The 2023 Youth Risk Behavior Survey: Adolescent Alcohol and Substance Use 

Group of teens outside smiling at the camera

At Pinnacle Treatment Centers, we specialize in supporting people diagnosed with alcohol and/or substance use disorders. Most of our treatment centers cater to adult patients, age 18+. However, at FCCR Radford in Richmond Virginia, we offer the following programs for adolescents diagnosed with alcohol and/or substance use disorders, a.k.a. alcohol or drug addiction:

Adolescent Early Intervention

Intensive Outpatient Program (IOP) For Adolescents

Continuing Care Groups for Adolescents

That’s why everyone on our clinical staff – and our top executives as well – stay current on the latest facts, figures, and trends in alcohol and substance use disorder among adolescents. We read peer reviewed journal articles and publications from reliable sources like the Centers for Disease Control (CDC), the National Institutes of Health (NIH), and the Substance Abuse and Mental Health Services Administration (SAMHSA). We recently posted this article on the blog section of our website about the relationship between adolescent drinking and adult alcohol use disorder:

Research Report: Adolescent Drinking and Adult Alcohol Use Disorder

In that article, we discuss the connection between teen drinking and excess/disordered drinking during adulthood. We learned that drinking among adolescents increased between 2019 and 2020. We also learned that solitary drinking at age 18 and at ages 24/25 predicted negative outcomes at age 35. Here are the facts:

  • Alcohol use frequency at age 18 predicted AUD symptom likelihood at age 35:
    • Higher frequency predicted higher frequency of AUD symptoms
  • Among solitary adolescent drinkers:
    • 8% were classified as having AUD symptoms at age 35
  • Binge drinking frequency at age 18 did not predict AUD symptom likelihood at age 35
  • Alcohol use frequency at age 23/24 predicted AUD symptom likelihood at age 35
    • Higher frequency predicted higher frequency of AUD symptoms
  • Binge drinking frequency at age 23/24 predicted AUD symptom likelihood at age 35:
    • Higher frequency predicted higher frequency of AUD symptoms

In this article, we’ll follow up on that information with a new set of data published in March 2023 in the 2023 Youth Risk Behavior Survey (2023 YRBS).

The 2023 YRBS: A Focus on Trends in Adolescent Alcohol and Substance Use

The CDC publishes the YRBS every two years and collects it through the Youth Risk Behavior Surveillance System (YRBSS). This system tracks six categories of behavior related to health risk, up to and including death, among adolescents and young adults. Here’s what the system tracks:

  • Behaviors that may result in injury
  • Behaviors related to violence
  • Sexual behavior
  • Alcohol use
  • Substance use
  • Tobacco use
  • Unhealthy dietary behaviors
  • Inadequate physical activity

The system was designed to help policymakers, medical professionals, mental health professionals, educators, and regular citizens understand the current state of safety among adolescents in the U.S. We use it to understand alcohol and drug use among adolescents in order to tailor our treatment programs and implement them where they’re needed most.

Researchers conduct surveys for the YRBS every other year, most often in the spring. A national survey conducted by the CDC provides data for 9th through 12th grade students in public and private schools across the country. In the past, the research team has collected data for the National Alternative High School Youth Risk Behavior Survey National (9,000 students in 1998) and the College Health Risk Behavior Survey (5,000 students in 1995).

In 2021, the source year for the 2023 YRBS, the research team collected data from over 13,000 high school students around the country. The 2023 YRBS publication also included something most YRBS surveys don’t: a ten-year analysis of trends in the survey areas. When data for the full ten years was unavailable, they included as much data as possible. We’ll focus on the data that’s most relevant to us in our work in treatment for alcohol and substance use disorder.

Let’s take a look at the survey.

Trends in Adolescent Alcohol and Substance Use, 2011-2021

We’ll begin this section with words from the report itself, which explain why the following facts and figures matter:

“Adolescent substance use is associated with sexual risk behavior, experiencing violence, and mental health problems.”

We’ll add – based on the information in the article we mention above – that adolescent alcohol use is associated with adult alcohol use disorder, and adolescent drug use is associated with increased rates of adult substance use disorder.

