Recovery and Recovery Support
Learn how recovery-oriented care and recovery support systems help people with mental and/or substance use disorders manage their conditions successfully.
The adoption of recovery by behavioral health systems in recent years has signaled a dramatic shift in the expectation for positive outcomes for individuals who experience mental and/or substance use conditions. Today, when individuals with mental and/or substance use disorders seek help, they are met with the knowledge and belief that anyone can recover and/or manage their conditions successfully. The value of recovery and recovery-oriented behavioral health systems is widely accepted by states, communities, health care providers, peers, families, researchers, and advocates including the U.S. Surgeon General, the Institute of Medicine(link is external), and others.
SAMHSA has established a working definition of recovery that defines recovery as a process of change through which individuals improve their health and wellness, live self-directed lives, and strive to reach their full potential. Recovery is built on access to evidence-based clinical treatment and recovery support services for all populations. Learn more about SAMHSA’s Working Definition of Recovery — 2012.
SAMHSA has delineated four major dimensions that support a life in recovery:
- Health—overcoming or managing one’s disease(s) or symptoms—for example, abstaining from use of alcohol, illicit drugs, and non-prescribed medications if one has an addiction problem—and, for everyone in recovery, making informed, healthy choices that support physical and emotional well-being
- Home—having a stable and safe place to live
- Purpose—conducting meaningful daily activities, such as a job, school volunteerism, family caretaking, or creative endeavors, and the independence, income, and resources to participate in society
- Community—having relationships and social networks that provide support, friendship, love, and hope
Hope, the belief that these challenges and conditions can be overcome, is the foundation of recovery. A person’s recovery is built on his or her strengths, talents, coping abilities, resources, and inherent values. It is holistic, addresses the whole person and their community, and is supported by peers, friends, and family members.
The process of recovery is highly personal and occurs via many pathways. It may include clinical treatment, medications, faith-based approaches, peer support, family support, self-care, and other approaches. Recovery is characterized by continual growth and improvement in one’s health and wellness that may involve setbacks. Because setbacks are a natural part of life, resilience becomes a key component of recovery.
Resilience refers to an individual’s ability to cope with adversity and adapt to challenges or change. Resilience develops over time and gives an individual the capacity not only to cope with life’s challenges but also to be better prepared for the next stressful situation. Optimism and the ability to remain hopeful are essential to resilience and the process of recovery. Visit SAMHSA’s Partners for Recovery Initiative’s Resilience Annotated Bibliography – 2013 (PDF | 531 KB).
Because recovery is a highly individualized process, recovery services and supports must be flexible to ensure cultural relevancy. What may work for adults in recovery may be very different for youth or older adults in recovery. For example, the promotion of resiliency in young people, and the nature of social supports, peer mentors, and recovery coaching for adolescents and transitional age youth are different than recovery support services for adults and older adults. Learn more about Cultural Awareness and Competency.
The process of recovery is supported through relationships and social networks. This often involves family members who become the champions of their loved one’s recovery. They provide essential support to their family member’s journey of recovery and similarly experience the moments of positive healing as well as the difficult challenges. Families of people in recovery may experience adversities in their social, occupational, and financial lives, as well as in their overall quality of family life. These experiences can lead to increased family stress, guilt, shame, anger, fear, anxiety, loss, grief, and isolation. The concept of resilience in recovery is also vital for family members who need access to intentional supports that promote their health and well-being. The support of peers and friends is also crucial in engaging and supporting individuals in recovery.
SAMHSA established the Recovery Support Strategic Initiative to promote partnering with people in recovery from mental and substance use disorders and their family members to guide the behavioral health system and promote individual, program, and system-level approaches that foster health and resilience (including helping individuals with behavioral health needs be well, manage symptoms, and achieve and maintain abstinence); increase housing to support recovery; reduce barriers to employment, education, and other life goals; and secure necessary social supports in their chosen community.
Recovery support is provided through treatment, services, and community-based programs by behavioral health care providers, peer providers, family members, friends and social networks, the faith community, and people with experience in recovery. Recovery support services help people enter into and navigate systems of care, remove barriers to recovery, stay engaged in the recovery process, and live full lives in communities of their choice.
Recovery support services include culturally and linguistically appropriate services that assist individuals and families working toward recovery from mental and/or substance use problems. They incorporate a full range of social, legal, and other services that facilitate recovery, wellness, and linkage to and coordination among service providers, and other supports shown to improve quality of life for people in and seeking recovery and their families.
