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COMMENTARY 

Substance Use Disorder in Young Adults 

Across the United States 
 

Shreya Patel1,2, Isabella Garcia1,3, Anahi Bernal1,3, Stephany Tapia1,4, Daniel Martinez1,4, Jocelin 

Hernandez1,4, Eric Molina1,4, Abril Acevedo1,4, Gabriel Martinez1,5, Christian Zuniga1,6 

 
1 3rdAnnual Junior Clinical Research Internship, South Texas Academy for Education & Training in Research, DHR Health  

   Institute for Research and Development 
2 South Texas ISD Health Professions, Mercedes, TX 
3 Academy of Health Science Professions & STEM, La Joya, Tx 
4 Juarez Lincoln High School, Mission, TX 
5 McAllen High School, McAllen, TX 
6 La Villa Early College High School, La Villa, TX 

 

Received: August 3, 2023 

Accepted for publication: November 3, 2023 

Published: November 16, 2023

 
 
Introduction 

 
More than any other age group in the United 

States, 32% of young adults between the ages of 18-

25 participate in frequent alcoholic misuse; with 22% 

further taking part in the abuse of illegal drugs.1 

Taking into consideration the rather vulnerable mind 

of young adults, they become more susceptible to risky 

behaviors that may lead to chronic long-term effects of 

irresponsible substance usage later on in their life.2 

Substance Abuse Disorder (SUD) is a 

neuropsychiatric disorder that is described by a 

continuing desire to take drugs or partake in alcohol 

consumption despite its potential harmful 

consumption.3 Although the majority of youth who 

partake in the use of substances do not reach 

problematic usage levels, 15% of young adults meet 

the criteria for SUD.4 Many young adults already have 

childhood risk factors, and the added stress from 

adulthood places these individuals at risk for misusing 

substances. Employment difficulties, lack of a positive 

parent role model, and academic stress can also 

increase the risk of young adults misusing 

substances.5,6 SUD however is a mental illness, and 

should be treated as any other chronic physical 

illnesses would be treated.7,8  

 

 

 

 

Alcohol Use Disorder 
 

Alcohol Use Disorder is a chronic health 

condition where individuals struggle to manage their 

alcohol consumption, without considering the 

detrimental impact on their social, mental, and 

physiological health. If not treated it may lead to 

alcohol abuse, where serious consequences result from 

repeated excessive drinking, or alcohol dependence, 

where the individual has no control over their drinking 

behaviors. With over 100 million people suffering 

from alcohol use disorder (AUD) in 2016, AUD 

continues to be a global public health concern, in 

which there were over 15 million reported cases in the 

US since 2018 according to the National Survey on 

Drug Use and Health (NSDUH).9 When compared to 

older individuals, young adults (ages 18 to 25) are 

more prone to engage in heavy episodic drinking and 

a variety of harmful alcohol-related activities, such as 

drunk driving. It is even estimated that excessive 

alcohol intake in the United States contributes to over 

79,000 fatalities annually, especially among young 

adults.10  

 

Effects of AUD on Mental and Social Health 

 
The majority of substance use disorders have 

substantial correlations with separate mood and 

anxiety disorders. With depressive type disorders 



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being the most common of the psychological 

symptoms to coexist with AUD, disruptive/irritable 

moods, feelings of worthlessness, and negative 

temperament are highly present amongst patients. 

These types of psychiatric disorders that affect the 

mood significantly have been 3.7 times more likely to 

be found as a result from extreme alcohol use and/or 

dependancy.11 It should be noted, however, that these 

symptoms can also very well be the causes for AUD. 

Additionally, riskier, irritable, and  impulsive behavior 

can  result from alcohol misuse as one may become 

more careless from episodic drinking, even to go as far 

as inflicting self-harm.12 

 

Alongside the mental effects that alcohol has 

on an individual, there are also social effects that affect 

both the individual and his/her relationships with 

others. Social interactions related to alcohol 

consumption often involve negative interpersonal 

exchanges and failure to meet commitments pertaining 

to relationships. Many alcohol related health problems 

affect others in addition to the drinker.13 Harm to 

relatives, harm to family members, a negative impact 

on work and education, public order, and driving 

accidents are some of the many social effects that 

alcohol consumption has on the drinker’s society.14 

 

Effects of AUD on Physiological Health 
 

The impact of alcohol use disorders (AUD) 

on the physiological well-being of individuals presents 

a need for understanding of its detrimental effects on 

many bodily systems. From the moment a user takes 

their first sip, their body, especially the bloodstream, 

is intoxicated leading to short and long-term failures 

throughout the physiological structure of the human 

body. The consequences of excessive consumption 

goes far beyond immediate effects such as to what is 

known as a mere hangover. Alcohol leads to life 

threatening health conditions including deficiency in 

all body systems.  

