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On a Scale of 1-10, How Well Is Your State Addressing Teen Substance Abuse?

First Lady Nancy Reagan speaking at a "Just Say No" Rally in Los Angeles.
U.S. National Archives and Records Administration

"Just Say No" is not enough anymore, according to a new report from the Trust for America's Health.

The health advocacy non-profit cites research showing that rates of illicit drug use among teens haven’t improved since 1994, though alcohol and tobacco use among teens declined significantly in that time. And, drug overdose death rates among 12- to 25-year-olds have risen dramatically since 2001. The most recent data, which is from 2011-2013, shows overdose death rates had doubled in 18 states, more than tripled in 12 states, and more than quadrupled in five states.

Real-world practice to-date has mostly emphasized personal willpower (as in the "Just Say No" campaign of the '80s and '90s) and reactive treatment for serious substance abuse problems. The Trust for America's Health argues instead for prevention, early intervention, and more comprehensive treatment in its report, "Reducing Teen Substance Misuse: What Really Works".

The report highlight ten strategies that have been shown to lead to reduced teen substance abuse, distilled from the findings of several recent research studies. It surveys and scores U.S. states based on how many of these strategies they are implementing (see graphic below). The top scoring states were Minnesota and New Jersey, which implement all ten strategies, while those that scored the worst were Idaho, Louisiana, Mississippi, and Wyoming (only implementing three). 

Youth Substance Misuse Prevention Indicator Map
Credit Trust for America's Health
Youth Substance Misuse Prevention Indicator Map

1) Keep Kids in School

Dropouts are more likely to use drugs. Support for students who are struggling academically or chronically absent can reduce substance abuse. The Trust For America’s health suggests a goal of having a high school graduation rate at or above 80 percent.

2) Prevent Bullying

Both the kids who are bullied and the kids who do the bullying are more likely to use or abuse drugs. Research suggests comprehensive bullying prevention laws can help create a climate that reduces substance abuse. These laws should define the role and authority of teachers and staff to address bullying and include a zero tolerance policy for bullying based on personal attributes like race, disability, or religion. The majority of district policies and state laws don't mention protection for students based on their real or perceived sexual orientation or gender identity.

3) Prevent Smoking

Illicit drug use is 8.5 times higher among teens who smoke. The report praises states with laws prohibiting smoking in public places, which limits opportunities for kids to smoke or start smoking. It highlights the value of raising the legal age to purchase tobacco products and increasing tobacco taxes as preventive measures.  

4) Prevent Underage Drinking

Underage drinking is associated with misuse of other drugs and increases risks for car crashes, violence, unsafe sex, and slipping academically, among other negative outcomes. The report recommends laws that hold businesses liable for selling alcohol to minors.

5) Screen, Intervene, and Refer to Treatment

Pediatricians tend not to ask teens about alcohol or drug use -- fewer than half do. The report suggests that should be part of routine check-ups, to destigmatize substance abuse and integrate treatment in a continuum of care. It praises states that have explicit Medicaid billing codes for screening, brief counseling, and referral to treatment as a demonstration they've committed to the proactive approach to identifying and helping kids who may have or are at risk of developing substance abuse problems.

6) Fund Mental Health Treatment

People with mood or anxiety disorders are twice as likely to have a substance abuse problem; people with substance abuse problems are twice as likely to have a mood or anxiety disorder. For kids, ADHD and behavior disorders are risk factors too. Access to mental health services can prevent individuals from using drugs to "self-medicate". So the Trust For America’s Health praises states for having increased funding for mental health services in fiscal year 2015.

7) Treat Depression

In 2013, 2.6 million U.S. kids age 12 to 17 had a major depressive episode in the past year, and 1.4 percent of them also had a substance abuse problem. Fewer than 40 percent got treatment for depression. If depression goes untreated, those teenagers are more likely to do poorly in school, be aggressive, or use drugs or alcohol.

8) Pass “Good Samaritan” Laws

With the assumption that teens may be particularly afraid of getting in trouble if they call for help, the report highlights the value of laws that provide some immunity from criminal charges for individuals who dial 9-1-1 in the case of an overdose. It gives kudos to the 90 percent of college campuses that have 'good samaritan' policies too, which has meant students are more likely to call for help.

9) Cover Treatment for Drug Abuse

With the passage of the federal Affordable Care Act and the Mental Health Parity and Addiction Equity Act have been passed, about 60 million people are covered for substance abuse and mental health treatment. But limitations -- like caps on how long a person can stay in treatment or the number of beds treatment centers are allowed to have -- persist. Treatment of prescription painkiller addiction in particular has been shown to be most effective when counseling is paired with medication that eases withdrawal symptoms and cravings, though the FDA hasn't approved those medications for treatment of patients younger than 16. Still, the report praises states that provide Medicaid coverage for all three of the FDA-approved medications for painkiller addiction.

10) Pass Sentencing Reform

States get credit for rolling back mandatory sentences for non-violent offenses. Youth who do time are more likely to develop mental health issues and less likely to graduate from high school. The report advocates early interventions and community supports to keep kids out of the judicial system in the first place.