Illicit drug and nicotine use among youth shows a different and worrisome pattern. The proportion of young people between the ages of 12 and 17 who used illicit drugs in the previous month decreased from a peak of 16 percent in 1979 to a low of 5 percent in 1992, but then doubled to 11 percent in 1995 (SAMHSA, 1996a). Rates of smoking have also increased recently among teenagers. Since 1992, the percentage of high school seniors who smoke (as reported in the past 30 days) has increased from 27.8 percent to 34 percent in 1996 (Johnston et al., 1997). Trends in past month use of marijuana, alcohol, and cigarette use for 8th and 10th graders, and high school seniors for 1992–1996 are shown in Table 2.1. Of special note is that despite the overall lower smoking rates among African-American youths, the rate of smoking among young African-American males has doubled in recent years, from 14 percent in 1991 to 28 percent in 1995 (MMWR, 1996).
Individuals who use and abuse illicit drugs, alcohol, and cigarettes have disproportionately high use of medical services and impose large costs on the economy and on the legal and criminal justice systems. Many studies of illicit drug, alcohol, and nicotine addiction have estimated the costs to the United States for addiction to each of these drugs both individually and collectively (Berry and Bowland, 1977; Cruze et al., 1981; Harwood et al., 1984; MMWR, 1994; OTA, 1985; Rice, 1993; Rice et al., 1986, 1990, 1991a–c, 1992; Shultz et al., 1991a,b). Estimates vary as a result of different data sets, different assumptions, and different methods of calculation. In 1990, 1 it was estimated that the abuse of illicit drugs, alcohol, and nicotine cost society approximately $257 billion (see Table 2.2). The economic cost to society was measured in terms of the direct medical care expenditures for treatment of patients suffering from the adverse health effects of use of these drugs, indirect costs associated with loss of earnings due to reduced or lost productivity (morbidity) and premature death (mortality), and other related costs (i.e., nonhealth care costs such as those associated with the criminal and social welfare systems).