Substance use is common among children, especially adolescents. Regardless of economic or ethnic background, alcohol, tobacco, and marijuana are consistently the most commonly used substances. Use of other substances, including amphetamines and methamphetamines, inhalants, hallucinogens, cocaine, anabolic steroids, opioids, and so-called date rape drugs and club drugs (eg, methylenedioxymethamphetamine [MDMA], ketamine, gamma hydroxybutyrate), is less common, and the prevalence of use of each varies more over time. Of growing concern is a reported increase in the prevalence of prescription opioid abuse.

Children and adolescents use drugs for a variety of reasons. Some do so to escape from perceived pressures (eg, parental pressure, societal pressure) or to challenge authority; others are disposed to novelty seeking and risk taking. Influence of peers and the media's portrayal of substances such as alcohol are other commonly cited reasons. Poor self-control, lack of parental monitoring, or various psychologic disorders (eg, conduct disorder, attention-deficit/hyperactivity disorder, depression) may increase risk. Parental attitudes and the examples that parents set in their own use of alcohol, tobacco, prescription drugs, and other substances are a powerful influence.

Diagnosis

• Screening

Primary care physicians should be prepared to screen their adolescent patients for use of alcohol and drinking and provide counseling and, when necessary, referral to other treatment services and resources. The CRAFFT questionnaire is one validated screening tool. Patients with ≥ 2 positive answers require further evaluation. Physicians ask patients whether they do or have done the following:

• C: Ride in a Car driven by someone (including themselves) who is “high” or has been drinking alcohol or using drugs
• R: Drink alcohol or use drugs to Relax, feel better about themselves, or fit in
• A: Drink alcohol or use drugs while they are Alone
• F: Forget things they did while drinking or using drugs
• F: Are ever told by family members or Friends that they should drink or use drugs less
• T: Get into Trouble while drinking or using drugs

Last full review/revision July 2008 by Patrick G. O'Connor, MD, MPH