December 19, 2012


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Dr. Nora Volkow, NIDA Director, discusses the results of the 2012 Monitoring the Future survey at a press conference from the National Press Club on December 19, 2012. Monitoring the Future tracks annual drug abuse trends of 8th, 10th, and 12th-grade students, including attitudes and perceived risk of specific drugs of abuse. Dr. Volkow is joined by joined by Howard Koh, M.D., M.P.H, HHS Assistant Secretary for Health; R. Gil Kerlikowske, Director, Office of National Drug Control Policy; Lloyd D. Johnston, Ph.D., Principal Investigator, Institute for Social Research, University of Michigan; and Chris Leibowitz, a young adult in recovery from drug addiction.


Jack Stein,
Director of the Office of Science Policy and Communications,
National Institute on Drug Abuse


Dr. Nora Volkow, M.D.,
National Institute on Drug Abuse

Dr. Howard Koh, M.D.,
Assistant Secretary,
Department of Health and Human Services

Gil Kerlikowske,
Office of National Drug Control Policy

Lloyd Johnston,
Principal Investigator, Institute for Social Research,
University of Michigan

Chris Leibowitz

Location: National Press Club, Washington, D.C.

Time: 10:00 a.m. EST
Date: Wednesday, December 19, 2012

Transcript by Federal News Service, Washington, D.C.

JACK STEIN: Well, good morning everyone. My name is Jack Stein, and I am the director of the Office of Science Policy and Communications at the National Institute on Drug Abuse, which is a component of the National Institutes of Health. I’d like to thank you all for attending this important press conference on this year’s Monitoring the Future survey.

Before we begin, I would like to take one moment on behalf of NIDA as well as the other – our other partners here at the dais represented today to extend our condolences to the families who have lost loved ones in last week’s tragedy in Newtown, Connecticut.


This year marks the 37th year of the Monitoring the Future survey. In 2012, the survey interviewed over 45,000 students in the eighth, 10th and 12th grade, from 395 schools in the United States. The survey took place earlier this year, and we are pleased to bring you the results today.

And we’re very happy to have with us today five distinguished presenters to discuss the survey findings and their perspectives about them. To my right is Dr. Nora Volkow, the director for the National Institute on Drug Abuse. To my left is Dr. Howard Koh, the assistant secretary for health in the U.S. Department of Health and Human Services. To Dr. Volkow’s right is Director Gil Kerlikowske, the director for the White House Office of National Drug Control Policy. To my left is Dr. Lloyd Johnston of the University of Michigan, who will be telling us about the Monitoring the Future survey results. And to my farthest left is Mr. Chris Leibowitz, who is an undergraduate student from Northern Virginia, who has an interesting story to share with us. Each panelist will speak for several minutes, followed by a question-and-answer period for the press in attendance as well as those who are listening in via our conference line set up for this event.

And in addition, we are also pleased to have some special guests with us in the audience today. The teens who you may see amongst them represent the future in the Monitoring the Future survey. Specifically, we have representatives from a number of high schools in the metropolitan D.C. area as well as several youth-focused drug prevention programs, including the Washington Regional Alcohol Program, United Planning Organization, which is in D.C. Ward 8, Washington Parks and People in D.C. Ward 7, Fairfax County Youth Councils Unified Prevention Coalition and Community of Concern.

And with that, I’d like to introduce and turn the podium over to the director of the National Institute on Drug Abuse, Dr. Nora Volkow. (Applause.)

DR. NORA VOLKOW: Good morning, Jack. Thanks very much. I wanted to welcome you and everyone here, and thank you for being here.

Every year, we do the Monitoring the Future. And it’s a way for us to get – (inaudible) – of the patterns of drug use in our country among high school students, but also, very importantly, about their perceptions. And it is through this information that we can guide our prevention efforts and also evaluate how effective interventions may have been in terms of the control of drug abuse patterns.

This year, we have indicators that are actually going towards the negative side, indicators that are not changing and indicators that are going towards the positive side. I’m going to start with those that are in the negative side because I think that we need to pay attention to them in order to be able to prevent from continue to go up, and that relates to the patterns of marijuana use.

Over the past five years we’ve seen significant increases in the use of marijuana among teenagers, high school students – eight-, 10- and 12th-graders. And indeed, we have currently among 12th-graders significantly high levels of daily use of marijuana. According to the survey, 6.5 percent of 12-graders are using marijuana daily, and yet only 44 percent of 12-graders perceive daily marijuana use as risky. And this very low perception of risk for regular use of marijuana is at its lowest since it’s been in 1983.

Coupled to these increases in marijuana use, actually, we have seen throughout surveys done in (health care ?) system a significant increase in the number of treatment of admissions for marijuana abuse, which have significantly increased, as well as increases in the admission for emergency medicine room departments. So clearly, the use – the increases in use of marijuana are being felt in terms of their consequences.

