MONITORING FUTURENATIONAL SURVEY RESULTS

ON DRUG USE1975-2017

2017 Volume 1

the

Sponsored by The National Institute on Drug Abuse at The National Institutes of Health

Secondary School Students

Richard A. Miech Lloyd D. Johnston

Patrick M. O’Malley Jerald G. Bachman

John E. SchulenbergMegan E. Patrick

MONITORING THE FUTURE

NATIONAL SURVEY RESULTS ON DRUG USE, 1975–2017

Volume I

Secondary School Students

by

Richard A. Miech, Ph.D. Lloyd D. Johnston, Ph.D.

Patrick M. O’Malley, Ph.D. Jerald G. Bachman, Ph.D.

John E. Schulenberg, Ph.D. Megan E. Patrick, Ph.D.

The University of Michigan Institute for Social Research

Sponsored by: The National Institute on Drug Abuse

National Institutes of Health

This publication was written by the principal investigators and staff of the Monitoring the Future project at the Institute for Social Research, the University of Michigan, under Research Grant No. R01 DA 001411 from the National Institute on Drug Abuse. The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the National Institute on Drug Abuse or the National Institutes of Health.

Public Domain Notice

All materials appearing in this volume are in the public domain and may be reproduced or copied, whether in print or in non-print media including derivatives, in any reasonable manner, without permission from the authors. If you plan to modify the material, please indicate that changes were made and contact MTF at mtfinformation@umich.edu for verification of accuracy. Citation of the source is appreciated, including at least the following: Monitoring the Future, Institute for Social Research, University of Michigan.

https://creativecommons.org/licenses/by/4.0/

Recommended Citation

Miech, R. A., Johnston, L. D., O’Malley, P. M., Bachman, J. G., Schulenberg, J. E., & Patrick, M. E. (2018). Monitoring the Future national survey results on drug use, 1975–2017: Volume I, Secondary school students. Ann Arbor: Institute for Social Research, The University of Michigan. Available at http://monitoringthefuture.org/pubs.html#monographs

Institute for Social Research The University of Michigan

Ann Arbor, Michigan Published June 2018

https://creativecommons.org/licenses/by/4.0/http://monitoringthefuture.org/pubs.html#monographs

ABBREVIATED CONTENTS*

Click on any item below (in blue) to go directly to that page.

Detailed Contents ............................................................................................................... iv

List of Tables ..................................................................................................................... ix

List of Figures ................................................................................................................. xix

Chapter 1 Introduction ................................................................................................ 1

Chapter 2 Key Findings in 2017 ............................................................................... 10

Chapter 3 Study Design and Procedures ................................................................. 16

Chapter 4 Prevalence and Frequency of Drug Use ................................................. 30

Chapter 5 Trends in Drug Use ................................................................................ 106

Chapter 6 Initiation Rates and Trends in Initiation Rates .................................. 279

Chapter 7 Degree and Duration of Drug Highs .................................................... 319

Chapter 8 Attitudes and Beliefs about Drug Use .................................................. 344

Chapter 9 The Social Context ................................................................................. 421

Chapter 10 Study Publications ................................................................................. 501

Appendix A Prevalence and Trend Estimates Adjusted for Absentees and Dropouts ............................................................................................ 516

Appendix B Definition of Background and Demographic Subgroups ................... 527

Appendix C Trends in Specific Subclasses of Hallucinogens, Amphetamines, Tranquilizers, Narcotic Drugs other than Heroin, and Sedatives ..................................................................................... 531

Appendix D Trends in Drug Use for Three Grades Combined .............................. 549

*See next page for Detailed Contents.

iii

DETAILED CONTENTS

Click on any item below (in blue) to go directly to that page. Chapter 1 Introduction ........................................................................................................................... 1

Content Areas Covered ....................................................................................................................... 2 Drug Classes ................................................................................................................................. 2 Attitudes, Beliefs, and Early Experiences .................................................................................... 3 Over-the-Counter Substances ....................................................................................................... 3 Cumulative Lifetime Daily Marijuana Use .................................................................................. 4 Trends in Use of Specific Alcoholic Beverages ........................................................................... 4 Sources of Prescription Drugs ...................................................................................................... 4 Synopses of Other MTF Publications ........................................................................................... 4 Appendixes ................................................................................................................................... 4

Purposes and Rationale for This Research .......................................................................................... 5 Chapter 2 Key Findings in 2017 ........................................................................................................... 10

Executive Summary .......................................................................................................................... 10

Illicit Drugs showing an Increase in Use in 2017 ....................................................................... 10 Illicit Drugs Showing Declines in Use in 2017 .......................................................................... 11 Most Illicit Drugs Held Steady in Use in 2017 ........................................................................... 12 Psychotherapeutic Drugs ............................................................................................................ 12 Most Forms of Tobacco Use Continue to Decline ..................................................................... 12 Vaping ........................................................................................................................................ 14 Alcohol Use Levels After a Long Decline.................................................................................. 15

Chapter 3 Study Design and Procedures .............................................................................................. 16

Research Design and Procedures for the 12th-Grade Surveys ........................................................... 16 The Population under Study ....................................................................................................... 16 The Omission of Dropouts.......................................................................................................... 17 Sampling Procedures and Sample Weights ................................................................................ 17 Questionnaire Administration ..................................................................................................... 18 Questionnaire Format ................................................................................................................. 18

Research Design and Procedures for the 8th- and 10th-Grade Surveys .............................................. 18 Mode of Administration ............................................................................................................. 19 Questionnaire Forms and Sample Proportions ........................................................................... 19

Research Design and Procedures for the 12th-Grade Follow-up Surveys ......................................... 20 Follow-Up Procedures ................................................................................................................ 20 Follow-Up Questionnaire Format ............................................................................................... 21

Representativeness and Sample Accuracy ........................................................................................ 21 School Participation .................................................................................................................... 21 Student Participation ................................................................................................................... 23 Sampling Accuracy of the Estimates .......................................................................................... 24

Panel Surveys .................................................................................................................................... 24 Validity of Measures of Self-Reported Drug Use ............................................................................. 24

Consistency and Measurement of Trends ................................................................................... 26

iv

DETAILED CONTENTS (continued)

Click on any item below (in blue) to go directly to that page.

Chapter 4 Prevalence and Frequency of Drug Use .............................................................................. 30

Prevalence and Frequency of Drug Use in 2017: All Students ......................................................... 30 Prevalence of Lifetime, Annual, and 30-Day Use ...................................................................... 30 Frequency of Lifetime, Annual, and 30-Day Use ....................................................................... 39 Prevalence of Current Daily Use ................................................................................................ 40

Noncontinuation Rates ...................................................................................................................... 41 Prevalence Comparisons for Important Subgroups ........................................................................... 42

Gender Differences ..................................................................................................................... 42 Differences Related to College Plans ......................................................................................... 45 Regional Differences .................................................................................................................. 46 Differences Related to Population Density ................................................................................. 48 Differences Related to Parental Education ................................................................................. 49 Racial/Ethnic Differences ........................................................................................................... 50 Interactions between Race/Ethnicity and Parental Education .................................................... 53

Chapter 5 Trends in Drug Use ........................................................................................................... 106

Two Themes in Drug Trends from 1975–2017 ............................................................................... 106 Trends in Prevalence of Use, 1975–2017 ........................................................................................ 107

Trends in Indices of Overall Illicit Drug Use ........................................................................... 107 Trends in Use of Specific Drugs ............................................................................................... 109

Summary ......................................................................................................................................... 127 Trends in Noncontinuation Rates: 12th Graders .............................................................................. 128 Implications for Prevention ............................................................................................................. 131 Trend Comparisons among Subgroups ........................................................................................... 131

