Substance Use and Sexual Risk Behaviors

Adolescent substance use is also associated with sexual risk behaviors that put young people at risk for HIV, sexually transmitted diseases (STDs), and pregnancy. ^2,7 To address these issues, more needs to be done to lessen risks and increase protective factors for youth.

According to the Surgeon General’s Report Facing Addiction in America,¹ the misuse of substances such as alcohol and drugs is a growing problem in the United States. Although substance misuse can occur at any age, the adolescent years are particularly critical at-risk periods. Research shows that the majority of adults who meet the criteria for having a substance use disorder started using substances during their youth.

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What We Know

Studies conducted among adolescents have identified an association between substance use and sexual risk behaviors such as ever having sex, having multiple sex partners, not using a condom, and pregnancy before the age of 15 years of age.^2,7

Researchers have found that as the frequency of substance use increases,the likelihood of sex and the number of sex partners also increases.³ In addition, studies show that sexual risk behaviors increase in adolescents who use alcohol, and are highest among students who use marijuana, cocaine, prescription drugs (such as sedatives, opioids, and stimulants), and other illicit drugs. Adolescents who reported no substance use are the least likely to engage in sexual risk-taking.⁴

According to the 2017 National Youth Risk Behavior Survey (YRBS), 40% of high school students have ever had intercourse and 29% of high school students are currently sexually active. Of the students who are currently sexually active, 19% drank alcohol or used drugs before last sexual intercourse.⁵

Fast Facts

Of the students who are currently sexually active:

19% drank alcohol or used drugs before last sexual intercourse

29% of high school students are currently sexually active

40% of high school students have ever had intercourse

Risk Factors and Prevention Activities

Substance use and sexual risk behaviors share some common underlying factors that may predispose youth to these behaviors. Because substance use clusters with other risk behaviors, it is important to learn whether precursors can be determined early to help identify youth who are most at risk. Primary prevention approaches that are most effective are those that address common risk factors. Prevention programs for substance use and sexual risk behaviors should include a focus on individuals, peers, families, schools, and communities. When students’ school environments are supportive and their parents are engaged in their lives, they are less likely to use alcohol and drugs and engage in sexual behaviors that put them at risk for HIV, STDs, or pregnancy.⁶

Substance use is associated with behaviors that put youth at risk for HIV, STDs, and pregnancy

Common risk factors for substance use and sexual risk behaviors include:

Extreme economic deprivation (poverty, over-crowding)
Family history of the problem behavior, family conflict, and family management problems
Favorable parental attitudes towards the problem behavior and/or parental involvement in the problem behavior
Lack of positive parent engagement
Association with substance using peers
Alienation and rebelliousness
Lack of school connectedness

For primary prevention activities targeting substance use and sexual risk behaviors to be effective, they should include:⁶

School-based programs that promote social and emotional competence
Peer-led drug and alcohol resistance programs
Parenting skills training
Parent engagement
Family support programs

What CDC Is Doing

CDC is engaging in a variety of efforts to develop strategies to combat substance use and sexual risk behaviors among youth. Some efforts include:

Conducting further analysis of existing data from the YRBS, School Health Policies and Practices Study (SHPPS), and School Health Profiles Profiles).
Improving YRBS questions pertaining to prescription opioids and other substances.
Conducting a three-year demonstration project called Teens Linked to Care (TLC). The project is supported by the Hilton Foundation and the CDC Foundation, and assesses the ability of rural communities to integrate substance use prevention and sexual risk prevention program activities in school-based settings.
Researching the topic of adolescent substance use and its association with a variety of risks and behaviors.
Conducting an analysis of local and state policies on adolescent substance use prevention.

U.S. Department of Health and Human Services (HHS), Office of the Surgeon General, Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health. Washington, DC: HHS, November 2016.
Clayton, H. B., Lowry, R., August, E., & Jones, S. E. (2016). Nonmedical use of prescription drugs and sexual risk behaviors. Pediatrics, 137(1), e20152480.
Cavazos-Rehg, P. A., Krauss, M. J., Spitznagel, E. L., Schootman, M., Cottler, L. B., & Bierut, L. J. (2011). Number of sexual partners and associations with initiation and intensity of substance use. AIDS and Behavior, 15(4), 869-874.
Lowry, R., Holtzman, D., Truman, B. I., Kann, L., Collins, J. L., & Kolbe, L. J. (1994). Substance use and HIV-related sexual Behaviors among US high school students: are they related?. American Journal of Public Health, 84(7), 1116-1120.
Kann, L., McManus, T., Harris, W. A., et al. (2018). Youth risk behavior surveillance—United States, 2017. MMWR Surveillance Summary, 67(8), 1-479.
Hawkins, J. D., Catalano, R. F., & Miller, J. Y. (1992). Risk and protective factors for alcohol and other drug problems in adolescence and early adulthood: implications for substance abuse prevention. Psychological bulletin, 112(1), 64-105.
Cavazos-Rehg, P. A., Krauss, M. J., Spitznagel, E. L., Schootman, M., Cottler, L. B., & Bierut, L. J. (2012). Brief report: pregnant by age 15 years and substance use initiation among US adolescent girls. Journal of Adolescence, 35(5), 1393-1397.