Office recognition and management of adolescent substance abuse

Purpose of review: Substance misuse and substance use disorders are important pediatric public health concerns. The prevalence is high, beginning in adolescence through adulthood, and there is marked morbidity. This is especially true in the adolescent population, in whom the three leading causes of death are all associated with substance abuse. The primary care physician is ideally situated to recognize, prevent, and triage significant substance abuse problems. This review will provide recent, relevant information for primary care physicians (PCP) to enable them to have the current knowledge, tools, and attitudes needed to address these issues. Recent findings: Epidemiologic studies continue to document the widespread use of licit and illicit substances by youth. Understanding of substance use disorders is moving forward with an increasing clarity of the multiple factors important in the development of these disorders. This has already led to the establishment of effective prevention programs, which may be applicable to the primary care setting. Research into psychosocial treatment is proceeding rapidly, and psychopharmacologic approaches are also being investigated. Evidence-supported approaches to treatment now exist. Summary: Substance abuse in youth is a serious public health problem, with significant morbidity and mortality. The primary care physician can make major inroads into effective prevention and treatment by recognizing and addressing these issues in the outpatient office setting.