Another indicator that is worrisome is that – a relatively recent draw, which is that of synthetic cannabinoids are actually – which came into the market, as I say, relatively recently – are already abused by 11 percent of 12th-graders in the past year, which is an extremely high number if you think about it. Considering then that you have on the one side marijuana increases and on the other one the synthetic cannabinoids, we’re actually recognizing that we’re going into an era where the cannabinoids are being – are being favored.

I always get asked the question, well, why worry about marijuana? Isn’t the alcohol and nicotine more worrisome? And people like to place one drug against the other. And my perspective is it’s not necessary to place one drug against the other. All of these drugs actually can have very profound and adverse consequences. And my question has always been that the more you make a drug available the higher the number of people that are going to be exposed to it. And we know from surveys that perception of risk is actually one of the factors that predicts whether a young person will take marijuana. We also unequivocally know that the use of marijuana during adolescence is actually deleterious for the function of the human brain, that actually translates into impaired cognitive performance and worse outcomes.

With respect to the indicators that are actually going in the right direction, many of the illicit substances are actually decreasing. And this is actually very, very good news, that of the illicit – both of the illicit drugs alcohol and nicotine continue to go down among teenagers. And for the case of nicotine across all of the grades, this is the lowest that the prevalence rates have been since the inception of these measurements. Similarly, for alcohol, we’re seeing decreases in the patterns of alcohol use across all ages. And because both, as of now, we know that alcohol and nicotine are the drugs that cause the greatest rates of morbidity and mortality, these are actually quite wonderful news that also identified the success of prevention efforts. We’ve been able to decrease the patterns of alcohol and tobacco use in young people because of a very aggressive prevention campaign.

Now with respect to indicators that had not changed much, that are still worrisome, is the pattern that we’re seeing of abuse of prescription medications through our country. Most attention has focused on the use of pain medications that contain opioids because of their association with high rates of overdose and death. The patterns of – as it relates to Vicodin, have gone down since its highest numbers of 10 percent; they are currently at 7.5 percent on the past year. But on the hand, those of OxyContin have remained stable at 4.5 percent for 12-graders under the past year. And as much as these drugs are highly addictive and are high risk of overdose, this continues to be a major priority with respect to prevention.

Unfortunately, we are seeing an increase in the abuse of stimulant medications, which are used for the treatment of attention deficit disorder, in particular amphetamine Adderall, which is a drug that can be abused and can be highly addictive, but it’s also currently used as a means to improve cognitive performance. And we’ve seen significant increases since 2009, and currently 7.6 percent of 12th-graders admit to the use of Adderall in the past year for non-medical purposes.

So as we look at these numbers and we look up here and try to determine what do they tell us, I think that they are identified areas where we need to pay attention and not become complacent irregardless of our perception of whether this drug is worse of the other. We do recognize that the more available a drug is, regardless of its addiction potential, the worse the outcomes. And so we need to put ourselves that question: Do we want to be facing rates of abuse that we are seeing with legal drugs for some drugs like marijuana or do we want to do prevention efforts that can avoid all of the human cost and medical consequences?

Thanks very much. (Applause.)

MR. STEIN: Thank you, Dr. Volkow. I failed to mention that Dr. Volkow has been the director for the National Institute on Drug Abuse since 2003 and has literally led the efforts to ensure that drug addiction is viewed as a chronic brain condition. And we really do appreciate the leadership that Dr. Volkow has taken in leading us in that respect.

Our next speaker is Dr. Howard Koh, who serves as the 14th assistant secretary for health for the U.S. Department of Health and Human Services, after being nominated by the president and confirmed by the Senate in 2009. And he oversees a number of offices, including the Office of the Surgeon General in the Department of Health and Human Services, and also serves a senior public health adviser to the secretary of health and human services. With that, Dr. Koh.


DR. HOWARD KOH: Thank you very much, Dr. Stein, for inviting me to this very important conference, and I want to express my gratitude to you and to Dr. Volkow for her leadership; Director Kerlikowske and his new deputy director, Mr. Botticelli; Mr. Leibowitz – thank you all so much for being leaders in this very important part of public health. And a special thanks to Dr. Johnston, because Monitoring the Future is a treasure for public health, and so it’s a great pleasure for me to be here.

In examining the results that are being unveiled today, we should remember that of all these agents, that tobacco remains the leading cause of premature and preventable death in the United States. Smoking kills more than 1,200 Americans every day and for every tobacco-related death, there are two new replacement cigarette smokers under the age of 26. It’s tragic that these replacement smokers are kids who start when they are not fully ready to make an informed choice.

And indeed, you have heard and it is true that tobacco addiction is a pediatric disease. Three out of four teens who smoke continue to smoke into adulthood, even though they intend to quit, and a typical smoker loses 13 to 14 years of precious life.