Recovery support services also include access to evidence-based practices such as supported employment, education, and housing; assertive community treatment; illness management; and peer-operated services. Recovery support services may be provided before, during, or after clinical treatment or may be provided to individuals who are not in treatment but seek support services. These services, provided by professionals and peers, are delivered through a variety of community and faith-based groups, treatment providers, schools, and other specialized services. For example, in the United States there are 22 recovery high schools that help reduce the risk environment for youth with substance use disorders. These schools typically have high retention rates and low relapse rates. The broad range of service delivery options ensures the life experiences of all people are valued and represented.
Supporting recovery requires that mental health and addiction services:
- Be responsive and respectful to the health beliefs, practices, and cultural and linguistic needs of diverse people and groups
- Actively address diversity in the delivery of services
- Seek to reduce health disparities in access and outcomes
Cultural competence describes the ability of an individual or organization to interact effectively with people of different cultures. To produce positive change, practitioners must understand the cultural context of the community they serve, and have the willingness and skills to work within this context. This means drawing on community-based values, traditions, and customs, and working with knowledgeable people from the community to plan, implement, and evaluate prevention activities.
Individuals, families, and communities that have experienced social and economic disadvantages are more likely to face greater obstacles to overall health. Characteristics such as race or ethnicity, religion, low socioeconomic status, gender, age, mental health, disability, sexual orientation or gender identity, geographic location, or other characteristics historically linked to exclusion or discrimination are known to influence health status.
SAMHSA is committed to addressing these health disparities by providing culturally and linguistically appropriate prevention, treatment, and recovery support programs. This commitment is reinforced through the agency’s disparity impact strategy that monitors programs and activities to ensure that access, use, and outcomes are equitable across racial and ethnic minority groups.
The SAMHSA Office of Behavioral Health Equity (OBHE) works to reduce mental health and substance use disparities among diverse racial and ethnic populations, as well as lesbian, gay, bisexual, and transgender (LGBT) populations. OBHE was established to improve access to quality care and in accordance with section 10334(b) of the Affordable Care Act of 2010, which requires six agencies under the Department of Health and Human Services (HHS) to establish an office of minority affairs.
Through the State Peer and Family Network Grant Programs, the Recovery Community Services Program, the National Consumer Supporter Technical Assistance Center(link is external) and the Targeted Capacity Expansion Peer-to-Peer grant program, SAMHSA is gathering data to assess the effectiveness of recovery supports delivered by peers with specific populations, and to identify program models that best address the needs of individuals in recovery. For example, SAMHSA works with tribal groups to develop culturally focused and person-centered health and wellness initiatives and housing supports – 2014 (PDF | 1.2 MB). Also see the SAMHSA’s Bringing Recovery Supports to Scale Technical Assistance Center Strategy (BRSS TACS) webinar Supports and Services for LGBT Youth in Recovery(link is external).
A recovery focus is also a preventive approach that simultaneously supports building resiliency, wellness, measureable recovery and quality of life. Visit SAMHSA’s Center for the Application of Prevention Technologies (CAPT) training and technical assistance (TTA) tools for Trauma and Resilience Resources.
Learn more about:
- SAMHSA’s Recovery Support Efforts
- Peer Support and Social Inclusion
- Grants Related to Recovery and Recovery Support
- Publications and Resources on Recovery and Recovery Support
Prevention of Substance Abuse and Mental Illness
SAMHSA promotes and implements prevention and early intervention strategies to reduce the impact of mental and substance use disorders in America’s communities.
Promoting mental health and preventing mental and/or substance use disorders are fundamental to SAMHSA’s mission to reduce the impact of behavioral health conditions in America’s communities.
Mental and substance use disorders can have a powerful effect on the health of individuals, their families, and their communities. In 2014, an estimated 9.8 million adults aged 18 and older in the United States had a serious mental illness, and 1.7 million of which were aged 18 to 25. Also 15.7 million adults (aged 18 or older) and 2.8 million youth (aged 12 to 17) had a major depressive episode during the past year. In 2014, an estimated 22.5 million Americans aged 12 and older self-reported needing treatment for alcohol or illicit drug use, and 11.8 million adults self-reported needing mental health treatment or counseling in the past year. These disorders are among the top conditions that cause disability and carry a high burden of disease in the United States, resulting in significant costs to families, employers, and publicly funded health systems. By 2020, mental and substance use disorders will surpass all physical diseases as a major cause of disability worldwide.