Trend Differences by Gender ................................................................................................... 132 Trend Differences by College Plans ......................................................................................... 139 Trend Differences by Region of the Country ........................................................................... 145 Trend Differences by Population Density ................................................................................ 150 Trend Differences by Socioeconomic Status ............................................................................ 155 Racial/Ethnic Differences in Trends ......................................................................................... 161

Chapter 6 Initiation Rates and Trends in Initiation Rates .................................................................. 279

Incidence of Use by Grade Level .................................................................................................... 280 Trends in Lifetime Prevalence at Earlier Grade Levels .................................................................. 283 Drugs No Longer Tracked for Initiation Due to Low Levels of Use .............................................. 289

Chapter 7 Degree and Duration of Drug Highs .................................................................................. 319

Degree and Duration of Highs among 12th Graders in 2017 ........................................................... 319 Trends in Degree and Duration of Drug Highs ............................................................................... 321

Chapter 8 Attitudes and Beliefs about Drug Use ............................................................................... 344

Perceived Harmfulness of Drug Use ............................................................................................... 345

Beliefs about Harmfulness among 12th Graders ....................................................................... 345

v

DETAILED CONTENTS (continued)

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Risk from Regular Use ............................................................................................................. 345 Risk from Experimental Use .................................................................................................... 346 8th and 10th Graders’ Beliefs about Harmfulness ...................................................................... 346

Trends in Perceived Harmfulness of Drug Use ............................................................................... 348 Trends in Perceived Harmfulness among 12th Graders ............................................................ 348 Trends in Perceived Harmfulness among 8th and 10th Graders ................................................. 357

Personal Disapproval of Drug Use .................................................................................................. 360 Extent of Disapproval among 12th Graders............................................................................... 360 Extent of Disapproval among 8th and 10th Graders ................................................................... 361

Trends in Disapproval of Drug Use ................................................................................................ 362 Trends in Disapproval among 12th Graders .............................................................................. 362 Trends in Disapproval among 8th and 10th Graders .................................................................. 365

Attitudes Regarding the Legality of Drug Use ................................................................................ 367 Attitudes about Legality of Drug Use among 12th Graders ...................................................... 368 Trends in Attitudes about Legality of Drug Use among 12th Graders ...................................... 368

The Legal Status of Marijuana ........................................................................................................ 369 Attitudes and Predicted Responses to Legalization of Marijuana ............................................ 369 Trends in Attitudes and Predicted Responses to Legalization of Marijuana ............................ 371

Chapter 9 The Social Context ............................................................................................................ 421

Perceived Attitudes of Friends and Parents: 12th Graders ............................................................... 421

Perceptions of Friends’ Attitudes ............................................................................................. 421 A Comparison of the Attitudes of Parents, Peers, and 12th Graders ......................................... 422 Trends in Perceptions of Friends’ Attitudes ............................................................................. 423 Methodological Implications .................................................................................................... 425

Friends’ Use of Drugs ..................................................................................................................... 425 Exposure to Drug Use by Friends and Others: 12th Graders ..................................................... 426 Friends’ Use of Drugs: 8th and 10th Graders, 2017 ................................................................... 427

Trends in Exposure to Drug Use and Friends’ Use of Drugs .......................................................... 428 Trends in Exposure to Drug Use by Friends and Others: 12th Graders .................................... 428 Specific Drugs .......................................................................................................................... 428 Trends in Friends’ Drug Use: 8th and 10th Graders ................................................................... 430

Sources of Certain Prescription Drugs Used Without Medical Supervision ................................... 431 Perceived Availability of Drugs ...................................................................................................... 432

Perceived Availability of Drugs, 2017: All Grades .................................................................. 433 Trends in Perceived Availability for All Grades ...................................................................... 434 The Importance of Supply Reduction versus Demand Reduction ............................................ 440

Chapter 10 Study Publications ............................................................................................................ 501

Adolescents’ prescription stimulant use and adult functional outcomes: A national prospective study ........................................................................................... 501

Age-related changes in associations between reasons for alcohol use and high-intensity drinking across young adulthood ............................................................. 501

Age-specific prevalence of binge and high-intensity drinking among U. S. young adults: Changes from 2005 to 2015 ............................................................................................ 502

vi

DETAILED CONTENTS (continued) Click on any item below (in blue) to go directly to that page.

Alcohol mixed with energy drink use during young adulthood ............................................... 502 Competitive sports participation in high school and subsequent substance use

in young adulthood: Assessing difference based on level of contact ............................. 503 Current high-intensity drinking among 8th and 10th grade students in the United States.......... 503 The developmental course of community service across the transition to adulthood

in a National U.S. sample .............................................................................................. 504 Do alcohol use reasons and contexts differentiate adolescent high-intensity drinking?

Data for U.S. high school seniors, 2005-2016 ............................................................... 504 Frequent binge drinking among U.S. adolescents, 1991-2015 ................................................. 505 Gender- and age-varying associations of sensation seeking and substance use

across young adulthood .................................................................................................. 505 High-intensity and simultaneous alcohol and marijuana use among high school seniors

in the U.S ........................................................................................................................ 506 High-intensity drinking and nonmedical use of prescription drugs: Results

from a national survey of 12th grade students ................................................................. 506 How collegiate fraternity and sorority involvement relates to substance use during

young adulthood and substance use disorders in early midlife: A national longitudinal study ........................................................................................................... 507

Inverse propensity score weighting with a latent class exposure: Estimating the causal effect of reported reasons for alcohol use on problem alcohol use 15 years later .......... 507

Joint effects of age, period, and cohort on conduct problems among American adolescents from 1991 through 2015 ................................................................................................. 508

Marital status as a partial mediator of the associations between young adult substance use and subsequent substance use disorder: Application of causal inference methods......... 508

Passing on pot: High school seniors’ reasons for not using marijuana as predictors of future use .................................................................................................................... 509

Patterns of high-intensity drinking among young adults in the United States: A repeated measures latent class analysis ....................................................................... 509

Patterns of simultaneous and concurrent alcohol and marijuana use among adolescents ........ 510 Prevalence and attitudes regarding marijuana use among adolescents over the past decade ... 510 Prevalence of concussion among U.S. adolescents and correlated factors ............................... 511 Prospective associations of 12th grade drinking intensity and age 19/20 driving-related

consequences in a national sample ................................................................................. 511 Reasons for vaping among U.S. 12th graders: A latent class analysis ...................................... 511 Risk is still relevant: Time-varying associations between perceived risk and marijuana

use among U.S. 12th grade students from 1991-2016 ..................................................... 512 A sequential mixed-mode experiment in the U.S. national Monitoring the Future Study ....... 512 Substance use behaviors and the timing of family formation during young adulthood ........... 513 Technology and interactive social media use among 8th and 10th graders in the U.S.

and associations with homework and school grades ....................................................... 513 U.S. adolescent alcohol use by race/ethnicity: Consumption and perceived need to

reduce/stop use ................................................................................................................ 514 Other Data on Correlates and Trends .............................................................................................. 514 Website ............................................................................................................................................ 514

Appendix A Prevalence and Trend Estimates Adjusted for Absentees and Dropouts .......................... 516

Corrections for 8th and 10th Grades ................................................................................................. 516

vii

DETAILED CONTENTS (continued) Click on any item below (in blue) to go directly to that page.

