Adolescent substance abuse. Recognition and early intervention.

Adolescent substance abuse is a common problem, with 90% of high school seniors reporting alcohol use and nearly half reporting some illicit drug use. Substance abuse interferes with the developmental tasks of adolescence: establishing an adult identity, achieving independence from parents and family, and learning to form intimate relationships with others. Although not all adolescent substance abuse leads to chemical dependency, even initial experimentation can have disastrous or fatal consequences. The early signs and symptoms of substance abuse are subtle, frequently presenting as behavioral changes, and less often as physical or laboratory findings. Early stages of substance abuse may be treated by the primary care physician in outpatient treatment settings. More advanced stages usually require inpatient treatment and should be referred to specialists in adolescent substance abuse treatment. Family involvement is a critical part of the treatment process. In addition to a key role in the early diagnosis, intervention, and referral of substance abuse problems, the primary care physician is an important source of support, reinforcement, and continuity in the aftercare program once the adolescent has completed initial substance abuse treatment.