So today we announce that cigarette use among youth is dropping, and that’s of course very positive news, but that still means that nearly one in five high school seniors – specifically, 17.1 percent – are still using cigarettes in the past month.

And then we should remember that kids are not just replacement cigarette users; they also use an array of other deadly tobacco products as well. The industry continues to create many tobacco products that you find appealing. For example, some cigarette-sized cigars include fruit and candy flavoring, like strawberry and grape. And furthermore, kids now have access to the latest smokeless tobacco products which are spitless or dissolve like mints. So these are appealing to young people in part because they can be used at school or at home in front of Mom and Dad and not be detected.

Unfortunately, these products too cause nicotine addiction and can lead to serious disease and even death. The data being announced today suggests that the considerable amount of use of other tobacco products, with more than a quarter of 12th-grade males, 27.1 percent, using small cigars, and furthermore, use of other tobacco products such as hookah is also a high – 18.3 percent of high school seniors report using a hookah with tobacco in the past year.

So in summary, while the declines in youth’s cigarette use is encouraging, we must do more overall to help kids be tobacco-free. And furthermore, the significant use of other tobacco products threaten to offset the gains made in the declines in cigarette use to date. So what should we do? We know what works: supporting comprehensive tobacco-free and other evidence-based tobacco control policies; fully supporting implementation of the historic 2009 Family Smoking Prevention and Tobacco Control Act; expanding use of tobacco cessation services; and using media to educate and encourage people, especially young kids, to live tobacco free.

Last month, the Department of Health and Human Services unveiled BeTobaccoFree.Gov; it’s a unified website for our department; please visit it. And also, we’re very pleased to note that recently our Food and Drug Administration, the FDA, announced an award of nine contracts with a budget of up to $600 million over five years to develop a sustainable public health education campaign to address the pervasive public health problem of tobacco use in kids.

So we are looking forward to coming back to you in the future to tell you how this campaign will be unveiled, how it will be launched, and how we focus on many parts of the youth population to send a message of prevention.

Now, overall, this survey is so valuable because it reports usage rates not just for tobacco but all illicit drugs and alcohol as well. And when you put it all together, some 40 percent of 10th graders and about half of 12th graders are using at least one, if not several, of these substances.

So again, we must work together to promote prevention, work with kids and parents, enforce alcohol-control policies, create environments that empower young people not to drink, use other drugs or use tobacco; identify alcohol and other drug abuse disorders early and provide brief intervention, referral and treatment; and reduce inappropriate access to and use of prescription drugs.

I am very grateful to Dr. Volkow and to NIDA, who have supported a robust research portfolio on prevention. We urge you to visit to view that portfolio, view their principles of prevention, and you may also want to look into the family checkup, a tool developed by the Child and Family Center at the University of Oregon, which highlights evidence-based parenting skills in preventing initiation and progression of drug use among youth.

So as I close, we should remind ourselves that our good health is a gift. It is precious; it is fragile; and it’s particularly fragile for our kids. So while we’ve made progress on a number of these issues, we need to redouble our efforts for prevention, we all can do more to help our kids enjoy a fighting chance for health.

Thank you very much. (Applause.)

MR. STEIN: Thank you, Dr. Koh. I’ve had the fortunate opportunity and unique one to interact with Dr. Koh and his staff over the last number of years on a number of initiatives, and currently, of course, working with Dr. Volkow and previously having the opportunity to work with our next speaker, who is Mr. Gil Kerlikowske, who was nominated by President Obama and confirmed by the U.S. Senate as the director of the Office of National Drug Control Policy in the White House. In this position, Mr. Kerlikowske coordinates all aspects of federal drug control programs and implementation of the president’s national drug control strategy. He brings 37 years of law enforcement and drug policy experience to the position and most recently served for nine years as the chief of police for Seattle, Washington, where he left crime at its lowest point in 40 years.

Mr. Kerlikowske? (Applause.)

GIL KERLIKOWSKE: Well, good morning, and thank you very much for being here. And this is the – a wonderful opportunity for me to associate again on this Monitoring the Future report with Dr. Volkow, and I thank her, and actually the great NIDA staff that supports Dr. Johnston in the work that he has done. And the assistant secretary of health, Dr. Koh, could not be a stronger partner on these health issues, in his words, about the health of young people and the responsibility we have as adults for them, I think, are particularly important. And Chris, I’m looking forward to hearing from you, and it’s always a great pleasure to be with Dr. Johnston, who has given us the information that helps so much in not only making policy, but also the information that’s needed to improve the nation’s health and particularly the health of young people.

So there are a couple of important things, I think, that I really took from this report. But to put it a little bit into context, remember that this is that snapshot of the prior year. And it’s also, I think, helpful to think about where we’ve been in the drug abuse and the drug field for the last number of decades, actually, over the last three decades.

