Technical ReportPDF Available

America's dropout crisis: The unrecognized connection to adolescent substance use



Content may be subject to copyright.
America’s Dropout Crisis:
The Unrecognized Connection
To Adolescent Substance Use
“There is no problem so bad that alcohol and drugs will not make it worse.”
Robert L. DuPont, M.D.1
Kimberly M. Caldeira, M.S.2
Helen S. DuPont, M.B.A.1
Kathryn B. Vincent, M.A.2
Corinne L. Shea, M.A.1
Amelia M. Arria, Ph.D.2,3
March 2013
1 Institute for Behavior and Health, Inc. (IBH), 6191 Executive Boulevard, Rockville, MD, 20852.
2 Center on Young Adult Health and Development (CYAHD), University of Maryland School of Public
Health, 1142 School of Public Health Building, College Park, MD 20742.
3 Treatment Research Institute (TRI), 600 Public Ledger Building, 150 S. Independence Mall West,
Philadelphia, PA 19106.
America’s Dropout Crisis:
The Unrecognized Connection to Adolescent Substance Use
About the Institute for Behavior and Health, Inc.
Established in 1978 as a nonprofit 501(c)3 organization, the mission of the Institute for Behavior
and Health, Inc. (IBH) is to shape drug policy to more effectively reduce illegal drug use. To further
this mission, IBH has focused on a small number of specific topics for study, research, and
discussion. This report, on the school dropout crisis, reflects years of investigation into teen drug
use and school-related outcomes and interventions. More information about IBH can be found at,, and
About the Center on Young Adult Health and Development
In 2009, the Center on Young Adult Health and Development (CYAHD) was established at the
School of Public Health on the College Park campus of the University of Maryland. This research
center is one of the first such centers in the United States specifically dedicated to understanding
the health and development of young adults. More information about CYAHD can be found at
Suggested Citation
DuPont, R. L., Caldeira, K. M., DuPont, H. S., Vincent, K. B., Shea, C. L., & Arria, A. M. (2013). America’s
dropout crisis: The unrecognized connection to adolescent substance use. Rockville, MD: Institute for
Behavior and Health, Inc. Available at,, and
“America’s Dropout Crisis: The Unrecognized Connection to Adolescent Substance Use” was
supported by the Institute for Behavior and Health, Inc.
Special thanks are given to Brittany A. Bugbee and Kaitlin A. Hippen for their invaluable help with
this report.
Copyright © 2013 by the Institute for Behavior and Health, Inc. All rights reserved.
America’s Dropout Crisis:
The Unrecognized Connection to Adolescent Substance Use
Table of Contents
Executive Summary ............................................................................................................................................... i
Section 1. The Scope of the Problem ............................................................................................................... 1
1.1. Substance Use among Adolescents in the United States ................................................................................... 1
1.2. High School Dropout among Adolescents in the United States ......................................................................... 1
1.2.1. Variation in dropout rates by sociodemographic characteristics .............................................................. 3
1.2.2. Concentration of dropouts within schools ................................................................................................. 3
1.2.3. Adverse social, economic, and health consequences of dropping out ...................................................... 4
1.2.4. Correlates of and risk factors for high school dropout .............................................................................. 5
1.2.5. The under-recognition of substance use as a risk factor for dropout ........................................................ 6
Section 2. Review of the Scientific Literature .............................................................................................. 8
2.1. Introduction ....................................................................................................................................................... 8
2.2. Methods Used to Review the Scientific Literature ............................................................................................ 8
2.3. Cross-sectional Studies on Substance Use and High School Dropout .............................................................. 10
2.3.1. Comparison of dropouts with non-dropouts on substance use .............................................................. 10
2.3.2. Comparison of substance users with non-users on rates of dropout ...................................................... 14
2.4. Longitudinal Studies on Substance Use as a Predictor of Dropout .................................................................. 17
2.4.1. Longitudinal studies of alcohol use only .................................................................................................. 17
2.4.2. Longitudinal studies of drugs other than alcohol .................................................................................... 19
2.4.3. Longitudinal studies of both alcohol and drug use .................................................................................. 20
2.4.4. Longitudinal studies using a composite measure of alcohol and drug use .............................................. 24
2.5. Studies Examining Substance Use Disorder as a Correlate or Predictor of Dropout ....................................... 25
2.6. Studies Examining the Relationship Between Substance Use and High School GPA ....................................... 26
2.7. Studies Examining Changes in Academic Performance Following Addiction Treatment ................................ 29
2.8. Limitations of the Research ............................................................................................................................. 31
2.9. Summary of Research Findings ........................................................................................................................ 32
Section 3. Mechanisms Linking Substance Use with Dropout ............................................................. 35
3.1. Substance Use “Hijacks” Neurobiological Reward Pathways in the Brain, Making Academic Pursuits
Less Meaningful to the Individual as their Relationship with Substances Becomes Stronger ........................ 35
3.2. Substance Use During Adolescence is Associated with Neurocognitive Deficits ............................................. 35
3.3. Early Learning Difficulties Lead to School Failure and Subsequently to Substance Use .................................. 36
3.4. “General Deviance” is a Common Root for both Academic Failure and Drug Use .......................................... 37
Section 4. Recommendations .......................................................................................................................... 38
4.1. What Do We Still Need To Know? Setting a Research Agenda ........................................................................ 38
4.2. Implications for Education Professionals ......................................................................................................... 39
4.3. Implications for Parental Involvement ............................................................................................................. 41
4.4. Implications for the Design of Interventions ................................................................................................... 41
4.5. Implications for Policy Makers ......................................................................................................................... 42
References .............................................................................................................................................................. 43
Appendix 1. Results of a Youth Survey ......................................................................................................... 54
America’s Dropout Crisis:
The Unrecognized Connection to Adolescent Substance Use
Tables and Figures
Box A: Terminology ................................................................................................................................................................ 2
Box B: Recent increases in adolescent marijuana use .............................................................................................. 3
Table 1: National data sources on adolescent substance use in the United States ...................................... 4
Box C: Conceptual model of substance use and dropout ......................................................................................... 7
Table 2: Types of research studies reviewed for this report ................................................................................ 8
Box D: Methods used to compare research studies in this report ....................................................................... 9
Figure 1: Rates of past-month substance use among 12,026 college-age persons in the United
States, by high school graduation status, from the National Household Survey on Drug Abuse,
1991 to 1993 ........................................................................................................................................................................... 10
Figure 2: Lifetime prevalence of substance use among 1,512 seventh through twelfth graders
in the Southwestern United States, by dropout status and race/ethnicity ................................................... 12
Figure 3: Past-month prevalence of substance use among 1,512 seventh through twelfth
graders in the Southwestern United States, by dropout status and race/ethnicity .................................. 13
Figure 4: Urine drug positivity rates by school status among 1,720 adolescent patients who
visited an outpatient clinic in Washington, DC, between April 1994 and March 1996 ............................ 14
Figure 5: Dropout status by marijuana use category, among 15,168 adolescents in the United
States who had not completed high school, from the National Household Survey on Drug
Abuse, 1997 to 1998 ............................................................................................................................................................ 16
Figure 6: Truancy by marijuana use category, among 15,168 adolescents in the United States
who had not completed high school, from the National Household Survey on Drug Abuse,
1997 to 1998 ........................................................................................................................................................................... 16
Figure 7: High school dropout by age 18 among 496 female middle school students in a large
United States city, by substance abuse developmental trajectory group membership ........................... 25
Figure 8: Academic achievement among 65,294 12- to 17-year-olds in the United States, by
lifetime substance use, from the National Survey on Drug Use and Health, 2002 to 2005 .................... 28
Figure 9: Academic achievement among 27,592 ninth through twelfth graders in the United
States, by lifetime substance use, from the Youth Risk Behavior Survey, 2001 to 2003 ......................... 28
Figure 10: High school graduation among 153 adolescents following inpatient drug
treatment, by substance use trajectory group membership ............................................................................... 30
Table 3: Results of a qualitative survey of 11 young adults with histories of substance abuse
problems ................................................................................................................................................................................... 54
America’s Dropout Crisis:
The Unrecognized Connection to Adolescent Substance Use
High School Dropout in the United States
To remain globally competitive in today’s knowledge-based economy, American high
schools must improve graduation rates and ensure that graduates have the necessary skills to enter
the productive workforce. High school dropout rates have been a concern for more than two
decades, and although some progress has been made, the problem still commands the attention of
policy makers at state and federal levels. In 2007, 16% of individuals ages 16 to 24, or 6.2 million
people, were high school dropouts (Center for Labor Market Studies and Alternative Schools
Network in Chicago, 2009). The ten largest public school systems in the U.S. failed to graduate more
than 60% of their students (Greene & Winters, 2006). Among the many dire consequences of failing
to graduate from high school is the increased risk for unemployment. In the U.S. today, 3.8 million
18- to 24-year-olds, or 15% of young adults, are neither employed nor in school (Annie E. Casey
Foundation, 2004); and 35% of men ages 25 to 54 without a high school diploma are unemployed,
up from 10% in the 1960s (Economist, 2011).
What Does the Research Show about the Connection Between Substance
Use and Dropout?
With its collective expertise in the fields of substance abuse and educational research and
policy, experts at the Institute for Behavior and Health, Inc. (IBH) and the Center on Young Adult
Health and Development (CYAHD) at the University of Maryland School of Public Health
investigated the connection between adolescent substance use and the risk for dropout in the U.S.
During the last year, this group conducted a comprehensive review of the empirical research
literature and policy-relevant documents, and consulted with clinicians, educators, and policy
makers to gain a better understanding of the dropout crisisits root causes, consequences, and
what strategies are being used to address it. These activities covered a variety of disciplines
including education, economics, sociology, psychology, and public health.
The following conclusions were made:
School dropout is a complex problem, the result of multiple pathways.
Vast resources are being expended to reduce dropout.
The social costs of dropout are enormous, ranging from the failure of an individual to
reach his or her potential, to the economic consequences of a lower skilled workforce, and
dependence on the social welfare system, to a decline in the U.S. position in the global
America’s Dropout Crisis:
The Unrecognized Connection to Adolescent Substance Use
The associations between substance use, academic failure, and dropout are strong and
well-recognized among researchers and educators who study adolescent substance use,
but they are rarely acknowledged in educational circles or among state and federal policy
While there is heated debate in the research literature and among policy makers
concerning the “chicken-egg” question of which one comes firstacademic difficulties
or substance usethere is compelling evidence that the association is bidirectional. In
some individuals, academic difficulties precede the onset of substance use, and in those
cases, a vicious cycle can ensueleading to even more severe academic difficulties and
eventual dropout. In other cases, even controlling for individual background characteristics,
substance use precedes and contributes to academic failure and dropout, especially when
substance use is frequent and severe.
There is general agreement about the biological, social, and environmental
mechanisms that explain the link between substance use, academic failure, and
Adolescents who are at risk for academic failure or have dropped out of school are
likely to have substance use problems in combination with an array of other problem
behaviors that, if not addressed, place them at extremely high risk for costly long-term
adversity, including unemployment, crime, and poor health.
Little is being done to screen for substance use in pediatric and educational settings,
and even less is being done to address escalating substance use problems among
adolescents at risk for dropout or those who have already dropped out of high school.
Of all the problems that contribute to dropping out, substance use is one of the easiest
to identify and one of the most easily stopped by interventions including treatment.
Research evidence shows that when adolescents stop substance use, academic
performance improves. This is consonant with long standing clinical anecdotal accounts.
Why Has So Little Action Been Taken to Identify Substance Use in Schools
and Among Dropouts if there is a Recognized Connection Between
Substance Use and Academic Failure?
While no one doubts that an association exists between substance use and dropout, a major
stumbling block to taking steps to address the problem is the lack of agreement on the nature of the
association. Two alternative views predominate: substance use is either the result of earlier
academic difficulties, or it is a contributory factor to academic difficulties. A third explanation is
that substance use and failing academic performance are the result of shared factors, such as a
general propensity for deviance. This debate about the directionality of the association and which
direction is predominant has resulted in an impasse among researchers and policy makers.
America’s Dropout Crisis:
The Unrecognized Connection to Adolescent Substance Use
Beyond the disagreement among experts of the causal directionality of dropout, there are
other reasons why efforts have not been organized to address substance use among students in
high school, starting with a lack of resources and leadership as well as the perception that there are
few or no effective solutions. Educators and policy makers must take action, shifting the focus from
theoretical debates to solutions to help students get back on track.
What Research Findings Show that the Association Between Substance Use
and Academic Failure is Bidirectional?
While it is generally acknowledged that academic performance problems can lead to
substance use, equal acknowledgement is lacking that adolescent substance use plays a substantial
role in academic failure. In fact, the association between substance use and academic failure is
bidirectional. The resistance to believing that substance use can lead to academic performance
problems is surprising given the many known negative consequences of substance use and
addiction, for example those that are health- and safety-related. Perhaps part of the resistance
stems from the general notion that substance use is normative and perhaps is even an accepted rite
of passage during adolescence.
Research on the association between substance use and academic performance using
different samples and different methodologies yield the following conclusions:
Substance-using students, compared with non-users, are at increased risk for academic
failure, including dropout, especially when their substance use is frequent and severe.
Studies utilizing longitudinal designs have shown that even after statistical adjustment for
problem behaviors and other important co-factors, substance use plays a role in increasing
the risk for dropping out of high school.
Marijuana use has a stronger negative relationship to academic outcomes such as
grade point average (GPA) and risk for dropout than alcohol use. Lighter, less frequent
alcohol use does not always have a statistically strong relationship with academic outcomes,
while marijuana use does. This might be due to differences in the patterns of consumption
between alcohol (which is typically consumed sporadically) and marijuana (which might be
consumed more regularly) among adolescents. In the studies that showed weak
associations with alcohol, the students investigated were, on average, very low level
drinkers. Some researchers observed that the heavier drinking adolescents dropped out of
school and thus were not available to participate in follow-up research interviews.
The more severe the substance use, the more likely the impact on academic
performance and risk for dropout.
America’s Dropout Crisis:
The Unrecognized Connection to Adolescent Substance Use
Some studies provide evidence that substance use precedes academic failure; other
studies provide evidence that early academic failure precedes substance use. The most
sensible interpretation of these seemingly conflicting findings is that the two scenarios are
not mutually exclusive. Clinical experience clearly supports a multitude of pathways leading
to different types of adverse outcomes during adolescence.
Cessation of substance use following treatment is associated with improvements in
academic performance. Although only a few studies could be located that assessed
adolescent academic functioning after treatment, this type of evidence strongly supports the
contributory role of substance use in academic failure.
High school dropouts, compared with non-dropouts, have dramatically higher rates of
substance use. Individuals who have dropped out of high school are at high risk for
exhibiting a constellation of behavioral problems that are amenable to early intervention.
It is Time to Act
Several questions are policy relevant. Does adolescent use of alcohol and drugs promote
dropping out? Are adolescents that stop using alcohol and drugs less likely to drop out? Once
dropout has occurred, does stopping alcohol and drug use encourage school reentry? Since the
answer to these questions is “yes”, the policy challenge is to identify best practices to reduce
adolescent alcohol and drug use in general. However it is particularly important to identify alcohol
and drug use among students that are at high risk for dropping out—the students with low
academic performance and high levels of truancyand to intervene to help them become alcohol-
and drug-free.
Dropout is costly. Adolescence (or even earlier) is the right time to intervene. If substance
use during adolescence is not addressed, problems escalate, become more difficult to solve, and the
subsequent consequences can be severe. Too much is at stake to delay action. On a practical level,
all that is important to know is that drug and alcohol use is sometimes the first sign of problematic
behavior, and that it is more often part of a broader constellation of maladaptive behaviors that
reduce academic performance and contribute to dropping out. Spending more time and discussion
on the complexity of these issues is unnecessary. It is time to shift our national energy and
resources to the design and implementation of scalable, cost-effective solutions for students at risk
for dropout and those who have dropped out already that address their substance use and other
problem behaviors. Such solutions hold promise for getting these students back on track. The
review of the literature included in this report shows evidence that with modest intervention or, in
the most severe cases, successful treatment, academic performance improves.
America’s Dropout Crisis:
The Unrecognized Connection to Adolescent Substance Use
What Actions Should be Taken to Reduce the Dropout Crisis?
At the root of the dropout issue lies a variety of sociodemographic and community-level risk
factors for dropout. Dropout rates are not uniformly distributed; rather, there are clear racial,
ethnic, and regional disparities. Many have described the process of “disengagement” that
eventually leads students to lose interest in academic pursuits. Others have focused on individual
learning difficulties that are present early in a child’s life, which if unaddressed because of
socioeconomic disadvantage or other reasons, can later contribute to dropout risk. Advocates
seeking to reduce dropout rates have called for increased resources to create better learning
environments, improve the quality of teaching, decrease class sizes, personalize learning, and
improve student-teacher relationships. All of these approaches aim to improve school bonding, and
thereby boost academic performance. There is no doubt that these reforms will enhance learning
Substance use and other problematic behaviors do commonly occur together. There is a
great need for new ways of thinking about the interconnected problems of substance use and poor
academic performance. Currently available scientific evidence, clinical experiences, and common
sense all support a series of steps to reduce students’ use of drugs and alcohol, both to improve
their academic performance and to prevent them from dropping out of school. The following
recommended actions reflect these major themes:
America’s Dropout Crisis:
The Unrecognized Connection to Adolescent Substance Use
1. Place more attention on at-risk students. To this end, it is critical to act early to
identify and address the variety of problem behaviors including truancy, drug and alcohol use,
delinquency, and academic “disengagement.” All students with early signs of academic difficulties
should be comprehensively assessed and carefully and specifically screened for drug and alcohol
use. Steps should be taken to ensure that these at-risk students become and stay drug- and alcohol-
free. By extrapolating from clinical experiences, the heterogeneity can be seen in the pathways by
which substance use and academic problems become intertwined. In some cases, early signs of
problematic behavior preceded the substance use. In other cases, affiliation with substance-using
peers provided opportunities for substance involvement and led to escalation of use, which then led
to skipping class, poor grades, and eventually to dropping out. A phrase from the recovery
community about the role of substance use states, “There is no problem so bad that alcohol and
drugs will not make it worse!” That wisdom, borne of the experience of thousands of individuals
recovering from alcohol and other drug abuse, applies to the problems of failing academic
performance and dropping out of school.
Because academic difficulty in a student is often a marker for substance use, assessment
and intervention should become routine in such cases. This is especially relevant where there is a
precipitous drop in academic performance in a student who was previously performing well.
2. Focus resources on empowering parents. Common sense and numerous research
studies underscore the importance of parents and other adults in the lives of students, in terms of
their role in preventing the onset and escalation of substance use, and setting high parental
expectations for their child’s achievement to reduce the likelihood of dropout. A concerted effort to
educate parents about their critical role during the adolescent years, and how they can be effective
within the context of the larger community support systemwhich, of course, includes the
schoolwill do much to reduce dropout rates. Because dropout is an extreme result of a complex
and interacting set of risk factors, prevention strategies must identify risk-promoting factors that
can be reduced and identify change agents who are willing to act and intervene. Empowering
parents with the knowledge and tools to be more effective parents is a cost-effective and feasible
3. Identify and study currently available policies and programs that deliver on the goal
of helping youth sustain long-term abstinence. The Achilles’ heel of existing efforts to reduce
substance use among high-risk youth is the paucity of cost-effective, scalable, and comprehensive
programs that systematically identify and intervene with youth who are using drugs and alcohol,
with the goal of helping them sustain long-term abstinence. We should learn from the successes of
existing programs and policies, and encourage model building on the basis of their experiences.
Moreover, evaluations of substance use prevention and intervention programs should include not
only substance use as a measurable outcome, but academic achievement as well.