The Effects of Missing Absentees ................................................................................................... 517 The Effects of Missing Dropouts .................................................................................................... 517

Extrapolation Methods ............................................................................................................. 518 Effects of Omitting Dropouts in Trend Estimates .................................................................... 519

Further Exploration of Corrections for Dropouts ............................................................................ 520 Examples of Revised Estimates for Two Drugs .............................................................................. 522 Summary and Conclusions .............................................................................................................. 522

Appendix B Definition of Background and Demographic Subgroups ................................................. 527

Appendix C Trends in Specific Subclasses of Hallucinogens, Amphetamines, Tranquilizers, Narcotic Drugs other than Heroin, and Sedatives ..................................... 531

Appendix D Trends in Drug Use for Three Grades Combined ............................................................. 549

viii

LIST OF TABLES Click on any item below (in blue) to go directly to that page. Table 1-1 New and Deleted Prevalence of Use Questions for 8th, 10th, and 12th

Graders ................................................................................................................... 8

Table 3-1 Sample Sizes and Response Rates ....................................................................... 27

Table 4-1a Lifetime Prevalence of Use for 8th, 10th, and 12th Graders, 2017, With Ninety-Five Percent Confidence Limits ...................................................... 54

Table 4-1b Annual Prevalence of Use for 8th, 10th, and 12th Graders, 2017, With Ninety-Five Percent Confidence Limits ..................................................... 56

Table 4-1c 30-Day Prevalence of Use for 8th, 10th, and 12th Graders, 2017, With Ninety-Five Percent Confidence Limits ...................................................... 58

Table 4-1d Daily Prevalence of Use for 8th, 10th, and 12th Graders, 2017, With Ninety-Five Percent Confidence Limits ............................................................... 60

Table 4-2 Prevalence of Use of Various Drugs for 8th, 10th, and 12th Graders, 2017...................................................................................................................... 62

Table 4-3 Prevalence of Use of Heroin with and without a Needle for 8th, 10th, and 12th Graders, 2017 ......................................................................................... 64

Table 4-4a Frequency of Use of Various Drugs: Lifetime, Annual, and 30-Day for 8th, 10th, and 12th Graders, 2017 ..................................................................... 65

Table 4-4b Frequency of Occasions of Heavy Drinking, for 8th, 10th, and 12th Graders, 2017 ....................................................................................................... 72

Table 4-4c Frequency of Occasions of Cigarette Smoking, and Smokeless Tobacco Use for 8th, 10th, and 12th Graders, 2017 ............................................... 73

Table 4-4d Frequency of Days Used in Lifetime and Past 30 Days for Various Tobacco and Other Substances for 8th, 10th, and 12th Graders, 2017 ................... 74

Table 4-5 Lifetime Prevalence of Use of Various Drugs by Subgroups for 8th, 10th, and 12th Graders, 2017 ................................................................................. 75

Table 4-6 Annual Prevalence of Use of Various Drugs by Subgroups for 8th, 10th, and 12th Graders, 2017 ................................................................................. 82

Table 4-7 Thirty-Day Prevalence of Use of Various Drugs by Subgroups for 8th, 10th, and 12th Graders, 2017 ........................................................................... 90

Table 4-8 Thirty-Day Prevalence of Daily Use of Various Drugs by Subgroups for 8th, 10th, and 12th Graders, 2017 ................................................... 97

Table 5-1 Long-Term Trends in Lifetime Prevalence of Use of Various Drugs in Grade 12 .............................................................................................. 170

ix

LIST OF TABLES (continued) Click on any item below (in blue) to go directly to that page. Table 5-2 Long-Term Trends in Annual Prevalence of Use of Various Drugs

in Grade 12 ......................................................................................................... 176

Table 5-3 Long-Term Trends in 30-Day Prevalence of Use of Various Drugs in Grade 12 ......................................................................................................... 182

Table 5-4 Long-Term Trends in 30-Day Prevalence of Daily Use of Various Drugs in Grade 12 .............................................................................................. 188

Table 5-5a Trends in Lifetime Prevalence of Use of Various Drugs in Grades 8, 10, and 12 ....................................................................................................... 193

Table 5-5b Trends in Annual Prevalence of Use of Various Drugs in Grades 8, 10, and 12 ........................................................................................................... 200

Table 5-5c Trends in 30-Day Prevalence of Use of Various Drugs in Grades 8, 10, and 12 ........................................................................................................... 210

Table 5-5d Trends in 30-Day Prevalence of Daily Use of Various Drugs in Grades 8, 10, and 12 .......................................................................................... 218

Table 5-5e Trends in Two Week Prevalence of Extreme Binge Drinking in Grades 8, 10, and 12 .......................................................................................... 220

Table 5-6a Trends in Lifetime Prevalence of Use of Heroin with and without a Needle in Grades 8, 10, and 12 .......................................................................... 224

Table 5-6b Trends in Annual Prevalence of Use of Heroin with and without a Needle in Grades 8, 10, and 12 .......................................................................... 225

Table 5-6c Trends in 30-Day Prevalence of Use of Heroin with and without a Needle in Grades 8, 10, and 12 .......................................................................... 226

Table 5-7a Trends in Noncontinuation Rates among 12th Graders Who Ever Used Drug in Lifetime ....................................................................................... 227

Table 5-7b Trends in Noncontinuation Rates among 12th Graders Who Used Drug 10 or More Times in Lifetime ................................................................... 230

Table 6-1 Incidence of Use of Various Drugs by Grade for 8th Graders, 2017 ................. 291

Table 6-2 Incidence of Use of Various Drugs by Grade for 10th Graders, 2017.................................................................................................................... 292

Table 6-3 Incidence of Use of Various Drugs by Grade for 12th Graders, 2017.................................................................................................................... 293

Table 6-4 Incidence of Use of Various Drugs: A Comparison of Responses from 8th, 10th, and 12th Graders, 2017 ................................................................ 294

x

LIST OF TABLES (continued) Click on any item below (in blue) to go directly to that page. Table 7-1 Marijuana: Trends in Degree and Duration of Feeling High in

Grade 12 ............................................................................................................. 325

Table 7-2 LSD: Trends in Degree and Duration of Feeling High in Grade 12 ....................327

Table 7-3 Hallucinogens other than LSD: Trends in Degree and Duration of Feeling High in Grade 12 .....................................................................................329

Table 7-4 Cocaine: Trends in Degree and Duration of Feeling High in Grade 12..........................................................................................................................331

Table 7-5 Narcotics other than Heroin: Trends in Degree and Duration of Feeling High in Grade 12 .....................................................................................333

Table 7-6 Amphetamines: Trends in Degree and Duration of Feeling High in Grade 12 ...............................................................................................................335

Table 7-7 Tranquilizers: Trends in Degree and Duration of Feeling High in Grade 12 ...............................................................................................................337

Table 7-8 Alcohol: Trends in Degree and Duration of Feeling High in Grade 12 ...............339

Table 8-1 Trends in Harmfulness of Drugs as Perceived by 8th Graders ........................... 372

Table 8-2 Trends in Harmfulness of Drugs as Perceived by 10th Graders .......................... 375

Table 8-3 Trends in Harmfulness of Drugs as Perceived by 12th Graders .......................... 378

Table 8-4 Trends in Disapproval of Drug Use in Grade 8 ................................................. 382

Table 8-5 Trends in Disapproval of Drug Use in Grade 10 ............................................... 385

Table 8-6 Trends in Disapproval of Drug Use in Grade 12 ............................................... 388

Table 8-7 Trends in 12th Graders’ Attitudes Regarding Legality of Drug Use .................. 392

Table 8-8 Trends in 12th Graders’ Attitudes Regarding Marijuana Laws .......................... 395

Table 9-1 Trends in Proportion of Friends Disapproving of Drug Use for 12th Graders ............................................................................................................... 442

Table 9-2 Trends in 12th Graders' Exposure to Drug Use .................................................. 445

Table 9-3 Trends in Friends’ Use of Drugs as Estimated by 8th Graders ........................... 449

Table 9-4 Trends in Friends’ Use of Drugs as Estimated by 10th Graders ......................... 451

Table 9-5 Trends in Friends’ Use of Drugs as Estimated by 12th Graders ......................... 453

Table 9-6 Trends in Availability of Drugs as Perceived by 8th Graders ............................. 460