So as we craft policy, it’s very helpful to take a look at that. And we’ve actually made huge strides forward in reducing illegal drug use in America, despite some of the increases in drug use over the past several years. Over the long term, the rates of drug use among young people today are far lower than they were 30 years ago.

But we have to continue a downward trend and we have to work on that very hard. And we have some troubling signs, as Dr. Volkow mentioned. We have to continue to educate people, particularly young people, about the risks that are associated with drug use. And just as we’ve actually educated people about the harms of tobacco and the dangers of alcohol-impaired driving, that information needs to be communicated, not in a threatening way and not in a scare-tactic way, but it needs to be communicated in a very direct way by parents and others, other adult influencers, as we like to call them, that can provide that kind of leadership.

As the president has noted, we’ve successfully changed attitudes regarding smoking and alcohol-impaired driving, and we very much can do the same when it comes to the findings around drugs. We recognize the impact that drug use has on this country, and too many of us have been touched by lives that have been cut short by an overdose, futures that have been significantly reduced or impacted by substance abuse dependence. Unfortunately, drugs hold back too many Americans from living up to the best things that they want to achieve in their lives.

And today’s findings give us some insights, information that’s going to be used to develop these evidence-based policies, not the policies of ideology and not the policies of which way the winds happen to be blowing on this issue but the evidence and the research and the data that’s needed to make a change. The young people represented in today’s studies are making decisions that really are going to define their future, and they’re going to define the future of this country. And the health of the next generation of Americans – of America’ leaders and innovators and citizens is just critically important to all of us. They deserve the strength and the support from us to make those healthy decisions and to choose a life that isn’t hindered by drug use. And that’s why the “Monitoring the Future” survey is so important, and it connects us to their experiences. And thanks to the work that’s gone on in this survey, we really do have the information that we need.

Well, the Obama administration is focused on one particular area most recently that Dr. Volkow mentioned, and that’s certainly prescription drug abuse. This year’s “Monitoring the Future” results show that that work has yielded some positive outcomes, including a decrease in the past month use of pain relievers by high school seniors. And to continue to help prevent the abuse of prescription drugs, we really encourage Americans to keep track of the prescription medications that are in their homes and to dispose of those unused or unneeded medications properly, and we have a lot of information on our websites that are very helpful to you in that. I think that the message that Dr. Koh presented on the anti-tobacco and the underage drinking issues are particularly important to the health of young people.

But in spite of the overall decline in the use of many illicit drugs, today’s survey also contains some disconcerting news. Marijuana use among teens remains at unacceptable levels, and it has increased in all three of the grade levels mentioned in recent years. There is another troubling point. Over the past several years the perception of harm and the perception of risk around the use of marijuana has declined, and the percentage of high school seniors who believe smoking marijuana regularly is harmful is lower than it has ever been since the 1970s. And historically, this dip in the perception not only leads to increased use, but we’ve certainly seen that in the survey’s results. In fact, more students now report smoking marijuana during the past month than they do smoking cigarettes.

Often users are uninformed and, frankly, they’re naïve about the dangers posed by the substances, the substances such as K2, the synthetic cannabinoids that have been receiving a lot of media attention and first were brought to the – to real awareness by the survey’s instrument results from two years ago; that was particularly helpful. We hope that we’ll start to see some decreases in the use of these synthetic cannabinoids, but the troubling number in the – in this survey particularly show that young people can tend to turn to those also. The most of the one-time use of 12th graders reporting synthetic cannabinoids is really alarmingly high, and despite – and of course, the psychotic effects and the stories that you’ve read in the press about the results of some of this – some of the use of this – of K2 is really very troubling.

We’re in a media environment that makes it difficult for parents and adult influencers to communicate the dangers of substance abuse, and we have to redouble our efforts to prevent more needless harm associated with it. In recent years we’ve seen an increase in the abuse of the stimulant Adderall among high school seniors, which had been accompanied by a decrease in the perception of risk associated with that drug. And with the availability of Adderall on college campuses having gone up, we have to carefully examine how young people are obtaining those drugs.

And that brings me to my final point. And while we’re re-examining how young people obtain Adderall, educating them about the dangers of the synthetic cannabinoids, showing them how marijuana use harms the developing brain, or empowering them to live free of tobacco and alcohol, the parents and the teachers and the coaches and the mentors and others can really have such an incredibly positive effect on young people’s lives, and prevention is very best tool that we have.

Our national media campaign is called “Above the Influence.” We’ve been amazed to see about 2 million young people that have taken up that message of prevention, and they make it their own, through their own interpretation of art and poetry and music and the written word, and I think that those are powerful statements, and we hope you take a look at that. We’ve been humbled to see the energy and the creativity of America’s youth as they assert their own aspects of being healthy, making positive choices in their lives and refuting the pro-drug messages that can so overwhelm them. We continue to support that spirit of prevention through that website, “Above the Influence,” and through that media campaign.