 

The effects of alcohol to the body depends on 

the blood alcohol concentration (BAC). BAC is the 

percent of ethyl alcohol or ethanol in an individual's 

bloodstream.15 The BAC levels will vary depending on 

the number of alcoholic drinks, the time in which 

drinks are consumed, body weight, water composition, 

enzyme production and levels, sex assigned at birth, 

medication influences, and whether any food has been 

consumed.16 BAC can be measured by breath, blood, 

or urine tests. The percentages range from 0% (no 

alcohol) to over 0.4% (possibly fatal).16 At 0.10% 

BAC, individuals may experience a further reduction 

in reaction time, along with slurred speech and slowed 

thinking, heightening the dangers of tasks like driving 

or operating machinery.16 Within the range of 0.15% 

to 0.30% BAC, confusion, vomiting, and drowsiness 

become more pronounced, signaling a higher level of 

impairment and vulnerability. Beyond 0.30% to 0.40% 

BAC, the risk of alcohol poisoning escalates 

significantly, potentially leading to life-threatening 

conditions. Individuals may lose consciousness, 

calling for immediate medical attention.17 When BAC 

surpasses 0.40%, it reaches a potentially fatal level, 

putting individuals at risk of coma and respiratory 

arrest, a critical situation where breathing stops.17 

 

Aside from these short term effects, alcohol 

use disorders in young adults aging 18 to 25 leads to 

long-term impairments since their bodies are still in 

crucial stages of development and maturation. 

However, the progression of most effects are 

diagnosed either months or years of misusing alcohol. 

An AUD significantly impacts the cardiovascular 

system which can include hypertension, tachycardia, 

and increasing the risk of heart disease, and stroke.18 It 

has been found that excessive alcohol consumption 

raises the blood pressure in several ways. It can 

directly stimulate the nervous system, increasing the 

sympathetic nervous system activity, which causes 

blood vessels to constrict or to become narrow.19 This 

narrowing causes a resistance to blood flow, 

consequently increasing blood pressure. In addition, it 

can also reduce the veins and arteries elasticity leading 

to hypertension.20 This is known as atherosclerosis. A 

risk of stroke is highered when the heart is exposed to 

blood clots; these clots are formed by excessive 

alcohol intake. Ethanol is rapidly and almost 

completely absorbed in the digestive tract, mainly the 

small intestine, and then metabolized in the liver, 

primarily converting into acetaldehyde, a toxic 

compound responsible for some of the detrimental 

effects of alcohol on the body, including steatosis, or 

fatty liver, alcoholic hepatitis, and liver cirrhosis, 

which can further complicate into liver cancer.21 

Moreover, alcohol has the ability to disturb the natural 

hormonal regulation responsible for controlling 

kidney function. Continuous and excessive alcohol 

consumption can lead to liver disease, which 

compounds the negative impact on the kidneys, 

causing problems in managing sodium and fluids and 

potentially leading to acute kidney failure.22 

Pancreatitis occurs from excessive alcohol 

consumption due to alcohol-induced inflammation and 

damage to the pancreas. Chronic alcohol use can lead 

to the activation of digestive enzymes within the 

pancreas, causing inflammation and potentially 

leading to pancreatitis. Alcohol use disorder can 

negatively impact brain development in young adults 

aged 18-25 due to the ongoing maturation of the brain 



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during this stage. Excessive alcohol consumption 

disrupts the normal processes of brain development, 

affecting crucial functions such as learning, memory, 

decision-making, and emotional regulation. 

Understanding the physiological impacts of alcohol 

use disorder in young adults in the US is crucial for 

developing targeted interventions and fostering a 

healthier future for this vulnerable population. 

 

Prevalence of AUD 

 
With regard to mental health and alcohol use 

problems, a significant amount of evidence exists 

which indicates that outcomes differ by both sex and 

race/ethnicity. Approximately 21% of males and 13% 

of women experience binge drinking.23 Men have been 

proven to consume more alcohol than women, 

drinking at least five times each month on average 

with 25% of them having at least nine drinks each 

time.23 Overall, 9% of adult women and 13% of adult 

men reported having an alcohol drinking disorder in 

2020.23 The prevalence of alcohol use disorders 

(AUD) varies across racial/ethnic groups, however, it 

is suggested that ethnic minorities may face higher 

rates of addiction than national averages due to poor 

living conditions; limited access to specialized care; 

and elevated social, economic, emotional, and 

environmental risk factors.24 It has often been shown 

that Native Americans are especially vulnerable to the 

negative health consequences of alcohol. However, 

given their small size in relation to other racial groups 

(2.9% of the total U.S. population), Native Americans' 

influence on alcohol-related health effects on the U.S. 

population as a whole is less clear.25 In addition, it is 

important to take into consideration other contexts of 

alcohol use, such as, social, political, and economic 

variables.  

