • Are American youth participating in prevention programs? 


Trends in Adolescent Alcohol and Drug Use

Far too many Americans initiate substance use during adolescence. Indeed, it is estimated that 7 million American underage youth drink alcohol each month (NIAAA, 2021). By our count, that is 7 million more youth than we would like to see.

In our research, we take the question one step further to examine if the percentage of American youth who use alcohol and drugs today is lower, higher, or about the same as it was in the past. Here we see good news. For example, our recent study found that, since 2002, rates of binge drinking among youth declined substantially among all age, gender, and racial/ethnic groups (Goings et al., 2019). Among 17-year-olds, rates dropped by more than half from 26% in 2002 to 12% in 2019.

Is this downward trend unique for alcohol? Fortunately, it is not. Our research also suggests that, since 2002, the proportion of American youth reporting cannabis use also declined (Salas-Wright et al., 2019a). This finding is particularly noteworthy given that rates of cannabis use among adult populations are increasing nationwide, and given that cannabis is viewed more favorably now than it was in the early 2000s (Salas-Wright & Vaughn, 2017).

Here we should note that this downward trend in alcohol and cannabis misuse among adolescents appears to be part of a larger decline in youth problem behavior in general. We have found similar results for a wide array of behaviors, including truancy, fighting and violence, and drug selling (Maynard et al., 2017; Salas-Wright et al., 2017; Vaughn et al., 2018a). Researchers are still working to understand why we are seeing this broad pattern of decline, but the take-away here is clear: fewer youth today are involved in substance misuse and many other risky/problem behaviors than was the case 10-20 years ago, and that is good news.


Characteristics of Youth Who Use Alcohol and Drugs

Books can and have been written detailing the individual, family, peer, school, and other contextual characteristics of young people who use alcohol and drugs. For our purposes, we will limit ourselves to three main points.
First, ample evidence makes clear that youth who use one psychoactive substance (say, alcohol) are much more likely to use other substances (say, cannabis). Second, youth who use alcohol and drugs are much more likely to take part in other risky and illegal behaviors like skipping school, drug selling, and theft.
Do all youth who use one substance also use others? And do all teens who drink or use cannabis break other laws? No, of course not. But we do know that, for many, these behaviors go together. And, from the vantage point of prevention, this is a critical point as it tells us that we should think very seriously about not only preventing the use of one type of substance, but substance use in general. And that we should also consider multicomponent programs that target both substance use and other risky/problem behaviors.

A third point is that a disproportionate amount of serious substance misuse and delinquency is accounted for by a small subset of youth (Vaughn et al., 2014). Indeed, roughly half of all adolescents in the NSDUH report no substance use and no problem behavior at all, and this number is increasing (Vaughn et al., 2018b). Taken together, these points suggest that targeted prevention with youth at the highest levels of risk may be quite effective.


Participation in Prevention Programming

Are American youth participating in substance use prevention programs? Yes, but rates are dropping. Somewhat paradoxically, at the same time that we saw declines in alcohol and drug use among youth, we also saw significant declines in the proportion of youth reporting participation in a school-based substance use prevention program (from 48% in 2002-2003 to 40% in 2015-2016; Salas-Wright et al., 2019b). This could be, in part, because—if fewer youth are using substances—then fewer youth got caught and were mandated to participate in such programs.
That said, we also note that declines in prevention participation were observed at the same time as we saw decreases in federal funding for prevention programming and a broader decline in funding for public education in general. Moreover, during the same time period, we saw also declines in the numbers of youth reporting participation in prevention programming focused on sexual risk behavior and violence (AbiNader et al., 2019; Salas-Wright et al., 2019c). NSDUH data do not provide answers as to why we are seeing a consistent decline in prevention programming, but the overall pattern of findings nevertheless is cause for concern.