4. Develop and evaluate new personalized approaches to intervening with students at
risk for dropout. Despite the success of many existing programs, we believe there remain
important opportunities to explore novel, research-based approaches to reducing substance use
and dropout risk in high schools. Specifically, we advocate an intervention involving
America’s Dropout Crisis:
The Unrecognized Connection to Adolescent Substance Use
comprehensive, confidential assessment and continued monitoring of student behaviors and
academic performance. An important first step will be to conduct a small-scale pilot demonstration
project within a public school system to identify and intervene with high school students who are at
risk for dropout. As with any novel approach, the program must be evaluated to quantify the cost-
benefit ratio of such an approach.
Substance use remains at high levels among high school students in the U.S. Given troubling
statistics regarding high dropout rates and poor readiness skills among our nation’s high school
students, it is urgent that we recognize the contribution of substance use to these problems. High
schools must implement innovative solutions, which should include reducing substance use by
students as an important part of a comprehensive plan to enhance social and emotional
development and to promote skill acquisition. This approach will ensure that students are well
prepared for the challenges they will face after graduation and as they become young adults.
While substance use is only one of many problems related to dropout, addressing it is one
essential component of a comprehensive solution to the dropout crisis. Such complex problems
demand complex solutions. It is commonly accepted that if early educational difficulties are present
in a third-grade child, then educational systems and families must act to detect and intervene to
improve that child’s chances of educational success. If early onset alcohol or drug use is present in a
seventh-grade or any other age child, then similarly, educational systems and families must detect
and intervene to improve that child’s chances of educational success and reduce the likelihood of all
outcomes typically associated with adolescent substance use. And for those who have already
dropped out, because they are at enormous risk, there must be mechanisms in place to assess and
address their drug, alcohol, and mental health issues and to help them get back on track.
America’s Dropout Crisis:
The Unrecognized Connection to Adolescent Substance Use
1.1. Substance Use among Adolescents in the United States
Substance use, including underage drinking (see Box A) has long been recognized as a
widespread problem among adolescents. In 2011, 12.7% of eighth graders reported having an
alcoholic drink during the past month, and 6.4% met criteria for “binge drinking” during the past
two weeks, defined as having five or more drinks in a row (Johnston, O'Malley, Bachman, &
Schulenberg, 2012). Also among eighth graders, more than one in ten (12.5%) have smoked
marijuana during the past year, with moderate differences observed between males (14.0%) and
females (10.6%). Most forms of substance use become much more common as adolescents grow
older. By their senior year, 25.5% of males and 17.6% of females have engaged in binge drinking
during the past two weeks, and 36.4% have smoked marijuana during the past year (Johnston et al.,
2012). Recent increases in marijuana use have been observed among youth, sparking concern
among public health professionals, prevention and treatment practitioners, and educators (see Box
B). Moreover, 24.9% of high school seniors have tried an illicit drug other than marijuana during
their lifetime, including using a prescription drug nonmedically (Johnston et al., 2012). The reader
is referred to many publicly available data sources (see Table 1), all of which show the magnitude
of the substance use problem among American youth over time as well as variation by
socioeconomic characteristics and gender. With respect to more severe manifestations of substance
use, 6.9% of 12- to 17-year-olds in the U.S. meet standard psychiatric criteria for substance use
disorders, with 3.8% meeting criteria for abuse or dependence on alcohol and 4.6% for abuse or
dependence on other drugs (Substance Abuse and Mental Health Services Administration, 2012).
1.2. High School Dropout among Adolescents in the United States
National attention has been focused on the “dropout crisis” in America for decades
(Rumberger & Lim, 2008; Tyler & Lofstrom, 2009). Trend lines in the proportion of the population
who have earned a traditional high school diploma after four years of high school have been
relatively flat during the last few decades (Heckman & LaFontaine, 2010). Not only are school
dropout rates unacceptably high, but they are costly for states and the federal government (Belfield
& Levin, 2007). The following grim statistics come at a time when the need for a more educated
workforce has never been greater, as the American workforce must now compete in a global
7,000 students drop out of high school every day, totaling more than one million students
per year (Alliance for Excellent Education, 2010; Tyler & Lofstrom, 2009).
America’s Dropout Crisis:
The Unrecognized Connection to Adolescent Substance Use
25% of students who are currently in school will eventually drop out (Stillwell, Stable, &
Plotts, 2011).
The ten largest public school systems in the U.S., which enroll 8% of the nation’s students,
failed to graduate more than 60% of their students (Greene & Winters, 2006).
In 2007, 16% of individuals ages 16 to 24, or 6.2 million people, were high school dropouts
(Center for Labor Market Studies and Alternative Schools Network in Chicago, 2009).
3.8 million 18- to 24-year-olds, or 15% of young adults, are neither employed nor in school
(Annie E. Casey Foundation, 2004).
Among 25- to 54-year-old males with no high school diploma, approximately 35% have no
job, up from about 10% in the 1960s. Among African-Americans, almost 70% of high school
dropouts have no job (Economist, 2011).
The lost income tax revenue associated with high school dropouts exceeds $50 billion
annually (Rouse, 2005).
As will be discussed in more detail in Section 1.2.4., dropout is the end-stage manifestation of a
wide variety of inter-connected issues, the pathways of which differ across individuals. The
multiple causal pathways to dropout involve influences at the individual, community, and family
levels. Although some controversy exists regarding how high school dropout is defined and
measured by school systems (Tyler & Lofstrom, 2009), there is unanimous agreement about the
seriousness of the issue and the social and economic consequences of the current situation.
America’s Dropout Crisis:
The Unrecognized Connection to Adolescent Substance Use
1.2.1. Variation in dropout rates by sociodemographic characteristics
Certain segments of the population are less likely to complete high school. For example,
significant differences exist between individuals of various racial and ethnic backgrounds, with
Asian-Americans having the highest high school graduation rates (91.8%) followed by Whites
(82.0%), Hispanics (65.9%), American Indians/Alaska Natives (64.8%), and African-Americans
(63.5%; Stillwell et al., 2011). The Southern region of the U.S. as a whole has dramatically higher
percentages of dropouts than the Northern regions (Laird, Kienzl, DeBell, & Chapman, 2007;
Stillwell et al., 2011). Parental education and other family characteristics are correlated with the
likelihood of dropping out of high school; for example, students whose parents are less educated or
have lower incomes are more likely to drop out (Rumberger & Lim, 2008).
1.2.2. Concentration of dropouts within schools
While dropout is a national issue, severe dropout problems are concentrated among a
modest percentage of schools in the U.S. For between 900 to 1,000 high schools (8% of all regular
and vocational high schools with 300 or more students) graduating is a 50/50 proposition at best
(Balfanz & Legters, 2004).1 Such schools have been labeled “dropout factories”. If one expands the
definition of a dropout factory to schools where the promoting power is 60% or less, then 18% of
high schools fall into this category (Balfanz & Legters, 2004).
1 The construct of promoting power is a comparison between the number of freshmen at a high school to the
number of seniors four years later.
America’s Dropout Crisis:
The Unrecognized Connection to Adolescent Substance Use
Table 1: National data sources on adolescent substance use in the United States
Monitoring the Future
Youth Risk Behavior
Surveillance System
National Survey on
Drug Use and Health
Sample 50,000 high school students 15,000 high school
70,000 individuals ages 12
and older
Subjects Behaviors and attitudes
6 priority health-risk
Substance use and mental
Timing Annually since 1975
Spring and fall of odd-
numbered years, since
Annually since 1988
Setting 420 public and private high
High schools in 47 states,
6 territories, 2 tribal
governments, and 22 of
the largest urban school
Funding National Institute on Drug Abuse
Centers for Disease
Control and Prevention
Substance Abuse and
Mental Health Services
Administration (SAMHSA)
1.2.3. Adverse social, economic, and health consequences of dropping out
The adverse consequences associated with dropping out of high school are numerous and
have been reviewed elsewhere (Belfield & Levin, 2007; Rouse, 2005; Tyler & Lofstrom, 2009). In
addition to being more likely to be dependent on public assistance, dropouts are generally less
healthy than individuals with more education (National Center for Health Statistics, 2012). Not only
are adults without a high school diploma more likely to have a lower life expectancy, poorer health
habits, and various chronic disease conditions, they are also more likely to have less healthy
children, including children who are obese. High school dropouts are less likely to access preventive
health services and be among the uninsured (National Center for Health Statistics, 2012).
The connection between high school dropout and these sorts of health outcomes are
complex, but health literacy and income are important mediators of this relationship. Certainly
employment opportunities are severely restricted for individuals who have not received a high
school diploma. According to one recent study in California that estimated the economic advantages
of graduation, each high school dropout earns on average $289,820 less during their lifetime than a
high school graduate (Belfield & Levin, 2007).
High school dropouts are also over-represented among the incarcerated population, with
41.3% having only some high school education or less (Harlow, 2003). Alternately, among 16- to
24-year-old males on any given day in 2006 or 2007, 9.4% of dropouts were incarcerated vs. 4.5%
America’s Dropout Crisis:
The Unrecognized Connection to Adolescent Substance Use
of high school graduates, including those who obtained additional education post-college (Sum,
Khatiwada, McLaughlin, & Palma, 2009).
Although the primary focus of this report is how substance use contributes to high school
dropout, dropout itself is a well-recognized contributor to substance use problems during
adulthood. Studies have demonstrated that high school dropout increases one’s risk for a
subsequent alcohol use disorder (Crum et al., 2006) and later drug use (Beauvais, Chavez, Oetting,
Deffenbacher, & Cornell, 1996; Substance Abuse and Mental Health Services Administration, 2013).
In a national sample of 1,762 African-American youth, Kogan and colleagues (2005) observed a
significant association between dropout and subsequent marijuana and cigarette use at age 18,
independent of earlier drug use and problem behaviors at age 16. In a second analysis of the same
dataset (although not restricted to African-Americans), Drapela (2006) found that high school
dropout predicted a 30% increase in substance use four years later among 10,678 adolescents,
independent of prior substance use and several other background factors. As discussed below, the
fact that dropout is associated with later substance use problems does not negate the substantial
contributory role that substance use plays in the pathway to dropout. As will be explained later, the
research evidence supports that the relationship between substance use and dropout is
1.2.4. Correlates of and risk factors for high school dropout
Understanding what factors distinguish students who persist rather than fail during high
school has been the focus of intensive research in the educational field (see Chapman, Laird, &
KewalRamani, 2011; Dewey, 1999; Rumberger, 1987; Rumberger & Lim, 2008; Rumberger, 2011;
Stillwell et al., 2011). Rumberger and Lim (2008) published a recent comprehensive review of
research studies on the factors related to dropout, and divided them into individual characteristics
and institutional characteristics; namely, family, school, and community characteristics. They
stressed that dropout is not an event, but rather a complex process that can involve a multitude of
influences that converge to result in the individual’s decision to drop out.
Not surprisingly, many of the individual-level factors related to dropout are performance
indicators such as grades, being held back, as well as attitudes such as academic expectations. Also
highlighted were a number of behaviors that increase the risk for dropping out, including affiliating
with deviant peers, delinquency, and drug use. Assuming adult roles early in life due to becoming a
parent or working full-time because of family circumstances can propel a student out of school,
although those events can also provide an incentive to be engaged in the workforce. Family
characteristics were also found to be highly influential on the risk for dropout. In addition to having
material resources, students from families with “social resources”such as having high educational
aspirations for their children, monitoring their child’s progress, communicating with schools, and
knowing the parents of their children’s friendswere less likely to drop out. With respect to school
characteristics, the review concluded that simply having a high level of school resources did not
automatically raise the chances of graduation; rather, the actions and policies of the school
appeared to matter more. For example, dropout is less frequent among schools with a strong
academic climate. Moreover, not allowing students to drop out prior to age 18, a policy set by 20
America’s Dropout Crisis:
The Unrecognized Connection to Adolescent Substance Use
states and the District of Columbia (Bush, 2010), has reduced, but not eliminated dropouts. Finally,
having high levels of community resources is associated with lower high school dropout rates. On
the other hand, growing up in high-poverty neighborhoods is not a guarantee that a student will fail
to graduate if other supports in the school and family are in place that can monitor the child’s
progress and allow them to achieve their potential.
1.2.5. The under-recognition of substance use as a risk factor for dropout
As will be described in Section 2, substantial evidence has accumulated that clearly
supports the role of substance use as a contributory factor for dropout. Moreover, clinical
experiences with substance-using adolescents reinforce the notion that drug use leads to declines
in academic motivation, study habits, and goal-setting (see Appendix 1). Namely, adolescents in
recovery report that, as their drug use problem escalated, they became completely disinterested in
school and found it much easier to affiliate with drug-using peers than academically-achieving
students. This pattern of “spiraling-out” is heard all too commonly by clinicians who treat
adolescents with substance use disorders.
Unfortunately, the contributory role of substance use in the pathway to dropout is less
recognized than other risk factors. Despite the compelling empirical and clinical evidence, the many
reports published on the dropout crisis in America pay little attention to the drug use-dropout
connection (Alliance for Excellent Education, 2010; Balfanz, 2007; Balfanz, Bridgeland, Moore, &
Fox, 2010; Boys and Girls Clubs of America, 2010; Center for Labor Market Studies and Alternative
Schools Network in Chicago, 2009; Chapman et al., 2011; Greene & Winters, 2006; Kennelly &
Monrad, 2007; Melville, 2006; Thomasian, Pound, Wilhoit, & Welburn, 2008). Fortunately, more
recent reports and reviews of research have begun to add drug and alcohol use to the list of
contributory factors (Hammond, Linton, Smink, & Drew, 2007; Kreamer, Fields, Stutman, Anderson,
& Barthwell, 2008; Rumberger & Lim, 2008), and thus recognize the opportunity for substance use
prevention as part of the solution to the dropout crisis. Discussions related to how early academic
difficulty is a risk factor for substance use and that dropout exacerbates substance use problems
have overshadowed the fact that substance use is also a contributor to poor academic performance
and dropout. As mentioned earlier, students who are less motivated than other students, not
interested in studying, or chronically skipping class are well accepted to be at high-risk for dropout.
But ultimately, to improve high school graduation rates, it is important to first understand the roots
of these issues. Problems with motivation and ineffective study skills should be seen as proximal
indicators of risk, and not necessarily risk factors themselves.
We call for a much more comprehensive view of the multiple causal components of dropout,
which includes increased recognition of the contributory role of substance use. It follows from this
model that interventions to reduce substance use should be seen as a viable strategy to reduce
dropout. Our model is depicted in Box C and illustrates the inter-relationships of substance use with
individual, parent, and school factors that are recognized to be influential for academic
performance and demonstrates how substance use is a contributory factor in the chain of events
leading to dropout.
America’s Dropout Crisis:
The Unrecognized Connection to Adolescent Substance Use
America’s Dropout Crisis:
The Unrecognized Connection to Adolescent Substance Use
2.1. Introduction
As discussed earlier, there is strong evidence to support substance use as part of the causal
pathway that leads to dropout for some individuals. This section describes our review of the
research studies from scientific literature that back up that claim. We begin by describing the
methods we used to search and summarize the scientific literature. Next, we describe the results of
the research studies we reviewed, which are organized into five main groups, as shown in Table 2.
Lastly, we discuss the limitations of these research studies, and conclude this section with a
summary of the major findings and consistent themes we found.
Table 2: Types of research studies reviewed for this report
Cross-sectionala studies on the association
between substance use and dropout
Comparing dropouts with non-dropouts on substance use
Comparing substance users with non-users on rates of
Longitudinala studies examining substance
use as a predictor of dropout
Alcohol use only
Drug use other than alcohol
Both alcohol and other drug use
Composite measures of alcohol and drug use
Studies examining substance use disorder (SUD) rather than substance use, per se, as a correlate or predictor
of dropout
Studies examining the relationship between substance use and high school GPA
Studies examining changes in academic performance following adolescent addiction treatment
2.2. Methods Used to Review the Scientific Literature
We reviewed the scientific literature on this topic by electronically searching the Education
Resources Information Center (ERIC) and PubMed databases with the search terms academic
performance, high school dropout, and educational attainment, and related these terms to alcohol,
drug, and substance use. Next, we reviewed the reference lists of all potentially relevant articles and
thereby identified several additional articles that were not located by the electronic search. We
restricted the pool of articles to: a) studies conducted on U.S. middle and high school students; b)
empirical studies (rather than opinion pieces or reviews); and, c) studies that analyzed either
America’s Dropout Crisis:
The Unrecognized Connection to Adolescent Substance Use
America’s Dropout Crisis:
The Unrecognized Connection to Adolescent Substance Use
dropout, grade point average (GPA), and/or academic failure as an outcome variable (rather than
studies that examined drug use as an outcome variable [those findings are mentioned in Section
1]). After setting these selection criteria, and reviewing abstracts of potentially relevant articles, we
identified 49 articles for thorough review that met our criteria. Included are three studies that
examined the changes in academic performance exhibited by adolescents who had received
addiction treatment. We reviewed both cross-sectional and longitudinal studies, which answer
different kinds of questions, as shown in Box D.
2.3. Cross-sectional Studies on Substance Use and High School Dropout
2.3.1. Comparison of dropouts with non-dropouts on substance use
By comparing individuals who have dropped out with those who have graduated from high
school, a variety of studies have consistently demonstrated that dropouts have much higher rates of
substance use. In an analysis of national data from the National Household Survey on Drug Abuse
(NHSDA) on more than 12,000 17- to 22-year-olds, Groeferer and colleagues (1997) found that high
school dropouts were significantly more likely than non-college-attending high school graduates to
have used marijuana and cigarettes during the past month, holding constant age, race/ethnicity,
and living arrangement. However, dropouts and graduates did not differ significantly on alcohol use
or heavy drinking (see Figure 1).
America’s Dropout Crisis:
The Unrecognized Connection to Adolescent Substance Use
A recent report published by the Substance Abuse and Mental Health Services
Administration (2013) updated this analysis by looking at data from the 2002 through 2010
National Survey on Drug Use and Health (NSDUH). It showed that among 16- to 18-year-olds,
students who were enrolled in twelfth grade used alcohol and other drugs at significantly lower
rates than dropouts. Dropouts were more likely than enrolled twelfth grade students to have used
the following substances during the past month: cigarettes (56.8% vs. 22.4%), alcohol (41.6% vs.
35.3%), binge alcohol (32.3% vs. 23.8%), any illicit drug (31.4% vs. 18.2%), marijuana (27.3% vs.
15.3%), and prescription drugs nonmedically (9.5% vs. 5.1%). This pattern was true among both
males and females. Although substance use was more prevalent among twelfth grade aged males
than females, more male dropouts and more female dropouts reported use than their school-
enrolled counterparts. However, female dropouts did not differ significantly from their enrolled
counterparts for past-month alcohol use. While both White dropouts and African-American
dropouts were significantly more likely than White and African-American enrolled twelfth grade
students to report substance use, this pattern was not true of Hispanic youth. Hispanic dropouts
only reported significantly more cigarette use during the past month. According to the Substance
Abuse and Mental Health Services Administration, because substance use is preventable public
health problem, “prevention efforts targeted to adolescents generally and to those at risk of
dropping out of high school more specifically might improve the educational, employment and
financial, and health outcomes of many youths.(p. 4)
Yamada and colleagues (1996) analyzed cross-sectional data of 672 twelfth graders from
one assessment of the National Longitudinal Survey of Youth (NLSY). They found that frequent
drinking (defined as twice a week or more) and monthly marijuana use were more likely to be
observed among those who did not graduate at the end of their senior year, compared with those
who graduated on time. The authors estimated that the probability of graduating on time was
reduced by 4.3% for frequent drinkers and by 5.6% for students who used marijuana at least once a
month. The study design was strengthened by the inclusion of a large number of covariates in the
statistical model (e.g., family structure, class rank, academic aptitude, religiosity, as well as
socioeconomic and demographic characteristics), which made it possible to isolate the effect of
substance use on dropout independent of these other factors.
These findings from large national surveys are reinforced by additional studies of smaller,
geographically localized samples. Fagan and Pabon (1990) compared two samples of adolescents:
a) 200 students who were currently attending high schools in 1985; and b) a group of 50 high
school dropouts who were identified through various community settings in the same communities
from which the schools were sampled. As expected, the groups differed in several significant ways.