 

Race/Ethnicity Alcoholism/ 

AUD  

Race/ 

Ethnicity 

American Indians and 

Alaska Natives 

14.9% 27.6% 

Caucasian 11.3% 17.0% 

Asian American, 

Native Hawaiian, and 

Other Pacific Islander 

4.6% 8.0% 

Hispanic or Latino 8.4% 15.7% 

African American  7.4% 17.2% 

Figure 1. The average percentage of 

alcoholism/AUD compared to overall substance 

abuse among various racial and ethnic groups from 

the years 2016-202126,27 

 

 

 

Marijuana Use Disorder 

 
The prevalence of marijuana has increased 

substantially in the United States over the past decade, 

making cannabis one of the most used illicit drugs in 

the US.28 Furthermore, this increase was aided 

dramatically due to the recent legalization of weed in 

various states across the US. The effects of cannabis 

on American society become more prevalent year after 

year; these effects include a drastic change in mental 

and social health among users. 

 

Effects of Marijuana Use on Mental and 

Social Health 

 
Marijuana Use Disorder takes a huge toll on 

one's mental and social health. Marijuana use can 

significantly affect social interactions and behavior 

towards others due to various factors. The drug's 

influence on verbal and nonverbal communication 

skills can result in difficulties expressing oneself 

clearly and accurately interpreting others' cues, 

leading to misunderstandings and reduced empathy.29 

Excessive marijuana use may lead to social 

withdrawal, as individuals prioritize drug use over 

engaging in social activities, straining relationships 

and limiting opportunities for interaction.29 The 

altered perception and behavior induced by marijuana 

can make users appear emotionally detached, 

impacting the dynamics of interpersonal 

relationships.29 Frequent use of marijuana on young 

adults causes mental health effects, most of them being 

mood disorders, respiratory, depression, and anxiety.30 

Marijuana use disorder in young adults can have 

significant effects on the developing brain, as their 

brains are still undergoing crucial neurodevelopmental 

processes.31 The active compound in marijuana, 

tetrahydrocannabinol (THC), binds to cannabinoid 

receptors in the brain, disrupting the endocannabinoid 

system's normal functioning.31 This leads to an altered 

brain structure, impaired brain maturation, and 

dependency on marijuana.31 

 

Effects of Marijuana Use on Physiological 

Health 

 
The excessive use of marjuana can have 

notable effects on the physiological well-being. 

Smoking marijuana can harm lung tissues, leading to 

potential scarring and respiratory problems, such as 

lung cancer. Furthermore, marijuana use can cause 

rapid changes in heart rate and diastolic blood 

pressure, as well as physical effects like red eyes, dry 

mouth and throat, increased appetite, and widening of 

blood vessels.32 While some users may experience 



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feelings of relaxation and euphoria, others may 

encounter negative psychological effects. Marijuana 

use can lead to disorientation, anxiety, and paranoia, 

particularly in individuals who may be more 

susceptible to these reactions. In more severe cases, 

marijuana use has been linked to temporary psychosis, 

characterized by losing touch with reality, 

experiencing hallucinations, and having paranoid 

thoughts.33 Long-term use may contribute to the 

development of disorders like schizophrenia, a serious 

mental illness characterized by distorted thoughts, 

emotions, and perceptions.34 Intoxication from high 

doses of cannabis can induce temporary psychotic 

symptoms in most individuals, heightening the risk of 

psychological distress associated with heavy use. 

Approximately 26% of Americans aged 18 to 26, 

roughly 1 in 4 young adults, experience diagnosable 

mental disorders in any given year.35 Depressive 

illnesses and anxiety disorders have a complex 

relationship with substance use, including marijuana.36  

 

Prevalence of MUD 
 

The consumption of marijuana has been the 

most common illegal drug in the United States; 48.2 

million people, or about 18% of Americans, consume 

it.37 From 2000 through 2008, there was no significant 

change in the annual number of rate ingestions of 

marijuana in young adults across the United States. 

