++
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.
++