Adolescence (12 to 17 years) is a critical and vulnerable stage of human development, during which males and females experience different biological, social, and cognitive changes. During this life stage, millions of adolescents experiment with substance use and engage in behaviors that can affect healthy neurological and psychological development. Understanding the behavioral health differences between adolescent males and females can help to inform public health policy and build prevention and intervention programs that strategically target the different needs of adolescent males and females.
Adolescent Risk Perceptions
One factor that can influence if youths will use tobacco, alcohol, or illicit drugs is the extent to which youths believe these substances might cause them harm. The National Survey on Drug Use and Health (NSDUH) asks respondents how much they thought people risk harming themselves physically and in other ways when they use various substances in certain amounts or frequencies.
Combined 2003–2006 NSDUH revealed that nationwide adolescents perceive:
- Smoking one or more packs of cigarettes per day is a greater risk than binge drinking once or twice a week.
- Binge drinking once or twice a week is perceived to be more risky than smoking marijuana once a month.
- The rates of the perception of risk associated with these behaviors are significantly higher for adolescent females than for adolescent males (Chart 1).
Chart 1 (click to enlarge)
Illicit Substance Use:
Marijuana is the most commonly used illicit drug in the United States. According to the combined 2003–2006 NSDUH:
- Approximately 2.6 million (10.4 percent) of the 25,239,000 adolescents nationwide used an illicit drug in the past month; 1,825,000 (7.2 percent) used marijuana, and 1.3 million (5.2 percent) used an illicit drug other than marijuana (Chart 2).
- Rates for illicit drug use other than marijuana were significantly higher for adolescent females than males and significantly lower than males for past-month marijuana use.
Chart 2 (click to enlarge)
The misuse of pain relievers is also a major public health concern.
- In the United States, 867,000 adolescent males and 968,000 adolescent females used pain relievers nonmedically in the 12 months prior to the interview (Chart 3).
- Rates for past-year nonmedical pain reliever use were significantly higher for adolescent females than for adolescent males (7.8 v. 6.7 percent).
Chart 3 (click to enlarge)
Adolescent Alcohol Use and Abuse in the United States:
- 17.1 percent (4,318,000) of adolescents used alcohol in the past month, and 10.5 percent (2,645,000) engaged in binge drinking. Binge drinking is defined as 5 or more drinks on the same occasion on at least 1 day of past 30 days.
- Rates of current alcohol use were significantly higher for females than males, and rates of past- month binge drinking were significantly higher for males than females; 16.6 percent of males and 17.6 percent of females currently used alcohol and 11.0 percent of males and 10.0 percent of females engaged in binge drinking in the month prior to the interview (Chart 4).
Chart 4 (click to enlarge)
Adolescent Tobacco Use:
- During the month prior to the interview, in the United States, over 1.5 million adolescent females and nearly 2 million adolescent males used any form of tobacco, and nearly 3 million adolescent males and females used cigarettes.
- Rates of past-month tobacco use behaviors were also significantly different between adolescent males and females nationwide.
- Overall, rates of any tobacco use were significantly higher among adolescent males (14.8 percent) than adolescent females (12.6 percent).
- Rates of cigarette use were significantly higher among adolescent females (11.6 percent) than adolescent males (11.0 percent) (Chart 5).
Chart 5 (click to enlarge)
Adolescent Alcohol and Illicit Drug Dependence or Abuse:
According to the 2003–2006 NSDUH:
- Nationwide nearly 1.5 million adolescents were dependent on or abused alcohol in the past year and more than 1.2 million adolescents were dependent or abused illicit drugs.
- Overall, the rates of past-year alcohol dependence and rates of past-year alcohol abuse or dependence were significantly higher for adolescent females than for adolescent males (Chart 6).
Chart 6 (click to enlarge)
ADOLESCENT SUBSTANCE ABUSE TREATMENT
State treatment data for substance use disorders are derived from two primary sources: (1) National Survey of Substance Abuse Treatment Services (N-SSATS), an annual 1-day census of clients in treatment and (2) the Treatment Episode Data Set (TEDS), which provides information on annual treatment admissions.
According to the 2006 N-SSATS survey:
- The United States showed a 1-day total of 1,130,881 clients in treatment, the majority of whom (1,008,915 or 89.2 percent) were in outpatient treatment. Of the total number of clients in treatment on this date, 91,873 (8.1 percent) were under the age of 18.
According to 2003–2006 TEDS data:
- Adolescent males accounted for 69.6 percent (414,304) of the 595,333 total adolescent substance abuse treatment admissions.