There has been a very increasing amount of young 

adults consuming marijuana.  The proportion of young 

adults that reported  marijuana use reached 43% in 

2021,, a significant increase from 34%, five years ago 

(2016) and 29%, ten years ago (2011).38 According to 

another study, an estimated 3 in 10 young adults use 

marijuana.39 The National Epidemiologic Survey on 

Alcohol and Related Conditions conducted a survey in 

2012 and 2013 on Marijuana use and DSM-IV 

marijuana use disorder. This survey interviewed 

36,309 adults over the age of 18. Results concluded 

that 9.52% of U.S. adults have used marijuana in the 

past year with a 2.9% of people having a diagnosis of 

DSM-IV marijuana use disorder. Age examinations 

had shown young adults to be highest at risk for MUD 

and males with the greater number of marijuana use 

and use disorder. The number of individuals using 

marijuana is predicted to continue to grow as well as 

the number of people being affected by the usage.40 

 

 

 

 

 

 

 

Race/Ethnicity Past-year 

Marijuana 

Use 

Past-year 

Marijuana 

Use Disorder 

Caucasian 9.4% 2.7% 

African 

American 

12.7% 4.6% 

Native American 17.1% 5.5% 

Asian 5.0% 1.3% 

Hispanic 8.4% 2.8% 

Figure 2. Marijuana Use and MUD in different 

races/ethnicities in young adults in the United 

States. 

 

Sex Past-year 

Marijuana 

Use 

Past-year 

Marijuana 

Use Disorder 

Male 12.3% 4.2% 

Female 6.9% 1.7% 

Figure 3. Marijuana Use and MUD varied 

percentages in sex in young adults in the United 

States. 

 

Opioid Use Disorder 

 
Opioid Use Disorder is another growing 

health concern among young adults. OUD is a chronic 

relapse disorder that can lead to significant life-

threatening effects on people worldwide, especially in 

the U.S.41,42 Opioids represent a large class of drugs 

that derive from the opium poppy plant. Heroin, 

fentanyl, pain relievers, and prescriptions such as 

oxycodone and morphine are all considered opioids 

and are frequently abused by millions around the 

world.43 These substances are highly addictive and 

contribute to a variety of mental health, social, and 

physiological disorders. The increasing popularity 

these drugs have been receiving causes young adults 

who are introduced to them more prone to being 

affected. Even though it is medically used for pain 

relief and initially blocks the pain signals between the 

brain and the body, some may use it for the euphoric 

effect produced. The more it is abused over time, 

tolerance begins to develop in the individual which 

leads to continuous use risking overdose and death.43 

Between 2005 to 2006, the rate of opioid abuse in the 

United States increased 64% and experienced the 

emergence of a nationwide public health crisis . Death 

rates increased in 2016 by 27% from 2015.44 The rate 

of opioid misuse is high in the U.S. and increasingly 

prevalent among young adults.  

 

 

 

 



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Effects of OUD on Mental and Social Health  
 

OUD has substantial mental effects on young 

adults, leading to cognitive impairments such as 

deficiencies in attention and judgment, as well as 

emotion dysregulation characterized by increased 

depression, anxiety, and suicide rates.45 The prefrontal 

cortex in the brain is responsible for executive 

functions such as judgment and planning. Individuals 

with addictive disorders such as OUD have 

abnormalities in that area of the brain which causes a 

decrease in their judgment to control the amount of 

drugs consumed.45 The more drugs consumed, the 

more dependent the brain gets resulting in more 

problems related to attention and regular executive 

functions. Many people who have opioid use disorder 

either have a co-existing mental health condition or 

develop one due to their OUD.46 In some cases, 

opioids are used to cope with the symptoms of their 

mental illness leading to OUD. Depression and 

anxiety disorders are commonly found in OUD 

patients who try to use the euphoric effects to relieve 

their symptoms.47 Opioids are highly addictive by 

creating artificial endorphins. Repeated usage alters 

the brain and causes the body to believe it is an 

essential component.45 The difficulty to break free 

from the addiction often leads to feelings of 

hopelessness and the belief that suicide is the only 

option. In 2017, more than 40% of suicide and 

overdose deaths involved opioids.48  

 

Mental  abnormalities caused by OUD lead to 

drastic changes of social patterns within the 

individual. Increased habits of hermit-like state  

continue to arise due to higher rates of depressive and 

anxiety induced symptoms.47, 49 Seclusion is often 

associated with lack of normal accountability found in 

regular social interactions.50 Vital support from friends 

and family are omitted in times of hardship. A meta-

analysis study conducted in the U.S. shows only 3 in5 

of those with OUD seek relief treatment (1 in5 in the 

first 12 months and 2 in5 during their lifetime).51 In 

scenarios of a user experiencing withdrawal, irritation 

and emotional irregularities prove evident with 

significant rates of self harm notable in OUD patients 

(around 10/100).52, 53  

 

