Shifts in Drug and Alcohol Use by Generation: What the Data Is Revealing 

Substance use in the United States does not affect every generation the same way. While some age groups are showing declines in certain substances, others are experiencing concerning increases.

Recent national survey data highlights an important shift. Teen alcohol and cigarette use have declined over the past decade, while alcohol use, stimulant misuse and overdose deaths have risen among adults.

Understanding these generational patterns helps families recognize risk and ensures treatment providers can adapt to evolving needs.

At Pyramid Healthcare, we pay close attention to these trends so we can provide care that reflects the realities individuals face at different stages of life.

Generation Z and Adolescents: Encouraging Declines With New Concerns

National surveys such as Monitoring the Future have shown significant declines in traditional substance use among teens compared to previous generations.

For example:

• In the early 1990s, nearly 50 percent of high school seniors reported drinking alcohol in the past month. Recent data shows that number has dropped to around 20 percent.
• Cigarette smoking among teens has dropped dramatically over the last two decades, from more than 25 percent reporting current use in the late 1990s to single digit percentages today.
• Marijuana use among teens has remained relatively stable or slightly declined in recent years, though it still remains one of the most commonly used substances in this age group.

While these declines are encouraging, new risks have emerged.

Using nicotine and cannabis vaping products remains prevalent among adolescents. National youth surveys have reported that more than 10 percent of high school students use e-cigarettes regularly. Many teens perceive vaping as less harmful than traditional smoking, despite growing evidence of health risks.

Synthetic products such as Delta 8 THC, THC A, and other hemp derived substances have also created confusion among youth who believe these products are safe because they are legal in some states.

Teen substance use may look different today, but prevention efforts must continue to evolve.

Millennials and Generation X: Rising Alcohol Use

While teen drinking has declined, alcohol use among adults has increased in several generational groups.

According to national public health data:

• Alcohol related deaths increased by nearly 30 percent between 2019 and 2022.
• Adults aged 35 to 54 experienced some of the largest increases in alcohol-related liver disease and alcohol-related mortality.
• Women have shown a sharper rise in heavy drinking compared to previous decades, narrowing the historical gender gap in alcohol use disorder.

Millennials and Generation X adults often face unique stressors such as career pressure, financial strain, caregiving responsibilities and post-pandemic mental health challenges. Increased normalization of daily drinking culture through social media and remote work environments may also play a role.

Unlike teen substance use, adult alcohol use is often socially accepted and legal, which can delay recognition of problematic patterns.

Opioids and Stimulants Among Adults

Drug use trends also vary significantly by age.

Synthetic opioids such as fentanyl have driven overdose rates in adults aged 25 to 44. In recent years, overdose has remained one of the leading causes of death for adults in this age range.

Additionally:

• Stimulant related deaths involving methamphetamine and cocaine have increased among adults aged 30 to 60.
• Prescription stimulant misuse has grown among young adults seeking academic or workplace performance enhancement.

These shifts highlight how adult substance use patterns are increasingly tied to stress, productivity culture and access to potent synthetic drugs.

Baby Boomers and Older Adults: A Growing Concern

Substance use among older adults is often under-recognized.

National data shows that alcohol use disorder among adults aged 60 and older has increased in recent years. Many older adults drink regularly, and some mix alcohol with prescription medications, increasing health risks.

Baby Boomers, who historically had higher rates of substance use earlier in life compared to prior generations, are aging into higher-risk health categories. As this population grows older, the medical complications associated with alcohol and drug use become more severe.

Older adults may experience substance use related challenges due to:

• Chronic pain
• Isolation or grief
• Retirement transitions
• Mental health conditions
• Long term prescription medication use

Because symptoms may overlap with other health issues, substance use in this group can go undetected.

Why Generational Patterns Are Shifting

Several factors contribute to these generational differences.

Prevention and Education

Long term public health campaigns targeting youth smoking and drinking have reduced teen rates significantly.

Cultural Changes

Alcohol marketing and social media trends have normalized frequent drinking among adults, especially in work-from-home culture.

Legalization and Accessibility

Cannabis legalization in many states has increased adult use, particularly among those over age 30.

Mental Health Awareness

Younger generations may be more open about mental health, which can reduce some substance use but also increase awareness of self-medication behaviors.

Potency of Modern Substances

Synthetic opioids and high potency stimulants are far more powerful than drugs available in past decades, contributing to higher overdose risk.

Substance use trends do not simply rise or fall across all ages at once. They shift depending on environment, culture and access.

What This Means for Families

Recognizing generational differences is important.

For teens, parents may need to focus on vaping, edibles and synthetic cannabis products.

For adults in their 30s and 40s, warning signs may include daily drinking, stress-related substance use or prescription misuse.

For older adults, increased alcohol tolerance, mixing substances with medications or unexplained health changes may signal concern.

Awareness allows for earlier conversations and intervention.

Treatment That Adapts to Every Generation

At Pyramid Healthcare, we recognize that addiction does not look the same at 18 as it does at 38 or 68.

Our programs address age specific needs through:

• Medical detox services for safe withdrawal
• Residential treatment for structured recovery
• Outpatient programs for continued support
• Integrated care for co-occurring mental health conditions

As generational patterns shift, treatment must remain flexible and evidence based.

Moving Forward

National data suggests that while traditional teen substance use has declined, adult alcohol use, stimulant misuse and overdose rates remain significant concerns. Older adults also represent a growing at-risk population.

Addiction trends evolve, but the need for accessible, compassionate treatment remains constant.

If you or someone you love is struggling with substance use at any age, reaching out early can make a meaningful difference in long term recovery.