Male and female dropouts were more likely than on-track students to have histories of excessive
drinking and more serious involvement with substance use. Interestingly, when dropouts were
asked about factors underlying their decision to leave school, substance use was the least
frequently reported contributing factor. In their minds, loss of interest in school and needing a job
topped the list of reasons. This finding is very interesting because it highlights students’ lack of
awareness of the link between substance use and having a loss of interest in school.
America’s Dropout Crisis:
The Unrecognized Connection to Adolescent Substance Use
From a clinical perspective, this lack of insight is commonand represents a potential
opportunity for intervention. One of the goals in treating individuals with substance use problems
is to make them aware of the connection between their behavior and their inability to set and attain
goals that are important to them. In many cases this is difficult because users often perceive their
substance use as innocuous or even beneficial for getting through their day. The other important
finding from this study was that family supports for socialization and valuing of education were less
frequent among the dropout group than the student sample.
Swaim and colleagues (1997) studied a matched sample of 774 dropouts and 738 students
from communities in the Southwest, Midwest, and Western regions of the U.S. (see Figures 2 and
3). Within all three ethnic groups studied (i.e., Non-Hispanic Whites, Native Americans, and
Mexican Americans), dropouts had significantly higher lifetime and past-month estimates of alcohol
intoxication, marijuana use, and inhalant use, relative to current students of the same gender,
grade, and ethnicity. For instance, past-month prevalence of marijuana use was more than twice as
high in dropouts compared with students, regardless of ethnicity. Moreover, lifetime and past-
month use of stimulants, cocaine, and LSD were also significantly more prevalent among dropouts
than students, albeit only within the Non-Hispanic White and Mexican American groups.
Two additional studies were conducted with minority adolescents residing in the
Southwestern part of the U.S. First, Beauvais and colleagues (1996) reported statistically significant
differences in drug use between three groups: students in good academic standing, students in poor
America’s Dropout Crisis:
The Unrecognized Connection to Adolescent Substance Use
academic standing, and school dropouts. Dropouts were defined as students recruited from the
community who had not attended school for at least 30 days, had not officially transferred to
another school, and who had not been in contact with school authorities seeking readmission. All
groups were matched on the school they were or had been attending. Results showed that about
one-fifth of female dropouts and about one-third of male dropouts were involved in heavy drug use,
much higher than students in good academic standing. Students in poor academic standing had
estimates that fell in between the two extreme groups. Importantly, while a statistical interaction
was found with gender (males had higher rates of drug use than females), the authors failed to find
a statistical interaction with ethnicity, suggesting that drug use was equally important for all
academically at-risk students regardless of ethnicity.
In a later study using the same population, Arellano and colleagues (1998) published
similar findings related to alcohol use, where dropouts were 2.5 times more likely to be frequent
users of alcohol, 3.2 times more likely to be heavy drinkers, and 3.0 times more likely to report
frequent drunkenness when compared with their in-school counterparts.
Guagliardo and colleagues (1998) assessed a predominantly African-American (92.3%) and
female (67.9%) sample of 1,720 inner-city adolescents (ages 12 to 18) attending a medical clinic in
Washington, DC. As shown in Figure 4, compared with students whose current grade level was “on
track” for their age, patients who self-identified as dropouts were more than twice as likely to test
positive for illicit drugs, and three times as likely to report an early age of drug use initiation (i.e.,
America’s Dropout Crisis:
The Unrecognized Connection to Adolescent Substance Use
before age 14). Furthermore, among current students, those who were old for their grade were
more than 40% more likely than on-track students to test positive for drugs, leading the authors to
express concern over a possible negative influence that old-for-grade students might have on their
on-track peers.
In contrast to the numerous studies focusing on economically disadvantaged minority youth
at risk for dropout, Franklin and Streeter (1995) described a sample of 200 middle-class dropouts
(88% White) who were attending an experimental alternative school located in an affluent
suburban area. Although this study did not include a comparison sample of non-dropouts, it offers
valuable insights into the perceptions of high school dropouts. The investigators found that one in
five (21.5%) cited drug and alcohol problems as a factor contributing to their dropout. Yet a
standardized psychological/behavioral assessment revealed that half (50.5%) were at risk for drug
problems, one-fourth (24.5%) had a clinically significant drug abuse problem, and 8.0% had a
clinically significant alcohol use problem. Nearly half of the sample (45.4%) had been in drug
treatment. None of the other problem areas that were assessed in the studyincluding
delinquency, risk-taking, and educational adjustmentwere seen in such a large proportion of
these middle-class, predominantly White dropouts.
2.3.2. Comparison of substance users with non-users on rates of dropout
Other cross-sectional studies have examined the substance use-dropout relationship by
comparing substance users with non-users on their dropout rates (see Box D). An early study of
America’s Dropout Crisis:
The Unrecognized Connection to Adolescent Substance Use
this type was conducted by Friedman and colleagues (1985), who observed a significant association
between alcohol and drug use severity and subsequent failure to graduate among a sample of
students attending urban high schools in Philadelphia, even after adjusting for a variety of family
background characteristics, academic motivation, and conduct problems.
In another early study, Mensch and Kandel (1988) used event-history analysis to document
that students who tried marijuana, cigarettes, or other illicit drugs were more likely to drop out of
high school. Moreover, the earlier use was initiated, the greater their likelihood of dropping out.
While prior alcohol use was not found to differentiate dropouts from non-dropouts in this study,
age of alcohol use initiation was significantly associated with dropout among males. The fact that
the drug use-dropout effect remained significantindependent of several other risk factors for
dropout such as family structure, academic aptitude, self-esteem, and delinquencyled the
researchers to conclude that “dropping out is a partial function of drug use itself.” (p. 111)
More recently, this type of research design was adopted in an analysis of the 1997 to 1998
National Household Survey on Drug Abuse (NHSDA; see Figures 5 and 6). Roebuck and colleagues
(2004) classified all 12- to 18-year-olds into three mutually exclusive groups based on their
marijuana use frequency during the past year: non-users, non-chronic users (i.e., less than weekly),
and chronic users (i.e., weekly or more). Because the sample was restricted to adolescents who had
not yet graduated or completed twelfth grade, the researchers could examine how these three
groups differed on school enrollment and attendance. Although chronic marijuana users had the
highest level of dropout risk and truancy, dropout risk was significantly higher for all levels of
marijuana use compared with non-users, even controlling for demographics, alcohol use, and other
substance use. For example, the rate of dropout among non-chronic users (5.8%) was twice as high
compared with non-users (2.2%). Chronic users had nearly six times as many dropouts as non-
users (12.8% vs. 2.2%). Similarly, both chronic and non-chronic marijuana users skipped more
days of school during the past month, on average, relative to non-users (1.34 and 0.77 vs. 0.19 days,
respectively). Any alcohol use during the past year was used as a control variable in the analyses
and was also significantly related to dropout.
A significant association between marijuana use frequency and risk for dropout was also
found in a smaller study by Trampush and colleagues (2009). Interestingly, the original aim of the
study was to investigate the extent to which a childhood diagnosis of Attention Deficit Hyperactivity
Disorder (ADHD) contributed to an increased risk for dropout. After controlling for IQ, frequency of
paternal contact, and frequency of marijuana use, a diagnosis of ADHD did not have a significant
effect on dropout status.
One cross-sectional study demonstrated that more intensive drug involvement
distinguishes students at high risk for dropout, even before the dropout occurs. Eggert and Herting
(1993) studied a sample of high school students in one urban school district (ages 14 to 19, 79.3%
White, 49.3% female). A subset of 160 students at high risk for dropout was identified based on
their academic standing, and compared with 203 “typical” students who were randomly selected.
High-risk youth had more severe patterns of alcohol and drug involvement than typical students, as
evidenced by more frequent drug use, more access to drugs, less control over their drug use, and
America’s Dropout Crisis:
The Unrecognized Connection to Adolescent Substance Use
America’s Dropout Crisis:
The Unrecognized Connection to Adolescent Substance Use
more adverse consequences from drug use. For example, weekly marijuana use was reported by
19% of high-risk youth, compared with only 3% of typical students. Not surprisingly, many high-
risk youth experienced adverse psychosocial consequences from their alcohol and other drug use,
such as family conflict, skipping class, and getting into trouble at school, whereas substance-related
consequences experienced by typical students were usually limited to physical symptoms resulting
from acute alcohol intoxication. The authors speculated that the transition from low dropout risk to
high dropout risk might be related to an increase in drug access and a decrease in self-control of
drug use.
2.4. Longitudinal Studies on Substance Use as a Predictor of Dropout
Prospective longitudinal studies are superior to cross-sectional studies because they can
lead to a better understanding of the timing between substance use and academic outcomes (see
Box D). A wide variety of datasets have been used to investigate the prospective association
between substance use and high school dropout, including large nationally representative samples
of school children, general community samples, and smaller samples of special populations,
including students with disabilities (Hollar & Moore, 2004), urban adolescents (Green, Doherty,
Stuart, & Ensminger, 2010; Trampush et al., 2009), and African-Americans (Ensminger & Lamkin,
1996; Green et al., 2010; Zimmerman & Schmeelk-Cone, 2003). In this section, we discuss the
findings of these and other longitudinal studies.
2.4.1. Longitudinal studies of alcohol use only
We identified three studies that examined the association between alcohol use and dropout
without measuring other types of drug use. Although these studies are helpful in understanding
how alcohol use might contribute to dropout, their findings are limited because alcohol and other
drug use are highly correlated.
The first is a study by Dee and Evans (2003), which is one of the most cited longitudinal
studies to refute the presence of a relationship between alcohol drinking and high school dropout.
In that study, investigators analyzed data from the National Education Longitudinal Survey (NELS-
88), which obtained a nationally representative sample of students enrolled at 1,052 grade schools
across the U.S. Students were first assessed during the eighth grade in 1988, and then completed
follow-up assessments every other year through 1994, corresponding to tenth grade, twelfth grade,
and two years after twelfth grade. Drinkers were defined as having had at least one drink during
the past month, and heavy drinking was defined as having had five or more drinks in a row at least
once during the two weeks prior to being surveyed. High school completion was measured by
receiving either a traditional diploma or a GED by the end of the study period (i.e., two years after
twelfth grade). Adjusting for parental education, family structure, and school, the investigators
initially found that students who drank or drank heavily in tenth grade were 3.5 and 5 percentage
points less likely than non-drinkers, respectively, to complete high school by the end of the study
period. A second analysis tested the hypothesis that prior academic achievement predicts drinking
levels during twelfth grade. They observed that test scores during eighth and tenth grade had been
America’s Dropout Crisis:
The Unrecognized Connection to Adolescent Substance Use
lower for twelfth graders who drank than for non-drinking twelfth graders, regardless of whether
they were already drinking by tenth grade. Thus, the authors concluded that the initial association
they observed was merely correlational and not causal, since academic difficulties could have
preceded the onset of drinking in twelfth grade. However, a major limitation of this study is that
dropouts were omitted from the second analysis because they were likely to differ greatly from
enrolled students in terms of having both heavier patterns of alcohol consumption and lower
academic performance. Another limitation is that a GED was treated as equivalent to a traditional
In a later study, Renna (2008) examined the potential effect of alcohol consumption on
graduation rates, and advanced the earlier work by Dee and Evans (2003) in two ways. First,
separate analyses were conducted for receiving a high school diploma and obtaining a GED. Second,
rather than using schools as a sampling frame, the investigators gathered survey data by mail from
a random sample of 2,263 youth living in the U.S. who were participants in the National
Longitudinal Survey of Youth (NLSY). By using this type of sampling design, dropouts were retained
in the analysis sample. The outcome variable of the studyeducational attainmentwas assessed
at age 19 and again at age 25. This study produced two important findings. First, the authors
observed that binge drinking during twelfth grade significantly reduced educational attainment,
such that each additional episode of binge drinking per month decreased the probability of
graduating by 2.45 percentage points. Second, in order to rule out a simple correlational
relationship between binge drinking and educational attainment, Renna (2008) examined the
influence of state alcohol policiesas a proxy for binge drinking rateson educational attainment.
In that analysis, Renna (2008) demonstrated that, although binge drinking per se had no net effect
on educational attainmentsimilar to what Dee and Evans (2003) reportedmore frequent binge
drinking (as indicated by a lower minimum legal drinking age) predicted greater likelihood of
obtaining a GED than a diploma, and, therefore, lower likelihood of graduating on time (i.e., by age
19). These findings were strengthened by statistical adjustment for a wide array of individual
background characteristics. Together, these findings suggest that students who drink heavily are at
risk for experiencing significant setbacks in completing high school, even though they might
eventually go back and earn their GED by age 25.
Koch and McGeary (2005) used yet another approach to examine the relationship between
alcohol use and dropout. They analyzed data from the 1979 to 1996 NLSY to develop a statistical
model to predict high school completion as a function of early initiation of alcohol use and several
other variables, including demographics and family history. They observed that alcohol use onset
before age 14 was strongly associated with dropping out of high school by age 20. In that sample,
39.3% of females and 47.8% of males who initiated alcohol consumption by age 14 did not
complete their high school degree by age 20, as compared with 27.1% of females and 32.1% of
males who delayed initiation of alcohol use until after age 14. Unfortunately, no analyses were
performed to indicate how different ages of alcohol use initiation were associated with the
likelihood of high school completion.
America’s Dropout Crisis:
The Unrecognized Connection to Adolescent Substance Use
2.4.2. Longitudinal studies of drugs other than alcohol
Some studies investigating the association between substance use and dropout only
included measures of illicit drug use, but not alcohol. All of these studies found that drug use during
high school is related to a decreased likelihood of graduation.
Kaplan and Liu (1994) conducted a longitudinal study of 2,805 seventh graders in Houston
in 1971. The students were then followed up in eighth grade and again in their mid-twenties. A
single measure of drug use (i.e., marijuana use during the past 30 days) was used in a series of
logistic regression models as a predictor of high school dropout after statistical adjustment for
father’s education, gender, race, ethnicity, deviant behavior, psychological distress, lack of personal
control, and grades. The results showed that although marijuana use during the seventh grade
accounted for only a small proportion of the variance explained in dropout, it retained statistical
significance after adjustment for control variables. Moreover, the study provided three possible
explanations for how marijuana use might have influenced dropout: a) via low levels of motivation;
b) via the experience of negative social sanctions; and c) via the adoption of precocious roles (e.g.,
pregnancy). Although this study was well-designed and based on a sophisticated theoretical
framework, sample attrition over time was significant, with marijuana users dropping out of the
study far more often than non-users. Nevertheless, the fact that marijuana use still predicted high
school dropout even with this substantial attrition bias underscores the importance of marijuana
use as a potential contributing factor to dropout.
In another large longitudinal study of 1,392 adolescents ages 16 to 18 from one school
system in the Southeast U.S., Bray and colleagues (2000) found that marijuana use initiation
significantly predicted subsequent dropout from high school, holding constant demographics and
onset of other drug use. Specifically, marijuana initiators were 2.3 times more likely to drop out of
high school than non-users. Unfortunately, the study did not examine the impact of marijuana use
frequency or duration on the risk for dropout.
Two studies used longitudinal data from the Woodlawn study in Chicago to investigate the
drug use-dropout relationship in an urban, predominantly African-American sample. Starting in
1966, all first-grade children in nine public and three parochial schools were assessed by their
teachers, and a structured assessment interview was conducted with their mothers. Ten years later
children and their mothers were reassessed, and in 1982, school graduation records were obtained.
In the first study, Ensminger and Lamkin (1996) examined the relationship between dropout and
an array of community-level variables (neighborhood, family residential mobility) as well as
individual and family characteristics, and found that adolescent marijuana smoking frequency was
related to the risk for high school dropout. Strikingly, living in a poverty census tract was not a
statistically significant predictor of high school graduation after accounting for individual and
family-level variables. In a second study utilizing the same dataset, Green and colleagues (2010)
observed that marijuana use frequency was a strong predictor of dropping out of high school, even
after adjustment for a number of potential confounding variables such as gender, socioeconomic
status, family background, school adaptation, school achievement, and delinquency.
America’s Dropout Crisis:
The Unrecognized Connection to Adolescent Substance Use
Finally, in a study of 3,525 males in the 1988 National Longitudinal Survey of Youth (NLSY)
cohort, Register and colleagues (2001) found that males who ever used illicit drugs by age 18
attained, on average, approximately one year less of formal education by middle adulthood, as
compared with non-users, even after holding constant sociodemographic factors such as parental
education, living in an urban area, number of dependents by age 18, and marital status by age 18.
However, this association retained statistical significance only for Whites, not for Blacks or
Hispanics. Among Whites, the association held true regardless of whether the drug use variable
included marijuana only or other drugs. Although this study did not investigate high school dropout
per se as an outcome variable, the findings on decreased educational attainment are relevant and
are consistent with other studies investigating the drug use-dropout relationship.
2.4.3. Longitudinal studies of both alcohol and drug use
Studies that have measured both alcohol and other types of drug use separately are useful
to understand the relative importance of each type of substance to dropout. The majority show that
the relationship with high school dropout is weaker for alcohol use than for other forms of drug
use. In this section, we also review findings related to the predictors of educational attainment from
the Monitoring the Future (MTF) study, the largest ongoing nationwide survey to monitor
adolescent drug use trends.
Newcomb and Bentler (1986) examined the predictive relationship of high school drug use
frequency for five categories of substances (cigarettes, alcohol, marijuana, “hard” drugs including
prescription drugs used nonmedically, and nonprescription drugs) with high school graduation.
Participants were 479 young adults ages 19 to 23 originally recruited during seventh through ninth
grade from 11 schools across Los Angeles county. The authors found that, with the exception of
nonprescription drugs, all the other drug use frequency measures significantly predicted lower
likelihood of high school graduation. However, due to considerable overlap in the variance
explained by these measures, only cigarette and “harddrug use retained statistical significance in
the combined model, even after statistical adjustment for grades and educational plans during high
Similar findings were reported by Garnier and colleagues (1997) who recruited 194
families through physicians’ offices in California and assessed them from 1974 to 1992. The past-
six-month frequency of alcohol and other drug use was measured and analyzed in relation to high
school dropout. Their results showed that adolescent drug use, more than alcohol use, was
associated with increased chances of dropping out of high school. This study was unique in that it
examined several factors related to family functioning and found, not surprisingly, that families
where adolescents used drugs had more dysfunction in other areas, including exposure to parental
drug use or family nonconventionality. The authors concluded that these problems are also likely
contributors to lowered academic achievement in drug-using adolescents.
In addition to studies of general community samples, the prospective relationship between
substance use and dropout has been replicated in special populations, such as African-Americans
and students with disabilities. Zimmerman and Schmeelk-Cone (2003) initially ascertained a
America’s Dropout Crisis:
The Unrecognized Connection to Adolescent Substance Use
sample of 681 African-American ninth graders and re-interviewed them annually for the next three
years, regardless of continued school attendance. Only students who had a GPA of 3.0 or lower were
eligible for the study, presumably to maximize the sample size for dropouts. The last wave of data
was collected six years post-baseline, at which time 16.4% had not received a high school diploma
or GED. The investigators assessed alcohol and marijuana use and school motivation over time. Low
school motivation contributed to continued drug use but was not a significant predictor of dropout.
Nevertheless, both alcohol and marijuana use during high school independently increased the
likelihood of not completing school even though this effect was not mediated through low school
Prompted by earlier findings showing that students with disabilities are at higher risk than
their non-disabled peers for both substance use and dropout, Hollar and Moore (2004) investigated
the relationship between substance use and dropout among 1,021 students with disabilities who
were identified in the National Education Longitudinal Survey (NELS-88) national dataset. These
students were identified in eighth grade by their parents as having either a physical, sensory,
learning, emotional, or health disability, and had received special education. Substance use
information (i.e., alcohol, tobacco, marijuana, and cocaine) was used from the twelfth grade
assessment. The investigators examined several educational, social, and functional outcomes, three
of which specifically pertained to dropout: dropping out by twelfth grade, not graduating in 1992
(i.e., on time), and not earning a high school diploma or equivalent by 2000 (i.e., eight years post-
high school). All three of these outcomes were significantly more likely among students who were
daily cigarette smokers, binge drinkers, or lifetime marijuana users in twelfth grade, as compared
with their non-using counterparts. Lifetime cocaine users were also more likely to have dropped
out by twelfth grade. The study did not examine whether or not substance use influenced dropout
risk differentially by disability type. The authors called for increased attention to the substance use
problems of students with disabilities, and the need for prevention strategies that specifically
address this subpopulation.