In addition, drug and alcohol use can lead to other chronic diseases such as diabetes and heart disease. Addressing the impact of substance use alone is estimated to cost Americans more than $600 billion each year.
Preventing mental and/or substance use disorders and related problems in children, adolescents, and young adults is critical to Americans’ behavioral and physical health. Behaviors and symptoms that signal the development of a behavioral disorder often manifest two to four years before a disorder is present. In addition, people with a mental health issue are more likely to use alcohol or drugs than those not affected by a mental illness. Results from the 2014 NSDUH report (PDF | 3.4 MB)showed that of those adults with any mental illness, 18.2% had a substance use disorder, while those adults with no mental illness only had a 6.3% rate of substance use disorder in the past year. If communities and families can intervene early, behavioral health disorders might be prevented, or symptoms can be mitigated.
Data have shown that early intervention following the first episode of a serious mental illness can make an impact. Coordinated, specialized services offered during or shortly after the first episode of psychosis are effective for improving clinical and functional outcomes.
In addition, the Institute of Medicine and National Research Council’s Preventing Mental, Emotional, and Behavioral Disorders Among Young People report – 2009(link is external) notes that cost-benefit ratios for early treatment and prevention programs for addictions and mental illness programs range from 1:2 to 1:10. This means a $1 investment yields $2 to $10 savings in health costs, criminal and juvenile justice costs, educational costs, and lost productivity.
A comprehensive approach to behavioral health also means seeing prevention as part of an overall continuum of care. The Behavioral Health Continuum of Care Model recognizes multiple opportunities for addressing behavioral health problems and disorders. Based on the Mental Health Intervention Spectrum, first introduced in a 1994 Institute of Medicine report, the model includes the following components:
- Promotion—These strategies are designed to create environments and conditions that support behavioral health and the ability of individuals to withstand challenges. Promotion strategies also reinforce the entire continuum of behavioral health services.
- Prevention—Delivered prior to the onset of a disorder, these interventions are intended to prevent or reduce the risk of developing a behavioral health problem, such as underage alcohol use, prescription drug misuse and abuse, and illicit drug use.
- Treatment—These services are for people diagnosed with a substance use or other behavioral health disorder.
- Recovery—These services support individuals’ abilities to live productive lives in the community and can often help with abstinence.
Risk and Protective Factors
People have biological and psychological characteristics that can make them vulnerable or resilient to potential behavioral health problems. Individual-level protective factors might include a positive self-image, self-control, or social competence.
In addition, people do not live in isolation, they are part of families, communities, and society. A variety of risk and protective factors exist within each of these environmental contexts. Learn more from the SAMHSA Center for the Application of Prevention Technologies’ Key Features of Risk and Protective Factors webpage and from the Risk and Protective Factors and Initiation of Substance Use: Results from the 2014 National Survey on Drug Use and Health (PDF | 1.5 MB). Review the chapter on Risk Factors and Protective Factorsin the National Institute on Drug Abuse’s report, Preventing Drug Use among Children and Adolescents.
Experts attest that an optimal mix of prevention interventions is required to address substance use issues in communities, because they are among the most difficult social problems to prevent or reduce. SAMHSA’s program grantees should consider comprehensive solutions that fit the particular needs of their communities and population, within cultural context, and take into consideration unique local circumstances, including community readiness. Some interventions may be evidence-based, while others may document their effectiveness based on other sources of information and empirical data.
Early intervention also is critical to treating mental illness before it can cause tragic results like serious impairment, unemployment, homelessness, poverty, and suicide. The Community Mental Health Services Block Grant (MHBG) directs states to set aside 5% of their MHBG allocation, which is administered by SAMHSA, to support evidence-based programs that address the needs of individuals with early serious mental illness, including psychotic disorders. The Guidance for Revision of the FY2014-2015 MHBG Behavioral Health Assessment and Plan (PDF | 92 KB) provides additional information.
Review SAMHSA’s criteria for defining a prevention program or early intervention as evidence-based. Also, search SAMHSA’s National Registry of Evidence-based Programs and Practices to find evidence-based programs related to prevention and early intervention(link is external) for all behavioral health issues.