With that, I will turn this back over to Dr. Stein and thank you all very much. (Applause.)

MR. STEIN: And thank you, Director Kerlikowske.

Our next speaker’s Dr. Lloyd Johnston, who is the distinguished senior research scientist at the University of Michigan’s Institute for Social Research and the principal investigator of the “Monitoring the Future” studies since its inception in 1975, which is an amazing contribution that he has provided over these last several decades to understanding the trends in drug use amongst youth in our country. He served as an adviser to the White House, Congress, and many other national and international bodies and has conducted research on a wide variety of issues, including, of course, the use of alcohol, tobacco and various illicit drugs. So let me turn the podium over to Dr. Johnston. (Applause.)

LLOYD JOHNSTON: Thank you very much, and good morning to all of you. Pleased that so many of you have turned out. It’s a pleasure to again be able to announce results from a study joining Director Kerlikowske, Assistant Secretary Koh, NIDA Director Volkow. We all did this last year and hopefully next. Despite all those years, I actually get younger each – (laughter) – each time we do the survey – special arrangements upstairs.

You’ve heard a lot of the results of the (release ?). So I’m going to sort of focus on some of the highlights that I think are most interesting and most important this year.

One of those has to do with bath salts. You’ve heard a lot in the press about bath salts and how dangerous they can be, and I think – I believe that. But I don’t believe there’s been any very good empirical evidence of how extensive their use is. And for the first time this year we had it in the survey, and we find fortunately that the results are very low-level use. A little over 1 percent have used in the past year among 12th graders, less than 1 percent of the 8th and 10th graders. Now, that’s the good news. The – it could be that we’re getting in on a late downturn because according to the national poison control centers, their reports with bath salts went up dramatically in 2010 but have been declining since, dropped by more than half, and they’re still declining. So I think maybe what’s happened is, first of all, the FDA has scheduled some of the ingredients used in these over-the-counter drugs – which, by the way, have nothing to do with bath salts; that’s just the term that’s used to make them look legitimate. And in addition, I think the media coverage has been so intense about the adverse effects of bath salts that probably a lot of kids have gotten the message. So anyway, the main point is that we’re at low level compared to what we might have had.

Now, as you’ve – as you’ve heard synthetic marijuana, that’s not true. This is a synthetic drug that has really made inroads, and it’s the second most widely used drug among 8th and 10th graders, the third among 12th graders after marijuana in every case and after inhalants among the 8th graders. And today we have 11.3 percent of the seniors or one in every nine indicating that they’ve used synthetic marijuana, which they buy in various head shops or novelty stores of various kinds, in just the past year. And that’s disturbing. And what’s more disturbing, I think, is that it hasn’t gone down. It’s exactly where it was last year, and despite the fact the DEA scheduled a number of the drugs which are used in these substances.

Now, marijuana, of course, remains the most widely used of all the drugs. That hasn’t changed for many years. But after rising for four years, it actually leveled off this year, at perhaps an unacceptable level, but it has at least leveled off. The bad news, as you’ve heard, is that daily marijuana use has maintained at a high level, probably the highest in the last 30 years that we’ve seen, with 6 ½ percent of high school seniors saying they smoked pot daily in just the past month. And that’s about one in every 15 seniors. So if you’re looking at a class of 30 kids, two of them are heavy pot smokers, on average. And given the increasing information about the consequences of that, including dependence, including brain damage, including the effect on IQ, that is really of concern, I think.

There are positive developments this year for sure. Ecstasy is down. Salvia is down significantly. Inhalants are down. And taking heroin without using a needle is also down. That was the form of heroin use that really burgeoned in the ‘90s and had a lot of users to heroin, above what people were using with needles.

And other narcotic drugs, as you’ve heard, specifically OxyContin and Vicodin, were down significantly this year too, if we looked at the three grades combined. And the proportion of kids using prescription drugs of any kind has leveled for several years. It’s about 15 percent of the high school seniors who say that they’ve used one of the Rx drugs without medical supervision in the prior year. Those are things like amphetamines or sedatives or tranquilizers or narcotic analgesics.

Most of the remaining drugs, and there are many now, either held steady or showed no significant declines this year. Many of them are well below levels that they’ve been at, say, five or 10 years ago. The level drugs include some important ones, like cocaine and crack, methamphetamine, crystal methamphetamine, LSD, steroids.

Now, you’ve heard about a couple of the licit drugs. Cigarette smoking continues its long-term decline. It’s really quite a dramatic decline over the last 15 years. And it was down again this year from – if you average across the three grades – from 11.7 percent who used in the last 30 days to 10.6. That’s statistically significant. It’s about a 9 percent drop in the number of kids who are smoking. And I can’t really begin to tell you what that’s going to mean for the long-term health and longevity of these youngsters, as Dr. Koh has alluded.