For the 2023 YRBS, we’ll share data on:

  • Current alcohol use
    • Defined as having used alcohol within the past 30 days
  • Current marijuana use
    • Defined as having used marijuana within the past 30 days
  • Current electronic vape products
    • Defined as having used an electronic vape product within the past 30 days
  • Lifetime illicit drug use
    • Defined as having ever used any illicit drug
  • Lifetime and current prescription opioid misuse
    • Defined as either having ever misused a prescription opioid or having misused a prescription opioid in the past month

Let’s get right to the data.

2023 YRBS Results: Adolescent Alcohol and Substance Use

Current Alcohol Use

  • By Year:
    • 2011: 39%
    • 2013: 35%
    • 2015: 33%
    • 2017: 30%
    • 2019: 29%
    • 2021: 23%
  • By Sex:
    • Total: 23%
    • Male: 19%
    • Female: 27%
  • By race/ethnicity:
    • American Indian or Alaska Native: 32%
    • Asian: 11%
    • Black: 13%
    • Hispanic: 23%
    • Native Hawaiian or Pacific Islander: 22%
    • White: 26%
    • Multiracial: 24%
  • By Sexual identity:
    • LGBQ*: 26%
    • Heterosexual: 22%
*The survey did not ask about trans identity, but only lesbian, gay, bisexual, and questioning identities*

This data tells us relatively good news: the prevalence of current alcohol use among teens has decreased by 41 percent over the ten years analyzed. That news is only relatively good because a. underage drinking is illegal, and b. 23 percent of teens in the U.S. – based on a general estimate of 25 million people aged 13-18 – works out to close to 6 million teens. Therefore, although rates of drinking have declined, underage drinking is still a significant cause for concern for people in the U.S. concerned about the overall health and welfare of the adolescent population.

Current Marijuana Use

  • By Year:
    • 2011: 23%
    • 2013: 23%
    • 2015: 22%
    • 2017: 20%
    • 2019: 22%
    • 2021: 16%
  • By Sex:
    • Total: 16%
    • Male: 14%
    • Female: 18%
  • By race/ethnicity:
    • American Indian or Alaska Native: 18%
    • Asian: 5%
    • Black: 20%
    • Hispanic: 17%
    • Native Hawaiian or Pacific Islander: 16%
    • White: 15%
    • Multiracial: 20%
  • By Sexual identity:
    • LGBQ: 22%
    • Heterosexual: 14%

Again, this is a mixed bag. A decline of 30 percent between 2011 and 2021 is a positive development. However – and we’ll repeat what we say above – marijuana use is illegal for all teenagers in the U.S. It’s true that many states have legalized the recreational use of marijuana, but the legal age for recreational use is 21. That means that every teen in this survey – unless they had a medical marijuana card – engaged in illegal activity, and increased their risk of developing a substance use disorder as an adult. When we do the math, 16 percent of teens in the U.S. works out to around 4 million teens.

Current Vape Use

  • By Year:
    • 2011: n/a
    • 2013: n/a
    • 2015: 24%
    • 2017: 13%
    • 2019: 33%
    • 2021: 18%
  • By Sex:
    • Total: 18%
    • Male: 15%
    • Female: 21%
  • By race/ethnicity:
    • American Indian or Alaska Native: 23%
    • Asian: 6%
    • Black: 14%
    • Hispanic: 18%
    • Native Hawaiian or Pacific Islander: 25%
    • White: 20%
    • Multiracial: 17%
  • By Sexual identity:
    • LGBQ: 22%
    • Heterosexual: 16%

These figures – like those above – give us reason for optimism and are also cause for concern. The decrease in vaping from 2014 to 2018 is a positive development. We’d also like to point out the power of regulation: in 2019, a third of teens reported vaping. After the FDA cracked down on the practice of selling flavored vape products geared toward teens, that number decreased by 45 percent. With that said, 18 percent of teens in the U.S. works out to about 4.5 million, which means millions of teens report current use of vape products, a number that’s far too large.

