Substance Use and Sexual Risk Behaviors

At a glance

  • Adolescent substance use is also associated with sexual risk behaviors that put young people at risk for HIV, sexually transmitted infections (STIs), and pregnancy.
  • To address these issues, we need to do more to lessen risks and increase protective factors for youth.
Four teenagers walking in a line with their arms around each other, smiling and laughing.

Overview

According to the Surgeon General's Report Facing Addiction in America, 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, adolescence is a particularly critical at-risk period.

Did you know?‎

Research shows that the majority of adults who meet the criteria for having a substance use disorder started using substances during their youth.

What we know

Studies done among adolescents show an association between substance use and sexual risk behaviors. Such behaviors include ever having sex, having multiple sex partners, not using a condom, and pregnancy before age 15 years.

Researchers have found that as substance use frequency increases, the likelihood of sex and the number of sex partners also increases.

Studies also show that sexual risk behaviors increase in adolescents who use alcohol. These behaviors are highest among students who use marijuana, cocaine, prescription drugs (like sedatives, opioids, stimulants), and other illicit drugs.

Adolescents who did not use such substances are the least likely to engage in sexual risk-taking.

Fast facts

According to the 2017 National Youth Risk Behavior Survey (YRBS), 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 factors that may make youth predisposed to these behaviors. It is therefore important to learn whether precursors can be found early—to help identify youth who are most at risk.

The most effective primary prevention approaches address common risk factors. Prevention programs for substance use and sexual risk behaviors should focus on individuals, peers, families, schools, and communities.

When students’ school environments are supportive and their parents are engaged in their lives, students are less likely to:

  • Use alcohol and drugs.
  • Engage in sexual behaviors that put them at risk for HIV, sexually transmitted infections (STIs), or pregnancy.

Common risk factors for substance use and sexual risk behaviors

  • Extreme economic disadvantages (poverty, overcrowding).
  • Family history of the problem behavior; family conflict; and family management problems.
  • Favorable parental attitudes about 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.

Effective primary prevention activities targeting substance use and sexual risk behaviors to be effective

  • 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 developing strategies to combat substance use and sexual risk behaviors among youth. Some efforts include:

  • Further analyzing data from the YRBS and School Health Profiles.
  • Improving YRBS questions about prescription opioids and other substances.
  • Doing a 3-year project called Teens Linked to Care (TLC). The project was supported by the Hilton Foundation and the CDC Foundation. The project assessed the ability of rural communities to include substance use prevention and sexual risk prevention in school-based settings.
  • Researching adolescent substance use and its links to a variety of risks and behaviors.
  • Analyzing local and state policies on adolescent substance use prevention.