Reducing Teen Substance Misuse: What Really Works

Virginia had the 14th lowest Rate of Youth Drug Overdose Death Rates, Rate has Increased in Just Over a Decade

Virginia scored Eight out of 10 on Substance Misuse Prevention Report Card

Washington, D.C., November 19, 2015– In a new report, Reducing Teen Substance Misuse: What Really Works, Virginia ranked 14th lowest for the number of youth drug overdose deaths, with a rate of 5.9 per 100,000 youth, ages 12 to 25. The national rate is 7.3 per 100,000.


The report’s analysis of the most recent drug overdose death rates among 12- to 25-year-olds found:

  • Current rates were highest in West Virginia (12.6 per 100,000 youth) – which were more than five times higher than the lowest rates in North Dakota (2.2 per 100,000).
  • Males are 2.5 times as likely to overdose as females (10.4 vs. 4.1 per 100,000). The rate in Virginia for males was 7.9 per 100,000 youth and 3.8 for females.
  • In 1999-2001, no state had a youth drug overdose death rate above 6.1 per 100,000. By 2011-13, 33 states were above 6.1 per 100,000. In the past 12 years:
    • Rates have more than doubled in 18 states (Alabama, Arizona, California, Colorado, Connecticut, Georgia, Hawaii, Idaho, Illinois, Kentucky, Nebraska, Nevada, New Jersey, New Mexico, North Carolina, Oregon, South Carolina and Tennessee);
    • Rates have more than tripled in twelve states (Arkansas, Delaware, Indiana, Iowa, Michigan, Minnesota, Missouri, New Hampshire, New York, Oklahoma, Utah and West Virginia); and
    • Rates have more than quadrupled in five states (Kansas, Montana, Ohio, Wisconsin and Wyoming).

The Reducing Teen Substance Misuse report also includes a review of 10 key indicators of leading evidence-based policies and programs that can improve the well-being of children and youth and have been connected with preventing and reducing substance— alcohol, tobacco or other drugs—misuse.

Virginia scored eight out of 10 and, nationally, 24 states scored a five or lower. Minnesota and New Jersey received the highest score of 10 out of a possible 10 points, while four states scored the lowest, Idaho, Louisiana, Mississippi and Wyoming, with three out of 10 points.

No. Indicator Virginia Number of States Receiving Points
A “Y” means the state received a point for that indicator
1 Support Academic Achievement: State has at least an 80 percent high school graduation rate (2012-2013).
Source: U.S. Department of Education, ED Data Express, Regulatory Adjusted Cohort Graduation Rates, 2013-2014.
Y 35
2 Preventing Bullying: State has comprehensive bullying prevention laws.
Source: American Academy of Pediatrics.
Y 21
3 Preventing Smoking: State has smoke-free laws that prohibit smoking in public places, including restaurants and bars.
Source: Campaign for Tobacco-Free Kids.
N/A 30 and Washington, D.C.
4 Preventing Underage Alcohol Sales: State has liability (dram shop) laws holding establishments accountable for selling alcohol to underage or obviously intoxicated individuals.
Source: National Conference of State Legislatures and NOLO.
N/A 37 and Washington, D.C.
5 Screening, Brief Intervention and Referral to Treatment Support: State has billing codes for Screening, Brief Intervention and Referral for Treatment (SBIRT) in their medical health (Medicaid or private insurance) programs.
Source: Institute for Research Education & Training in Addictions and Community Catalyst.
Y 32 and Washington, D.C.
6 Mental Health Funding: State increased funding for mental health services for Fiscal Year 2015.
Source: National Alliance on Mental Illness.
Y 29 and Washington, D.C.
7 Depression Treatment: State has rates of treatment for teens with major depressive episodes above the National percentage of 38.1 percent (2009-2013).
Source: SAMHSA, Behavioral Health Barometer: United States, 2014.
Y 30 and Washington, D.C.
8 Good Samaritan Laws: State has laws in place to provide some immunity from criminal charges or mitigation of sentencing of seeking help for an overdose.
Source: Network for Public Health Law.
Y 31 and Washington, D.C.
9 Treatment and Recovery Support for Prescription Drug Misuse: State provides Medicaid coverage for all three FDA-approved medications for the treatment of painkiller dependence.
Source: American Society of Addiction Medicine.
Y 30 and Washington, D.C.
10 Sentencing Reform: State has taken action to roll back “one-size-fits-all” sentences for nonviolent drug offenses.
Sources: The Vera Institute of Justice for 2000-2013 laws. For 2014 updates, The Sentencing Project, National Conference of State Legislatures and additional legislative scans for states meeting the thresholds set by the Vera Institute review.
Y 31 and Washington, D.C.
Total Eight

“More than 90 percent of adults who develop a substance use disorder began using before they were 18,” said Jeffrey Levi, PhD, executive director of TFAH. “Achieving any major reduction in substance misuse will require a reboot in our approach – starting with a greater emphasis on preventing use before it starts, intervening and providing support earlier and viewing treatment and recovery as a long-term commitment.”

The increase in youth drug overdose deaths is largely tied to increases in prescription drug misuse and the related doubling in heroin use by 18- to 25-year-olds in the past 10 years – 45 percent of people who use heroin are also addicted to prescription painkillers.