Although we have observed that many adolescents abstain from alcohol and drug use and that rates of youth substance use and problem behavior are declining nationwide, substance use risk remains high for millions of American youth. Evidence-informed prevention is a cost-effective and strategic approach to addressing complex behavioral problems before they start. Our hope is that, over the next decade, rates of adolescent substance use continue to decline and that opportunities for quality prevention programming for youth increase substantially.


About the Authors

Click on the names below for more information about the authors:

Christopher Salas-Wright PhD, MSW, MA & Michael Vaughn, Ph.D.



AbiNader, M., Salas-Wright, C.P., Vaughn, M.G., Oh, S., & Jackson, D.B.(2019) Trends and correlates of youth violence prevention program participation, 2002-2016. American Journal of Preventive Medicine, 56(5), 680-688. doi: 10.1016/j.amepre.2018.12.016

Goings, T.T., Salas-Wright, C.P., Belgrave, F., Nelson, E., Harezlak, J., & Vaughn, M.G. (2019) Trends in binge drinking and alcohol abstention among adolescents in the US, 2002-2016. Drug and Alcohol Dependence, 200(1), 115-123. doi: 10.1016/j.drugalcdep.2019.02.034

Maynard, B.R., Vaughn, M.G., Nelson, E.J., Salas-Wright, C.P., Heyne, D., & Kremer, K.P. (2017). Truancy in the United States: Examining temporal trends and correlates by race, age, and gender. Children and Youth Services Review, 81, 188-196. doi: 10.1016/j.childyouth.2017.08.008

National Institute on Alcohol Abuse and Alcoholism (NIAAA)(2021). Underage drinking. Retrieved from: https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/underage-drinking

Salas-Wright, C.P., & Vaughn, M.G. (2017). Marijuana use among young people in an era of policy change: What does recent evidence tell us? American Journal of Drug and Alcohol Abuse, 43(3), 231-233. doi: 10.1080/00952990.2016.1226319

Salas-Wright, C.P., AbiNader, M., Vaughn, M.G., Sanchez, M., De La Rosa, M. (2019c). Trends in participation in teen pregnancy and STI prevention programming, 2002-2016. Preventive Medicine, 126, 105753. doi: 10.1016/j.ypmed.2019.105753

Salas-Wright, C.P., AbiNader, M., Vaughn, M.G., Schwartz, S.J., Oh, S., Delva, J., & Marsiglia, F.F. (2019c). Trends in substance use prevention program participation among adolescents in the United States. Journal of Adolescent Health, 63(3), 426-429. doi: 10.1016/j.jadohealth.2019.04.010

Salas-Wright, C.P., John, R., Vaughn, M.G., Eschmann, R.D., Cohen, M., AbiNader, M.A., & Delva, J. (2019a). Trends in cannabis use among immigrants in the United States, 2002-2017: Evidence from two national surveys. Addictive Behaviors, 99, 106029. doi: 10.1016/j.addbeh.2019.106029

Salas-Wright, C.P., Nelson, E., Vaughn, M.G., Reingle Gonzalez, J.M. & Córdova, D. (2017). Trends in fighting and violence among adolescents in the United States, 2002-2014. American Journal of Public Health, 107(6), 977-982. doi: 10.2105/AJPH.2017.303743

Vaughn, M.G., Salas-Wright, C.P., DeLisi, M., & Maynard, B.R. (2014). Violence and externalizing behavior among youth in the United States:  Is there a Severe 5%?  Youth Violence and Juvenile Justice, 12(1), 3-21. doi: 10.1177/1541204013478973 

Vaughn, M.G., AbiNader, M.A., Salas-Wright, C.P., Oh, S., & Holzer, K.J. (2018a). Declining trends in drug dealing among adolescents in the United States. Addictive Behaviors, 84, 106-109. doi: 10.1016/j.addbeh.2018.04.006

Vaughn, M.G., Nelson, E.J., Oh, S., & Salas-Wright, C.P., DeLisi, M., & Holzer, K. (2018b). Abstention from drug use and delinquency increasing among youth in the United States, 2002-2014. Substance Use and Misuse, 53(9), 1468-1481. Vaughn et al., 2018