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Substance abuse among children and adolescents.

1. Marc Fishman, MD*
2. Ann Bruner, MD†
3. Hoover Adger Jr, MD MPH‡


 

1. 

2. *Department of Psychiatry and Behavioral Sciences

3. 

4. †Department of Pediatrics, the Johns Hopkins University School of Medicine, Baltimore, MD.

5. ‡Deputy Director, Office of Drug Control Policy, Washington, DC.

1. The prevalence of drug use has increased over the past 5 years, while the age of first use has decreased.

2. Substance abuse in the family is a major risk factor for adolescent substance abuse.

3. Pediatricians are ideally situated to screen for substance abuse; can perform the initial assessment; and can provide support, counseling, referral, and education/prevention about substance abuse to adolescents and their families.

4. Substance abuse should be included in the differential diagnosis for any child or adolescent who exhibits a change in behavior (school performance/attendance, family relationships).

5. Substance abuse and dependence are multifactorial and multi-dimensional disorders that have no single etiology.

Alcohol and other drug use poses a serious threat to the health of children and adolescents. In addition to the health risks inherent with alcohol and other drug use, substance abuse often is linked with other risk behaviors (early sexual activity, violence, academic failure, truancy/ school dropout, delinquency). Pediatricians and other primary care providers are in an ideal position to identify substance abuse and to provide preventive guidance and education to children, adolescents, and their families. In this article, we use the term substance abuse to refer to substance use disorders in general, including abuse and dependence, unless otherwise specified.

Following declines in the late 1980s and early 1990s, prevalence rates of alcohol and other drug (AOD) use among adolescents are increasing again. The proportion of eighth graders using an illicit drug in the past year nearly doubled in the period from 1991 to 1995 (11% to 21%). Almost 40% of 1995 high school seniors reported use of some type of illicit drug in the past 12 months (up from 30% in 1991). Overall, one of every two adolescents has tried an illicit drug by the time he or she graduates from high school. The most common drug …