In addition, youth marijuana rates have increased by nearly 6 percent since 2008 and more than 13 percent of high school students report using e-cigarettes. Youth from affluent families and/or neighborhoods report more frequent substance and alcohol use than lower-income teens – often related to having more resources available to access alcohol and drugs.

“The case for a prevention-first and continuum-of-care approach is supported by more than 40 years of research, but the science hasn’t been implemented on a wide scale in the real world,” said Alexa Eggleston, senior program officer, domestic programs, Conrad N. Hilton Foundation. “It’s time to bring innovations to scale and invest in more proactive and sustained approaches that promote positive protective factors, like safe, stable families, homes, schools and communities and intervene early to address youth substance use before addiction develops.”

Reducing Teen Substance Misuse identified a set of research-based approaches and recommendations to modernize the nation’s strategy to prevent and reduce substance use and support a full continuum-of-care, including:

  • Putting prevention first, using evidence-based approaches across communities and in schools. Each state should have an end-to-end network of experts and resources to support the effective community-based selection, adoption, implementation and evaluation of evidence-based programs;
  • Strategically investing in evidence-based programs that show the strongest results in reducing risk factors for substance misuse, poor academic performance, bullying, depression, violence, suicide, unsafe sexual behaviors and other problems that often emerge during teen years and young adulthood;
  • Integrating school-based and wider community efforts, via multisector collaboration – and effectively collecting data to assess community needs, better select programs that match with those needs and improve accountability. Schools cannot and should not be expected to solve the problem on their own;
  • Renewing efforts to gain support for the adoption and implementation of evidence-based and sustained school-based programs – moving beyond decades of ineffective approaches;
  • Incorporating SBIRT as a routine practice in middle and high schools and healthcare settings – along with other regular health screenings – even brief counseling and interventions can have a positive impact; and
  • Increasing funding support for sustained and ongoing mental health and substance use treatment and recovery.

The report provides additional research-based recommendations for preventing and reducing youth substance misuse. It was supported by a grant from the Conrad N. Hilton Foundation and is available on TFAH’s website at

Score Summary:

A full list of all of the indicators and scores, listed below, is available along with the full report on TFAH’s web site at  For the state-by-state scoring, states received one point for achieving an indicator or zero points if they did not achieve the indicator. Zero is the lowest possible overall score, 10 is the highest.

  • 10 out of 10: Minnesota and New Jersey
  • 9 out of 10: California, Connecticut, Maine, Maryland, New Mexico, New York and Vermont
  • 8 out of 10: Delaware, District of Columbia, Massachusetts, New Hampshire, Ohio, Oregon, Virginia, Washington and Wisconsin
  • 7 out of 10: Colorado, Iowa, North Carolina and Pennsylvania
  • 6 out of 10: Alabama, Illinois, Missouri, Rhode Island and Utah
  • 5 out of 10: Arkansas, Florida, Hawaii, Kansas, Kentucky, Michigan, Montana, North Dakota and Oklahoma
  • 4 out of 10: Alaska, Arizona, Georgia, Indiana, Nebraska, Nevada, South Carolina, South Dakota, Tennessee, Texas and West Virginia
  • 3 out of 10: Idaho, Louisiana, Mississippi and Wyoming

State-by-state Youth Drug Overdose Death Rankings:

Note: Rates include drug overdose deaths, for 2011-2013, a three-year average, for 12- to 25-year-olds. 1 = Highest rate of drug overdose fatalities, 51 = lowest rate of drug overdose fatalities. States with statistically significant (p<0.05) increases since 2005-2007 are noted with an asterisk (*), while states with a statistically significant decrease are noted with two asterisks (**).

1. West Virginia (12.6); 2. New Mexico (12.5); 3. Utah (12.1); 4. Pennsylvania (11.8); 5. Nevada (11.6); 6. New Jersey (10.7*); 7. Kentucky (10.5); 8. (tie) Arizona (10.2*) and Colorado (10.2*) and Delaware (10.2*); 11. Wyoming (9.8*); 12. Indiana (9.6); 13. Missouri (9.5*); 14. Oklahoma (9.4); 15. New Hampshire (9.3); 16. Ohio (9.1*); 17. Wisconsin (8.8*); 18. Maryland (8.5); 19. Arkansas (8.4); 20. Connecticut (8.3); 21. Illinois (8.2*); 22. Michigan (8.1*); 23. Massachusetts (7.8); 24. Alaska (7.2); 25. North Carolina (7.1); 26. (tie) Montana (7.0) and Tennessee (7.0**) and Vermont (7.0); 29. (tie) New York (6.9*) and Washington (6.9); 31. Oregon (6.5); 32. (tie) Alabama (6.2) and Louisiana (6.2**); 34. (tie) Rhode Island (6.0) and Texas (6.0); 36. (tie) Kansas (5.9) and Virginia (5.9); 38. (tie) Idaho (5.8) and South Carolina (5.8); 40. (tie) Florida (5.7**) and Minnesota (5.7*); 42. Georgia (5.2); 43. California (4.9*); 44. Maine (4.7**); 45. Hawaii (4.6); 46. Iowa (4.3); 47. (tie) Mississippi (3.7**) and Nebraska (3.7); 49. South Dakota (3.3); 50. North Dakota (2.2).

Trust for America’s Health is a non-profit, non-partisan organization dedicated to saving lives by protecting the health of every community and working to make disease prevention a national priority.