Understanding and preventing substance abuse by adolescents: a guide for primary care clinicians

Substance abuse in adolescents: a complex conundrum for the clinician

Substance abuse remains a complex and pervasive conundrum for society and for clinicians seeking to improve the lives of their pediatric patients. Substance abuse is linked to the human instinct for pleasure at any cost and is fueled by enticing encouragement of the media teaching society to seek drug-induced pleasure without fear of negative consequences. Other complications are the limited education about psychoactive substances provided to youth and the health care profession pledged to serve them. Primary care clinicians must provide their adolescent patients with adequate screening and counseling about substance abuse. Treatment of the substance-abusing patient is often a combination of behavioral interventions (including family therapy), and, in limited situations, addiction-specific medications. Research suggests that female drug addicts have a better outcome in female-only drug treatment programs. In addition, new drugs are being developed that target specific brain mechanisms involved in drug addiction; these drugs will have less toxicity and less abuse potential than illicit drugs such as cocaine. Vaccines are being developed that will block the effects of such drugs as cocaine and PCP. Medications developed for the treatment of depression and epilepsy will be a source of medications for the treatment of drug addiction. The study of endorphins and the neurobiology of stress and substance abuse promise to develop potent anti-addiction chemicals, greatly aiding in the war on drug abuse.

Diagnosis and treatment of teen drug use

Small but significant decreases in adolescent abuse of tobacco, alcohol, and marijuana in recent national surveys allow clinicians to feel some optimism about defeating the specter of substance abuse. It appears that changing the perception of risk and increasing adolescent disapproval of substance abuse are key goals. For every adolescent, reducing risk factors while identifying and enhancing protective factors optimizes an individual's opportunity to avoid potentially harmful behaviors. While focusing energy and commitment on each adolescent, however, clinicians cannot ignore the need for wider social change because the proximal adolescent domains of individual, family, and school factors are interrelated and embedded in the community and societal contexts. Every sector in society plays a crucial role in preventing adolescents from experimenting with and continuing to abuse tobacco, alcohol, or illicit drugs, from parents, physicians, educators, and policy makers to every adult invested in the health and well-being of adolescents.