Scholars@Duke publication: Alcohol and Cannabis Use Trends Among Adolescents With and Without a History of Recent Suicidal Thoughts and Behavior: 1991-2023.

Alcohol and Cannabis Use Trends Among Adolescents With and Without a History of Recent Suicidal Thoughts and Behavior: 1991-2023.

Publication , Journal Article

Cheek, SM; Grove, JL; Barnes, SE; Goldston, DB

Published in: J Adolesc Health

August 2025

PURPOSE: Trends in alcohol and cannabis use among adolescents in the United States have generally declined in prevalence since the 1990s. However, it is unknown if these trends are observed among adolescents with suicidal thoughts and behaviors (STBs), a population particularly vulnerable to maladaptive outcomes associated with substance use. METHOD: In the present study, 32 years (1991-2023) of survey data from the Youth Risk Behavior Surveillance System were analyzed with joinpoint regression to explore trends in alcohol use, binge drinking, and cannabis use in a sample of adolescents in grades 9-12 (N = 254,675) with and without recent histories of STBs. RESULTS: Analyses revealed that alcohol use and binge drinking prevalence have decreased overall, whereas trends differed among adolescents with a recent history of suicide attempts, for whom prevalence has been decreasing more modestly. Cannabis use prevalence has decreased significantly since 1995 for adolescents with no STB history, but not for adolescents with recent suicidal ideation or attempt. Furthermore, when stratified by gender, alcohol and cannabis use among females with recent history of suicide attempt declined at a more modest rate, with rates of cannabis use in particular plateauing since the 1990s. DISCUSSION: Adolescents with histories of STBs, may be more resistant to factors responsible for the overall decline in substance use among adolescents, suggesting a need for continued substance use screening and targeted intervention efforts for psychiatrically vulnerable youth.