To address the question of the relationship between early substance usenamely use that
is present in middle schooland later dropout, Ellickson and colleagues (1998) measured the
substance use patterns of a large cohort of students (n=4,390) who were first enrolled in the study
as seventh graders from public schools in Oregon and California. Importantly, to isolate the specific
contribution of substance use, the investigators statistically adjusted for a wide range of other
factors that could be related to dropoutnamely, demographics, family background, academic
orientation, problem behavior, peer influence, and school environment. The results showed that
after adjustment for covariates, early cigarette use, but not alcohol use, predicted dropping out of
high school. The study’s results were strengthened by the use of non-response weighting
procedures to adjust for attrition bias that might have resulted from individuals dropping out of the
study being different from individuals who did not have missing data. Another strength of the
design was the use of saliva tests to validate self-reported cigarette smoking. The investigators
speculated that alcohol use was too prevalent in the sample (74.4% of the sample had tried alcohol
by the seventh grade) to have predictive value for dropout. Because all of the early marijuana users
also smoked cigarettes, the authors re-ran their statistical model without cigarette use, and found
that marijuana use significantly predicted dropout, but that alcohol use remained statistically non-
America’s Dropout Crisis:
The Unrecognized Connection to Adolescent Substance Use
significant. The absence of a relationship between alcohol use and dropout in the overall sample
might be related to the fact that alcohol use was measured with a one-time assessment of use in
seventh grade.
Early substance use was also the focus of two studies using data from the Rochester Youth
Development Study (RYDS), which began surveying 775 middle school adolescents in 1988 and
assessed them through age 20. The investigators measured early substance use frequency for
alcohol, marijuana, and other drugs. Krohn and colleagues (1997) observed that early substance
use was related to dropout and other “precocious transitions” such as impregnating a partner or
moving out of the parental home. For males but not females, this association remained significant
even when several demographic, peer, and parent factors were held constant. Interestingly, this
study also demonstrated the bidirectional relationship between substance use and dropout, in that
dropout predicted greater likelihood of substance use during young adulthood, even independent
of early substance use and other control variables. In a seven-year study of 538 males in the RYDS,
McCluskey and colleagues (2002) observed that more frequent substance use (including alcohol,
marijuana, and other illicit drugs) by age 15 was positively associated with greater risk for
subsequent dropout, even holding constant family and school factors.
Finally, the Monitoring the Future (MTF) study has yielded several publications and reports
focused on how tobacco, alcohol, marijuana, and other drug use relate to educational outcomes,
including high school dropout (Bachman et al., 2007a; Bryant, Schulenberg, Bachman, O'Malley, &
Johnston, 2000; Bryant, Schulenberg, O'Malley, Bachman, & Johnston, 2003). Here we briefly
describe the findings specifically related to high school dropout that were reported in their book
“The Education-Drug Use Connection” (Bachman et al., 2007b). This book described the results of
longitudinal analyses that were conducted on nationally representative samples of students that
were originally enrolled in the study as eighth graders in 1991 to 1993 and followed up with mail
surveys every two years (i.e., at modal ages 16, 18, 20, and 22). One major strength of their analytic
strategy was the use of structural equation modeling to examine the various ways in which
substance use and academic outcomes are linked over the course of adolescent development.
One central premise of their work is that educational achievement is a stable characteristic
of most people, and therefore school difficulties would usually manifest early, and set the stage for
disengagement in academic pursuits, involvement in delinquency, and subsequent substance use. In
general, the authors concluded that poor academic performance in the early years is an important
risk factor for the development of subsequent substance use. The authors recognize that,
…an effect on substance use on educational success might grow stronger over time
through the buildup of educational setbacks. Thus, substance use might have a
greater impact on later-occurring, cumulative educational indicators such as
dropping out of high school or educational attainment in adulthood rather than
earlier or more immediate measures such as school engagement. (p. 28)
They also state that “the normative stability in academic achievement may hide smaller segments of
the population whose substance use does alter their academic achievement trajectory”. (p. 19)
America’s Dropout Crisis:
The Unrecognized Connection to Adolescent Substance Use
Their empirical findings provide some evidence that substance use contributed to the risk
for later dropout. The degree to which these associations hold true varies by substance, with
cigarette smoking having the strongest association. Eighth graders who smoked cigarettes during
the past 30 days were more likely to become high school dropouts than non-smokers, and the
quantity of smoking was related to risk for dropout in a dose-dependent fashion. Conversely,
individuals who self-reported superior grades were less likely to smoke in the future.
With respect to marijuana, evidence supported a relationship between early academic
failure and marijuana use, but after adjustment for covariates, the relationship between marijuana
use and high school dropout did not retain statistical significance. However, frequent and heavy
marijuana use was associated with decreases in academic performance. The authors argue that
because the majority of students in the U.S. do not smoke marijuana frequently, it cannot be seen as
a major cause of poor educational outcomes. With respect to alcohol use, heavy drinking was
negatively correlated with educational success during adolescence (especially at ages 14 to 16).
Cocaine use reported at modal age 16 appears to contribute to dropping out of high school.
According to the authors, the major implications of their finding is that preventing academic
failure and promoting school achievement will be a better way to solve the drug problem than
instituting traditional drug prevention programs. They state that “early educational interventions,
additional support for low-achieving students, and a focus on personal growth rather than social
comparisons could be some of the most effective ways to decrease substance use and delinquency
when students reach adolescence.” (p. 30)
One limitation of MTF is that the follow-up response rates declined over time (81% for the
first follow-up assessment, 67%, 63%, and 57% thereafter until participants were a modal age of
22). More importantly, the investigators acknowledge that attrition was disproportionately higher
among students who were substance users by the end of eighth grade, and that dropouts were
likely to be underrepresented in the sample that responded to mail surveys during the follow-up
period. The investigators utilized statistical techniques to partially compensate for potential
attrition bias. Another important consideration when interpreting the findings is that most analyses
used dichotomous measures of past 30-day substance use versus non-use; only a few analyses
focused on the frequency of use within the past year or the past 30 days.
On the whole, the general conclusions stated in this book favor the idea that substance use
is a result of rather than a contributory factor to academic performance, but the authors qualify this
interpretation with several important points. First, as mentioned earlier, one of the foundational
elements of their thinking is that educational success and failure are relatively stable during the
early years of development. Therefore, it is likely that early academic failure begets continued
declines in motivation and academic performance. However, the authors acknowledge that this
overall premise might obscure individual cases that experience dramatic drops in academic
performance, and for these individuals, it is entirely plausible that substance use can be at the root
of this change in their achievement trajectory. Another critical issue that they raise concerns
developmental timing. The authors acknowledge that the negative impact of early substance use on
academic performance might grow stronger over time. The analyses provide evidence that in many
America’s Dropout Crisis:
The Unrecognized Connection to Adolescent Substance Use
cases early educational failure might precede the onset of substance use early in development.
However, continuing to experience academic failures might lead to worsening of a substance use
problem, which in turn might result in later dropout. This notion comports with the findings of
Zimmerman and Schmeelk-Cone (2003), who observed that low academic motivation can precede
alcohol use, and continued and worsening alcohol use can precipitate dropout. The authors make a
strong case that strengthening school experiences and providing the proper support to students
who are struggling academically during the early years of adolescence might be one viable way of
preventing substance use initiation. This idea is not in conflict with the major premise of the
present reportthat preventing substance use might reduce the likelihood of subsequent dropout.
2.4.4. Longitudinal studies using a composite measure of alcohol and drug use
Other investigators have used a composite measure of alcohol and drug involvement
(including frequency of use and selling) rather than separately examining the effects of each drug.
The advantage of this approach is that high scores on such a measure can indicate greater severity
of drug involvement, and thereby inform about the “dose-response” relationship between overall
substance use involvement and risk for dropout. On the other hand, the limitation of this approach
is that the unique influence of a given substance on dropout cannot be examined separately.
In one study by Tanner and colleagues (1999), National Longitudinal Survey of Youth
(NLSY) data were used to create a composite index of substance use during adolescence: the
number of occurrences during the past year of drinking alcohol, smoking or selling marijuana or
hashish, and using other drugs. The study examined 2,257 14- to 17-year-olds who were attending
school in 1979. Dropout was assessed in 1990 and 1992, when participants were 25 to 30 years of
age. This measure of drug use/selling significantly predicted both lower likelihood of high school
graduation by 1992 and fewer years of educational attainment by age 25 to 30. This effect held true
for both males and females, even controlling for demographic and academic variables. Youth who
dropped out of school prior to study enrollment were not included.
In an eight-year study of 496 adolescent females ages 13 to 20, Marti and colleagues (2010)
used a statistical technique to derive different groups within their sample, based on developmental
trajectories of substance use frequency (including alcohol, marijuana, and other drugs; see Figure
7). They found that the trajectory group who started using heavily early (i.e., by age 13) versus late
(steadily increasing from age 14 onward), experienced a 4.5 times greater likelihood of school
dropout by age 18. Compared with non-abusers (3.7% of whom experienced dropout), every
substance use trajectory group had a higher rate of school dropout by age 18 (“moderate-
escalating” group: 4.8%; “adolescent-limited heavy” group: 33.3%; and “moderate decreasing”
group: 16.7%).
America’s Dropout Crisis:
The Unrecognized Connection to Adolescent Substance Use
2.5. Studies Examining Substance Use Disorder as a Correlate or Predictor
of Dropout
In addition to the preceding studies that assessed substance use or frequency of use, four
studies were located in our review that examined the relationship between substance use disorder
(SUD, defined by meeting standard psychiatric criteria for abuse or dependence) and dropout.
Using SUD as a predictor is important because it enables one to understand the relationship
between the most severe manifestation of substance use and risk for academic failure. However, it
is important to recognize that this approach is, by definition, conservative because it does not
account for how dropout might be impacted by less intense substance use patterns that do not
qualify the individual for a diagnosis of SUD.
One of the first investigations of this kind utilized data from the New Haven site of the
National Institute of Mental Health’s Epidemiologic Catchment Area (NIMH ECA) dataset. It did not
specifically focus on high school dropout as an outcome, but rather income with years of
educational attainment as a potential mediator. Using data from 561 males ages 25 to 64, the
researchers concluded that the presence of alcoholism symptoms prior to age 18 was significantly
related to reduced educational attainment by 11%, which in turn was related to reduced earnings.
An important strength of the study was that fathers’ educational and occupational status were
America’s Dropout Crisis:
The Unrecognized Connection to Adolescent Substance Use
included, which were known to influence sons’ occupational status, at least during the historical
period in which this study was conducted (Mullahy & Sindelar, 1994).
Two other studies used data from the National Comorbidity Survey (NCS), a large nationally
representative study, and its later replication. First, in a sample of 5,877 15- to 54-year-olds,
Kessler and Foster (1995) documented that onset of SUD prior to high school graduation was
associated with more than a two-fold increased odds of dropout. They also observed a dose-
response relationship between the number of psychiatric disorders and the likelihood of dropout,
such that the presence of multiple psychiatric disorders was related to an even greater dropout risk
than a single disorder. They concluded that 3.7% of dropout cases were attributable to prior SUD,
with slight differences for males (4.9%) and females (2.4%).
Second, Breslau and colleagues (2008) conducted a survival analysis from NCS data
collected on a sample of 5,692 U.S. adults ages 18 and older and found that individuals who met
criteria for any SUD prior to age 18 were nearly three times as likely as their counterparts to have
dropped out of high school, even controlling for the effects of demographics and several childhood
adversity measures related to educational attainment. More specifically, alcohol dependence was
associated with a 90% increase in the likelihood of dropping out, and drug dependence was
associated with a 250% increase.
A smaller study of 240 mothers and their adolescent children by Bohon and colleagues
(2007) investigated the impact of maternal depression on dropout, and SUD in the child was also
included in the assessment. In addition to finding a strong and significant effect of maternal
depression on risk for dropout, the study also found that SUD prior to ninth grade significantly
predicted dropout. The final models also adjusted for mother’s educational level, IQ of the child, and
behavioral problems.
2.6. Studies Examining the Relationship Between Substance Use and High
School GPA
The studies discussed thus far examined dropout as the outcome variable of interest.
Because of the relatedness of academic performance, as measured by high school GPA, to dropout,
we included studies that we located as part of our review that focus on GPA as the dependent
One of the earliest published studies to examine the relationship between substance use
and school grades was conducted in California. Paulson and colleagues (1990) collected data from
446 youth sampled using various community outreach methods (e.g., Boys Clubs). The sample was
divided into those who did and did not use alcohol or any other drug during the past 30 days. In this
study, significantly fewer substance users reported excellent or above average grades (6.4% and
38.7%, respectively) compared with non-users (13.6% and 50.4%, respectively). Substance users
also had more absences from school, lower educational aspirations (defined as their desired level of
education), lower expectations of completing postsecondary education, and lower perceived
importance of learning. Similarly, 80.2% of the non-users reported that their parents would like
America’s Dropout Crisis:
The Unrecognized Connection to Adolescent Substance Use
them to complete some college, as compared with 65.2% of the users, although this difference was
not statistically significant. Interestingly, virtually none (95.4%) of the entire sample reported that
they were thinking about dropping out of school, with no statistically significant differences
between users and non-users on the intention to drop out.
Similar findings were observed in much later analyses of the 2002 to 2005 National Survey
on Drug Use and Health (NSDUH) and 2001 to 2003 Youth Risk Behavior Survey (YRBS) by Martins
and Alexandre (2009). Compared with non-users, drug-using adolescents earned significantly
lower grades (see Figures 8 and 9). Specifically, compared with non-users of any substances,
lifetime marijuana users were three times as likely to earn a C average and six to seven times as
likely to earn a D average (reference=A or B average), holding constant demographics. Lifetime
ecstasy use, which was much less prevalent than marijuana use, was even more strongly related to
lower grades, with ecstasy users being four times as likely to earn a C average and 12 times as likely
to earn a D average, compared with non-users of any substances. Thus, even while students are still
in school, drug use is an important marker for academic problems. Given that ecstasy use is likely to
be a proxy for an overall heavier pattern of substance useincluding alcohol, marijuana, and other
illicit drugsthese findings add to other evidence supporting the existence of a dose-response
relationship between drug use and academic problems (see Section 2.4.4.).
Crosnoe (2006) used data on 11,927 middle and high school students from the National
Longitudinal Study of Adolescent Health (Add Health) dataset to investigate the extent to which the
frequency of alcohol use during the past year was associated with academic failure. Students were
assessed at two time points, in 1995 and one year later. Information from parent interviews
gathered during the first wave of data collection was also used for analyses. Academic failure was
measured by self-report as the number of D’s or F’s students received. In addition to demographic
factors, several other covariates were assessed, including family organization, peer norms, school
and family bonding, delinquency, and marijuana use. Using cross-lagged panel models, the
investigators concluded that, after adjustment for all the covariates, the evidence for early academic
failure predicting alcohol use was stronger than the evidence for alcohol use predicting later
academic failure.
In a follow-up analysis of the same dataset, Crosnoe and colleagues (2012) used transcript
data instead of self-reported grades to test the “self-medication” hypothesisnamely, that feelings
of not fitting in leads to alcohol use, which in turn leads to decreased academic performance. The
findings did not support the self-medication hypothesis; instead, the association was operating in
the opposite direction of what was expected. Alcohol use at Wave 1 was significantly associated
with decreases in GPA at Wave 2, and this effect appeared to operate through increased feelings of
social marginalization (e.g., not being socially accepted, trouble getting along with others, etc.). This
effect was especially strong in schools with low overall levels of drinking, such that drinking
students felt even more marginalized when fewer of their peers were drinking.
America’s Dropout Crisis:
The Unrecognized Connection to Adolescent Substance Use
America’s Dropout Crisis:
The Unrecognized Connection to Adolescent Substance Use
In another recent study of the Add Health cohort, Balsa and colleagues (2011) combined
self-reported data on substance use and background characteristics with GPA data from school
transcripts, spanning two consecutive years of high school. They found that alcohol use was related
to small but statistically significant reductions in GPA one year later, as well as and increases in the
number of skipped school days. However, these associations were significant only for males.
Although females’ drinking did not appear to lower their grades, it was related to an increased
probability of having academic difficulty (per self-report) one year later. When drug use was
included in the model, the effect of alcohol use decreased, suggesting that drug use might be more
strongly associated than alcohol use with decreases in GPA. Because this study focused on changes
in GPA, by definition it excluded students who dropped out of school after the first wave of data.
Considering that these dropouts had more intense drinking patterns, lower GPAs, and more missing
GPA data while they were still enrolled (as compared with their peers who stayed in school), these
findings are not as useful as one would hope to explain the connections between substance use and
GPA, and certainly cannot inform about the drug use-dropout relationship.
DeSimone (2010) used combined data from the 2001 and 2003 Youth Risk Behavior
Surveys (YRBS) to investigate the relationship between binge drinking and grades among high
school drinkers. Binge drinking (defined as consuming five or more drinks within a few hours on at
least one occasion) had a small negative impact on grades, even after adjustment for several
potentially confounding variables, including self-esteem, depression, and risk aversiveness. The
results of a subgroup analysis suggested that the effect of binge drinking on grades might be larger
for students who are more risk-averse, future-oriented, and drug-free. Importantly, the inclusion of
cigarette smoking and other drug use in the model reduced the strength of the association between
binge drinking and academic performancesimilar to findings from Balsa and colleagues (2011)
and Newcomb and Bentler (1986) discussed abovesuggesting that drug use is more strongly
associated with academic performance than alcohol use.
Sabia (2010) reported similar findings in a longitudinal analysis of Add Health data.
Specifically, while binge drinking was observed to have a negative impact on grades and to increase
the likelihood of suspensions and unexcused absences among both male and female high school
students, the effect was dampened significantly when marijuana use frequency was added to the
model, showing that marijuana use is more strongly related to grades than alcohol. However, in the
final model, frequent binge drinking (more than once per month) was associated with moderate
declines in GPA, unexcused absences, and out-of-school suspensions. This study was somewhat
unique in that it also adjusted for having a biological parent with alcohol problems, which was
observed to have a significant negative impact on educational outcomes.
2.7. Studies Examining Changes in Academic Performance Following
Addiction Treatment
If substance use is detrimental to academic performance, it follows that academic
performance should improve after substance use is stopped. We found three studies that examine
the academic outcomes of adolescents after they received treatment for substance use problems.
America’s Dropout Crisis:
The Unrecognized Connection to Adolescent Substance Use
These studies highlight the malleability of substance use, and provide clear hope that addressing
substance use is a viable dropout prevention strategy.
First, Engberg and Morral (2006) studied adolescents entering treatment for alcohol and
other drug use. Data were combined from seven treatment sites, representing follow-up of 1,084
adolescents quarterly for a year following treatment admission. Results indicated that individuals
who ceased marijuana use were more likely to be attending school, independent of prior substance
use and other baseline characteristics. Interestingly, reductions in marijuana use frequency did not
increase the probability of school attendance unless those reductions amounted to complete
cessation. Additionally, school attendance was more likely among individuals who used alcohol and
stimulants less frequently. An important advancement of this study over prior studies was that, by
testing alternative models with random and fixed effect estimators, the authors ruled out the
possibility that the observed associations between substance use and attendance could be
attributed to factors such as personality traits or underlying predisposition to attend school. This
study is significant because it highlights the potential of effective interventions not only to reduce
drug use, but also to benefit secondarily students’ academic performance.