Something else that I found this year was that – speaking of Dr. Koh, is that those other forms of tobacco that he’s particularly concerned about – smokeless tobacco, in general has declined, but the other forms, like hookah and dissolvable tobacco and so forth, all of those stayed level this year. So I think in a way, that’s good news. You’d like to see them down. Small cigars, too.

And alcohol is really at the lowest levels we’ve seen in the life of the study, as are cigarettes. And that’s pretty dramatic change, I think, for as inculturated a behavior as alcohol consumption is in this culture. But this year it only continued down among the eighth graders, leveled among the 10th, and the 12th graders actually showed a slight uptick, especially in binge drinking, where it went from 22 percent to 24 percent who said in the past two weeks they’ve had five or more drinks in a row at least once.

Alcohol availability to eighth graders did continue to decline, as did tobacco availability. So I think some policy efforts out there, probably at the local and state levels, are having an effect in cutting down access to these drugs for young people.

So to summarize, marijuana use is level, though daily use is still at unacceptably high levels. Synthetic marijuana use also has leveled, but it remains at a high rate, one in every nine 12th graders. Cigarette smoking is declining and is at historically low levels. Alcohol use is declining, but it’s up a little in the 12th grade. And a number of the specific illicit drugs, including some very important ones, are declining.

And finally, as I started, bath salts have not made a very serious inroad at this point. I think that’s encouraging.

Thank you. (Applause.)

MR. STEIN: Thank you, Dr. Johnston.

Before we open it up for questions from the press, we thought it would be important to ground us in terms of people who are most affected by the findings of the survey, and that really is our future generations. And we came upon our next speaker, Mr. Chris Leibowitz, a couple of months ago at a town forum in Arlington, Virginia, and were so struck by his story that we invited Chris to come and join us today to speak briefly about his experiences and help us get a better perspective of how the impact that these findings may have in our future prevention efforts. Chris. (Applause.)

CHRIS LEIBOWITZ: Hi. Thanks for having me up here. I don’t necessarily feel qualified to stand up here with you guys, but what are you going to do; I’m here. (Laughter.)

So I’ve never done bath salts. I was just thinking about that. But I know for me, when I was using drugs, I probably would have used bath salts if it was available, because my drug of choice was “yes”; like, I’ll take it, whatever it was laid out in front of me. But it started with using marijuana because – a couple of you guys were talking about alcohol and marijuana – or alcohol and cigarettes – they weren’t really available when I was 13, and – you know, they were controlled and you needed an ID. And when you’re 13, it’s hard to have a fake ID that says you’re 21.

So marijuana was available, and it was natural, man. It’s – you can smoke it, it’s all good. And that’s what I did. And I was terrified of it. You know, everyone told me it was a gateway drug. And then my friends were, like, Dude, that’s propaganda, man, it’s all right. So I ended up smoking weed when I was – marijuana when I was 13.

And, you know, it hit me and it had this effect that I wanted, and I chased that and I built my life around that, pretty much. My group of friends sort of dropped off and I started hanging out with people who smoked marijuana like I did. That was it. And, you know, eventually it wasn’t enough. Eventually, just smoking marijuana was not enough.

And I remember the first time I did something else. I was at a party and I was high from smoking, and someone put out this white line in front of me. And I was like, what’s that? And they were, like, it’s cocaine, man; it’s just coke. And I was terrified. I think I was, like, 16, and I was terrified of it because of all the stuff that I heard. But the only thing that came out of my mouth was, yes. And I did it.

And I remember looking back a couple minutes after I did it, like, oh, my god, I just did cocaine; oh, my god, what am I going to do? And, you know, what I proceeded to do was use more cocaine for the next couple months. And, you know, just like what a couple people were talking about up here, I ended up getting Vicodin from one of our friend’s parents’ medicine cabinets, and I took that. And it was like – you know, it was – my tolerance was getting higher and higher with these other drugs, and when I took that, I had this feeling; I was like, yes, that’s what I want.

And eventually – I grew up in McLean, Virginia, and OxyContin sort of just flooded, flooded our town. And we used there. I used it a lot. And eventually, you know, I started – somehow, I started dealing drugs. I was this OxyContin drug dealer before I even knew it, and, you know, started going through withdrawals through the drug.

And, you know, the people started cracking down on OxyContin use, and it was harder to find. And someone was like, hey, man, you know, heroin is – all of a sudden we were scientists or something – like, it’s only a couple molecules away from OxyContin, man. (Laughter.) It’s really not that different. And I was like, OK, couple molecules. It’s nothing. Yeah, I’ll do that.

And you know, that night I shot up heroin and I remember – I remember the same moment – I kept having these moments of did I just shoot up heroin? Like, what is going on? I need to stop and – but I didn’t, and eventually my tolerance got high with that, and – just like with any drug. And I had to steal – you know, I’m a convicted felon today because I was stealing every day to get my drugs. I needed the drugs. My whole life was these drugs, and I needed these drugs.