Many prevention approaches, such as selective prevention strategies, focus on helping individuals develop the knowledge, attitudes, and skills they need to make good choices or change harmful behaviors. Many of these strategies can be classroom-based. Learn more from the SAMHSA Center for the Application of Prevention Technologies’ comprehensive review of classroom-based programs.
Universal prevention approaches include the use of environmental prevention strategies, which are tailored to local community characteristics and address the root causes of risky behaviors by creating environments that make it easier to act in healthy ways. The successful execution of these strategies often involves lawmakers, local officials, and community leaders, as well as the acceptance and active involvement of members from various sectors of the community (such as business, faith, schools, and health). For example, the use of this type of strategy may offer fewer places for young people to purchase alcohol, so consuming alcohol becomes less convenient; therefore, less is consumed.
Environmental change strategies have specific advantages over strategies that focus exclusively on the individual. Because they target a much broader audience, they have the potential to produce widespread changes in behavior at the population level. Further, when implemented effectively, they can create shifts in both individual attitudes and community norms that can have long-term, substantial effects. Strategies that target the environment include:
Visit the SAMHSA Center for the Application of Prevention Technologies’ Evaluating Environmental Change Strategieswebpage for more prevention information and resources.
SAMHSA is a leader in the promotion of prevention and early intervention, most notably through its Strategic Prevention Framework (SPF) and participation in the President’s Now Is The Time initiative.
Learn about SAMHSA’s many prevention and early intervention programs, initiatives, and partnerships:
- SAMHSA’s Efforts Related to Prevention and Early Intervention
- SAMHSA’s Prevention Efforts for Specific Populations
- Grants Related to the Prevention of Substance Abuse and Mental Illness
- Publications and Resources on the Prevention of Substance Abuse and Mental Illness
Cultural Awareness and Competency
Improving cultural and linguistic competence is an important strategy for addressing persistent behavioral health disparities experienced by diverse communities, including the lesbian, gay, bisexual, and transgender population and racial and ethnic minority groups. These diverse populations tend to have less access to prevention services and poorer behavioral health outcomes.
Cultural and linguistic competence includes, but is not limited to, the ability of an individual or organization to interact effectively with people of different cultures. To produce positive change, prevention practitioners must understand the cultural and linguistic context of the community, and they must have the willingness and skills to work within this context.
For diverse populations to benefit from prevention and early intervention programs, SAMHSA ensures that culture and language be considered at every step when developing and then implementing these programs. For more information and resources, visit the Strategic Prevention Framework’s Cultural Competence webpage. In addition, the SAMHSA Center for the Application of Prevention Technologies lists the elements of a culturally competent prevention system. With regard to the development of a culturally diverse workforce, the Now Is The Time: Minority Fellowship Program – Youth expands on the existing Minority Fellowship program to support master’s level-trained behavioral health providers in the fields of psychology, social work, professional counseling, marriage and family therapy, and nursing. In addition, SAMHSA supports the Now Is The Time: Minority Fellowship Program – Addiction Counselors, which supports students pursuing master’s level degrees in addiction/substance abuse counseling as well as the Minority Fellowship Program whose purpose is to reduce health disparities and improve health care outcomes of racially and ethnically diverse populations by increasing the number of culturally competent behavioral health professionals available to underserved populations in the public and private nonprofit sectors.
Community coalitions are increasingly used as a vehicle to foster improvements in community health. A coalition is traditionally defined as “a group of individuals representing diverse organizations, factions or constituencies who agree to work together to achieve a common goal.” Community coalitions differ from other types of coalitions in that they include professional and grassroots members committed to work together to influence long-term health and welfare practices in their community. Additionally, given their ability to leverage existing resources in the community and convene diverse organizations, community coalitions connote a type of collaboration that is considered to be sustainable over time.
The federal government has increasingly used community coalitions as a programmatic approach to address emerging community health issues. Community coalitions are composed of diverse organizations that form an alliance in order to pursue a common goal. The activities of community coalitions include outreach, education, prevention, service delivery, capacity building, empowerment, community action, and systems change. The presumption is that successful community coalitions are able to identify new resources to continue their activities and sustain their impact in the community over time. Given the large investment in community coalitions, researchers are beginning to systematically explore the factors that affect the sustainability of community coalitions once their initial funding ends.
