Michael Botticelli currently serves as the Acting Director of the Office of National Drug Control Policy.

Q: Why is it important for health care providers and other professionals who work with youth to engage young people in conversations about substance use and its impact on their health and goals in life?

A: Health care providers and other professionals who work with youth should engage in conversations about substance use because these conversations can prevent young people from beginning to drink or use drugs. The US Health and Human Services Department has developed a website with information to facilitate such conversations. The program, entitled “Talk. They Hear you.” provides adults with tools to begin the dialogue with young people about substance use. While the website is focused primarily on underage drinking, this same information can also be useful for discussing all drug use.

Beginning this conversation at a young age is important as the rate of current substance use increases 9-fold between ages 12 and 18. The graph below illustrates this trend. Overall drug use rates are highest for ages 18 to 22, with at least one in five reporting current use of an illicit drug.

Prevention by age graph

The consequences of youth drug use can be serious. In 2012, the National Academy of Sciences published a study showing that participants who used cannabis heavily in their teens and continued through adulthood showed a significant drop in IQ by age 38—an average of 8 points for those who met criteria for cannabis dependence three or more times over the course of the study. Further, students with an average grade of “D” or lower are more likely to be substance users compared to students whose grade average is better than “D.”

The good news is that we can make a difference. Each dollar invested in an evidence-based school drug prevention program can reduce costs related to substance use by an average of $18. When schools work to create a more positive school climate, good things happen—perceptions of school safety and school connectedness improve, and there are fewer experiences of harassment, bullying, physical violence, substance use at school, and lower truancy rates. The health care system is another key avenue for addressing youth substance use. Health care providers must focus on integration of substance use disorders into primary care. Screening is essential for case identification and getting individuals the care they need. When local, state, and regional supporters work together, change is possible.

Q: If you could debunk a myth about adolescent substance use what would it be and why?

A: The myth that marijuana is not addictive or harmful. If young people believe that marijuana use is harmless, they are more likely to initiate use.
Marijuana use can lead to addiction; that is, people have difficulty controlling their drug use and cannot stop even though it interferes with many aspects of their lives. It is estimated that 9 percent of people who ever use marijuana will become dependent on it sometime during their lifetime. A study of over 300 fraternal and identical twin pairs found that the twin who had used marijuana before the age of 17 had elevated rates of other drug use and drug problems later on, compared with their twin who did not use before age 17.

Study findings show that marijuana can be harmful to young people, including their intellectual and academic life. In addition, young people who begin marijuana use at a young age and use it intensively have a higher probability of dropping out of high school. Young people who use marijuana before the age of 14 are:

  • Four times as likely to ever be suspended from school;
  • Nearly three times as likely to ever have to repeat a year
  • Less likely to graduate from high school; and
  • More likely to have a lower university entrance score.

For more information, go to the NIDA Web page.

Q: Why is it important to support a spectrum of approaches for preventing and treating substance use disorders?

A: Research and experience demonstrate that prevention works, treatment can be effective, and people do recover. A spectrum of approaches is important because there is no “one size fits all” approach that will effectively reduce drug use and its consequences.

Substance use disrupts our families, schools, and communities and limits the hopes and dreams of young people across the country. Unfortunately illicit drug use is associated with addiction, disease, and lower academic performance among our young people, and contributes to crime, injury, and serious dangers on our Nation’s roadways. Successfully addressing these complex issues requires a range of approaches. The President has set forth a plan to reform drug policy that has four key elements:

  • Prevent drug use before it ever begins;
  • Expand access to treatment for Americans struggling with substance use disorders;
  • Reform our criminal justice system to break the cycle of drug use, crime, and incarceration while ensuring public safety; and
  • Support Americans in recovery by lifting the stigma associated with those suffering or in recovery from substance use disorders.

By supporting these approaches, we can make a difference for individuals, families, communities, and, ultimately, the Nation.