Second, Balsa and colleagues (2009) studied 384 adolescents who completed intake
assessments at four intensive outpatient treatment programs that were part of a private managed
care organization in California during 2000 and 2002. Findings indicated that treatment initiation
(defined as having at least two visits by 60 weeks after intake) significantly predicted increased
likelihood of attending school one year later.
America’s Dropout Crisis:
The Unrecognized Connection to Adolescent Substance Use
In a smaller study of 153 adolescents attending one inpatient drug treatment center,
Anderson and colleagues (2010) identified six drug use trajectory groups during the ten years
following treatment (see Figure 10). Within each trajectory group, they then quantified the
proportion who had graduated from high school. They observed the highest rates of high school
graduation among abstainers (71.1%) and in the group that was characterized by no drug use, but
some alcohol consumption after the attainment of legal drinking age (82.6%). In comparison, the
lowest graduation rate was found among the individuals who relapsed to a chronic drug use
pattern (28.6%), with the remaining groups having intermediate graduation rates.
2.8. Limitations of the Research
Inherent in all research studies investigating complex behavior among adolescents are
methodological limitations. The studies we reviewed were no exception and several had
noteworthy limitations. First, many of the studies were published prior to 2000 or utilize samples
of students that attended school two decades ago or more. This is problematic not necessarily
because the quality of the research can be criticized for being dated, but because contemporaneous
student samples are growing up and going to school within a different historical context. For one,
the drug landscape has changedfor example, with greater opportunities today for nonmedical use
of prescription drugs. Additionally, markedly increased availability of marijuana is on the rise, more
so in some regions of the country than others. Moreover, the increasingly high levels of the active
ingredient in marijuana, THC, are of great concern.
Almost all of the studies reviewed used a fairly cursory way to characterize the substance
use of participants. Only four publications were identified that measured substance use disorder on
the basis of a diagnostic interview (Bohon et al., 2007; Breslau et al., 2008; Kessler & Foster, 1995;
Mullahy & Sindelar, 1994). Most studies used a single measure such as frequency of marijuana use
during the 30 days prior to being surveyed. Although measures such as this have validity in
detecting individuals with a current drug problem, they do not capture changes in substance use
patterns over time. Future studies should attempt to understand how changes in the severity of
substance use are related to changes in academic performance over time. The study by Anderson
and colleagues (2010) used state-of-the-art statistical techniques to isolate groups of individuals
who have various substance use trajectories following drug treatment. Similar methods could be
applied with data derived from community samples. In Section 4.1., we call for other ways in which
research designs could be enhanced to give us a more complete understanding of the drug use-
dropout relationship.
Another major methodological limitation concerns studies that sampled students from
schools. As DeSimone (2010) articulated, these samples have special limitations for investigating
the association between alcohol and drug use and dropout:
Because the YRBS is administered to students during class sessions, the
estimates do not pick up potential effects of drinking on school dropout.
Moreover, students with high absenteeism rates are less likely to be
sampled. If absent students drink more heavily and perform more poorly in
America’s Dropout Crisis:
The Unrecognized Connection to Adolescent Substance Use
school than do others, and drinking directly reduces grades (possibly
through absenteeism), this selection process will bias the estimated drinking
effect towards zero. (p. 1485)
This limitation also holds true, to a lesser extent, for other studies that we reviewed that
utilized large community-based datasets. In several studies, marijuana and alcohol use frequency
was greater in individuals who had dropped out of the study as compared with students who
completed all assessments. Future studies should overcome this limitation by enrolling individuals
into research outside of classroom settings and/or following up with participants regardless of
continued school attendance.
2.9. Summary of Research Findings
High school dropout is a massive problem in the U.S. and it has serious social and economic
consequences for individuals and society. While the heterogeneity of the processes involved in
dropout presents challenges to researchers, understanding them is critical because preventive
interventions must be directed at the many components of the causal chain leading to dropout. The
research studies we reviewed demonstrate the critically important role of substance use in the
chain of events leading to dropout. Most produced quite similar findings, despite using different
types of samples from various regions of the country and different ways of measuring substance
use. Several studies demonstrated a relationship between substance use and dropout using
longitudinal designs that statistically adjust for the effects of potential confounding variables, such
as demographic variables, parental education, and propensity for rule-breaking behavior. Some
studies found that the effect of substance use operates via decreasing students’ motivation to stay
in school and by decreasing their engagement in academic pursuits, which is consistent with clinical
experiences with youth seeking help for their drug and alcohol use problems.
Several major conclusions can be drawn from our review. First, substance-using students,
compared with non-users, are at increased risk for academic failure, including dropout, especially
when their substance use is frequent and severe. From a clinical perspective, it is not difficult to
imagine why the severity of a drug or alcohol problem would be a crucial dimension accounting for
the association between substance use and academic difficulties.
Second, marijuana use appears to have a stronger negative relationship with academic
outcomes such as GPA and risk for dropout than alcohol use. However, regardless of substance
type, the more frequent and/or severe the involvement of substance use, the more likely it will be
for substance use to affect academic performance and increase the risk for dropout. We speculate
that the lack of strong associations with alcohol, compared with marijuana, is due, in part, to
differences in the patterns of consumption between alcohol (which is typically consumed
sporadically during adolescence) and marijuana (which might be consumed more regularly). For
instance, it might be less obvious to a school official that a student is high on marijuana as
compared with being intoxicated on alcohol. Similarly, marijuana is more likely to be used
throughout the day and day after daymore like tobaccothan is alcohol. Because they might
have an easier time escaping detection, marijuana-using students might not hesitate to smoke
America’s Dropout Crisis:
The Unrecognized Connection to Adolescent Substance Use
during the week before going to school, thus compromising their ability to participate in school or
comprehend the material being presented in a classroom. Alcohol might be more likely to be
consumed at night with friends on the weekends, rather than before school. However, these
scenarios are speculative, and are in need of confirmation by both qualitative and empirical studies.
Moreover, in the studies that showed weak associations with alcohol, the students investigated
were, on average, very low level drinkers. Some researchers even mentioned that the heavier
drinking adolescents dropped out of school and thus were not available to participate in follow-up
research interviews. Alcohol use is more prevalent and thus less likely to distinguish students with
academic problems from those who are not experiencing difficulties. However, it is also true that
frequent heavy drinking, as opposed to any alcohol use, does appear to be associated with dropout
in several studies, even when drug use is included as a separate predictor.
Third, it is clear that dropout is the end result of a process that involves multiple events, the
timing of which might differ across individuals. Substance use might appear early or later in the
chain of events that eventually leads to dropout. In the case of a student who was performing
adequately or even superiorly in school prior to initiating substance use, once substance use begins,
a slight drop in academic performance might be seen initially. Disengagement from school might
occur as substance use becomes more frequent. The risk for dropout increases as substance use
increases. Importantly, the earlier the age of initiation of substance use, the greater the risk for
extensive substance involvement later on, and the more serious the consequences.
An alternative scenario is a student who experiences early learning difficulties, which then
leads to problems engaging in school, selecting peers with similar problems, skipping class, using
drugs and alcohol, and ultimately dropping out of school. These two scenarios differ with respect to
which problem (substance use or academic difficulties) comes first, but both are possible. Clinical
experience clearly supports a multitude of pathways leading to different types of adverse outcomes
during adolescence.
The finding that the association between alcohol use and dropout was strongest for
students who were risk-averse and drug-free (DeSimone, 2010) is intriguing because it supports
anecdotal clinical evidence about the devastating impact of substance use on academically-
achieving students. For example, the onset of a substance use problem could have a dramatic
impact on a student without pre-existing learning problems, and who is a high achiever in middle
school, because in a sense, they have “farther to fall.” Clinically, cases have been seen where the
strong positive drive for academic pursuits and extracurricular activities has been replaced with an
equally strong relationship with marijuana and alcohol.
Fourth, many studies highlighted the associations between substance use and a
constellation of other problem behaviors such as conduct problems, impulsivity, and delinquency.
These behaviors can lead to difficulties socializing appropriately with peers and teachers and work
in concert with substance use to exacerbate academic performance problems.
Fifth, the cessation of substance use following treatment is associated with improvements
in academic performance. This type of evidence strongly supports the contributory role of
substance use in academic failure.
America’s Dropout Crisis:
The Unrecognized Connection to Adolescent Substance Use
Lastly, our review revealed a severe lack of attention to the large segment of the population
who are high school dropouts with respect to the need to address their substance use problems.
While the need for remedial education and employment opportunities is clearly recognized, equally
important is the need for interventions targeted at reducing substance use among these individuals.
Not addressing these issues is likely to lead to escalating problems, criminal justice involvement,
and continued marginalization from the productive workforce.
America’s Dropout Crisis:
The Unrecognized Connection to Adolescent Substance Use
So far, the preceding sections have illustrated the widespread agreement that an association
between substance use and dropout exists, and evidence has been described supporting the claim
that the association is bidirectional. In this section, we discuss several possible non-mutually-
exclusive mechanisms that could link substance use with dropout.
3.1. Substance Use “Hijacks” Neurobiological Reward Pathways in the
Brain, Making Academic Pursuits Less Meaningful to the Individual as
their Relationship with Substances Becomes Stronger
A cardinal feature of the progression from substance use to addiction is the individual’s
increased level of preoccupation with the drug. Activities once enjoyed or people once important
take a “back seat” to the relationship with the drug. Recent research has confirmed the
neurobiological processes that underlie this intense desire to seek out and use the drug, even in the
face of damaging personal consequences or the effects on others (National Institute on Drug Abuse,
2010). Clinicians working with adolescents have long recognized that pleasures associated with
school achievement decrease very quickly when drug use begins and escalates. The phenomenon is
often referred to drugs “hijacking” the brain’s reward system and is a key mechanism to explain the
association between substance use and high school dropout. Clinical experiences support the
notion that adolescent alcohol and drug use is often associated with reductions in the number of
hours committed to studying, completing homework assignments, and attending school (see
Appendix 1). A vicious cycle ensues, especially when students begin affiliating with other drug-
using peers who, because of their drug use, have little interest in pursuing academic goals.
3.2. Substance Use During Adolescence is Associated with Neurocognitive
Exposure to alcohol and drugs, especially during the vulnerable period of adolescent
development, can lead to acute cognitive difficulties such as difficulty concentrating and sleep
disturbances. These cognitive problems might make it more difficult to function academically.
Recent research has identified areas of the brain involved in learning and memory that are affected
adversely by alcohol consumption (Zeigler et al., 2005). Other research studies have observed
structural and functional changes in adolescent brain development associated with early heavy
alcohol consumption that can manifest as poor planning, impaired executive functioning, and
spatial and attention deficits (Brown, Tapert, Granholm, & Delis, 2000; Jacobus & Tapert, in press;
White & Swartzwelder, 2005).
America’s Dropout Crisis:
The Unrecognized Connection to Adolescent Substance Use
The cognitive effects of marijuana use have been summarized in several reviews of the
literature (Ashton, 2001; Crean, Crane, & Mason, 2011; Hall, 2009; Hall & Degenhardt, 2009;
Schweinsburg, Brown, & Tapert, 2008). Deficits appear to be strongly related to both age of onset
(Ehrenreich et al., 1999; Pope et al., 2003), as well as frequency and duration of use. While acute
effects of marijuana intoxication are well recognized and include numerous attention and
concentration difficulties, as well as decreased working memory, decision response speed, and
information processing (Bolla, Brown, Eldreth, Tate, & Cadet, 2002; Solowij et al., 2002), longer-
term problems have been demonstrated as well (Hanson, Cummins, Tapert, & Brown, 2011;
Schwartz, Gruenewald, Klitzner, & Fedio, 1989). Neuropsychological deficits include impaired
planning, organizing, and problem solving. Newer research has confirmed earlier findings of
Solowij and colleagues (1991) showing longer term residual deficits related to allocation of
attentional resources, filtering out irrelevant material, and retrieval and immediate verbal memory
deficits (Solowij et al., 2011; Takagi et al., 2011), all of which are necessary for performing well in
and outside of the classroom. Importantly, these problems have been demonstrated even after
statistically adjusting for premorbid intellectual ability (Solowij et al., 2011). Fontes and colleagues
(2011) demonstrated that early-onset marijuana users were more likely than late-onset users to
show deficits on sustained attention, impulse control, and executive functioning. Moreover,
researchers are beginning to uncover possible neuroanatomical correlates to some of these
performance deficits using magnetic resonance imaging (MRI; Bava, Jacobus, Mahmood, Yang, &
Tapert, 2010).
3.3. Early Learning Difficulties Lead to School Failure and Subsequently to
Substance Use
Several studies reviewed in this paper have concluded that early learning difficulties
preceded the onset of substance use. Having such early learning difficulties might set off a cascade
of effectspoor school performance leading to disengagement from school activities because of
frustration, and subsequent affiliation with peers with similar problems that might provide
opportunities to initiate substance use. Students with Attention Deficit Hyperactivity Disorder
(ADHD), for example, are at risk for both substance use and poor performance in school
(Biederman & Faraone, 2005; Klein et al., 2012; Mannuzza, Klein, Bessler, Malloy, & LaPadula, 1993;
Marshal, Molina, & Pelham, 2003).2 Many students, however, might not meet the specific clinical
criteria to receive diagnosis of ADHD, but could still exhibit subtle problems in attention as well as
an inability to plan and regulate their behavior (beyond what could be attributed to “normal”
adolescent development). These students might have a greater propensity than other students for
involvement in substance use (McGue, Iacono, Legrand, Malone, & Elkins, 2001; Sloboda, Glantz, &
Tarter, 2012; Tarter et al., 2011). Lejeuz and colleagues (2010) comprehensively reviewed the
various dimensions of impulsivity and their relation to alcohol use, related problems, and alcohol
2 An in-depth discussion of ADHD, its relationship with student functioning, and its treatment is beyond the
scope of this paper; the reader is referred to Tamm and colleagues (2012) and Wilens and colleagues (2011)
for more information about ADHD and its treatment.
America’s Dropout Crisis:
The Unrecognized Connection to Adolescent Substance Use
use disorder and concluded that there is clear evidence of the role of impulsivity in the spectrum of
alcohol involvement. Several features of impulsivity described by Lejeuz and colleagues (2010),
including a diminished ability to focus on tasks at hand (i.e., attentional impulsiveness) or a
tendency to act on the spur of the moment, might also be related to one’s ability to perform well in
school. The important thing to keep in mind is that substance use is certainly not going to improve
academic performance among students with ADHD or with more subtle learning deficits. To the
contrary, because substance use will most likely exacerbate the problem, addressing it must be part
of the intervention plan to ensure success in school.
3.4. “General Deviance” is a Common Root for both Academic Failure and
Drug Use
Rather than assume a causal relationship at all, many have argued that the connection
between drug use and academic failure can be explained by the fact that both are the result of an
individual’s propensity for deviant behavior. General deviance is characterized by a low degree of
commitment to traditional values and disrespect for rules and authority (McGee & Newcomb,
1992). Problem Behavior Theory, originally advanced by Jessor and Jessor (1977) and further
articulated by Donovan and Jessor (1985), postulates that multiple problem behaviors are often
observed in the same individual. Having this orientation, individuals are not likely to be interested
in following the rules necessary to advance in academic settings and have few self-imposed
boundaries on risky behavior such as drinking or drug use. This theory stresses the importance of
social contexts that perpetuate problem behaviors, such as deviant peer affiliation that favors non-
conventional values and activities, and community and family influences conducive to the
escalation of problem behaviors. The social context of drug use tends to promote adoption of anti-
conventional norms including a rejection of the value of education (see Fergusson & Horwood,
1997; Kandel, Davies, Karus, & Yamaguchi, 1986; Lynskey & Hall, 2000).
Empirical evidence for such a problem behavior syndrome has been demonstrated in
several studies, and this theory remains well accepted (McGee & Newcomb, 1992; Newcomb &
Bentler, 1986; Newcomb et al., 2002). As adolescent drug users engage in a whole host of impulsive
and rule-breaking behaviors, they are likely to be disruptive to other children and school officials,
leading to parental frustration and sometimes parental rejection (see Brook, Brook, Zhang, &
Cohen, 2009; Pires & Jenkins, 2007). As a result, these children might not be given appropriate
opportunities to succeed in school environments. Unfortunately, little is being done to address drug
use at this stage—one of the more malleable aspects of the problem behavior syndrome. Knowing
that adolescent substance use is part of a larger constellation of problem behaviors among some
youth should not deter parents or other professionals from acting and intervening to address the
substance use.
America’s Dropout Crisis:
The Unrecognized Connection to Adolescent Substance Use
4.1. What Do We Still Need To Know? Setting a Research Agenda
Although we believe the evidence linking substance use and dropout is substantial enough
to generate immediate action on several fronts, an invigorated research agenda is required to
answer several critical questions. We recommend the following research areas for consideration:
1. Studies focused on the academic performance of adolescents who have received early
intervention or drug treatment services or who are attending recovery high schools. We found
only three published studies in the literature that assessed academic outcomes among a sample of
adolescents who attended drug treatment (Anderson et al., 2010; Balsa et al., 2009; Engberg &
Morral, 2006). These studies made a convincing case that drug use is a factor in declining academic
performance by showing that when the substance use ceased, many individuals were able to get
back on track academically. Certainly, our clinical experience echoes this finding. More studies of
this type with samples of adolescents receiving and benefiting from help for their drug problems
are needed to replicate or refute these findings. It will be important for such studies to document
whether substance use ceased altogether not only during treatment, but during a prolonged follow-
up period. It is commonly recognized that cessation of substance use will require long-term
monitoring and management. Recovery high schools are promising models to enhance the success
of young people who have prior substance use (Lanham & Tirado, 2011) and studies are underway
to evaluate the impact of attending recovery high schools on fulfilling educational goals (Moberg &
Finch, 2007).
2. Studies linking regional data on adolescent substance use patterns with data on school
dropout. Several federally funded datasets exist that contain regional data on adolescent drug use
(see Table 1). Studies are needed that link these regional data to school dropout statistics in the
same areas, and perhaps over time. Such ecological analyses are not without limitations, but they
might offer a promising and cost-effective way of understanding the association from a broader
national and regional context.
3. Studies that examine the association between substance use and more nuanced patterns
of academic performance. Most studies that we reviewed focused on a few major academic
outcomes such as failure to graduate and GPA. A few examined unexcused absences, skipped
classes, and study time, all of which might be considered intermediary outcome variables. However,
additional longitudinal research is needed to examine changes in academic performance that
parallel changing patterns of substance use. Clinically, drug use is accompanied by precipitous
drops in academic performance that are out of the ordinary for the individual, although by other
standards, they might be performing adequately. For example, decreased academic performance as
America’s Dropout Crisis:
The Unrecognized Connection to Adolescent Substance Use
measured by receiving mostly As one semester to mostly Bs in the next semester could easily go
unnoticed. However, it is important to understand the degree to which such subtle changes in
academic performance could be related to drug use. Such information could be useful for parents
and educators for identifying problems at very early stages.
4. Studies that examine the cumulative and interactive impacts of multiple risk and
protective factors, such as early onset psychiatric symptoms. Although many studies statistically
adjusted for a wide range of covariates to isolate the potential impact of substance use on academic
outcomes, few studies explored the cumulative effect of multiple risk factors or the interactions
between variables. Because several other factors are known to be significantly influential on a
child’s risk for drug initiation and subsequent problems, it is important to understand their
association with academic performance as well. For one, mental health problems often co-exist with
substance use and both could potentially reduce academic performance.
5. Studies that examine parenting expectations regarding substance use as well as
expectations of academic achievement on academic performance. Studies are needed to further
understand the impact of parent practices on the substance using behaviors of their children, as
well as of setting high expectations for academic achievement, both of which might have a
beneficial impact on reducing drug use as well as sustaining academic success.
