Substance Use and Mental Health of Adolescents

The COVID-19 pandemic and the measures taken to combat it created challenges in the everyday lives of Americans, including affecting their mental health and substance use. Poor mental health among children was a substantial public health concern even before the pandemic.29

The COVID-19 pandemic may also have affected access to substance use treatment in different ways. In response to the COVID-19 pandemic, for example, health care providers (including behavioral health care providers) turned to virtual (or telehealth) services as a means of delivering services while also limiting in-person contact.

Figure 19: Perceived COVID-19 effect on substance use among adolescents ages 12–17 who reported past-year illicit drug or past-year alcohol use by level of COVID-19 effect reported, October–December 2020
Perceived COVID-19 effect on substance use among adolescents ages 12–17 who reported past-year illicit drug or past-year alcohol use by level of COVID-19 effect reported, October–December 2020

NOTE: Respondents with unknown information on their perception of the COVID-19 pandemic's effect on their substance use were excluded. Respondents were asked how much, if at all, the COVID-19 pandemic affected their substance use. Potential responses were "much less," "a little less," "about the same," "a little more," or "much more" as compared to before the pandemic.

SOURCE: Substance Abuse and Mental Health Services Administration, National Survey on Drug Use and Health.

  • In October–December 2020, about 46% of adolescents ages 12–17 who used illicit drugs in the past year perceived that they were using those substances "a little less or much less" than they did before the COVID-19 pandemic began. This is compared with 15% of adolescents ages 12–17 who perceived that they were using those substances "a little more or much more."
  • About 39% of adolescents ages 12–17 who drank alcohol in the past year perceived that they were drinking "a little less or much less" than they did before the COVID-19 pandemic began. This is compared with 15% of adolescents ages 12–17 who perceived that they were drinking "a little more or much more."

Depression has a significant impact on adolescent development and well-being.30 Adolescent depression can adversely affect school and work performance, impair peer and family relationships, and exacerbate the severity of other health conditions such as asthma and obesity.31, 32, 33 Depressive episodes often persist, recur, or continue into adulthood.34 Youth who have had a major depressive episode (MDE) in the past year are at greater risk for suicide and are more likely than other youth to initiate alcohol and other drug use, experience concurrent substance use disorders, and smoke daily.35, 36, 37 The COVID-19 pandemic may have exacerbated the effect of MDE on adolescents.38

Figure 20: Perceived COVID-19 effect on emotional or mental health among adolescents ages 12–17 by past-year major depressive episode (MDE) status and level of COVID-19 effect reported, October–December 2020
Perceived COVID-19 effect on emotional or mental health among adolescents ages 12–17 by past-year major depressive episode (MDE) status and level of COVID-19 effect reported, October–December 2020

NOTE: Respondents with unknown information on their perception of the COVID-19 pandemic's negative effect on their emotional or mental health, with unknown past-year major depressive episode (MDE) data, and with unknown impairment data were excluded. Respondents were asked how much, if at all, the COVID-19 pandemic affected their mental health. Potential responses were "not at all," "a little," "some," "quite a bit," or "a lot."

SOURCE: Substance Abuse and Mental Health Services Administration, National Survey on Drug Use and Health.

  • In October–December 2020, almost 1 in 5 adolescents (18%) perceived that the COVID-19 pandemic negatively affected their mental health "quite a bit or a lot," and an additional 51% perceived "a little or some" negative effect on their mental health.
  • Adolescents ages 12–17 who had a past-year MDE or a past-year MDE with severe impairment were more likely than those without a past-year MDE to perceive that the COVID-19 pandemic negatively affected their mental health "quite a bit or a lot" (49% and 55%, respectively). In comparison, 13% of adolescents without a past-year MDE perceived the COVID-19 pandemic negatively affected their mental health "quite a bit or a lot."

Figure 21: Perceived COVID-19 effect on access to substance use treatment among all adolescents ages 12–17 and among those who reported substance use in the past year by type of COVID-19 effect reported, October–December 2020
Perceived COVID-19 effect on access to substance use treatment among all adolescents ages 12–17 and among those who reported substance use in the past year by type of COVID-19 effect reported, October–December 2020

NOTE: Respondents who reported that the respective question did not apply to them were classified as not having experienced that effect. Respondents with unknown information on their perception of the COVID-19 pandemic's effect on their access to substance use treatment were excluded.

SOURCE: Substance Abuse and Mental Health Services Administration, National Survey on Drug Use and Health.

  • In October–December 2020, among all adolescents ages 12–17, about 6% had their substance use treatment appointments moved from in-person to telehealth, 7% experienced delays or cancellations in appointments, 3% experienced delays in getting prescriptions, and 2% were unable to access needed care, resulting in a moderate to severe impact on health.
  • Among adolescents with past-year alcohol or illicit drug use, 9% had their substance use treatment appointments moved from in-person to telehealth, 12% experienced delays or cancellations in appointments, 3% experienced delays in getting prescriptions, and 1% were unable to access needed care, resulting in a moderate to severe impact on health.

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29 Bitsko, R. H., Claussen A. H., Lichstein, J., ... & Ghandour, R. M. (2022). Mental health surveillance among children—United States, 2013–2019. MMWR Surveillance Summaries, 71(2), 1–42.

30 Mojtabai, R., Olfson, M., & Han, B. (2016). National trends in the prevalence and treatment of depression in adolescents and young adults. Pediatrics, 138(6), Article e20161878.

31 Office of Applied Studies. (2008). Major depressive episode among youths aged 12 to 17 in the United States: 2004 to 2006. Substance Abuse and Mental Health Services Administration. https://ntrl.ntis.gov/NTRL/dashboard/searchResults/titleDetail/PB2009115665.xhtml

32 Van Lieshout, R. J., & MacQueen, G. (2008). Psychological factors in asthma. Allergy, Asthma and Clinical Immunology, 4(1), 12–28.

33 Goodman, E., & Whitaker, R. C. (2007). A prospective study of the role of depression in the development and persistence of adolescent obesity. Pediatrics, 110(3), 497–504.

34 Weissman, M. M., Wolk, S., Goldstein, R. B., Moreau, D., Adams, P., Greenwald, S., & Wickramaratne, P. (1999). Depressed adolescents grown up. Journal of the American Medical Association, 282, 1701–1713.

35 Substance Abuse and Mental Health Services Administration. (2020). Key substance use and mental health indicators in the United States: Results from the 2019 National Survey on Drug Use and Health (HHS Publication No. PEP20-07-01-001, NSDUH Series H-55). Center for Behavioral Health Statistics and Quality. https://www.samhsa.gov/data/sites/default/files/reports/rpt35325/NSDUHFFRPDFWHTMLFiles2020/2020NSDUHFFR1PDFW102121.pdf

36 Shaffer, D., Gould, M. S., Fisher, P., Trautman, P., Moreau, D., Kleinman, M., & Flory, M. (1996). Psychiatric diagnosis in child and adolescent suicide. Archives of General Psychiatry, 53, 339–348. http://archpsyc.ama-assn.org/cgi/content/abstract/53/4/339

37 Office of Applied Studies. (2007). The NSDUH report: Depression and the initiation of alcohol and other drug use among youths aged 12 to 17. Substance Abuse and Mental Health Services Administration.

38 Guessoum, S. B., Lachal, J., Radjack, R., Carretier, E., Minassian, S., Benoit, L., & Moro, M. R. (2020). Adolescent psychiatric disorders during the COVID-19 pandemic and lockdown. Psychiatry Research, 291, Article 113264. https://doi.org/10.1016/j.psychres.2020.113264

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