Table 9-7 Trends in Availability of Drugs as Perceived by 10th Graders ........................... 462

xi

LIST OF TABLES (continued) Click on any item below (in blue) to go directly to that page. Table 9-8 Trends in Availability of Drugs as Perceived by 12th Graders........................... 464

Table 9-9 Source of Prescription Drugs among Those Who Used in Last Year Grade 12, 2009-2017 ......................................................................................... 467

Table A-1 Past Month Substance Uses among 12th Grade Aged Youths, by Dropout Status, NSDUH 2002–2010 (Combined) ............................................. 523

Table A-2 Estimated Prevalence Levels for Marijuana and Cocaine, 2013, Based on Data from Monitoring the Future and The National Survey on Drug Use and Health ......................................................................... 524

Table C-1 Specific Hallucinogens Other Than LSD: Trends in Annual Prevalence of Use for All Seniors ...................................................................... 535

Table C-2 Specific Amphetamines: Trends in Annual Prevalence of Use for All Seniors ......................................................................................................... 538

Table C-3 Specific Tranquilizers: Trends in Annual Prevalence of Use for All Seniors................................................................................................................ 541

Table C-4 Specific Narcotics other than Heroin: Trends in Annual Prevalence of Use for All Seniors ........................................................................................ 544

Table C-5 Specific Sedatives: Trends in Annual Prevalence of Use for All Seniors................................................................................................................ 547

Table D-1 Trends in Lifetime Prevalence of Use of Various Drugs for Grades 8, 10, and 12 Combined ..................................................................................... 550

Table D-2 Trends in Annual Prevalence of Use of Various Drugs for Grades 8, 10, and 12 Combined ..................................................................................... 552

Table D-3 Trends in 30-Day Prevalence of Use of Various Drugs for Grades 8, 10, and 12 Combined ..................................................................................... 554

Table D-4 Trends in Daily Prevalence of Use of Selected Drugs and Heavy Use of Alcohol and Tobacco for Grades 8, 10, and 12 Combined .................... 556

xii

LIST OF FIGURES Click on any item below (in blue) to go directly to that page. Figure 3-1 Schools included in 1 Year’s Data Collection: 8th, 10th,

and 12th Grades ......................................................................................................28

Figure 3-2 School Participation Rates .....................................................................................29

Figure 4-1 Prevalence and Recency of Use of Various Types of Drugs in Grades 8, 10, and 12, 2017 ..................................................................................100

Figure 4-2 Thirty-Day Prevalence of Daily Use of Various Types of Drugs in Grade 12, 2017 .................................................................................................103

Figure 4-3 Noncontinuation Rates: Percentage of Lifetime Users Who Did Not Use in Last 12 Months in Grades 8, 10, and 12, 2017 ..................................104

Figure 5-1 An Illicit Drug Use Index: Trends in Lifetime Prevalence by Grade ..................233

Figure 5-2 An Illicit Drug Use Index: Trends in Annual Prevalence by Grade ....................234

Figure 5-3 An Illicit Drug Use Index: Trends in 30-Day Prevalence by Grade ....................235

Figure 5-4a Marijuana: Trends in Annual Prevalence and 30-Day Prevalence of Daily Use in Grades 8, 10, and 12 .......................................................................236

Figure 5-4b Synthetic Marijuana: Trends in Annual Prevalence in Grades 8, 10, and 12 ........................................................................................237

Figure 5-4c Inhalants: Trends in Annual Prevalence in Grades 8, 10, and 12 ........................238

Figure 5-4d Hallucinogens and PCP: Trends in Annual Prevalence in Grades 8, 10, and 12 ........................................................................................239

Figure 5-4e LSD and Hallucinogens other than LSD: Trends in Annual Prevalence in Grades 8, 10, and 12 ......................................................................240

Figure 5-4f Ecstasy (MDMA): Trends in Annual Prevalence in Grades 8, 10, and 12 ........................................................................................241

Figure 5-4g Cocaine, Crack, and Cocaine other than Crack: Trends in Annual Prevalence in Grades 8, 10, and 12 ......................................................................242

Figure 5-4h Heroin: Trends in Annual Prevalence in Grades 8, 10, and 12 ............................243

Figure 5-4i Narcotics other than Heroin: Trends in Annual Prevalence in Grade 12 ...............................................................................................................244

Figure 5-4j Amphetamines: Trends in Annual Prevalence in Grades 8, 10, and 12 ...................................................................................................................245

Figure 5-4k Methamphetamine and Crystal Methamphetamine (Ice): Trends in Annual Prevalence in Grades 8, 10, and 12 .........................................................246

xiii

LIST OF FIGURES (continued) Click on any item below (in blue) to go directly to that page. Figure 5-4l Sedatives (Barbiturates): Trends in Annual Prevalence in Grade 12 ...................247

Figure 5-4m Tranquilizers: Trends in Annual Prevalence in Grades 8, 10, and 12..........................................................................................................................248

Figure 5-4n Rohypnol: Trends in Annual Prevalence in Grades 8, 10, and 12 .......................249

Figure 5-4o Alcohol and Been Drunk: Trends in Annual Prevalence in Grades 8, 10, and 12.........................................................................................250

Figure 5-4p Five or More Drinks in a Row: Trends in 2-Week Prevalence in Grades 8, 10, and 12 ........................................................................................251

Figure 5-4q Cigarettes: Trends in 30-Day Prevalence and 30-Day Prevalence of Daily Use in Grades 8, 10, and 12 .......................................................................252

Figure 5-4r Smokeless Tobacco: Trends in 30-Day Prevalence and 30-Day Prevalence of Daily Use in Grades 8, 10, and 12 ................................................253

Figure 5-4s Steroids: Trends in Annual Prevalence in Grades 8, 10, and 12 ..........................254

Figure 5-5a Marijuana: Trends in 30-Day Prevalence of Daily Use in Grade 12 by Total and by Gender........................................................................................255

Figure 5-5b Alcohol: Trends in 30-Day Prevalence of Daily Use in Grade 12 by Total and by Gender........................................................................................256

Figure 5-5c Cigarettes: Trends in 30-Day Prevalence of Daily Use in Grade 12 by Total and by Gender........................................................................................257

Figure 5-6a Alcohol: Trends in 2-Week Prevalence of Heavy Drinking in Grade 12 by Gender .............................................................................................258

Figure 5-6b Steroids: Trends in Annual Prevalence in Grade 12 by Total and by Gender ........................................................................................259

Figure 5-7 An Illicit Drug Use Index: Trends in Annual Prevalence in Grade 12 by Gender ........................................................................................................260

Figure 5-8 An Illicit Drug Use Index: Trends in Annual Prevalence in Grade 12 by College Plans .............................................................................................261

Figure 5-9 Cigarettes: Trends in 30-Day Prevalence in Grades 8, 10, and 12 by College Plans ........................................................................................................ 262

Figure 5-10a An Illicit Drug Use Index: Trends in Annual Prevalence in Grade 12 by Region of the Country ................................................................................263

Figure 5-10b Cocaine: Trends in Lifetime Prevalence in Grade 12 by Region of the Country...........................................................................................................264

xiv

LIST OF FIGURES (continued) Click on any item below (in blue) to go directly to that page. Figure 5-10c Cigarettes: Trends in 30-Day Prevalence in Grade 12 by Region of

the Country...........................................................................................................265

Figure 5-11a An Illicit Drug Use Index: Trends in Annual Prevalence in Grade 12 by Population Density .....................................................................................266

Figure 5-11b Alcohol and Marijuana: Trends in Annual Prevalence in Grade 12 by Population Density ..........................................................................................267

Figure 5-11c Cocaine and Ecstasy (MDMA): Trends in Annual Prevalence in Grade 12 by Population Density ..........................................................................268

Figure 5-11d Cigarettes and Smokeless Tobacco: Trends in 30-Day Prevalence in Grade 12 by Population Density ......................................................................269

