Student Assistance Programs: An Important Approach to Drug Abuse Prevention
McGovern, John P., DuPont, Robert L., Journal of School Health
The American Medical Association's report on adolescent health opened with this sentence:
"As the year 2000 approaches many adolescents in the United States will experience problems that threaten not only their current health but also their ability to become healthy adults capable of leading full, productive lives."
The last three decades have been characterized by a disturbing deterioration of adolescent behavior. Adolescents are increasingly impulsive and less restrained by traditional and family-based controls over behavior. Though many adolescents do not exhibit high-risk behavior, large percentages do, at great personal and social cost. The AMA estimated that 25% of American adolescents now engage in serious health-threatening behavior.
While the death rates for Americans ages 10-19 as a results of natural causes fell dramatically between 1933-1985, death rates from violence and injury increased over the same time period; they now exceed deaths from natural causes (Figure 1). The rate of homicide doubled among those ages 10-14 in the past 20 years, becoming the leading cause of death among African-American youth ages 15-19. During the same period, the suicide rate among those ages 10-14 tripled. The suicide rate doubled among those ages 15-19. Suicide is three times as common among whites as among African-Americans. Abuse and neglect of teen-agers have increased 74% during the past decade. 
By age 18, 65% of boys and 51% or girls are sexually active. Eleven percent of adolescent girls become pregnant each year, and 4% have an abortion. Gonorrhea rates are higher among those ages 15-19 than among those ages 20-24. AIDS is a growing threat to adolescents today. 
Between the 1950s and the 1980s, the percentage of students who used an illicit drug rose from 5% to 30%. White adolescents are more likely than African-American or Hispanic youth to use illicit drugs and more likely to become heavy users of all these substances except alcohol (Table 1). These new data are from the High School Senior Survey conducted for the National Institute on Drug Abuse (NIDA) by the University of Michigan involving a representative sample of all American high school seniors in the years 1985-1989 combined.  These data showed that the rates of use for alcohol and other drugs for males were generally higher than those for females. Daily use was even more concentrated among males. On the other hand, dasily cigarette smoking was higher among females (Table 2). Similar data on ethnic differences in use of cigarettes, alcohol, and other drugs for youth ages 12-17 in 1988 are shown in Figure 2. These data, from a separate NIDA survey, confirm the findings of the High School Senior Survey. 
Adolescent rug use proceeds in steps, usually beginning with cigarette, alcohol, and marijuana use -- the gateway drugs in the U.S. today.  Adolescents who currently drink alcohol are 10 times more likely than nondrinkers to use marijuana and 11 times more likely to use cocaine.  Similar data about the increased risk from alcohol and illicit drugs found in association with cigarette smoking are shown in Figure 3. For example, 48% of cigarette-smoking teen-agers use marijuana, while only 6% of their nonsmoking peers use marijuana.
While problem behavior of all kinds increased during the past three decades, the largest increase occurred in substance use, which also is the problem behavior most often engaged in by adolescents. The core of any public health approach to high-risk behavior among adolescents must focus on substance abuse prevention.  Substance use increase with age during adolescence so that by the senior year in high school in 1990, the most recent year for which data are available, the following percentages had used each drug at least once the previous month (current use) 57% alcohol, 29% cigarettes, 14% marijuana, and 2% cocaine. Use of all these substance -- including alcohol and cigarettes -- is illegal for teen-agers. …