The Office of National Drug Control Policy (ONDCP) and the SAMHSA Center for Substance Abuse Prevention (CSAP) support Drug-Free Communities (DFC) Support Program grants, which were created by the Drug-Free Communities Act of 1997 (Public Law 105-20). The DFC Support Program has two goals:
- Establish and strengthen collaboration among communities, public and private non-profit agencies, as well as federal, state, local, and tribal governments to support the efforts of community coalitions working to prevent and reduce substance use among youth
- Reduce substance use among youth and, over time, reduce substance abuse among adults by addressing the factors in a community that increase the risk of substance abuse and promoting the factors that minimize the risk of substance abuse
Long-term analyses suggest a consistent record of positive accomplishment for substance use outcomes in communities with a DFC grantee from 2002 to 2012. The prevalence of past 30-day use of alcohol, tobacco, and marijuana declined significantly among both middle school and high school students. The prevalence of past 30-day alcohol use dropped the most in absolute percentage point terms, declining by 2.8 percentage points among middle school students and declining by 3.8 percentage points among high school students. The prevalence of past 30-day tobacco use declined by 1.9 percentage points among middle school students, and by 3.2 percentage points among high school students from DFC grantees’ first report to their most recent report. Though significant, the declines in the prevalence of past 30-day marijuana use were less pronounced, declining by 1.3 percentage points among middle school students and by 0.7 percentage points among high school students. Learn more from the Drug-Free Communities Support Program: 2012 National Evaluation Report (PDF | 648 KB).
Prescription Drug Misuse and Abuse
SAMHSA addresses prescription drug misuse and abuse using a public health approach that includes early intervention, prevention, treatment, and recovery support services.
Prescription drug misuse and abuse is the intentional or unintentional use of medication without a prescription, in a way other than prescribed, or for the experience or feeling it causes. Results from the 2014 National Survey on Drug Use and Health (NSDUH) (PDF | 3.4 MB) indicate that about 15 million people aged 12 or older used prescription drugs non-medically in the past year, and 6.5 million did so in the past month. This issue is a growing national problem in the United States. Prescription drugs are misused and abused more often than any other drug, except marijuana and alcohol. This growth is fueled by misperceptions about prescription drug safety, and increasing availability. A 2011 analysis by the Centers for Disease Control and Prevention found that opioid analgesic (pain reliever) sales increased nearly four-fold between 1999 and 2010; this was paralleled by an almost four-fold increase in opioid (narcotic pain medication) overdose deaths and substance abuse treatment admissions almost six times the rate during the same time period.
Prescription drug abuse-related emergency department visits and treatment admissions have risen significantly in recent years. Other negative outcomes that may result from prescription drug misuse and abuse include overdose and death, falls and fractures in older adults, and, for some, initiating injection drug use with resulting risk for infections such as hepatitis C and HIV. According to results from the 2014 NSDUH report, 12.7% of new illicit drug users began with prescription pain relievers.
A 2008 report by the Coalition Against Insurance Fraud (PDF | 2.3 MB)(link is external) estimates that the abuse of opioid analgesics results in more than $72 billion in medical costs alone each year. This is comparable to costs related to other chronic diseases such as asthma(link is external) and HIV.
The problem of prescription drug abuse and overdose is complex, involving insufficient oversight to curb inappropriate prescribing, insurance and pharmacy benefit policies, and a belief by many people that prescription drugs are not dangerous. The 2014 National Drug Control Strategy (PDF | 1.5 MB) serves as the blueprint for reducing drug use and its consequences in the United States. The new strategy reviews the progress made over the past four years and looks ahead to continuing efforts to reform, rebalance, and renew the national drug control policy to address the public health and safety challenges of the 21st century.
Learn more about:
Alcohol, Tobacco, and Other Drugs
The misuse and abuse of alcohol, over-the-counter medications, illicit drugs, and tobacco affect the health and well-being of millions of Americans.