Figure 5-12a Marijuana: Trends in Annual Prevalence in Grade 12 by Average Education of Parents ............................................................................................270

Figure 5-12b Cocaine: Trends in Annual Prevalence in Grade 12 by Average Education of Parents ............................................................................................271

Figure 5-12c LSD: Trends in Annual Prevalence in Grade 12 by Average Education of Parents ............................................................................................272

Figure 5-12d Amphetamines: Trends in Annual Prevalence in Grade 12 by Average Education of Parents ..............................................................................273

Figure 5-12e Alcohol: Trends in 2-Week Prevalence of 5 or More Drinks in a Row in Grade 12 by Average Education of Parents ........................................... 274

Figure 5-12f Cigarettes: Trends in Daily Prevalence in Grade 12 by Average Education of Parents ............................................................................................275

Figure 5-13a Marijuana and Cocaine: Trends in Annual Prevalence in Grade 12 by Race/Ethnicity ................................................................................................. 276

Figure 5-13b Alcohol and Cigarettes: Trends in Prevalence in Grade 12 by Race/Ethnicity ......................................................................................................277

Figure 5-13c Inhalants and LSD: Trends in Annual Prevalence in Grade 12 by Race/Ethnicity ...................................................................................................... 278

Figure 6-1 Any Illicit Drug: Trends in Lifetime Prevalence at Earlier Grade Levels based on Retrospective Reports from 12th Graders ..................................295

Figure 6-2 Any Illicit Drug other than Marijuana: Trends in Lifetime Prevalence at Earlier Grade Levels based on Retrospective Reports from 12th Graders ................................................................................................ 296

xv

LIST OF FIGURES (continued) Click on any item below (in blue) to go directly to that page. Figure 6-3 Any Illicit Drug other than Marijuana or Amphetamines: Trends in

Lifetime Prevalence at Earlier Grade Levels based on Retrospective Reports from 12th Graders .............................................................297

Figure 6-4 Marijuana: Trends in Lifetime Prevalence at Earlier Grade Levels based on Retrospective Reports from 12th and 8th Graders ..................................298

Figure 6-5 Daily Marijuana Use for a Month or More: Trends in Lifetime Prevalence for Earlier Grade Levels based on Retrospective Reports from 12th Graders ....................................................................................299

Figure 6-6 Inhalants: Trends in Lifetime Prevalence at Earlier Grade Levels based on Retrospective Reports from 12th and 8th Graders ..................................300

Figure 6-7 Hallucinogens: Trends in Lifetime Prevalence at Earlier Grade Levels based on Retrospective Reports from 12th and 8th Graders .......................301

Figure 6-8 LSD: Trends in Lifetime Prevalence at Earlier Grade Levels based on Retrospective Reports from 12th and 8th Graders ............................................302

Figure 6-9 Hallucinogens other than LSD: Trends in Lifetime Prevalence at Earlier Grade Levels based on Retrospective Reports from 12th and 8th Graders ........................................................................................................... 303

Figure 6-10 Cocaine: Trends in Lifetime Prevalence at Earlier Grade Levels based on Retrospective Reports from 12th and 8th Graders................................304

Figure 6-11 Crack Cocaine: Trends in Lifetime Prevalence at Earlier Grade Levels based on Retrospective Reports from 12th and 8th Graders ..................... 305

Figure 6-12 Other Forms of Cocaine: Trends in Lifetime Prevalence at Earlier Grade Levels based on Retrospective Reports from 12th and 8th Graders .................................................................................................................306

Figure 6-13 Heroin: Trends in Lifetime Prevalence at Earlier Grade Levels based on Retrospective Reports from 12th and 8th Graders .................................307

Figure 6-14 Narcotics other than Heroin: Trends in Lifetime Prevalence at Earlier Grade Levels based on Retrospective Reports from 12th Graders .................................................................................................................308

Figure 6-15 Amphetamines: Trends in Lifetime Prevalence at Earlier Grade Levels based on Retrospective Reports from 12th and 8th Graders ..................... 309

Figure 6-16 Sedatives (Barbiturates): Trends in Lifetime Prevalence at Earlier Grade Levels based on Retrospective Reports from 12th Graders .......................310

Figure 6-17 Tranquilizers: Trends in Lifetime Prevalence at Earlier Grade Levels based on Retrospective Reports from 12th and 8th Graders ..................... 311

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LIST OF FIGURES (continued) Click on any item below (in blue) to go directly to that page. Figure 6-18 Alcohol: Trends in Lifetime Prevalence at Earlier Grade Levels

based on Retrospective Reports from 12th and 8th Graders ................................. 312

Figure 6-19 Been Drunk: Trends in Lifetime Prevalence at Earlier Grade Levels based on Retrospective Reports from 12th and 8th Graders ................................. 313

Figure 6-20 Cigarettes: Trends in Lifetime Prevalence at Earlier Grade Levels based on Retrospective Reports from 12th and 8th Graders ................................. 314

Figure 6-21 Cigarette Smoking on a Daily Basis: Trends in Lifetime Prevalence at Earlier Grade Levels based on Retrospective Reports from 12th and 8th Graders .................................................................................................... 315

Figure 6-22 E-Cigarettes: Trends in Lifetime Prevalence for Earlier Grade Levels based on Retrospective Reports from 12th and 8th Graders ...................... 316

Figure 6-23 Smokeless Tobacco: Trends in Lifetime Prevalence at Earlier Grade Levels based on Retrospective Reports from 12th and 8th Graders .................................................................................................................317

Figure 6-24 Steroids: Trends in Lifetime Prevalence at Earlier Grade Levels based on Retrospective Reports from 12th ......................................................... 318

Figure 7-1 Degree of Drug Highs Attained by Recent Users for Various Drugs in Grade 12, 2017 .................................................................................................341

Figure 7-2 Duration of Drug Highs Attained by Recent Users for Various Drugs in Grade 12, 2017 ......................................................................................342

Figure 7-3 Marijuana: Trends in Annual Prevalence, Percent of Recent Users Getting Moderately or Very High, and Percent of Recent Users Staying High 3 or More Hours in Grade 12 .........................................................343

Figure 8-1a Marijuana: Trends in Perceived Harmfulness for Different Levels of Use in Grades 8, 10, and 12 .............................................................................398

Figure 8-1b Marijuana: Trends in Disapproval of Different Levels of Use in Grades 8, 10, and 12 ............................................................................................399

Figure 8-2a Cocaine: Trends in Perceived Harmfulness for Different Levels of Use in Grades 8, 10, and 12 .................................................................................400

Figure 8-2b Cocaine: Trends in Disapproval of Different Levels of Use in Grades 8, 10, and 12 ............................................................................................401

Figure 8-3a Crack: Trends in Perceived Harmfulness for Different Levels of Use in Grades 8, 10, and 12 .................................................................................402

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LIST OF FIGURES (continued) Click on any item below (in blue) to go directly to that page. Figure 8-3b Crack: Trends in Disapproval of Different Levels of Use in

Grades 8, 10, and 12 ............................................................................................403

Figure 8-4 Marijuana: Trends in Perceived Availability, Perceived Risk of Regular Use, and Prevalence of Use in Past 30 Days in Grade 12 ......................404

Figure 8-5 Cocaine: Trends in Perceived Availability, Perceived Risk of Trying, and Prevalence of Use in Last 12 Months in Grade 12 ...........................405

Figure 8-6 Ecstasy (MDMA): Trends in Perceived Availability, Perceived Risk of Trying, and Prevalence of Use in Last 12 Months in Grade 12 ...............................................................................................................406

Figure 8-7a Amphetamines and Sedatives (Barbiturates): Trends in Perceived Harmfulness for Different Levels of Use in Grade 12 .........................................407

Figure 8-7b Amphetamines and Sedatives (Barbiturates): Trends in Disapproval of Different Levels of Use in Grade 12 ...............................................................408