Lifetime Illicit Drug Use

  • By Year:
    • 2011: 19%
    • 2013: 16%
    • 2015: 13%
    • 2017: 13%
    • 2019: 13%
    • 2021: 13%
  • By Sex:
    • Total: 13%
    • Male: 12%
    • Female: 15%
  • By race/ethnicity:
    • American Indian or Alaska Native: 20%
    • Asian: 7%
    • Black: 9%
    • Hispanic: 14%
    • Native Hawaiian or Pacific Islander: n/a
    • White: 14%
    • Multiracial: 18%
  • By Sexual identity:
    • LGBQ: 21%
    • Heterosexual: 11%

The drugs considered illicit in this survey – aside from marijuana and opioids – included drugs like cocaine, heroin, methamphetamine, inhalants, hallucinogens, and ecstasy. Although rates of illicit drug use decreased between 2011 and 2021, it’s important to note that many of these drugs – cocaine, heroin, methamphetamine, and ecstasy, for instance – are now at high risk of containing fentanyl. That means that close to 3 million adolescents report potential exposure to a drug that can kill in one dose: that’s legitimate cause for concern.

Lifetime/Current Prescription Opioid Misuse

  • Lifetime, by Year:
    • 2011: n/a
    • 2013: n/a
    • 2015: n/a
    • 2017: 14%
    • 2019: 14%
    • 2021: 12%
  • Current use, by year*:
    • 2019: 7%
    • 2021: 6%
*The survey began asking about current prescription opioid misuse in 2019*
  • By Sex (Lifetime):
    • Total: 12%
    • Male: 10%
    • Female: 15%
  • By race/ethnicity (Lifetime):
    • American Indian or Alaska Native: 15%
    • Asian: 11%
    • Black: 14%
    • Hispanic: 14%
    • Native Hawaiian or Pacific Islander: 12%
    • White: 11%
    • Multiracial: 12%
  • By Sexual identity (Lifetime):
    • LGBQ: 20%
    • Heterosexual: 9%

We’ll point out two things in this data set: the small decreases in lifetime use and current use. Those are important, when we understand the big picture. The big picture here is that prescription opioid misuse can escalate quickly to illicit opioid misuse. Illicit opioid misuse – when we think of adolescent alcohol and substance use in general – is among the most dangerous and risky behaviors possible.


The presence of fentanyl in the supply of illicit opioids. The Drug Enforcement Agency released a public service announcement called “Fentanyl: One Pill Can Kill” that indicates 60 percent of illicit pills designed to look like prescription medication contain “potentially lethal doses of fentanyl.” We understand that phrases like one pill can kill sound like archaic scare-tactic soundbites, but in this case, the DEA is not exaggerating at all: fentanyl is deadly, and one pill can kill. That’s why any misuse of prescription opioids by adolescents is incredibly dangerous: it can be the first step on a path that can lead to accidental overdose and death.

How We Can Help Our Adolescents Thrive

The editors of the YRBS indicate two primary protective factors that can help adolescents thrive on mental, physical, psychological, and emotional levels: feeling connected to peers and teachers at school and parental monitoring. Thriving for adolescents – by our definition – includes not engaging in alcohol or drug use, which statistics show millions of teens do engage in currently.

To foster connectedness at school – and decrease alcohol and drug use – we can all work together to do the following:

  • Improve education around addiction and addiction treatment
  • Increase awareness of the negative consequences of alcohol and drug use
  • Increase mental health support in schools
  • Train key school staff to provide direct mental health support
  • Connect students and families to social support resources for mental health and addiction
  • Train key staff to help students and families connect to social support resources for mental health and addiction
  • Improve general health education, and ensure health classes are grounded in science, developmentally appropriate, and culturally sensitive

Those are solid suggestions that are well within the reach of our schools, school administrators, and teachers: we can all start on these suggestions today.

With regards to parental monitoring, we encourage all parents to know what, where, and who at all times:

What teens are doing, where they are, and who they’re with.

With that said, we encourage parents to resist the impulse to micromanage their teens 24/7/365. Anyone who’s been a teen – meaning all of us – know that this is close to impossible, and creates conflict for everyone involved. Instead, knowing those three things can help a parent pinpoint any problems – and fix them – sooner, rather than later. For every parent, there’s an important balance to strike between safety and freedom. Our teens need freedom to learn and grow, but need the safety adults provide. Finding that balance is different for every teen and every family. It may be a challenge, but it’s worth the effort. When a family finds that balance, everyone thrives.

The materials provided on the Pinnacle Blog are for information and educational purposes only. No behavioral health or any other professional services are provided through the Blog and the information obtained through the Blog is not a substitute for consultation with a qualified health professional. If you are in need of medical or behavioral health treatment, please contact a qualified health professional directly, and if you are in need of emergency help, please go to your nearest emergency room or dial 911.