Emotional distress is a known risk factor for substance use among youth. 

A special note about 2021 YRBS data: The data from the 2021 YRBS should be interpreted with caution as due to the COVID-19 pandemic, this year’s YRBS was done in the fall instead of the usual spring timeline, meaning that students were overall younger when they completed the survey. In addition, students who participated in the 2021 YRBS may have had a different educational and social experience compared to previous participants. Disruptions, including remote learning, lack of social interactions and extracurricular activities, are likely reflected in the survey results.

Reference: 

National Research Council and Institute of Medicine. (2009). Preventing Mental, Emotional, and Behavioral Disorders Among Young People: Progress and Possibilities. Committee on the Prevention of Mental Disorders and Substance Abuse Among Children, Youth, and Young Adults: Research Advances and Promising Interventions. Mary Ellen O’Connell, Thomas Boat, and Kenneth E. Warner, Editors. Board on Children, Youth, and Families, Division of Behavioral and Social Sciences and Education. Washington, DC: The National Academies Press.