Figure 8-8a LSD: Trends in Perceived Harmfulness for Different Levels of Use in Grades 8, 10, and 12 ........................................................................................409

Figure 8-8b LSD: Trends in Disapproval of Different Levels of Use in Grades 8, 10, and 12 .........................................................................................................410

Figure 8-9a Heroin: Trends in Perceived Harmfulness for Different Levels of Use in Grade 12 ...................................................................................................411

Figure 8-9b Heroin: Trends in Disapproval of Different Levels of Use in Grade 12 ...............................................................................................................412

Figure 8-10a MDMA (Ecstasy): Trends in Perceived Harmfulness for Experimental Use in Grades 8, 10, and 12 ...........................................................413

Figure 8-10b MDMA (Ecstasy): Trends in Disapproval of Experimental Use in Grades 8, 10, and 12 ............................................................................................414

Figure 8-11a Alcohol: Trends in Perceived Harmfulness for Different Levels of Use in Grades 8, 10, and 12 .................................................................................415

Figure 8-11b Alcohol: Trends in Disapproval of Different Levels of Use in Grades 8, 10, and 12 ............................................................................................416

Figure 8-12a Cigarettes: Trends in Perceived Harmfulness of Smoking 1 or More Packs per Day in Grades 8, 10, and 12 ................................................................417

Figure 8-12b Cigarettes: Trends in Disapproval of Smoking 1 or More Packs per Day in Grades 8, 10, and 12 .................................................................................418

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LIST OF FIGURES (continued) Click on any item below (in blue) to go directly to that page. Figure 8-13a Smokeless Tobacco: Trends in Perceived Harmfulness of Regular

Use in Grades 8, 10, and 12 .................................................................................419

Figure 8-13b Smokeless Tobacco: Trends in Disapproval of Regular Use in Grades 8 and 10 ...................................................................................................420

Figure 9-1a Marijuana: Trends in Disapproval; 12th Graders, Parents, and Friends..................................................................................................................468

Figure 9-1b Cocaine and LSD: Trends in Disapproval; 12th Graders, Parents, and Friends ...........................................................................................................469

Figure 9-1c Amphetamines and Sedatives (Barbiturates): Trends in Disapproval; 12th Graders, Parents, and Friends ..................................................470

Figure 9-2a Alcohol: Trends in Disapproval; 12th Graders, Parents, and Friends...................471

Figure 9-2b Cigarettes: Trends in Disapproval; 12th Graders, Parents, and Friends..................................................................................................................472

Figure 9-3a Any Illicit Drug: Trends in 30-Day Prevalence and Friends’ Use in Grade 12 ............................................................................................................... 473

Figure 9-3b Any Illicit Drug other than Marijuana: Trends in 30-Day Prevalence and Friends Use in Grade 12 .............................................................474

Figure 9-3c Marijuana: Trends in 30-Day Prevalence and Friends’ Use in Grade 12 ...............................................................................................................475

Figure 9-3d Inhalants: Trends in 30-Day Prevalence and Friends’ Use in Grade 12 ...............................................................................................................476

Figure 9-3e LSD: Trends in 30-Day Prevalence and Friends’ Use in Grade 12 .....................477

Figure 9-3f Hallucinogens other than LSD: Trends in 30-Day Prevalence and Friends’ Use in Grade 12 .....................................................................................478

Figure 9-3g MDMA (Ecstasy, Molly): Trends in 30-Day Prevalence and Friends’ Use in Grade 12 .....................................................................................479

Figure 9-3h Cocaine: Trends in 30-Day Prevalence and Friends’ Use in Grade 12 ...............................................................................................................480

Figure 9-3i Crack: Trends in 30-Day Prevalence and Friends’ Use in Grade 12 ...................481

Figure 9-3j Cocaine Powder: Trends in 30-Day Prevalence and Friends’ Use in Grade 12 ...............................................................................................................482

Figure 9-3k Heroin: Trends in 30-Day Prevalence and Friends’ Use in Grade 12 ...............................................................................................................483

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LIST OF FIGURES (continued) Click on any item below (in blue) to go directly to that page. Figure 9-3l Narcotics other than Heroin: Trends in 30-Day Prevalence and

Friends’ Use in Grade 12 .....................................................................................484

Figure 9-3m Amphetamines: Trends in 30-Day Prevalence and Friends’ Use in Grade 12 ...............................................................................................................485

Figure 9-3n Crystal Methamphetamine (Ice): Trends in 30-Day Prevalence and Friends’ Use in Grade 12 .....................................................................................486

Figure 9-3o Sedatives (Barbiturates): Trends in 30-Day Prevalence and Friends’ Use in Grade 12 .....................................................................................487

Figure 9-3p Tranquilizers: Trends in 30-Day Prevalence and Friends’ Use in Grade 12 ...............................................................................................................488

Figure 9-3q Alcohol: Trends in 30-Day Prevalence and Friends’ Use in Grade 12 ...............................................................................................................489

Figure 9-3r Been Drunk: Trends in 30-Day Prevalence and Friends’ Use in Grade 12 ...............................................................................................................490

Figure 9-3s Cigarettes: Trends in 30-Day Prevalence and Friends’ Use in Grade 12 ...............................................................................................................491

Figure 9-3t Steroids: Trends in 30-Day Prevalence and Friends’ Use in Grade 12 ...............................................................................................................492

Figure 9-4 Proportion of Friends Using Each Drug as Estimated by 8th, 10th, and 12th Graders, 2017 .........................................................................................493

Figure 9-5a Various Drugs: Trends in Perceived Availability in Grade 12 (Marijuana, Amphetamines, Cocaine, Crack, and Crystal Methamphetamine) ............................................................................................. 496

Figure 9-5b Various Drugs: Trends in Perceived Availability in Grade 12 (Narcotics other than Heroin, Sedatives [Barbiturates], Heroin, and Tranquilizers) ...................................................................................................... 497

Figure 9-5c LSD and Hallucinogens other than LSD: Trends in Perceived Availability in Grade 12 .......................................................................................498

Figure 9-5d Ecstasy (MDMA) and Steroids: Trends in Perceived Availability in Grade 12 ...............................................................................................................499

Figure 9-6 Source of Prescription Drugs among Those Who Used in Past Year Grade 12, 2016-2017 ...........................................................................................500

Figure A-1 High School Completion by 20- to 24-Year-Olds ............................................... 525

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LIST OF FIGURES (continued) Click on any item below (in blue) to go directly to that page. Figure A-2 Estimates of Prevalence and Trends for the Entire Age/Class

Cohort (Adjusting for Absentees and Dropouts) for 12th Graders ...................... 526

Figure D-1 Any Illicit Drug, Marijuana, and Inhalants: Trends in Annual Prevalence for Grades 8, 10, and 12 Combined ..................................................558

Figure D-2 Hallucinogens: Trends in Annual Prevalence for Grades 8, 10, and 12 Combined ....................................................................................................... 559

Figure D-3 Ecstasy (MDMA): Trends in Annual Prevalence for Grades 8, 10, and 12 Combined ................................................................................................ 560

Figure D-4 Cocaine and Crack: Trends in Annual Prevalence for Grades 8, 10, and 12 Combined ................................................................................................ 561

Figure D-5 Heroin and Narcotics other than Heroin: Trends in Annual Prevalence for Grades 8, 10, and 12 Combined...................................................562

Figure D-6 Stimulant Drugs: Trends in Annual Prevalence for Grades 8, 10, and 12 Combined ................................................................................................ 563

Figure D-7 Tranquilizers and Steroids: Trends in Annual Prevalence for Grades 8, 10, and 12 Combined .......................................................................... 564

Figure D-8 Club Drugs: Trends in Annual Prevalence for Grades 8, 10, and 12 Combined ............................................................................................................ 565