- Of the total male admissions, 40.6 percent were drug treatment admissions, 49.4 percent were alcohol and drug treatment, 5.9 percent were alcohol treatment, and 4.1 did not report type of treatment.
- Of the total adolescent female admissions, 36.2 percent were drug treatment, 48.8 percent were alcohol and drug treatment, 9.5 percent were alcohol treatment, and 5.5 did not report type of treatment (Chart 7).
Chart 7 (click to enlarge)
Among adolescent admissions, marijuana and alcohol were the most prevalent substances of abuse.
- Of the total adolescent male admissions, 86.1 percent (356,803) reported marijuana use and 55.3 percent (229,158) reported alcohol use.
- Of the total adolescent female admissions, 75.2 percent (136,217) percent reported marijuana use and 58.3 percent (105,537) reported alcohol use.
- Further, 7.6 percent (45,198) of the total adolescent admissions reported methamphetamine use, 5.4 percent (22,334) of male admissions and 12.6 percent (22,864) of female admissions. 8.8 percent (52,094) of total admissions reported cocaine use, 7.5 percent (30,871) of male admissions and 11.7 percent (21,223) of female admissions (Charts 8 and 9).
Chart 8 (click to enlarge)
Chart 9 (click to enlarge)
Primary Referral Sources to Treatment for Adolescents
TEDS collects data on referral sources to treatment for adolescents. On average, trends from 2003–2006 in TEDS show the following:
- Overall, the court systems/criminal justice is the leading referral source to treatment for adolescents (51.5 percent) followed by individual/self-referrals (16.6 percent), schools (11.6 percent), and other community referrals (9.5 percent).
Although primary referral sources for adolescent male and female admissions follow similar patterns, percentages of referral sources vary between males and females.
- The criminal justice system accounted for 56.6 percent of adolescent male treatment referrals and 39.8 percent of adolescent female treatment referrals.
- Self-referrals accounted for 15.0 percent of referrals for adolescent male admissions and 20.3 percent of adolescent female admissions.
- School referrals accounted for 10.8 percent of referrals for adolescent male admissions and 13.3 percent of adolescent female admissions, and other community referrals accounted for 7.9 percent of male referrals and 13.2 percent of female referrals (Chart 10).
Chart 10 (click to enlarge)
UNMET NEED FOR SUBSTANCE ABUSE TREATMENT
NSDUH 2003–2006 estimates that more than 1.16 million adolescents needed but did not receive treatment for illicit drug problems and more than 1.3 million needed but did not receive treatment for alcohol problems. NSDUH defines “unmet treatment need” as an individual who meets the criteria for abuse of or dependence on illicit drugs or alcohol according to the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV), but who has not received specialty treatment for that problem in the past year.
In 2003–2006,
- There were no significant differences in rates of the unmet need for past-year drug treatment, but rates of unmet need for past-year alcohol treatment were significantly higher for adolescent females than males.
- 605,000 (4.7 percent) adolescent males and 562,000 (4.6 percent) adolescent females needed but did not receive treatment for past-year drug problems (Chart 11).
- 667,000 (5.2 percent) adolescent males and 707,000 adolescent females (5.7 percent) needed but did not receive treatment for past-year alcohol problems (Chart 12).
Chart 11 (click to enlarge)
Chart 12 (click to enlarge)
ADOLESCENT MENTAL HEALTH
Major Depressive Episodes
NSDUH uses the DSM-IV to define a “major depressive episode” as a period of 2 or more weeks during which the individual experiences loss of interest, depressed mood, or loss of pleasure, and four or more additional symptoms.
From 2004–2006, approximately 24,899,000 adolescents lived in the United States; 12,740,000 males and 12,158,000 females.
- MDEs impacted more than 2.1 million adolescents nationwide in the year prior to the 2004–2006 NSDUH surveys.
- Overall, adolescent females were almost three times more likely than adolescent males to experience a past-year MDE (12.7 v. 4.6 percent) (Chart 13).
Chart 13 (click to enlarge)
Summary
Approximately 2.6 million (10.4 percent) adolescents nationwide used an illicit drug in the past month. 1,825,000 (7.2 percent) used marijuana, and 1.3 million (5.2 percent) used an illicit drug other than marijuana. Rates of great perceptions of risk associated with substance use were significantly higher for females than males. Rates of current alcohol use, illicit drug use other than marijuana, past-month cigarette use, past-year nonmedical use of pain relievers, and major depressive episodes (MDEs) were significantly higher for females than males.
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