6. Studies that examine academic performance outcomes as part of evaluations of
substance prevention programs. Several randomized controlled drug prevention program trials
have been conducted with the primary outcome variable being substance use initiation or
progression to more severe drug involvement (Ellickson, McCaffrey, Ghosh-Dastidar, & Longshore,
2003; Kellam et al., 2011). It is not clear whether or not these trials collected data on academic
performance in tandem with drug use outcomes. New data are needed to understand the possible
benefits that reducing drug use has on increasing school engagement and high school graduation
4.2. Implications for Education Professionals
It is imperative that high schools develop cost-effective strategies to identify and intervene
with students to prevent dropout. Ultimately, to improve student retention, it will be necessary to
expand and enhance communication regarding exemplary models of success that have had positive
impacts on improving student retention, especially among the most at-risk students. Basic
information on successful existing models are needed. For instance, the extent to which high
schools are engaged in screening and intervening with students at risk for dropout is not known.
Obviously, high schools vary tremendously with respect to their emphasis on and resources
available for academic assistance services. It is important to understand the type and intensity of
various programs, practices, and policies related to assisting students with academic challenges.
As part of a broad comprehensive plan to improve academic outcomes, high schools should
develop strong policies to reduce substance use by students as well as address related problem
behaviors and mental health problems. The settings and ways that substance use problems among
America’s Dropout Crisis:
The Unrecognized Connection to Adolescent Substance Use
youth in schools are detected, if at all, have not been described. Having a coordinated plan to
address substance use and related problems among students who are experiencing academic
difficulties is an important first step. A second step would be to develop early warning and
continued care monitoring systems to track their progress and provide more intensive supports as
necessary. These strategies would have wider appeal if they were regarded as necessary supports
for promoting success, rather than as punitive methods that lead to student expulsion, which would
defeat their intended purpose entirely. Developing standardized assessment and intervention
practices related to substance use and mental health problems is also necessary, and should include
identifying and training responsible personnel, utilizing reliable measures for detecting problems,
understanding how often to administer such measures, and developing individualized action plans
on the basis of ongoing assessment results. As argued by Beauvais and colleagues (1996), the multi-
problem nature of youth either at risk for dropout or who have already dropped out calls for more
comprehensive and intensive solutions.
Similar to the training that is taking place in medical schools to identify and address
substance use in patients, training related to how to recognize and address alcohol and drug use
could be integrated into standard curriculum for educational professionals. For example, screening
and brief intervention (SBI) strategies have demonstrated efficacy in identifying youth at risk for
alcohol and drug involvement and have shown small, but promising effects, for interventions
(Harris et al., 2012; Spirito et al., 2004). Additional research is needed to refine and evaluate new
SBI approaches both in educational settings and in primary care settings. These types of
interventions could plausibly reduce the chance for drug involvement, and also improve academic
performance. On the bright side, most students who are involved with alcohol and/or drugs during
middle and high school do not meet criteria for dependence. It is much easier to intervene at this
early stage than later when problems escalate and have impacts on not only the individual’s well-
being and safety, but potentially cause harm to others (e.g., car accidents). Schools should be
prepared to facilitate referrals to professionals who can help families address the continuum of
problems that might exist, including co-morbid mental health problems. Linkages between schools,
specialty care centers, and community-based resources should be in place for more serious cases.
A very thoughtful analysis of what it might take to improve academic performance was
described in a case study report by Socias and colleagues (2007). The authors began by identifying
a unique set of schools in Californianamely, schools where at least 50% of the students were
disadvantaged (as defined by being eligible for free or reduced price lunch), but at the same time
had unusually high academic achievement rates. Basically, the six schools they studied were the
worst of the worst, but achieving like the best of the bestthey labeled these schools as “Beating-
the-Odds” (BTO) schools. They then investigated the “common denominator” strategies and policies
that these schools had in place. Four themes emerged: a) connecting with and engaging students; b)
engaging parents and community members to support school efforts; c) providing interventions
and individualized supports to students at risk for dropping out; and d) creating a culture of
accountability and high expectations. This case study provided valuable lessons about what might
be possible, even in the face of challenges and adversity.
America’s Dropout Crisis:
The Unrecognized Connection to Adolescent Substance Use
4.3. Implications for Parental Involvement
Parents play a critical role in a child’s development by setting educational standards and
expectations in the context of a warm and supportive relationship. As educational task demands
become greater as children get older, so do the competing influences of extracurricular activities,
friendships, and exposure opportunities for drug use. Parents are confronted with the enormous
challenge of having to maintain awareness of all the different influences on their child’s behavior.
Empowering parents and caregivers with practical knowledge, tools, and resources to be an
effective parent is one of the most promising strategies for reducing the risk for substance use.
Decades of research have identified several ways in which parents directly influence their child’s
behavior. Parent behaviors that have shown to reduce the risk for substance use involvement
include monitoring and supervision of child activities and whereabouts (Ary et al., 1999a; Ary,
Duncan, Duncan, & Hops, 1999b; Chilcoat & Anthony, 1996; Richardson, Radziszewska, Dent, &
Flay, 1993), expressing disapproval of underage drinking and other drug use (Boyle & Boekeloo,
2006; Catalano et al., 1992), and communicating a zero-tolerance message (Abar, Morgan, Small, &
Maggs, 2012). Moreover, parents can influence their child’s behavior by restricting alcohol
availability, encouraging healthy peer selection, and increasing perceived risk through parent-child
communication (Bahr, Hoffmann, & Yang, 2005; Dick & Kendler, 2012; Kelly, Comello, & Hunn,
Parents must be encouraged to recognize that a decline in academic performance might be
an early warning sign of learning problems, substance use, and/or mental health problems. This
insidious process might go unnoticed at first because parents might expect that a previously
achieving student will recover quickly from a temporary “dip” in academic performance. In such
cases, it might be prudent to consider the possibility that substance use might underlie the decrease
in academic motivation or performance. A comprehensive assessment should followincluding an
assessment not only of possible learning disabilities, but also of possible drinking, drug
involvement, and mental health problems. In this way, parents can serve as a “first-line defense” in
addressing a child’s problem. Proactively addressing the problem is warranted rather than waiting
for it to resolve itself without intervention.
4.4. Implications for the Design of Interventions
A challenge of designing intervention strategies to improve academic performance among
youth and reduce the risk for school failure is the need to identify the intervention targetthat is,
we need to choose the most important outcome of our intervention strategy. Possible outcomes
include eliminating alcohol and drug use, reducing school absences, or promoting a sense of
commitment to school-related activities. The goals of any intervention strategy can be multifaceted.
Another challenge in designing an intervention is how to choose a target populationfor
example, should “at-risk” be defined as students who are identified to be drug users in schools? Or
should the focus be only on students who are having academic difficulties? Should all students be
America’s Dropout Crisis:
The Unrecognized Connection to Adolescent Substance Use
screened on a routine basis, or just the students who exhibit some kind of problem or come to the
attention of school authorities?
Next, who would be enlisted as the “change agent” in the intervention? Possible individuals
include teachers, parents, coaches, other caregivers or trusted adults, peers, and even community
members, such as businesses who can reinforce the value of schooling for ensuring employment
opportunities. Reiff (1998) argues that physicians who routinely care for adolescents have a role in
facilitating academic support since academic failure should be seen as a “failure to thrive”.
Intervention strategies that are most likely to have an impact include those that are comprehensive
and address many facets of behavior and the environment in which the child lives. Moreover,
single-shot solutions are not likely to be effective; rather interventions that continuously monitor
students and are adapted based on the child’s progress hold more promise.
4.5. Implications for Policy Makers
Policy makers have long recognized the severity of the dropout crisis and its ramifications
for securing America’s global competitiveness. Steadily increasing resources are being directed to
address the problem. In the 2009, 2011, and 2012 State of the Union addresses, President Obama
highlighted the need to increase graduation rates (Obama, 2009, 2011, 2012). However, little
attention has been paid to the notion that reducing substance use is a viable strategy for improving
school performance and addressing the dropout crisis. We expect that the research evidence
provided in this report will create new opportunities for policy makers seeking successful solutions
for the dropout crisis. To this end, policy makers must recognize that schools should bolster their
current capacity to screen and intervene early to address student substance use. As mentioned
earlier, rather than a punitive approach where students with drug and alcohol problems are
expelled from school, more constructive alternatives should be implemented.
Reducing the nation's dropout rate needs to be approached with a can-do spirit, supported
by aggressive research on not only the nature of the problem but also specific cost-effective scalable
interventions that hold the promise of significantly reducing dropout. We believe reducing
substance use—preventing it in the first place and stopping it when it has already occurredis a
vitally important part of reducing dropout and that substance use by youth is one of the
contributory factors that is most responsive to successful interventions. In the past, substance use
prevention and intervention strategies have been largely neglected in the design of programs,
practices, and policies to reduce high school dropout. As we have shown in this report, there is
abundant evidence that substance use and dropout are connected. We believe that an honest
appraisal of that evidence can only lead to the logical conclusion that a significant increase is
needed in both research and programmatic actions to reduce this path to dropout.
America’s Dropout Crisis:
The Unrecognized Connection to Adolescent Substance Use
Abar, C. C., Morgan, N. R., Small, M. L., & Maggs, J. L. (2012). Investigating associations between
perceived parental alcohol-related messages and college student drinking. Journal of Studies
on Alcohol and Drugs, 73(1), 71-79.
Alliance for Excellent Education. (2010). High school dropouts in America. Washington, DC: Alliance
for Excellent Education.
Anderson, K. G., Ramo, D. E., Cummins, K. M., & Brown, S. A. (2010). Alcohol and drug involvement
after adolescent treatment and functioning during emerging adulthood. Drug and Alcohol
Dependence, 107(2-3), 171-181. doi:10.1016/j.drugalcdep.2009.10.005
Annie E. Casey Foundation. (2004). Kids count data book, 2004: Moving youth from risk to
opportunity. State profiles of child well-being. Baltimore, MD: Annie E. Casey Foundation.
Arellano, C. M., Chavez, E. L., & Deffenbacher, J. L. (1998). Alcohol use and academic status among
Mexican American and White non-Hispanic adolescents. Adolescence, 33(132), 751-760.
Ary, D. V., Duncan, T. E., Biglan, A., Metzler, C. W., Noell, J. W., & Smolkowski, K. (1999a).
Development of adolescent problem behavior. Journal of Abnormal Child Psychology, 27(2),
141-150. doi:10.1023/A:1021963531607
Ary, D. V., Duncan, T. E., Duncan, S. C., & Hops, H. (1999b). Adolescent problem behavior: The
influence of parents and peers. Behaviour Research and Therapy, 37(3), 217-230.
Ashton, C. H. (2001). Pharmacology and effects of cannabis: A brief review. British Journal of
Psychiatry, 178(2), 101-106. doi:10.1192/bjp.178.2.101
Bachman, J. G., Freedman-Doan, P., O'Malley, P. M., Schulenberg, J. E., Johnston, L. D., & Messersmith,
E. E. (2007a). Substance use and academic success: Results from three longitudinal panels,
including analyses of adjustments for panel attrition. Monitoring the Future Occasional Paper
Series. Ann Arbor, MI: Institute for Social Research, The University of Michigan.
Bachman, J. G., O'Malley, P. M., Schulenberg, J. E., Johnston, L. D., Freedman-Doan, P., & Messersmith,
E. E. (2007b). The education-drug use connection: How successes and failures in school relate
to adolescent smoking, drinking, drug use, and delinquency. New York, NY: Lawrence
Erlbaum Associates, Taylor & Francis Group.
Bahr, S. J., Hoffmann, J. P., & Yang, X. (2005). Parental and peer influences on the risk of adolescent
drug use. Journal of Primary Prevention, 26(6), 529-551. doi:10.1007/s10935-005-0014-8
Balfanz, R., & Legters, N. (2004). Locating the dropout crisis. Baltimore, MD: Center for Research on
the Education of Students Placed At Risk, Johns Hopkins University.
Balfanz, R. (2007). What your community can do to end its drop-out crisis: Learning from research
and practice. Baltimore, MD: Center for Social Organization of Schools, Johns Hopkins
America’s Dropout Crisis:
The Unrecognized Connection to Adolescent Substance Use
Balfanz, R., Bridgeland, J. M., Moore, L. A., & Fox, J. H. (2010). Building a grad nation: Progress and
challenge in ending the high school dropout epidemic. Washington, DC: Civic Enterprises,
Everyone Graduates Center, Johns Hopkins University, and America’s Promise Alliance.
Balsa, A., Homer, J., French, M., & Weisner, C. (2009). Substance use, education, employment, and
criminal activity outcomes of adolescents in outpatient chemical dependency programs.
Journal of Behavioral Health Services and Research, 36(1), 75-95. doi:10.1007/s11414-007-
Balsa, A. I., Giuliano, L. M., & French, M. T. (2011). The effects of alcohol use on academic
achievement in high school. Economics of Education Review, 30(1), 1-15.
Bava, S., Jacobus, J., Mahmood, O., Yang, T. T., & Tapert, S. F. (2010). Neurocognitive correlates of
white matter quality in adolescent substance users. Brain and Cognition, 72(3), 347-354.
Beauvais, F., Chavez, E. L., Oetting, E. R., Deffenbacher, J. L., & Cornell, G. R. (1996). Drug use,
violence, and victimization among White American, Mexican American, and American
Indian dropouts, students with academic problems, and students in good academic
standing. Journal of Counseling Psychology, 43(3), 292-299. doi:10.1037//0022-
Belfield, C. R., & Levin, H. M. (2007). The economic losses from high school dropouts in California:
California Dropout Research Project report #1. Santa Barbara, CA: California Dropout
Research Project, American Institutes for Research (AIR).
Biederman, J., & Faraone, S. V. (2005). Attention-deficit hyperactivity disorder. The Lancet,
366(9481), 237-248. doi:10.1016/s0140-6736(05)66915-2
Bohon, C., Garber, J., & Horowitz, J. L. (2007). Predicting school dropout and adolescent sexual
behavior in offspring of depressed and nondepressed mothers. Journal of the American
Academy of Child and Adolescent Psychiatry, 46(1), 15-24.
Bolla, K. I., Brown, K., Eldreth, D., Tate, K., & Cadet, J. L. (2002). Dose-related neurocognitive effects
of marijuana use. Neurology, 59(9), 1337-1343.
Boyle, J. R., & Boekeloo, B. O. (2006). Perceived parental approval of drinking and its impact on
problem drinking behaviors among first-year college students. Journal of American College
Health, 54(4), 238-244. doi:10.3200/JACH.54.4.238-244
Boys and Girls Clubs of America. (2010). Our nation’s dropout crisis is everyone’s problem. Atlanta,
GA: Boys and Girls Clubs of America.
Bray, J. W., Zarkin, G. A., Ringwalt, C., & Qi, J. (2000). The relationship between marijuana initiation
and dropping out of high school. Health Economics, 9(1), 9-18. doi:10.1002/(SICI)1099-
Breslau, J., Lane, M., Sampson, N., & Kessler, R. C. (2008). Mental disorders and subsequent
educational attainment in a US national sample. Journal of Psychiatric Research, 42(9), 708-
716. doi:10.1016/j.jpsychires.2008.01.016
America’s Dropout Crisis:
The Unrecognized Connection to Adolescent Substance Use
Brook, J. S., Brook, D. W., Zhang, C., & Cohen, P. (2009). Pathways from adolescent parent-child
conflict to substance use disorders in the fourth decade of life. American Journal on
Addictions, 18(3), 235-242. doi:10.1080/10550490902786793
Brown, S. A., Tapert, S. F., Granholm, E., & Delis, D. C. (2000). Neurocognitive functioning of
adolescents: Effects of protracted alcohol use. Alcoholism: Clinical and Experimental
Research, 24(2), 164-171. doi:10.1111/j.1530-0277.2000.tb04586.x
Bryant, A. L., Schulenberg, J. E., Bachman, J. G., O'Malley, P. M., & Johnston, L. D. (2000). Acting out
and lighting up: Understanding the links among school misbehavior, academic achievement,
and cigarette use. Monitoring the Future Occasional Paper Series. Ann Arbor, MI: Institute
for Social Research, The University of Michigan.
Bryant, A. L., Schulenberg, J. E., O'Malley, P. M., Bachman, J. G., & Johnston, L. D. (2003). How
academic achievement, attitudes, and behaviors relate to the course of substance use during
adolescence: A 6-year, multiwave national longitudinal study. Journal of Research on
Adolescence, 13(3), 361-397. doi:10.1111/1532-7795.1303005
Bush, M. (2010). Compulsory school age requirements. State Notes: Attendance. Denver, CO:
Education Commission of the States.
Catalano, R. F., Morrison, D. M., Wells, E. A., Gillmore, M. R., Iritani, B., & Hawkins, J. D. (1992). Ethnic
differences in family factors related to early drug initiation. Journal of Studies on Alcohol,
53(3), 208-217.
Center for Labor Market Studies and Alternative Schools Network in Chicago. (2009). Left behind in
America: The nation’s dropout crisis. Boston, MA: Northeastern University.
Chapman, C., Laird, J., & KewalRamani, A. (2011). Trends in high school dropout and completion rates
in the United States: 19722009. Washington, DC: United States Department of Education,
National Center for Education Statistics.
Chilcoat, H. S., & Anthony, J. C. (1996). Impact of parent monitoring on initiation of drug use through
late childhood. Journal of the American Academy of Child and Adolescent Psychiatry, 35(1),
91-100. doi:10.1097/00004583-199601000-00017
Crean, R. D., Crane, N. A., & Mason, B. J. (2011). An evidence based review of acute and long-term
effects of cannabis use on executive cognitive functions. Journal of Addiction Medicine, 5(1),
1-8. doi:10.1097/ADM.0b013e31820c23fa
Crosnoe, R. (2006). The connection between academic failure and adolescent drinking in secondary
school. Sociology of Education, 79(1), 44-60. doi:10.1177/003804070607900103
Crosnoe, R., Benner, A. D., & Schneider, B. (2012). Drinking, socioemotional functioning, and
academic progress in secondary school. Journal of Health and Social Behavior, 53(2), 150-
164. doi:10.1177/0022146511433507
Crum, R. M., Juon, H.-S., Green, K. M., Robertson, J., Fothergill, K., & Ensminger, M. (2006).
Educational achievement and early school behavior as predictors of alcohol-use disorders:
35-year follow-up of the Woodlawn Study. Journal of Studies on Alcohol, 67(1), 75-85.
Dee, T. S., & Evans, W. N. (2003). Teen drinking and educational attainment: Evidence from two-
sample instrumental variables estimates. Journal of Labor Economics, 21(1), 178-209.
America’s Dropout Crisis:
The Unrecognized Connection to Adolescent Substance Use
DeSimone, J. (2010). Drinking and academic performance in high school. Applied Economics, 42(12),
1481-1497. doi:10.1080/00036840701721554
Dewey, J. D. (1999). Reviewing the relationship between school factors and substance use for
elementary, middle and high school students. Journal of Primary Prevention, 19(3), 177-225.
Dick, D. M., & Kendler, K. S. (2012). The impact of gene-environment interaction on alcohol use
disorders. Alcohol Research: Current Reviews, 34(3), 318-324.
Donovan, J. E., & Jessor, R. (1985). Structure of problem behavior in adolescence and young
adulthood. Journal of Consulting and Clinical Psychology, 53(6), 890-904. doi:10.1037/0022-
Drapela, L. A. (2006). Investigating the effects of family, peer, and school domains on postdropout
drug use. Youth and Society, 37(3), 316-347. doi:10.1177/0044118X05278264
Economist. (2011, April 28). Decline of the working man: Why ever fewer low-skilled American
men have jobs. Economist. Retrieved November 5, 2012, from
Eggert, L. L., & Herting, J. R. (1993). Drug involvement among potential dropouts and 'typical' youth.
Journal of Drug Education, 23(1), 31-55. doi:10.2190/9RCJ-DTYE-KL5L-HDRA
Ehrenreich, H., Rinn, T., Kunert, H. J., Moeller, M. R., Poser, W., Schilling, L., Gigerenzer, G., & Hoehe,
M. R. (1999). Specific attentional dysfunction in adults following early start of cannabis use.
Psychopharmacology, 142(3), 295-301. doi:10.1007/s002130050892
Ellickson, P., Bui, K., Bell, R., & McGuigan, K. A. (1998). Does early drug use increase the risk of
dropping out of high school? Journal of Drug Issues, 28(2), 357-380.