Figure D-9 Alcohol and Tobacco: Trends in 30-Day Prevalence for Grades 8, 10, and 12 Combined ...........................................................................................566

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Chapter 1

INTRODUCTION Substance use is a leading cause of preventable morbidity and mortality; it is in large part why, among 17 high-income nations, people in the U.S. have the highest probability of dying by age 50.1 Substance use is also an important contributor to many social ills including child and spouse abuse, violence more generally, theft, suicide, and more; and it typically is initiated during adolescence. It warrants our sustained attention. Monitoring the Future (MTF) is designed to give sustained attention to substance use among the nation’s youth and adults. It is an investigator-initiated study that originated with, and is conducted by, a team of research professors at the University of Michigan’s Institute for Social Research. Since its onset in 1975, MTF has been continuously funded by the National Institute on Drug Abuse—one of the National Institutes of Health—under a series of peer-reviewed, competitive research grants. The 2017 survey, reported here, is the 43rd consecutive survey of 12th grade students and the 27th such survey of 8th and 10th graders. MTF contains ongoing national surveys of both adolescents and adults in the United States. It provides the nation with a vital window into the important but often hidden problem behaviors of illegal drug use, alcohol use, tobacco use, anabolic steroid use, and psychotherapeutic drug use without medical supervision. For four decades, MTF has helped provide a clearer view of the changing topography of these problems among adolescents and adults, a better understanding of the dynamics of factors that drive some of these problems, and a better understanding of some of their consequences. It has also given policymakers, government agencies, and nongovernmental organizations (NGOs) in the field some practical approaches for intervening. A widespread epidemic of illicit drug use emerged in the 1960s among American youth, and since then dramatic changes have occurred in the use of nearly all types of illicit drugs, as well as alcohol and tobacco. Of particular importance, as discussed in detail below, are the many new illicit drugs that have emerged, along with new forms of alcoholic beverages and tobacco products. Among the more recently abused substances are new classes of drugs, including over-the-counter medications, synthetic marijuana, synthetic stimulants such as “bath salts,” drugs taken for strength enhancement, and new tobacco- and nicotine-based products. New devices for taking drugs, such as vaporizers and e-cigarettes, provide novel ways to use substances and in new combinations. Unfortunately, while many new substances have been added to the list over the years, very few have been removed because they have remained in active use. Throughout these many changes, substance use among the nation’s youth has remained a major concern for parents, teachers, youth workers, health professionals, law enforcement, and policymakers, largely because substance abuse is one of the largest and yet most preventable causes of morbidity and mortality during and after adolescence.

1 Case, A. & Deaton, A. (2015) Rising morbidity and mortality in midlife among white non-Hispanic Americans in the 21st century. Proceedings of the National Academy of Sciences, 112(49), 15078-15083.

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This annual monograph series has been a primary vehicle for disseminating MTF’s epidemiological findings. This monograph presents the results of the 43rd survey of drug use and related attitudes and beliefs among American high school seniors and 27th such survey of 8th and 10th grade students. The next monograph in this series will report the 38th such survey of American college students and same-age youth who do not attend college, as well as findings regarding substance use prevalence and trends among adults through age 60. An annual monograph on risk and protective behaviors for the spread of HIV/AIDS2 among young adults was added beginning in 2009. (In years prior to 2009, findings from the study on risk and protective behaviors related to the spread of HIV/AIDS were contained in Volume II.) All MTF publications, including press releases, are available on the project website at http://monitoringthefuture.org. CONTENT AREAS COVERED

Two of the major topics included in the present volume are (a) the prevalence and frequency of use of a great many substances, both licit and illicit, among American secondary school students in 8th, 10th, and 12th grades and (b) historical trends in use by students in those grades. Distinctions are made among important demographic subgroups in these populations based on gender, college plans, region of the country, population density, parent education, and race/ethnicity. MTF has demonstrated that key attitudes and beliefs about drug use are important determinants of usage trends, in particular the amount of risk to the user perceived to be associated with the various drugs and disapproval of using them; thus, those measures also are tracked over time, as are students’ perceptions of certain relevant aspects of the social environment—in particular, perceived availability, peer norms, use by friends, and exposure to use by others of the various drugs. Data on grade of first use, discontinuation of use, trends in use in lower grades, and intensity of use are also reported here. Drug Classes Initially, 11 separate classes of drugs were distinguished in order to heighten comparability with a parallel series of publications based on the National Survey of Drug Use and Health (NSDUH): marijuana (including hashish), inhalants, hallucinogens, cocaine, heroin, narcotics other than heroin (both natural and synthetic), amphetamines, sedatives, tranquilizers, alcohol, and tobacco. Separate statistics have been presented for a number of subclasses of drugs within these more general categories: PCP and LSD (both hallucinogens), barbiturates and methaqualone (both sedatives), methamphetamine, crystal methamphetamine (“ice”), and crack and cocaine other than crack. In the years since the study was launched, many additional categories of abusable substances have been added to the MTF questionnaires, in many but not all cases to the questionnaires used with all three grades. Relatively few substances have been dropped due to very low prevalence. The substances added and dropped are shown in Table 1-1 sequentially by year and within year by the grades affected. The large number of substances added over the years illustrates the dynamic and multidimensional nature of the country’s drug problems. As time passes and new trends develop, additional drugs

2 Johnston, L. D., O'Malley, P. M., Bachman, J. G., Schulenberg, J. E., Patrick, M. E., & Miech, R. A. (2017). HIV/AIDS: Risk & protective behaviors among adults ages 21 to 40 in the U.S., 2004-2016. Ann Arbor: Institute for Social Research, The University of Michigan.

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will be added to the study’s coverage; occasionally ones that prove to have very low prevalence (like kreteks, bidis, PCP, and Provigil) will be dropped. It is important, given this rapidly shifting smorgasbord of drugs, that information be gathered relatively quickly to inform legislators, regulatory agencies, scientists, practitioners in the field, parents, and educators about the extent to which newer drugs are making inroads in the youth population and what subgroups are proving most vulnerable. Most of the information reported here deals with illicit use of controlled substances. The major exceptions are alcohol, cigarettes, other tobacco products, inhalants, nonprescription stimulants, medicines taken appropriately by prescription in the treatment of ADHD, creatine, cough and cold medicines, and salvia. In the questions about nonmedical use of psychotherapeutic drugs, respondents are asked to exclude any use under medical supervision. Throughout this report, we also focus attention on drug use at the higher frequency levels in addition to reporting proportions that have ever used various drugs. This is done to help differentiate levels of seriousness, or extent, of drug involvement. While there is no public consensus on what levels or patterns of use constitute abuse, there is a consensus that higher levels of use are more likely to have detrimental effects for the user and for society. We have also introduced indirect measures of dosage per occasion by asking respondents about the duration and intensity of highs they usually experience with each type of drug. These items have shown some interesting trends over the years, detailed in Chapter 7. Attitudes, Beliefs, and Early Experiences Separate sections or whole chapters are devoted to the following issues related to a number of licit and illicit drugs:

• grade of first use; • noncontinuation of use; • respondents’ own attitudes and beliefs; • degree and duration of the highs attained; • perceptions of drug availability; and • perceptions of attitudes and behaviors of others in the social environment.

Some of these variables have proven to be very important in explaining changes in use, as we discuss in detail in Chapter 8. Over-the-Counter Substances This Volume discusses use of nonprescription stimulants, including diet pills, stay-awake pills, and “look-alike” pseudo-amphetamines. Questions on these substances were added beginning in 1982 because their use appeared to be on the rise, and it seemed that some respondents inappropriately included these substances in their answers about amphetamine use. That inappropriate inclusion affected some of the observed trends in amphetamine use until the clarification in 1982. Tables on the performance-enhancing substances androstenedione (andro)—previously an over-the-counter substance—and creatine are also included.

