Violent Attacks and Drug Use Among Youth in the United States 2002-2013

Background and Purpose.  Recent research has made an important contribution to our understanding of the interrelatedness of substance use and violence; however, a number of important questions remain. First, although it is now well-established that substance use and violence co-occur, less is understood in terms of the ways in which this relationship might vary based on the degree of youth involvement in violence. While it is reasonable to surmise that the prevalence of substance use would be greater among youth involved more frequently in violence, empirical evidence in this area is lacking. Similarly, it is also uncertain if salient intrapersonal and contextual factors related to substance use risk vary among less and more frequently violent youth.  Finally, we know that the prevalence of substance use disorders is certainly higher among youth involved in violence; however, we also know that most youth involved in violence do not meet criteria for substance use disorders. As such, questions remain as to what factors predict substance use morbidity among youth involved in episodic and repeated acts of violence.

Methods. Data were derived from a population-based study (National Survey on Drug Use and Health) of youth ages 12-17 (n = 216,852) in the United States between 2002 and 2013.  To examine involvement in violence, respondents were asked: “During the past 12 months, how many times have you attacked someone with the intent to seriously hurt them?”  Multinomial regression was used to examine differences between youth reporting episodic (1-2 times, n = 13,091; 5.84%) and repeated violent attacks (3+ times, n = 1,819; 0.83%) in contrast with youth reporting no attacks. Additional analyses examined the association of sociodemographic, intrapersonal, and contextual factors with substance use disorders among the subset of youth reporting violent attacks.

Results. Substance use morbidity among youth with no attacks was only 6% as compared to 22% among episodic and 36% among repeatedly violent youth. Compared to those reporting no attacks, episodic and repeatedly violent youth were significantly more likely to report “enjoying” risky behavior as well as relatively easy access to illicit drugs and receipt of a recent drug offer. Violent youth were also significantly more likely to report past 12-month alcohol, cannabis, and other illicit drug use and to have met criteria for DSM-IV substance use disorders. Contrasting adolescents reporting episodic (1-2 episodes) and repeated (3 or more episodes) involvement in violent attacks revealed far greater substance use risk among the minority of youth involved repeated violent attacks.

Conclusions and Implications. Findings from the present study point to the importance of distinguishing between the various gradations of violence among youth in understanding the relationship between substance use and violence, as well as shed light on the intrapersonal and contextual factors that can help identify violent youth at greatest risk for substance use problems. Overall, this pattern of results points to the importance of targeted substance use prevention among serious and chronically violent youth and perhaps the development of intervention programs designed specifically for this subset of at-risk youth.