Ellickson, P. L., McCaffrey, D. F., Ghosh-Dastidar, B., & Longshore, D. L. (2003). New inroads in
preventing adolescent drug use: Results from a large-scale trial of Project ALERT in middle
schools. American Journal of Public Health, 93(11), 1830-1836.
Engberg, J., & Morral, A. R. (2006). Reducing substance use improves adolescents' school
attendance. Addiction, 101(12), 1741-1751. doi:10.1111/j.1360-0443.2006.01544.x
Ensminger, M. E., & Lamkin, R. P. (1996). School leaving: A longitudinal perspective including
neighborhood effects. Child Development, 67(5), 2400-2416. doi:10.1111/1467-
Fagan, J., & Pabon, E. (1990). Contributions of delinquency and substance use to school dropout
among inner-city youths. Youth and Society, 21(3), 306-354.
Fergusson, D. M., & Horwood, L. J. (1997). Early onset cannabis use and psychosocial adjustment in
young adults. Addiction, 92(3), 279-296. doi:10.1111/j.1360-0443.1997.tb03198.x
Fontes, M. A., Bolla, K. I., Cunha, P. J., Almeida, P. P., Jungerman, F., Laranjeira, R. R., Bressan, R. A., &
Lacerda, A. L. T. (2011). Cannabis use before age 15 and subsequent executive functioning.
The British Journal of Psychiatry, 198(6), 442-447. doi:10.1192/bjp.bp.110.077479
America’s Dropout Crisis:
The Unrecognized Connection to Adolescent Substance Use
Franklin, C., & Streeter, C. L. (1995). Assessment of middle class youth at-risk to dropout: School,
psychological and family correlates. Children and Youth Services Review, 17(3), 433-448.
Friedman, A. S., Glickman, N., & Utada, A. (1985). Does drug and alcohol use lead to failure to
graduate from high school? Journal of Drug Education, 15(4), 353-364. doi:10.2190/EW8R-
Garnier, H. E., Stein, J. A., & Jacobs, J. K. (1997). The process of dropping out of high school: A 19-
year perspective. American Educational Research Journal, 34(2), 395-419.
Gfroerer, J. C., Greenblatt, J. C., & Wright, D. A. (1997). Substance use in the US college-age
population: Differences according to educational status and living arrangement. American
Journal of Public Health, 87(1), 62-65. doi:10.2105/AJPH.87.1.62
Green, K. M., Doherty, E. E., Stuart, E. A., & Ensminger, M. E. (2010). Does heavy adolescent
marijuana use lead to criminal involvement in adulthood? Evidence from a multiwave
longitudinal study of urban African Americans. Drug and Alcohol Dependence, 112(1-2), 117-
125. doi:10.1016/j.drugalcdep.2010.05.018
Greene, J. P., & Winters, M. A. (2006). Leaving boys behind: Public high school graduation rates. New
York, NY: Center for Civic Innovation and the Bill and Melinda Gates Foundation.
Guagliardo, M. F., Huang, Z., Hicks, J., & D'Angelo, L. (1998). Increased drug use among old-for-grade
and dropout urban adolescents. American Journal of Preventive Medicine, 15(1), 42-48.
Hall, W. (2009). The adverse health effects of cannabis use: What are they, and what are their
implications for policy? International Journal of Drug Policy, 20(6), 458-466.
Hall, W., & Degenhardt, L. (2009). Adverse health effects of non-medical cannabis use. Lancet,
374(9698), 1383-1391. doi:10.1016/S0140-6736(09)61037-0
Hammond, C., Linton, D., Smink, J., & Drew, S. (2007). Dropout risk factors and exemplary programs:
A technical report. Clemson, SC: National Dropout Prevention Center/Network and
Communities In Schools, Inc.
Hanson, K. L., Cummins, K., Tapert, S. F., & Brown, S. A. (2011). Changes in neuropsychological
functioning over 10 years following adolescent substance abuse treatment. Psychology of
Addictive Behaviors, 25(1), 127-142. doi:10.1037/a0022350
Harlow, C. W. (2003). Education and correctional populations: Bureau of Justice Statistics special
report. Washington, DC: Bureau of Justice Statistics.
Harris, S. K., Csémy, L., Sherritt, L., Starostova, O., Van Hook, S., Johnson, J., Boulter, S., Brooks, T.,
Carey, P., Kossack, R., Kulig, J. W., Van Vranken, N., & Knight, J. R. (2012). Computer-
facilitated substance use screening and brief advice for teens in primary care: An
international trial. Pediatrics, 129(6), 1072-1082. doi:10.1542/peds.2011-1624
Heckman, J. J., & LaFontaine, P. A. (2010). The American high school graduation rate: Trends and
levels. Review of Economics and Statistics, 92(2), 244-262. doi:10.1162/rest.2010.12366
America’s Dropout Crisis:
The Unrecognized Connection to Adolescent Substance Use
Hollar, D., & Moore, D. (2004). Relationship of substance use by students with disabilities to long-
term educational, employment, and social outcomes. Substance Use and Misuse, 39(6), 931-
962. doi:10.1081/JA-120030894
Jacobus, J., & Tapert, S. F. (in press). Neurotoxic effects of alcohol in adolescence. Annual Review of
Clinical Psychology. doi:10.1146/annurev-clinpsy-050212-185610
Jessor, R., & Jessor, S. L. (1977). Problem behavior and psychosocial development: A longitudinal
study of youth. New York, NY: Academic Press.
Johnston, L. D., O'Malley, P. M., Bachman, J. G., & Schulenberg, J. E. (2012). Monitoring the Future:
National survey results on drug use, 1975-2011: Volume I: Secondary school students. Ann
Arbor: Institute for Social Research, The University of Michigan.
Kandel, D. B., Davies, M., Karus, D., & Yamaguchi, K. (1986). The consequences in young adulthood
of adolescent drug involvement: An overview. Archives of General Psychiatry, 43(8), 746-
754. doi:10.1001/archpsyc.1986.01800080032005
Kaplan, H. B., & Liu, X. (1994). A longitudinal analysis of mediating variables in the drug use-
dropping out relationship. Criminology, 32(3), 415-439. doi:10.1111/j.1745-
Kellam, S. G., Mackenzie, A. C. L., Brown, C. H., Poduska, J. M., Wang, W., Petras, H., & Wilcox, H. C.
(2011). The good behavior game and the future of prevention and treatment. Addiction
Science and Clinical Practice, 6(1), 73-84.
Kelly, K. J., Comello, M. L. G., & Hunn, L. C. P. (2002). Parent-child communication, perceived
sanctions against drug use, and youth drug involvement. Adolescence, 37(148), 775-787.
Kennelly, L., & Monrad, M. (2007). Approaches to dropout prevention: Heeding early warning signs
with appropriate interventions. Washington, DC: National High School Center.
Kessler, R. C., & Foster, C. L. (1995). Social consequences of psychiatric disorders, I: Educational
attainment. American Journal of Psychiatry, 152(7), 1026-1032.
Klein, R. G., Mannuzza, S., Olazagasti, M. A. R., Roizen, E., Hutchison, J. A., Lashua, E. C., & Castellanos,
F. X. (2012). Clinical and functional outcome of childhood attention-deficit/hyperactivity
disorder 33 years later. Archives of General Psychiatry, 69(12), 1295-1303.
Koch, S. F., & McGeary, K. A. (2005). The effect of youth alcohol initiation on high school completion.
Economic Inquiry, 43(4), 750-765. doi:10.1093/ei/cbi052
Kogan, S. M., Zupei, L., Brody, G. H., & Murry, V. M. (2005). The influence of high school dropout on
substance use among African American youth. Journal of Ethnicity in Substance Abuse, 4(1),
35-52. doi:10.1300/J233v04n01_04
Kreamer, J., Fields, G. M., Stutman, R. M., Anderson, G. L., & Barthwell, A. G. (2008). The overlooked
cause of children being left behind: Drug use compromising academic success. Naperville, IL:
Education Voices, Inc.
Krohn, M. D., Lizotte, A. J., & Perez, C. M. (1997). The interrelationship between substance use and
precocious transitions to adult statuses. Journal of Health and Social Behavior, 38(1), 87-
103. doi:10.2307/2955363
America’s Dropout Crisis:
The Unrecognized Connection to Adolescent Substance Use
Laird, J., Kienzl, G., DeBell, M., & Chapman, C. (2007). Dropout rates in the United States: 2005.
Compendium report. Washington, DC: National Center for Education Statistics.
Lanham, C. C., & Tirado, J. A. (2011). Lessons in sobriety: An exploratory study of graduate
outcomes at a recovery high school. Journal of Groups in Addiction and Recovery, 6(3), 245-
263. doi:10.1080/1556035x.2011.597197
Lejuez, C. W., Magidson, J. F., Mitchell, S. H., Sinha, R., Stevens, M. C., & de Wit, H. (2010). Behavioral
and biological indicators of impulsivity in the development of alcohol use, problems, and
disorders. Alcoholism: Clinical and Experimental Research, 34(8), 1334-1345.
Lynskey, M., & Hall, W. (2000). The effects of adolescent cannabis use on educational attainment: A
review. Addiction, 95(11), 1621-1630. doi:10.1080/09652140020000867
Mannuzza, S., Klein, R. G., Bessler, A., Malloy, P., & LaPadula, M. (1993). Adult outcome of
hyperactive boys: Educational achievement, occupational rank, and psychiatric status.
Archives of General Psychiatry, 50(7), 565-576.
Marshal, M. P., Molina, B. S. G., & Pelham, W. E., Jr. (2003). Childhood ADHD and adolescent
substance use: An examination of deviant peer group affiliation as a risk factor. Psychology
of Addictive Behaviors, 17(4), 293-302. doi:10.1037/0893-164x.17.4.293
Marti, C. N., Stice, E., & Springer, D. W. (2010). Substance use and abuse trajectories across
adolescence: A latent trajectory analysis of a community-recruited sample of girls. Journal of
Adolescence, 33(3), 449-461. doi:10.1016/j.adolescence.2009.06.005
Martins, S. S., & Alexandre, P. K. (2009). The association of ecstasy use and academic achievement
among adolescents in two U.S. national surveys. Addictive Behaviors, 34(1), 9-16.
McCluskey, C. P., Krohn, M. D., Lizotte, A. J., & Rodriguez, M. L. (2002). Early substance use and
school achievement: An examination of Latino, White, and African-American youth. Journal
of Drug Issues, 32(3), 921-944. doi:10.1177/002204260203200313
McGee, L., & Newcomb, M. D. (1992). General deviance syndrome: Expanded hierarchical
evaluations at four ages from early adolescence to adulthood. Journal of Consulting and
Clinical Psychology, 60(5), 766-776. doi:10.1037/0022-006X.60.5.766
McGue, M., Iacono, W. G., Legrand, L. N., Malone, S., & Elkins, I. (2001). Origins and consequences of
age at first drink. I. Associations with substance-use disorders, disinhibitory behavior and
psychopathology, and P3 amplitude. Alcoholism: Clinical and Experimental Research, 25(8),
1156-1165. doi:10.1111/j.1530-0277.2001.tb02330.x
Melville, K. (2006). The school dropout crisis: Why one-third of all high school students don’t
graduate. Charlottesville, VA: Pew Partnership for Civic Change.
Mensch, B. S., & Kandel, D. B. (1988). Dropping out of high school and drug involvement. Sociology
of Education, 61(2), 95-113. doi:10.2307/2112267
Moberg, D. P., & Finch, A. J. (2007). Recovery high schools: A descriptive study of school programs
and students. Journal of Groups in Addiction and Recovery, 2(2-4), 128-161.
America’s Dropout Crisis:
The Unrecognized Connection to Adolescent Substance Use
Mullahy, J., & Sindelar, J. L. (1994). Alcoholism and income: The role of indirect effects. Milbank
Quarterly, 72(2), 359-375. doi:10.2307/3350300
National Center for Health Statistics. (2012). Health, United States, 2011: With special feature on
socioeconomic status and health. Hyattsville, MD: Centers for Disease Control and
National Institute on Drug Abuse. (2010). Drugs, brains, and behavior: The science of addiction.
Bethesda, MD: National Institutes of Health.
Newcomb, M. D., & Bentler, P. M. (1986). Drug use, educational aspirations, and work force
involvement: The transition from adolescence to young adulthood. American Journal of
Community Psychology, 14(3), 303-321. doi:10.1007/BF00911177
Newcomb, M. D., Abbott, R. D., Catalano, R. F., Hawkins, J. D., Battin-Pearson, S., & Hill, K. (2002).
Mediational and deviance theories of late high school failure: Process roles of structural
strains, academic competence, and general versus specific problem behavior. Journal of
Counseling Psychology, 49(2), 172-186. doi:10.1037/0022-0167.49.2.172
Obama, B. (2009, February 24). Address to Joint Session of Congress/State of the Union Address.
Retrieved February 18, 2013, from
Obama, B. (2011, January 25). State of the Union Address. Retrieved February 18, 2013, from
Obama, B. (2012, January 24). State of the Union Address. Retrieved February 18, 2013, from
Paulson, M. J., Richardson, M. A., & Coombs, R. H. (1990). School performance, academic aspirations,
and drug use among children and adolescents. Journal of Drug Education, 20(4), 289-303.
Pires, P., & Jenkins, J. (2007). A growth curve analysis of the joint influences of parenting affect,
child characteristics and deviant peers on adolescent illicit drug use. Journal of Youth and
Adolescence, 36(2), 169-183. doi:10.1007/s10964-006-9127-5
Pope, H. G., Jr., Gruber, A. J., Hudson, J. I., Cohane, G., Huestis, M. A., & Yurgelun-Todd, D. (2003).
Early-onset cannabis use and cognitive deficits: What is the nature of the association? Drug
and Alcohol Dependence, 69(3), 303-310. doi:10.1016/S0376-8716(02)00334-4
Register, C. A., Williams, D. R., & Grimes, P. W. (2001). Adolescent drug use and educational
attainment. Education Economics, 9(1), 1-18. doi:10.1080/09645290110038000
Reiff, M. I. (1998). Adolescent school failure: Failure to thrive in adolescence. Pediatrics in Review,
19(6), 199-207. doi:10.1542/pir.19-6-199
Renna, F. (2008). Teens' alcohol consumption and schooling. Economics of Education Review, 27(1),
69-78. doi:10.1016/j.econedurev.2006.05.002
America’s Dropout Crisis:
The Unrecognized Connection to Adolescent Substance Use
Richardson, J. L., Radziszewska, B., Dent, C. W., & Flay, B. R. (1993). Relationship between after-
school care of adolescents and substance use, risk taking, depressed mood, and academic
achievement. Pediatrics, 92(1), 32-38.
Roebuck, M. C., French, M. T., & Dennis, M. L. (2004). Adolescent marijuana use and school
attendance. Economics of Education Review, 23(2), 133-141. doi:10.1016/S0272-
Rouse, C. E. (2005). The labor market consequences of an inadequate education. Paper presented at
the Equity Symposium on “The Social Costs of Inadequate Education” at Teachers’ College at
Columbia University, New York, NY.
Rumberger, R. W. (1987). High school dropouts: A review of issues and evidence. Review of
Educational Research, 57(2), 101-121. doi:10.3102/00346543057002101
Rumberger, R. W., & Lim, S. (2008). Why students drop out of school: A review of 25 years of research.
Santa Barbara, CA: University of California Santa Barbara.
Rumberger, R. W. (2011). Dropping out: Why students drop out of high school and what can be done
about it. Cambridge, MA: Harvard University Press.
Sabia, J. J. (2010). Wastin' away in Margaritaville? New evidence on the academic effects of teenage
binge drinking. Contemporary Economic Policy, 28(1), 1-22. doi:10.1111/j.1465-
Schwartz, R. H., Gruenewald, P. J., Klitzner, M., & Fedio, P. (1989). Short-term memory impairment
in cannabis-dependent adolescents. American Journal of Diseases of Children, 143(10), 1214-
1219. doi:10.1001/archpedi.1989.02150220110030
Schweinsburg, A. D., Brown, S. A., & Tapert, S. F. (2008). The influence of marijuana use on
neurocognitive functioning in adolescents. Current Drug Abuse Reviews, 1(1), 99-111.
Sloboda, Z., Glantz, M. D., & Tarter, R. E. (2012). Revisiting the concepts of risk and protective
factors for understanding the etiology and development of substance use and substance use
disorders: Implications for prevention. Substance Use and Misuse, 47(8-9), 944-962.
Socias, M., Dunn, L., Parrish, T., Muraki, M., & Woods, L. (2007). California high schools that beat the
odds in high school graduation. Santa Barbara, CA: California Dropout Research Project,
American Institutes for Research (AIR).
Solowij, N., Michie, P. T., & Fox, A. M. (1991). Effects of long-term cannabis use on selective
attention: An event-related potential study. Pharmacology, Biochemistry, and Behavior,
40(3), 683-688. doi:10.1016/0091-3057(91)90382-C
Solowij, N., Stephens, R. S., Roffman, R. A., Babor, T., Kadden, R., Miller, M., Christiansen, K., McRee,
B., & Vendetti, J. (2002). Cognitive functioning of long-term heavy cannabis users seeking
treatment. Journal of the American Medical Association, 287(9), 1123-1131.
Solowij, N., Jones, K., Rozman, M., Davis, S., Ciarrochi, J., Heaven, P. L., Lubman, D., & Yücel, M.
(2011). Verbal learning and memory in adolescent cannabis users, alcohol users and non-
users. Psychopharmacology, 216(1), 131-144. doi:10.1007/s00213-011-2203-x
America’s Dropout Crisis:
The Unrecognized Connection to Adolescent Substance Use
Spirito, A., Monti, P. M., Barnett, N. P., Colby, S. M., Sindelar, H., Rohsenow, D. J., Lewander, W., &
Myers, M. (2004). A randomized clinical trial of a brief motivational intervention for
alcohol-positive adolescents treated in an emergency department. Journal of Pediatrics,
145(3), 396-402. doi:10.1016/j.jpeds.2004.04.057
Stillwell, R., Stable, J., & Plotts, C. (2011). Public school graduates and dropouts from the common
core of data: School year 2008-09. Washington, DC: National Center for Education Statistics.
Substance Abuse and Mental Health Services Administration. (2012). Results from the 2011 National
Survey on Drug Use and Health: Summary of national findings. Rockville, MD: Substance
Abuse and Mental Health Services Administration.
Substance Abuse and Mental Health Services Administration. (2013). Substance use among 12th
grade aged youths by dropout status. The NSDUH Report. Rockville, MD: Center for
Behavioral Health Statistics and Quality.
Sum, A., Khatiwada, I., McLaughlin, J., & Palma, S. (2009). The consequences of dropping out of high
school joblessness and jailing for high school dropouts and the high cost for taxpayers. Boston,
MA: Center for Labor Market Studies, Northeastern University.
Swaim, R. C., Beauvais, F., Chavez, E. L., & Oetting, E. R. (1997). The effect of school dropout rates on
estimates of adolescent substance use among three racial/ethnic groups. American Journal
of Public Health, 87(1), 51-55. doi:10.2105/AJPH.87.1.51
Takagi, M., Yucel, M., Cotton, S. M., Baliz, Y., Tucker, A., Elkins, K., & Lubman, D. I. (2011). Verbal
memory, learning, and executive functioning among adolescent inhalant and cannabis users.
Journal of Studies on Alcohol and Drugs, 72(1), 96-105.
Tamm, L., Adinoff, B., Nakonezny, P. A., Winhusen, T., & Riggs, P. (2012). Attention-
deficit/hyperactivity disorder subtypes in adolescents with comorbid substance-use
disorder. American Journal of Drug and Alcohol Abuse, 38(1), 93-100.