According to SAMHSA’s National Survey on Drug Use and Health (NSDUH) – 2014 (PDF | 3.4 MB), about two-thirds (66.6%) of people aged 12 or older reported in 2014 that they drank alcohol in the past 12 months, with 6.4% meeting criteria for an alcohol use disorder. Also among Americans aged 12 or older, the use of illicit drugs has increased over the last decade from 8.3% of the population using illicit drugs in the past month in 2002 to 10.2% (27 million people) in 2014. Of those, 7.1 million people met criteria for an illicit drug use disorder in the past year. The misuse of prescription drugs is second only to marijuana as the nation’s most common drug problem after alcohol and tobacco, leading to troubling increases in opioid overdoses in the past decade. An estimated 25.2% (66.9 million) of Americans aged 12 or older were current users of a tobacco product. While tobacco use has declined since 2002 for the general population, this has not been the case for people with serious mental illness where tobacco use remains a major cause of morbidity and early death.
Additional data from SAMHSA’s Behavioral Health Barometer – 2014 (PDF | 3.9 MB) show that:
- Men reported higher rates of illicit drug dependence than women, 3.8% to 1.9%.
- American Indians and Alaska Natives have the highest rates of illicit drug dependence at 6%, followed by African Americans at 3.6%. Asian Americans reported the lowest rate at 1%.
- About 14% of adults with illicit drug dependence reported receiving treatment in the past year, which did not vary by gender.
- Each year, approximately 5,000 youth under the age of 21 die as a result of underage drinking.
- In 2012, 58.3% of people who tried alcohol for the first time were younger than 18.
- More than 50% of people aged 12 or older in 2011-2012 who used pain relievers for non-medical reasons in the past year got them from a friend or relative.
Find more information and resources for the following:
- Other Drugs
- Publications and Resources on Alcohol, Tobacco, and Other Drugs
To learn more about SAMHSA’s work on alcohol, tobacco, and other drug abuse prevention, treatment, and recovery, visit these other topics:
- Behavioral Health Treatments and Services
- Health Disparities
- Mental and Substance Use Disorders
- Prescription Drug Misuse and Abuse
- Prevention of Substance Abuse and Mental Illness
- Recovery and Recovery Support
- School and Campus Health
- Specific Populations
- Tribal Affairs
- Underage Drinking
For information on SAMHSA’s campaigns and programs, including tools and resources to prevent alcohol abuse, tobacco use, and other drug use, visit:
SAMHSA provides information on the dangers of underage drinking and offers tips on how to prevent this threat to adolescent development and health.
Alcohol is the most widely misused substance among America’s youth. Consumption of alcohol by anyone under the age of 21, also known as underage drinking, remains a considerable public health challenge. Adolescent alcohol use is not an acceptable rite of passage, but a serious threat to adolescent development and health. Medical research shows that the developing adolescent brain may be particularly susceptible to long-term negative consequences of alcohol use. In 2014, more than 1.6 million people between the ages of 12 and 20 reported driving under the influence of alcohol in the past year. This accounts for almost 4.4% of people between these ages.
In March 2007, the Acting Surgeon General of the United States issued a Call to Action to Prevent and Reduce Underage Drinking. In that report, the Surgeon General addressed the need for a comprehensive approach to prevention that includes support from parents, families, schools, colleges, communities, the health care system, and all levels of government.
Learn more about:
- Contributing Factors and What You Can Do
- STOP Act Legislation
- Underage Drinking and School and Campus Health
- Grants Related to Underage Drinking
- Publications and Resources on Underage Drinking
Underage drinking is a significant, but often overlooked, problem in the United States. More teens use alcohol than tobacco or other drugs.
Although adolescents and young adults drink less often than adults, they tend to drink more than adults, frequently drinking as many as 5 or more drinks on a single occasion. Rates of binge and heavy alcohol use among people under the age of 21 declined from 2002 and 2014, according to SAMHSA’s 2014 National Survey on Drug Use and Health; however, over 5 million youth between the ages of 12 and 20 reported being binge drinkers, and 1.3 million reported being heavy drinkers.
The results showed 77% of current underage drinkers reported drinking while with a group, while 6.3% reported drinking alone. The remaining youth reported they drank with one other person the last time they drank.
For young people between the ages of 12 and 20, the reported rates of alcohol use in the past month in 2014 were:
- 13.5% of Asian Americans
- 17.3% of African-Americans
- 21.1% of people reporting two or more races
- 21.2% of Hispanics
- 21.9% of American Indians/Alaska Natives
- 26% of whites
Reports of underage alcohol use were highest in the Northeast (28.3%) and lowest in the South (22.3%). Rates in the Midwest and West were both around 24.5%.