3

Cumulative Lifetime Daily Marijuana Use Also included are trend results from a set of questions about cumulative lifetime marijuana use at a daily or near-daily level. These questions were added to enable us to develop a more complete individual history of daily use over a period of years. They reveal some important facts about frequent users of this drug. Trends in Use of Specific Alcoholic Beverages Twelfth grade data are reported for a wide spectrum of substances, including beer, liquor, wine, wine coolers, and flavored alcoholic beverages. (For 8th and 10th graders, the measures of specific alcoholic substances are restricted to beer and wine coolers, though the category of wine coolers was dropped from the questionnaires in 2004 to make space for the more general class of flavored alcoholic beverages.) Results on these various substances are discussed in Chapters 4 and 5. Beginning in 2003, and in every year since, we have also published an occasional paper on subgroup usage and trends for all substances with tables including prevalence and trend estimates for use of specific classes of alcoholic beverages.3 Sources of Prescription Drugs MTF has previously reported on the growing importance of prescription-type psychotherapeutic drugs used without medical supervision. In 2007, new questions regarding where users secured several such drugs were added to one 12th grade questionnaire form. A section in Chapter 9 reports responses to these questions, as well as to other questions, which have since been elaborated. Since 2008, Chapters 4 and 5 also contain estimates of the proportion of 12th grade students who use any psychotherapeutic drugs in each prevalence period; these estimates can be made only for 12th graders, because estimates of use of sedatives and narcotics other than heroin are not reported for students in the lower grades due to concerns about the validity of their reports of these substances. Synopses of Other MTF Publications Chapter 10 contains short synopses of other MTF publications produced during the past year (journal articles, chapters, occasional papers, etc.). References to the full documents are provided, and some are available on the MTF website. Appendixes Appendix A addresses the issue of whether absentees and school dropouts affect MTF results and, if so, to what extent. For illustrative purposes, the appendix provides estimates of prevalence and trends for marijuana and cocaine use adjusted for these missing segments of the population. Appendix B gives the definitions of the various demographic subgroups discussed. Appendix C provides trends for 12th grade only on various subclasses of drugs within each of the following five general classes: hallucinogens other than LSD, amphetamines, tranquilizers, narcotics other than heroin, and sedatives. These tables provide annual prevalence levels over time and show how the mix of subclasses has changed over the years within each of the general classes. 3 Johnston, L. D., Miech, R. A., O'Malley, P. M., Bachman, J. G., Schulenberg, J. E., & Patrick, M. E. (2018). Demographic subgroup trends among adolescents in the use of various licit and illicit drugs 1975-2017 (Monitoring the Future Occasional Paper No. 90). Ann Arbor, MI: Institute for Social Research, University of Michigan.

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Appendix D provides trends since 1991 in drug use for the three grades combined, as well as the absolute decline and the proportional decline in the prevalence of each drug since the most recent peak level. Such tables are helpful in getting a quick read on the trends. By combining the three grades, however, much of the meaningful detail available from grade-specific estimates is lost, including evidence of cohort effects. In years 2017 and earlier the Appendix C of Volume 1 reported information on how to calculate confidence intervals for point estimates and how to calculate statistics that test the significance of changes over time or of differences between subgroups. This appendix is no longer necessary with the opening of MTF’s remote portal at the National Addiction and HIV Data Archive Program, which now allows researchers to compute such statistics directly using MTF weights and clustering variables. Interested readers may refer to Appendix C of earlier volumes for the information in provides about design effects and how their computational influence varies by substance. PURPOSES AND RATIONALE FOR THIS RESEARCH

Perhaps no social problem has proven more clearly appropriate for and in need of the application of systematic research and reporting than that of substance abuse. Substance-abusing behaviors are often hidden from public view, can change rapidly and frequently, and are of great importance to the well-being of the nation. Many legislative and programmatic interventions are aimed at these behaviors, such as the policies that were put into place in response to the increases in adolescent smoking and illicit drug use we reported in the 1970s and then again in the 1990s as a relapse in the drug epidemic unfolded. Young people are often at the leading edge of social change, and this has been particularly true of drug use. The substantial changes in illicit drug use during the last 50 or so years have proven to be largely a youth phenomenon. MTF documented that the relapse in the drug epidemic in the early 1990s initially occurred almost exclusively among adolescents. Adolescents and adults in their 20s fall into the age groups at highest risk for illicit drug use. Moreover, for some drug users, use that begins in adolescence continues well into adulthood. This is indicated in the cohort effects that we report for a number of substances (and even in some attitudes and beliefs about them). The original epidemic of illicit drug use in the 1960s began on the nation’s college campuses and then spread downward in age. By way of contrast, MTF has shown that the relapse phase in the 1990s first manifested itself among secondary school students and then started moving upward in age as those cohorts matured. One purpose of MTF is to develop an accurate description of these important changes as they are unfolding. An accurate picture of the basic size and contours of the illicit drug use problem among youth in the U.S. is a prerequisite for informed public debate and policymaking. In the absence of reliable prevalence data, substantial misconceptions can develop and resources can be misallocated. The same is true for different forms of alcohol and tobacco use. In the absence of reliable trend data, early detection and localization of emerging problems are more difficult and societal responses, more lagged. For example, MTF provided early evidence that cigarette smoking among American adolescents was rising sharply in the early 1990s, which helped stimulate and support some extremely important policy initiatives that culminated in the tobacco settlement between the tobacco industry and the states. MTF documented and described the sharp rise and

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subsequent decline in ecstasy use, illustrating the important role that perceived risk played in these changes, as it has done for a number of other drugs in the past. The study also helped draw attention to the rise in steroid and androstenedione use among adolescents in the late 1990s, resulting in legislative and regulatory action. It exposed a rise in the use of narcotic drugs other than heroin (especially certain prescription-type analgesics), stimulating an initiative at the White House Office of National Drug Control Policy aimed at reducing use. More recently, MTF has become a key source of information on use of electronic vaping devices, which in just a few years has rapidly become one of the most common forms of substance use among adolescents. In addition to enabling early detection and localization of problems, valid trend data make assessments of the impact of major historical and policy-induced events much less conjectural. The accurate empirical comparison of subgroup differences has challenged conventional wisdom in some important ways. Accurately characterizing not only differences but also differential changes among subgroups has been an important scientific contribution from MTF. For example, dramatic racial/ethnic differences in cigarette smoking have emerged during the life of the study—differences that were almost nonexistent when MTF began in 1975. Further, the misinformed assumption that African-American students use illicit drugs more than do White students has been disconfirmed since the beginning of the study, which shows lower levels of use for African-American students in most years, though these differences have been narrowing in recent years. MTF also monitors a number of factors—peer norms regarding drugs, beliefs about the dangers of drugs, and perceived availability—that help explain the historical changes observed in drug use. Monitoring these factors has made it possible to examine a central policy issue in this nation’s efforts to reduce drug use—namely, the relative importance of supply versus demand factors in bringing about some of the observed declines and increases in drug use.4 Our group has also put forth a general theory of drug epidemics that uses many of these concepts to help explain the rises and declines that occur in use and emphasizes the importance of demand-side factors.5 In addition to accurately assessing prevalence and testing explanations of their causes, the integrated MTF study of adolescents and adults has a substantial number of other important research objectives. These include (a) helping to determine which young people are at greatest risk for developing various short- and long-term patterns of drug abuse; (b) gaining a better understanding of the lifestyles and value orientations associated with various patterns of drug use, and monitoring how subgroup differences shift over time; (c) determining the immediate and more general aspects of the social environment associated with drug use and abuse; (d) determining how major transitions in the social environment (e.g., entry into military service, civilian employment, college, homemaking, and unemployment) or in social roles (e.g., engagement, marriage, pregnancy, parenthood, divorce, and remarriage) affect changes in drug use; (e) determining the life course trajectories and comorbidity of the various drug-using behaviors from early a