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Substance use and abuse in adolescence is a major public health problem. Identification of adolescents at risk or those currently abusing substances in the health care setting is often missed, or the substance abuse undertreated. Although the prevalence for substance use over the past decade has decreased from higher rates in the late 1970s, the 2007 lifetime prevalence rates of alcohol use and cigarette smoking among adolescents remain high at 72.2% and 46.2% respectively.1,2 Lifelong substance use habits are formed during adolescence and young adulthood and are associated with short-term and long-term health consequences.


Substance use begins in adolescence or earlier. Among 8th-grade students, the peak years for smoking initiation are between 11 and 13 years of age.1 The average age of first use of alcohol is 14 years,3 and first marijuana use is 16.1 years.4 The most common drugs of use and abuse include alcohol, nicotine, and marijuana. Other substances are drugs used as part of the nightclub/bar and trance scenes, such as ecstasy, rohypnol, γ-hydroxybutyrate, and ketamine. Substances also include over-the-counter drugs, such as sleeping aids, cough and cold medicines and inhalants; and prescription medications, such as pain relievers, amphetamines, and stimulants.


There is no pathognomonic clinical presentation of drug abuse. Signs of drug abuse in an adolescent may manifest in an increasing degree of emotional and physical isolation from the rest of the family, absent or hostile communication, deteriorating school attendance/performance, decrease in athletic performance, a change in peer group, crime involvement, and unplanned/unsafe sexual practices. Known risk factors for the development of substance abuse and dependence are multifold and include male gender, household member drug abuse (eg, by parents), use by peers, earlier age of onset, cognitive disability, and psychiatric comorbidities such as attention deficit hyperactivity disorder and depression.


Common Substances of Abuse


Table 71-1 provides a summary of common substances; examples of commercial and street drug names; route of administration; onset of action and duration; and common intoxication effects, withdrawal symptoms and potential consequences.

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Table 71-1. Common Substances of Abuse by Adolescents*

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