And when you steal every day, you go to jail is what happens. And I went to jail. And you know, finally, you know, it’s like – reality hit me, and it’s like, what are you doing? And it took a couple times of going to jail, you know. It took the last time of them putting me in jail and the magistrate saying, no, you’re not getting a bond today. You keep doing the same thing every time we let you out, so you’re staying in here.

And so that’s when reality hit me in the face, and you know, I eventually got out of there a couple months on the conditions that I go to treatment. And I ended up going in this treatment center called A New Beginning in Chantilly, Virginia, and you know, I stayed there for three months – and that was in January 2010 – and been clean since.

But you know, it – what the – what the people that I talk to at National Institute on Drug Abuse wanted me to talk about was, you know, I don’t think I ever would have snorted that line of cocaine if I wasn’t high that night, you know – not saying I’m a victim of marijuana. I don’t think I’m a victim of anything. I chose what I chose, and I – you know, I’m here today because of that. But you know, I would have never gone from growing up in McLean and playing sports and doing all the things that I was to injecting heroin. You know what I mean? That never would have happened. Any of the people that I meet today that have the same story that I have, it never happened like that. It was a very slow lowering of the bar, really, not raising it, you know. And you know, for me, my start was smoking marijuana. It sort of opened up – opened up this world that led me to being a convicted felon and, you know, whatever.

So – but I’m really grateful to be here. I don’t really know what I’m doing here. I was telling my friends like – all these speakers, like, have – you know, directors and, like, Ph.D.s and doctors and it’s like, I work at Starbucks, man, like – (laughter, applause) – I really don’t know what the hell I’m doing here.

But yeah, one day – like I – like I’m going to school for social work, and I do – I hope to, you know, work with – have my own practice or, you know, work in a treatment center working with adolescents in – who are in addictions.

So I’m really grateful to be here and meet you guys. So thanks. (Applause.)

MR. STEIN: Chris, you are more than qualified to be here. (Laughter.) Trust us. Thank you for your – sharing your thoughts.

We have some time now, of course, and we’d like to open the microphone up to questions from the – from the media. We’ll be fielding questions from the media here in the room first and then we have some who are on the phone and may be chiming in then as well.

After the event is over, for those of you who are not with the media, our panelists – some of them will be available to interact with you on a one-on-one basis. So we’re happy to extend the invite to you in that respect.

So if there – I don’t think there’s a floating microphone, so – there is. OK. So please state your name and the affiliation with your – that you are with.

Q: OK. Donna Leinwand Leger with USA Today. This is for anyone who wants to take it. What impact do you think the state – the various state debates on legalizing medical marijuana or decriminalizing marijuana has had on youth perceptions and this sort of high use of daily marijuana among teenagers?

MR. STEIN: Dr. Volkow?

DR. VOLKOW: What we’ve been seeing –for example, just to answer that question with respect to prescription drug use, we were interested on knowing why kids were starting to favor these drugs, and one of the consistent findings is their belief that because they are being prescribed for medical purposes, they’re actually much less risky. So if you extrapolate that to the dialogue of whether marijuana has potentially therapeutic effects, if not, the message is that, we’re saying, is equivalent to that of the prescription medications: Because they are prescribed for medical purposes, they could not be so harmful. So that, I think, is one of the element that’s contributing.

At the same time, we also recognize that individuals – one of the factors that contributes for people not using drugs is their illegal quality. And that is a deterrent for many individuals. And when you start to have a debate and you have some of the states where this is actually no longer the case, then that deterrent is not present. So we can actually ascribe those two factors to contributing to increasing the likelihood of people getting exposed to the use of marijuana.

MR. STEIN: Thank you.

Other questions from the floor, from the press? OK. Yeah.

Q: (Off mic.) (Laughter.)

MR. STEIN: OK. USA Today. Yeah.

Q: USA Today, yeah. This is for Chris. How old are you now? And what were some of the things that affected your perceptions of the risk of marijuana?

MR. LEIBOWITZ: I’m 25. And the – I guess some of the biggest perceptions that I had – the influences I had on my perception of marijuana was the people around me, like my older sister, I knew, had used marijuana, and her boyfriend – and I remember – I looked up to him and, you know, sort of people in my neighborhood, the cool kids in school – that’s sort of the perceptions that I had.

Also I remember hearing some stuff during like health class about it but the only thing that I remember about marijuana – us being taught was that it wasn’t addictive. That’s the only thing I remember about that.

MR. STEIN: Thanks, Chris.

MR. : Which is untrue.

MR. STEIN: If there are none from the floor, I will –

MS. : (Off mic.)

MR. STEIN: Is there one over there? Yes, sir. Again, please identify yourself and thank you.

