National Survey of Alcohol and Drug Use by Students and Adults Going Back to the High School Class of 1976

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By Christopher Johnston, MD ABPM-ADM, Chief Medical Officer, Pinnacle Treatment Centers

One of my favorite topics at national addiction medicine conferences is hearing the latest results from the Monitoring the Future (MTF) surveys. It is designed and administrated by public health researchers at the University of Michigan. The Michigan team distributes, receives, and assesses detailed questionnaires from over fifty-thousand college students and young adults each year about their drug and alcohol use and has followed original survey participants for up to 43 years. In recent years, researchers added questions designed to gather information on the attitudes and personal opinions of these age groups about alcohol and drug use.

The most recently published MTF, which offers data for 2019, expands the sections on personal attitudes and opinions, and includes and a set of questions on the perceived harm of alcohol and drug use. The goal of the new questions is to generate an evidence-based snapshot of what people think about alcohol and drug use. To paraphrase, the new MTF asks questions like:

Do you think…

…trying marijuana once or twice is harmful?

…having one or two alcoholic beverages a day is harmful?

…smoking marijuana every day is harmful?

…drinking more than five alcoholic beverages two nights each weekend is harmful?

These questions help MTF researchers gauge – among other things – the effect of awareness campaigns and public health initiatives around alcohol and drug use. Data on these topics – i.e. how people think and feel about alcohol and drug use – is relevant in light of recent developments in the public sphere such as the opioid crisis, the trend toward legalized cannabis, and changing sentiments around treatment for alcohol and substance use disorder.

New Data from 2019: Detailed Categories for Adults

We’ll dedicate a separate article to a discussion of evolving attitudes around alcohol and drug use. This article addresses another change in the MTF data for 2019. For the first time, the statisticians reported detailed data for adults age 19-30 and specific data for adults age 31 and over. In previous years, data for people age 18 + appeared in age ranges, such as 18-25, 26-35, 35-54, 55-64, and 65 +. This year, the MTF team published MTF 2019 – Volume 2: College Students & Adults Ages 19-60. In this iteration of the report, the MTF team shares and analyzes data every 2 years from 19-30 and 5 years age 30-60.

This new approach to analyzing reported alcohol and drug use data give us a new level of clarity, in comparison to the previous surveys, on exactly what, how, and how often adults in these new categories report the use of alcohol and drugs. This level of detail helps us understand how to best support people of all ages, and direct us toward the groups that need the most support.

That’s valuable data for us.

First, we’ll look at the key findings for young adults, then discuss notable trends for older adults.

We’ll start with a general data breakdown, then move on to specific sets that merit attention for young adults age 19-30, and finish with data for adults age 35 and over.

Disclaimer: This is Pre-Pandemic Data

Over the past two years, the amount of use of alcohol and drugs has changed across almost all demographics 2019 data is still important to us, however, for two reasons: the age-level breakouts are specific to 2019, and the 2020/2021 MTF surveys had issues collecting data, limiting them to their original focus, which was on high school students.

With that said, the long-term trends identified before the pandemic matter, because they allow us to calibrate our awareness to the big picture. While it’s important to be responsive to changes as they happen, it’s also important not to overreact to outlier years like 2020 and 2021: yes, we need to adapt to meet the demands of these challenging years, but we also need to situate our behavior in the greater context.

Therefore, let’s have a look at the trend the MTF identified just before the pandemic arrived.

Almost All Illicit Drug Use Improved, But Trends Show Increased Marijuana Use

With some exceptions, illicit drug use among all age groups has decreased over the four decades. Marijuana use – daily and past-month – rose in young adult categories, and past-month marijuana use increased among adults age 35-55. Prevalence of marijuana vaping increased for all demographics, which can be explained by the fact that vaping is new, and non medical cannabis is now legal in 18 states. In addition, we expect marijuana prevalence to change as a result of new legislation, but since the changes are so recent, we don’t have long-term data from which to draw conclusions that give us a clear perspective.

Nevertheless, we’re keeping our eye on that data.

We do, however, have notable data for young adults who reported binge drinking and past-month marijuana use, and vaping marijuana.

Here’s the data:

Alcohol Use, Marijuana Use, and Vaping Marijuana: Adults 30 and Under

Alcohol Use

  • Between 2017-2019, the prevalence of consuming more than five drinks in a row in the two weeks before answering the survey did not change significantly.

Marijuana Use

  • Between 2015-2019, the prevalence of smoking marijuana at least once in the month before answering the survey increased as well as daily marijuana use.
  • Between 2017-2019, the prevalence of vaping marijuana at least once in the month before answering the survey increased even more dramatically.

As you see these results, keep in mind that all these figures are pre-COVID, so COVID-related stress is not related to any of these increases. Of the data above, the most notable increases are marijuana use – particularly vaping – in almost all groups age 18-30.

The marijuana use numbers jumped for both smoking marijuana and vaping. Smoking marijuana increased significantly for all age groups 18-30, with daily use almost doubling in several categories. Vaping is the area where the increase in prevalence was most pronounced. Between 2017-2019, vaping almost tripled for 18-year-olds, more than tripled for age 29-30, and more than doubled for age 19-20, age 21-22, and age 25-26.

Whether these marijuana numbers are attributable to the novelty of vaping and the move toward legalization for non medical use remains to be seen. Research efforts to answer these questions are under way, and we’ll report the data when it becomes available.

Now, we’ll look at prevalence trends in marijuana use in older adults.

Prevalence of Drug Use Among Adults 35-55

The MTF survey broke out the data for older adults age 35-55. In all of these age groups, marijuana use increased.

Let’s have a look at the statistics.

Marijuana Use: Adults 35 +

  • Between 2015-2019, the prevalence of smoking marijuana at least once in the month before answering the survey increased for the following ages:
    • 35:
      • 2015: 13.2%
      • 2019: 16.0%
    • 40:
      • 2015: 8.8%
      • 2019: 16.4%
    • 45:
      • 2015: 7.8%
      • 2019: 10.2%
    • 50:
      • 2015: 8.0%
      • 2019: 10.3%
    • 55:
      • 2015: 8.6%
      • 2019: 10.9%

We can’t ignore the increase in regular marijuana use. If an individual of any age – whether they’re 25 or 65 – turns to a mind altering drug to handle stress or disruptive emotions, they increase their risk of developing a substance use disorder (SUD). Also, the practice of self-medication of a mental health disorder can delay seeking professional support and care to resolve those issues: they rarely simply go away on their own and some mental health problems are made worse by regular marijuana use. While we have no absolute proof of physical harm from marijuana, we have strong associations with risk of early onset psychosis and reduced educational status with early age of regular use.

I am glad the severe law enforcement punishment approach to marijuana is a thing of the past but am concerned that one day we will look back and realize that better public health could have come from more intensive education of our youth who are most susceptible to ill effects of marijuana use.

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