Effects of OUD on Physiological Health 

 
Analgesic opioids are notorious for being 

abused and may lead to vast amounts of physiological 

damage in the user. Short-term effects immediately 

after ingestion include nausea, changes in heart rate 

and breathing, euphoric like feelings, and a sedated 

state.54 These are in response to an opioid connecting 

and inhibiting receptors relating to feeling pain.55 

Long term effects of abnormal opioid use include the 

aforementioned symptoms as well as hypogonadism, 

decreased bone health, decreased pain tolerance,  

nervous/ gastrointestinal discrepancies and in extreme 

cases, death. More than 47,000 individuals in the U.S. 

die annually).56-60 An individual with an OUD can 

experience withdrawal when they try to stop their 

addiction and can experience increased sensations of 

muscle/skeletal ache, muscular spasms, cravings, skin 

irritation and constipation.61, 62 These symptoms are an 

important factor for the continued use of opioids. 

 

Prevalence of OUD 
 

In the US, the prevalence of OUD in young 

adults continues to increase. The more accessible and 

popular the drugs become, the greater the rates of 

OUD in young adults become. In order to monitor the 

prevalence of opioid misuse and use disorder, a 

national survey study was done in 2015 and 2016.63 

This survey included 28,213 young adults which 

corresponded to an estimate of 69.5 million young 

adults. From a total number of 56,070 individuals, 

32.2% of those were young adults who reportedly used 

prescription opioids, with an additional 7.8% reporting 

a misuse of prescription opioids or use disorder.63 

Along with age groups, this survey also obtained 

results on the prevalence of prescription opioid misuse 

in different races/ethnicities which is displayed on the 

table below. It can be seen that Caucasians have the 

greatest percentage of reported OUD followed by 

Hispanics.  

 

Race/Ethnicity Prescription 

Opioid Use 

Disorder 

Percentage 

Prescription 

Opioid 

Misuse 

Without 

Disorder 

Caucasian 3.2%  20.2% 

African 

American 

1.9% 17.6% 

Hispanic 3.0% 18.2% 

Others 2.6% 17.8% 

Figure 4. Opioid use disorder and opioid misuse 

in young adults from different races/ethnicities in 

the United States from 2015 to 2016. 

 

Conclusion 
 

The US Food and Drugs Administration 

(FDA) approved drugs for treatments of substance use 

disorder such as (buprenorphine,methadone, and 

naltrexone) to help people with their addiction.64 

These relieve the withdrawal symptoms and 



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psychological craving that causes Chemical 

imbalances in the body.65 However, treatments should 

be obligated for better improvements on mental health, 

such as counseling and behavioral therapies, and 

medications for these SUD. Acamprosate, naltrexone, 

and disulfiram, medications used by people in 

recovery, are proven to be very effective for 

preventing addiction and maintaining sobriety.65 

There are no current medications approved by the 

FDA for MUD treatment.66 

Education about the usage, prevalence, as well as 

awareness of the biological effects of substance use 

were some of the most favored and promising 

strategies to reduce substance abuse in young adults.67 

Risk reduction techniques were also successful at 

changing behavior, in addition to hearing testimonies. 

Other methods that have been beneficial in modifying 

behavior include taking part in programs that address 

sexual assault prevention, or learning about safety 

issues like drunk driving.67 Although preventative 

initiatives have shown to be successful, families and 

other significant adults continue to have the greatest 

influence over how young adults handle drugs. It is 

essential to become involved early, before high school, 

to educate the next generation about addiction and 

substance use disorders. Among the youth-focused 

preventive measures are programs that instruct parents 

on how to properly watch over, communicate with, 

and set and enforce family rules surrounding substance 

use.68, 69 

 

Since drug and alcohol abuse is a widespread 

issue that frequently begins among high school and 

college students, a variety of protective factors should 

be taken into account. The effective way for 

prevention of adolescent alcohol and other drugs is 

through a risk-focused approach, a prevention to know 

what decision has to be made.70 Having strong beliefs 

against substance abuse, the desire to maintain one's 

health, high paternal awareness of drugs, school 

connectedness, structured activity and having strong 

religious beliefs.71 Any positive change is progress to 

prevent substances from destroying someone's future. 

 

Acknowledgements 

 
Monica Betancourt-Garcia, MD, Program Director; 

Melissa Eddy, MS, Program Manager  

 

Funding 

 
Funded by DHR Health Institute for Research & 

Development; DHR Health; Region One ESC 

GEARUP College Ready, Career Set!; Region One 

ESC GEARUP College Now, Career Connected; 

Region One ESC PATHS; Region One ESC Upward   

Bound Math & Science; Benavides ISD; and Jubilee 

Academy-Brownsville   

 

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