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
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.
Table 71-1. Common Substances
of Abuse by Adolescents* |Favorite Table|Download (.pdf)
Table 71-1. Common Substances
of Abuse by Adolescents*
|Substance (Active Ingredient)||Commercial/Street Drug Names||Route||Onset of Action/Duration ||Intoxication Effects||Withdrawal Symptoms||Potential Consequences|
|Alcohol (Ethanol)||Booze, brew, juice, beer, 40 ounce||Ingested|
- Onset: within 10 min
- Peak: 40–60 min
- Duration: based on amount consumed,
drinking rate, and food intake
- Symptoms depend on BAL (measured as mg % = mg ethanol mL blood, mg/dL)
- Mild intoxication (BAL < 100 mg/dL): altered cognition, disinhibition, euphoria, talkativeness
- Moderate intoxication (BAL 100–200 mg/dL): sedation, slurred speech, impaired mentation, incoordination
- Severe intoxication (BAL > 200 mg/dL): dehydration,
hypothermia, hypoglycemia, lactic acidosis, stupor, cardiorespiratory
compromise. Eye findings: nystagmus, normal pupil size
- Legal intoxication: BAL 0.05–0.10%
- Early symptoms: anxiety, insomnia, irritability,
hypertension, tachycardia, nausea/vomiting, hyperthermia, tremulousness,
mydriasis, confusion, headache
- Late symptoms: seizures, alcohol
hallucinosis, respiratory ...
Log In to View More
If you don't have a subscription, please view our individual subscription options below to find out how you can gain access to this content.
Want remote access to your institution's subscription?
Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.
If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.
AccessPediatrics Full Site: One-Year Subscription
Connect to the full suite of AccessPediatrics content and resources including 20+ textbooks such as Rudolph’s Pediatrics and The Pediatric Practice series, high-quality procedural videos, images, and animations, interactive board review, an integrated pediatric drug database, and more.
Pay Per View: Timed Access to all of AccessPediatrics
24 Hour Subscription $34.95
48 Hour Subscription $54.95
Pop-up div Successfully Displayed
This div only appears when the trigger link is hovered over.
Otherwise it is hidden from view.