Q: I’m Patrick Healey (sp) from Gonzaga College High School, a member of the Community for Concern. Do you see a higher risk of substance abuse in a youth’s household where an older sibling has used drugs, compared to when an older sibling hasn’t? (Inaudible.)

MR. STEIN: Do you want to take that?

DR. VOLKOW: Actually, that’s a very good question, and even though I have not seen specifically surveys to try to actually address that, I would basically predict that you will, because, for example, what we’ve – what surveys have shown is that the perception that kids have of other kids using drugs is a very good predictor of whether they would take that drug or not. So if they’re perceiving that others are actually taking that drug, they’re much more likely to do it. And I think that Chris’ response also attests to that.

So – and kids are very much – we actually all, as humans, imitate our entourage and we learn from others. And the relationship with siblings is probably one of the closest ones.

MR. STEIN: Great. Thank you. Thanks for that question.

Are there – is there a question there? Yes, please.

Q: Hi. I’m Monique Endaga (ph) from School without Walls. And do you believe that incarceration and mandatory minimum sentencing for substance abuse is more effective than rehab and community-based programs?

MR. KERLIKOWSKE: I can grab that.

I think if you look at President Obama’s drug strategy, the very first one that was issued in his administration, in 2010, it’s very clear that not talking about this as a war on drugs, that minimum mandatory sentences, the president was the first president in four decades to actually reduce a minimum mandatory sentence, and that was on crack and powder cocaine. And he did that in a bipartisan way with Congress.

So the focus of the president’s drug strategy is all around public health, public education, prevention programs, et cetera, and we’re seeing that same federal policy being used by a number of states. So I don’t think we could be any clearer that incarceration levels and minimum mandatory sentences for drug addiction and use of drugs, not drug trafficking – and use of drugs is not a particularly effective way. And we’ve seen a very great movement away from that both at the federal level and at the state level.

MR. STEIN: Oh, there’s a reporter from the phone. Can we open that line?

OPERATOR: You have a question from the line of Dirk Hanson with Addiction Inbox. Please go ahead with your question. (Background noise.) And Dirk Hanson, your line is open. Please go ahead with your question.

Q: Yes, this is Dirk Hanson with Addiction Inbox, and I was wondering if Dr. Volkow could comment on the question of whether or not we believe at this point that bath salts and Spice-type synthetic marijuana are, in fact, addictive drugs.

DR. VOLKOW: Yes, and the answer is, actually, we know that they are addictive drugs. The bath salts are stimulant-like drugs with some perceptual distortion properties. But from work that has been done for many years on this type of compound, we know that they actually can be addictive. With respect to the cannabinoids, now it is the data unequivocally shows, whether we want to accept it or not, that drugs that target the cannabinoid receptor actually can produce addiction in those individuals that are vulnerable.

MR. STEIN: Thank you. Is there a hand up there?

Q: Hi, I am Mimi Fleury, and I’m the president and the co-founder of the Community of Concern, which is an initiative to educate parents about the effects of alcohol, tobacco and other drugs on young people.

My question relates to the use of marijuana. Are there any studies that show brain imaging relating to the effects of marijuana on the development of young brains?

DR. VOLKOW: Yes, and actually it’s very interesting, because this year there were two really important studies that showed – and that’s why I felt comfortable to say clearly giving evidence that the effects of marijuana during adolescence are deleterious for the human brain. And both of those studies – one of them was done on imaging, and the other one was measuring IQ – did basically demonstrate that when individuals were exposed to marijuana during adolescence, though they didn’t show any effects when the exposure was in adulthood, got significant changes both in the connectivity of the brain, on the one hand, and on having lower IQ on the other.

The brain imaging study actually was very interesting, because it specifically showed that the fibers that connect the hippocampus, which is the area of the brain involved with memory and crucial for learning, actually were dramatically reduced. And when I speak “dramatically,” it was a 90 percent reduction in the density of the fibers that were connecting with the hippocampus only in those individuals that had been exposed during adolescence consistently to marijuana.

And the other study, which showed that lower IQ, was also a very important study, because it actually was one of the first ones on a large sample size to document a decreasing IQ even after they have corrected for the IQ of those individuals before they got exposed to marijuana, which has always been a criticism of studies: How do you know that this lower cognitive performance on these kids taking marijuana is not because they started with a lower IQ? So these two studies allow us to answer, at this point, that exposure to marijuana during adolescence is actually harmful for the brain.

MR. STEIN: Thank you. We are almost out of time, and so we could probably field one more question from the – from the press, and if not, we can begin to conclude. OK.

With that, I would like to thank everyone for their attendance here. A quick reminder that the NIDA’s National Drug Facts Week begins January 28th. You can find more about that on our website at

And with that, I’d like to thank all of our panelists and for you all to be in attendance today and to be tracking the activities of this event on the NIDA website as well. So thank you all. (Applause.)