Tanner, J., Davies, S., & O'Grady, B. (1999). Whatever happened to yesterday's rebels? Longitudinal
effects of youth delinquency on education and employment. Social Problems, 46(2), 250-
274. doi:10.2307/3097255
Tarter, R. E., Fishbein, D., Kirisci, L., Mezzich, A., Ridenour, T., & Vanyukov, M. (2011). Deviant
socialization mediates transmissible and contextual risk on cannabis use disorder
development: A prospective study. Addiction, 106(7), 1301-1308. doi:10.1111/j.1360-
Thomasian, J., Pound, W. T., Wilhoit, G., & Welburn, B. (2008). Accelerating the agenda: Actions to
improve America's high schools. Washington, DC: National Governors Association Center for
Best Practices, National Conference of State Legislatures, National Association of State
Boards of Education, and Council of Chief State School Officers.
Trampush, J. W., Miller, C. J., Newcorn, J. H., & Halperin, J. M. (2009). The impact of childhood ADHD
on dropping out of high school in urban adolescents/young adults. Journal of Attention
Disorders, 13(2), 127-136. doi:10.1177/1087054708323040
Tyler, J. H., & Lofstrom, M. (2009). Finishing high school: Alternative pathways and dropout
recovery. Future of Children, 19(1), 77-103.
America’s Dropout Crisis:
The Unrecognized Connection to Adolescent Substance Use
White, A. M., & Swartzwelder, H. S. (2005). Age-related effects of alcohol on memory and memory-
related brain function in adolescents and adults. In M. Galanter (Ed.), Recent developments in
alcoholism (161-176). New York, NY: Kluwer Academic/Plenum Publishers.
Wilens, T. E., Martelon, M., Joshi, G., Bateman, C., Fried, R., Petty, C., & Biederman, J. (2011). Does
ADHD predict substance use disorders? A 10-year follow-up study of young adults with
ADHD. Journal of the American Academy of Child & Adolescent Psychiatry, 50(6), 543-553.
Yamada, T., Kendix, M., & Yamada, T. (1996). The impact of alcohol consumption and marijuana use
on high school graduation. Health Economics, 5(1), 77-92. doi:10.1002/(SICI)1099-
Zeigler, D. W., Wang, C. C., Yoast, R. A., Dickinson, B. D., McCaffree, M. A., Robinowitz, C. B., & Sterling,
M. L. (2005). The neurocognitive effects of alcohol on adolescents and college students.
Preventive Medicine, 40(1), 23-32. doi:10.1016/j.ypmed.2004.04.044
Zimmerman, M. A., & Schmeelk-Cone, K. H. (2003). A longitudinal analysis of adolescent substance
use and school motivation among African American youth. Journal of Research on
Adolescence, 13(2), 185-210. doi:10.1111/1532-7795.1302003
America’s Dropout Crisis:
The Unrecognized Connection to Adolescent Substance Use
We conducted a qualitative survey with a convenience sample of eleven young adults
between the ages of 17 and 21 with histories of substance abuse problems. They were ascertained
from either an addiction treatment center in Maryland (n=5) or a recovery high school (n=6).
Participants were asked about the effects of alcohol and other drug use on their own academic
performance and school attendance.
All participants agreed that alcohol and other drug use had a negative impact on their
academic performance and school attendance. They reported that when they stopped using alcohol
and other drugs, their school attendance and academic performance improved.
Table 3: Results of a qualitative survey of 11 young adults
with histories of substance abuse problems
n %
Did your use of alcohol and other drugs have a negative
impact on your academic performance and/or your school
Yes 11 100%
If YES, to what extent did your use of these drugs
affect academics? School attendance?
Major Impact
Minor Impact
Major Impact
Minor Impact
When you stopped alcohol and drug use, did stopping
improve these two areas of your school life?
Yes 10 90%
If YES, to what extent did your stopping affect
Major Impact 7 70%
Minor Impact 3 30%
Major Impact 9 90%
Minor Impact 1 10%
America’s Dropout Crisis:
The Unrecognized Connection to Adolescent Substance Use
When asked how the use of drugs affected academics and attendance, responses from high
school age youth included:
“[Drugs] took the place of studying. They decreased my motivation.” (18-year-old male)
“I didn’t care about my academics and I skipped some days of school to use as well.” (18-
year-old male high school senior)
“I didn’t want to do anything.” (17-year-old female high school senior)
“Lazy, unwillingness, no motivation, slept in class, wouldn’t go to school, skipped school
often.” (18-year-old female high school senior)
“I stopped focusing on wanting good grades. I stopped studying, doing homework and as a
result, my grades went down. I skipped school, came in late, went to classes late and had my
mom call me in sick.” (17-year-old female high school senior)
“With pot mostly my grades went down the drain.” (17-year-old male high school senior)
When asked how stopping use affected academics and attendance, responses from high
school age youth included:
“I started doing my school work and going to school.” (18-year-old male high school senior)
“I went to school and cared about my grades.” (17-year-old female high school senior)
“I had more motivation, improved grades and relationships with teachers. I cared about my
future and wanted to go to college.” (18-year-old female high school senior)
“I was able to do assignments, study, and focus because I wasn’t high. I was able to learn. I
actually cared about school and would go so I didn’t have to make up work. I wouldn’t be
tired from the night before and wouldn’t have to call in sick.” (17-year-old female high
school senior)
When asked how the use of drugs affected academics and attendance, responses from
college age young adults included:
“I never went to class.” (20-year-old female college junior)
“I did not care about school. I would skip class to use.” (19-year-old female college student)
“I did not go to schoolwanted to get high more than study.” (21-year-old female college
“I slept at school.” (18-year-old female college freshman)
America’s Dropout Crisis:
The Unrecognized Connection to Adolescent Substance Use
When asked how stopping use affected academics and attendance, responses from college
age young adults included:
“My academics improved immediately because I had time to study and I could remember
what I studied. The attendance did not improve quickly because it took quite some time to
show up to class regularly.” (21-year-old female college junior)
“I rarely to never skip class and I am now on the Dean’s List. I have been sober for almost
two years.” (20-year-old female college junior)
“I stopped for a year and a half while in high school. I cared about my school work. I wanted
to get to college.” (21-year-old female college student)
“I did not go to class and when I did, I had a hard time remembering what I learned.” (21-
year-old female college junior)
“I started to care about my grades. I started going to class and taking it seriously. “I actually
cared about where my life was going.” (18-year-old female college freshman)
Three staff members at a recovery school reported that youth alcohol and other drug use is a major
factor that contributes to poor academics and poor school attendance. Likewise, they each reported
that achieving abstinence significantly improves academics and attendance.
Two staff members listed substance use as the top factor that contributes to poor academic
performance and poor school attendance. The third staff member named substance use third,
following poverty and trauma.
With regard to the 12-step programs, staff members reported:
“If a student is faithful in attending their meetings weekly and staying sober, I see their
grades and attendance stay in a normal pattern. When they are using, they are all over the
place; including grades, attendance, and moods.” (50-year-old female administrative
assistant with 6 years’ experience working with youth)
“Recovery (12-step fellowship) seems to be the missing piece to long-term success as it
provides structure, support, and accountability.” (41-year-old female educator with 20
years’ experience working with youth)
“Through participation in the 12-step programs students adopt a new philosophy on how to
live their lives. They become open-minded and willing to look at how their choices are
impacting their lives and futures. The program offers them an opportunity to repair harms
to those that have been affected by their use and restore those relationships. They begin to
build their self-esteem through service work offered by the program. Their sponsors lead by
example and hold them accountable.” (32-year-old female clinician with 6 years’ experience
working with youth)
... Homeschooled adolescents were "homeschooled at any time" in the past year. Dropout risks were having one or more of grades Dþ at the last grading period, 1 year older than typical for grade, and the adolescent "hated going to school"; these have been linked to elevated dropout risk [9] and PDM [7]. ...
... This difference was likely because Vaughn et al. [3] aggregated all adolescents, and Thomson and Jang [4] did not differentiate public/private schooleattending adolescents by dropout risk. Adolescents not in school and those at risk for dropout have significantly higher substance use rates [7,9], highlighting the importance of comparison groups in studying homeschooled adolescents. ...
... In addition, future longitudinal research is needed to capture potential causality in the relationships among educational status, substance use, and mental health. Policies are needed to limit adolescent dropout by addressing underlying factors, including substance use and academic factors [9]; screening for psychopathology is recommended in at-risk adolescents. As some homeschooled adolescents have elevated substance use rates, careful substance use screening for all adolescents is warranted. ...
Purpose U.S. homeschooling increased by 50% over 2007–2016. Homeschooled adolescents may have lower substance use rates, but previous research treated other adolescents as homogeneous despite within-group differences. We used the 2015–2018 National Survey on Drug Use and Health to compare adolescent substance use and psychopathology by homeschooled/educational status. Methods Data were from 52,089 adolescents, classified by educational status (i.e., homeschooled; public/private school, low dropout risk; public/private school, at risk for dropout; and not in school) and compared on substance use and psychopathology variables. Results Substance use rates were lowest in adolescents at low dropout risk, with significantly lower past-year prescription opioid misuse, tobacco use, nonmarijuana illicit drug use, and nicotine dependence rates than homeschooled adolescents. Psychopathology treatment prevalence was lowest in homeschooled adolescents. Those at risk for dropout had the highest rates of substance use. Conclusions Although homeschooled adolescents have relatively low substance use rates, they exceed those of low dropout risk adolescents.
... Socioeconomic status, family structure, and the role of parents in academic performance have all been linked to school dropout (Townsend et al., 2007;DuPont et al., 2013;Goldberg-Looney et al., 2016;Park & Kim, 2016). Family socialization theory highlights the interconnectedness of home environment and school achievement, with stressful circumstances like parental divorce impacting a student's behavior both inside and outside the classroom (De Witte et al., 2013). ...
... Adolescent substance use and mental health problems are a significant public health concern and exact a considerable toll on individuals, and their families and communities. They often result in serious academic [1,2], employment [3], legal [4] consequences for young people, and high societal costs (estimated at over half a trillion dollars annually in the U. S.) [5]. Research shows that adolescent substance use and mental health problems are associated with adult substance use disorders, and psychiatric and chronic medical conditions [6]. ...
Full-text available
Purpose Screening, brief intervention, and referral to treatment (SBIRT) may impact future comorbidity and healthcare utilization among adolescents screening positive for substance use or mood problems. Methods In a randomized trial sample, we compared an SBIRT group to usual care for substance use, mental health, medical diagnoses, and healthcare utilization over 7 years postscreening. Results In logistic regression models adjusting for patient characteristics, the SBIRT group had lower odds of any substance (Odds Ratio[OR] = 0.80, 95% Confidence Interval [CI] = 0.66–.98), alcohol (OR = 0.69, 95% CI = 0.51–0.94), any drug (OR = 0.73, 95% CI = 0.54–0.98), marijuana (OR = 0.70, 95% CI = 0.50–0.98), and tobacco (OR = 0.83, 95% CI = 0.69–1.00) diagnoses, and lower odds of any inpatient hospitalizations (OR = 0.59, 95% CI = 0.41–0.85) compared with usual care. Negative binomial models examining number of visits among adolescents with at least one visit of that type found that those in the SBIRT group had fewer primary care (incidence rate ratio[iRR] = 0.90, p < .05) and psychiatry (iRR = 0.64, p < .01) and more addiction medicine (iRR = 1.52, p < .01) visits over 7 years compared with usual care. In posthoc analyses, we found that among Hispanic patients, those in the SBIRT group had lower odds of any substance, any drug and marijuana use disorder diagnoses compared with usual care, and among Black/African American patients, those in the SBIRT group had lower odds of alcohol use disorder diagnoses compared with usual care. Discussion Beneficial effects of adolescent SBIRT on substance use and healthcare utilization may persist into young adulthood.
... Alcohol use is associated with a range of unwanted consequences, including academic impacts, dropping out of school, social outcomes, drivingrelated risks, and health effects (U.S. Department of Health and Human Services, 2016; Dupont et al., 2013;White & Hingson, 2013). Drinking by adolescents is influenced by a number of factors including alcohol-related social media engagement (Curtis et al., 2018), television, music, advertising, and other media exposure (Kilmer, Kilmer, & Grossberg, 2014), parental influences (Rusby, Light, Crowley, & Westling, 2018), enforcement of underage drinking laws (Paschall, Grube, Thomas, Cannon, & Treffers, 2012), perceived social norms (Pedersen et al., 2017), and interactions of multiple variables (e.g., media and norms) (Janssen et al., 2018). ...
Full-text available
This research evaluated the impact of the Positive Community Norms (PCN) approach on (a) correcting misperceptions of norms of peer alcohol use and (b) reducing prevalence of monthly alcohol use among a sample of high-school students. A 5-year intervention (consisting of a mix of strategies centered around promoting actual norms related to alcohol use) was implemented by community coalitions in 11 school districts selected by the Minnesota Department of Human Services. Yearly assessments of teen substance abuse norms were conducted in each community, as well as surveys of parents and adults in the community. In the absence of control communities, national data from Monitoring the Future (MTF) (Miech et al. in Monitoring the future national survey results on drug use, 1975–2017: secondary school students, vol I [Monograph]. Institute for Social Research, The University of Michigan, Ann Arbor, MI, 2018) were utilized as a comparison condition. At the end of the 5 years, 8th- and 10th-grade students in the PCN intervention communities were more likely to report never using alcohol than students in the MTF Survey comparison group. This finding was also true for 8th-, 10th-, and 12th-grade students combined. This research provides evidence for utilizing the PCN approach to effectively correct misperceptions of norms and integrate strategies to reduce and prevent teen alcohol use at community population levels.
... Alcohol use among adolescents is associated with multiple deleterious health outcomes, including increased likelihood of using other substances [3], depression and anxiety disorders [4], and risk of attempting suicide [5]. Underage drinking, particularly binge drinking, also has important implications for academic performance and has been found to decrease the likelihood that youth will complete high school [6]. ...
Purpose: Certain groups, particularly sexual minority youth, demonstrate notable disparities in alcohol use risk. Assessing trends in alcohol use behaviors by sexual orientation over time is therefore important to the epidemiologic study of adolescent health equity. Methods: We analyzed age at first drink, lifetime drinking behavior, current drinking, and binge drinking in a large, national sample of high school youth across six time points, beginning in 2007 and biennially through 2017. We assessed trends by sex, sexual identity, and sexual behavior, controlling for race/ethnicity and age. Results: Our results demonstrated that, although overall alcohol use is decreasing among youth, disparities between heterosexual and sexual minority youth remain significant. The largest decreases were seen in current alcohol use among lesbian youth, which fell from a prevalence of 56.1% in 2007 to 38.9% in 2017, and among bisexual females (64.3% in 2007 to 41.1% in 2017). Despite this, alcohol use behaviors were still elevated among lesbian and bisexual female youth compared with heterosexual sex-matched counterparts. Heterosexual-identified male students saw significant decreases in alcohol use, whereas most alcohol use behaviors among sexual minority males decreased but not to a statistically significant degree, with the exception of binge drinking among those who identified as gay (2007: 36.0% to 2017: 12.6%) and bisexual (2007: 24.7% to 2017: 11.6%). Results by sexual behavior are presented within. Conclusions: Sexual minority youth continued to demonstrate markedly high prevalence of alcohol use behaviors compared with heterosexual peers across all time points. Downward trends in alcohol use may thus mask serious population health risks if not adequately explored. Research and health promotion efforts must consider sexual minority orientation to avoid incomplete or inaccurate representation of findings.
... It is difficult to discern which is the cause and which is the effect between poor academic achievement and SUD. 43 The 2017 National Survey on Drug Use and Health found that substance use was more likely among 12th grade aged dropouts than among those who were still in school. Dropouts reported any illicit substance use 1.7 times more and nonmedical use of prescriptiontype drugs 2.1 times more than 12th grade students. ...
Opioid use disorder (OUD) is a pediatric and adolescent problem as most young adults (aged <25 years) in treatment programs report initiating use before 25 years of age, and there are lifelong impacts from early substance use necessitating early screening for opioid use and subsequent treatment. Medication-assisted treatment (MAT) is a highly effective intervention for OUD, and there is strong evidence for its use with adolescents; however, most adolescents with OUD are unable to access MAT or remain in MAT long term to achieve substantial recovery. Using case examples drawn from a pediatric and adolescent physician's experiences proving MAT to adolescents and young adults (ages 16-24 years), this article explores the personal and socioeconomic determinants in MAT of OUD in adolescents and young adults and provides suggestions for advocacy areas and resources to improve MAT with this population.
Full-text available
La prevalencia del consumo de sustancias entre jóvenes representa un reto significativo para su desarrollo integral. Las intervenciones docentes y políticas públicas emergen como herramientas cruciales para abordar esta situación. Esta investigación buscó comprender el impacto de dichas políticas en las prácticas formativas de docentes de la Institución Educativa Juan XXIII de Medellín. Se empleó un enfoque cualitativo, basado en la praxis hermenéutica, para decodificar significados en el lenguaje y acciones de los participantes. A través de la triangulación interpretativa, se examinaron seis categorías vinculadas a políticas y proyectos educativos locales. Los hallazgos indican una "distancia hermenéutica" entre políticas formuladas y su aplicación real, atribuida a diversos factores, como la desconexión entre teoría y práctica. En conclusión, el estudio destaca la necesidad de brindar apoyo emocional y mental a los estudiantes y de proporcionar suficientes recursos y apoyo para la aplicación efectiva de las políticas públicas.
Full-text available
The aim of this study is to contribute new knowledge about interactions of power and social pedagogical recognition in narratives of students who use alcohol and drugs in an upper secondary school context. In this context, the student narratives create and re-create a series of images of varied treatment by professional actors (e.g., teachers, student coordinators, counsellors). The reproduced power interactions in narratives describing the practices of professional actors are significant for student learning, teaching, nurturing, inclusion, change, discipline, and identity creation. The social pedagogical recognition of the “other party” in the pupil–professional actor relationship is especially important for achieving the aims of including pupils who use alcohol and drugs in a learning context and enacting positive change through the creation and re-creation of social pedagogical identities (e.g., successful pupil identity) in the upper secondary school context.
Background Previous research has shown that a majority of adolescents in the United States initiate and drink alcohol prior to graduating high school and nearly twenty percent of high school seniors engage in heavy episodic drinking. Despite anecdotal evidence and media portrayals of alcohol use during high school events (e.g., prom), little is understood about alcohol use surrounding specific events that may be identified as “high-risk” events and addressed in specific interventions. Similarly, normative perceptions exert powerful influence on behaviors but little is understood about normative perceptions of alcohol use at high school events. Objectives: The purpose of the present study was to understand whether high school alcohol use is associated with specific events by describing behaviors and normative perceptions Methods Participants were 386 U.S. college students age 18 to 19 (60.4% female, mean age = 18.4) who provided retrospective accounts of their alcohol use surrounding senior year high school events (either before, which is relevant to pregaming addressed in this special issue, during, or after). Results Most students did not drink surrounding high school events but nearly all reported that they perceived that the typical high school senior did. Those who did drink alcohol tended to drink heavily, particularly during prom. Alcohol use was associated with other high school events ranging from the beginning of senior year (e.g., Homecoming) though the end (e.g., graduation parties) Conclusions Results indicate the importance of future research efforts tailoring intervention efforts around specific events and the applicability of personalized normative feedback approaches.
Full-text available
Problem behavior theory predicts that norm-violating attitudes and activities reflect a syndrome. Hierarchical latent-factor models examined the integrity of this syndrome at 4 developmental stages from early adolescence to adulthood. Latent constructs of Drug Use, Academic Orientation, Social Conformity, Criminal Behavior, and Sexual Involvement were assessed up to 4 times at 4-year intervals in a community sample. Second-order constructs of General Deviance confirmed integrity of the syndrome at these life stages, although subtle changes in certain components of the construct emerged. Criminal Behavior was more determined by General Deviance in adulthood than in young adulthood, whereas Sexual Involvement became less determined by the common factor between these times. Drug Use and low Social Conformity were consistently strong indicators of General Deviance.