Although adolescence brings increased risk for alcohol use, some factors put teens at higher risk for abusing alcohol. These include high levels of impulsiveness, novelty seeking, and aggressive behavior; having conduct or behavior problems; and a tendency not to consider the possible negative consequences of one’s actions.
- Is responsible for more than 4,300 annual deaths among underage youth
- Is linked to 189,000 emergency rooms visits by people under age 21 for injuries and other conditions
- Contributes to the likelihood of risky sexual behavior, including unwanted, unintended, and unprotected sexual activity, and sex with multiple partners
- Increases the risk of encountering legal problems, such as being arrested for drunk driving or physically hurting someone while drunk
- Increases the risk of physical and sexual assault
- Increases the risk for suicide and homicide
- Increases the risk of memory problems
- Increases the risk of using and misusing other drugs
- Increases the risk of changes in brain development that may have life-long effects
- Is a risk factor for heavy drinking later in life, which can lead to other medical problems (youth who start drinking before age 15 are almost 5 times more likely to develop alcohol dependence or abuse later in life than those who begin drinking at or after age 21)
Addressing underage drinking has historically been a top priority for SAMHSA. SAMHSA’s Strategic Initiatives, as outlined in 2011, underscored the importance of public awareness and health education to address and prevent underage drinking. As SAMHSA looks to the future, it remains committed to engaging with parents and other caregivers, schools, communities, and youth in a coordinated national effort to prevent underage drinking.
Underage Drinking Campaign
Mandated by the Sober Truth on Preventing Underage Drinking Act (STOP Act) of 2006, SAMHSA’s underage drinking prevention campaign—“Talk. They Hear You.”—helps parents and caregivers start talking to their children early—as early as 9 years old—about the dangers of alcohol. The goals of the campaign are to:
- Increase parents’ awareness of the prevalence and risk of underage drinking
- Equip parents with the knowledge, skills, and confidence to prevent underage drinking
- Increase parents’ actions to prevent underage drinking
Over the past few years, thousands of communities across the United States have held events to educate people about the dangers of underage drinking and to involve people in proven prevention strategies. The impact of this continuing initiative is presented in the report 2012 Town Hall Meetings to Prevent Underage Drinking: Moving Communities Beyond Awareness to Action. In April 2014, SAMHSA launched its 2014 Town Hall Meetings to prevent underage drinking.
What Is the Difference between Substance Abuse And Addiction?
SAMHSA defines use, abuse, and addiction to any illicit substance very specifically. “Use”of drugs and alcohol includes any alcohol or drug ingestion by any means with the intent to socialize and relax with others on a recreational level. Though the amount used may not seem to be harmful and may not ultimately lead to dependence upon the substance of choice, it may still put the individual in harm’s way if recreational drug or alcohol use leads to unsafe choices or situations while the person is under the influence.
“Abuse”of drugs and alcohol is defined as chronic use of any illicit substance that results in at least one of the following issues in the past year:
- An inability to maintain commitments or fulfill obligations in one’s career, at school, or in the home.
- Physically dangerous situations that could lead to accident.
- Legal problems related to use of any substance or choices made while under the influence.
- Relationship difficulties at home, with neighbors, and/or in the workplace.
“Addiction,”or dependence upon a drug or drugs, including alcohol, is defined by experiencing three or more of the following problems within the past year as a direct consequence of chronic use of the substances of choice:
- The individual builds a tolerance to the drug of choice (e.g., requiring higher and higher doses in order to experience the “high”associated with use).
- Money designated for survival (e.g., rent, food, utilities) is instead used to buy drugs and alcohol.
- Care of dependent family members or regard for the safety of others in general, including in the workplace and on the road, becomes negligent.
- The individual experiences physical withdrawal symptoms when without the drug of choice that will vary depending on the specific substance but may include nausea, shaking, chills, sweating, vomiting, body pains, and more.
- The individual takes the substance of choice more often or in larger amounts than originally intended.
- Despite a genuine desire to stop using or drinking, the individual is unable to moderate or stop use of all substances for any length of time.
- The major focus of almost every day is getting high or drunk, recovering from the effects of drugs or alcohol, obtaining more drugs and alcohol, or doing things that will in general enable the ability to get and stay high.
- Individuals may no longer take part in hobbies or social events that were once important to them due to substance abuse.
- Despite the fact that negative consequences of using drugs and alcohol continue to pile up, the individual is unable to quit.