Adolescent Substance Abuse Treatment

A healthy 16-year-old boy comes to your office with his parents, who are afraid of his months of bad behavior.

Patient Detail:

A healthy 16-year-old boy comes to your office with his parents, who are afraid of his months of bad behavior. Sometimes he has more energy, decreased appetite and needs less sleep than usual; other times he sleeps non-stop and weakly. He didn't do well at school. He looked blushing last night and was overwhelmed, had a growing number of students, and complained that "people were there to get him." The family remarked that he would jump to school at any moment, and they were reluctant to announce that he had been arrested 2 weeks ago for robbery. You know he's in good health and he used to be a good student. It looks normal now.


Summary: A 16-year-old previously healthy teenager with recent behavioral changes and reduced school performance.

Most likely diagnosis: Drug abuse (possibly cocaine, maybe amphetamine).

Gjende The following evaluation steps: History, research, urine drug screening and screening for other commonly associated consequences of drug abuse (sexually transmitted infections [STI], hepatitis).

Lange Long-term assessment and therapy: three approaches: (1) detoxification program, (2) follow-up with a developmentally appropriate psychosocial support system, and (3) possible long-term assistance with a substance abuse management specialist. INVESTIGATION


1. Learn to see patterns of behavior in young people who abuse drugs.

2. Know the signs and symptoms of frequent drug abuse.

3. Understand a general approach to therapy for an adolescent who abuses drugs.


Rarely can a brain tumor explain to an adolescent that there has been a new onset of behavioral change. In general, however, new onset behaviors, depression, or declining rates in adolescents are more often associated with substance abuse. An undiagnosed psychiatric history (mania or bipolar disorder) should also be considered. Anamnesis, family history, physical examination (especially neurological and psychological aspects) and laboratory screening may help to explain. The information may come from the patient, his family or other stakeholders (teachers, trainers and friends). Asking teens directly about substance abuse itself is helpful during a routine medical visit or if signs and symptoms suggest abuse.

Adolescent Substance Abuse Treatment


SUBSTANCE USE: The use of alcohol or other drugs, which results in harm or anxiety, causes non-compliance at school or work, physical injury, legal issues related to the substance or continued use, even social or interpersonal consequences resulting from the effects of the drug.

SUBSTANCE DEPENDENCE: Use of alcohol and other drugs causing loss of control over further use (requiring a higher dose or discontinuation after discontinuation), forced and drug use, and continued use despite persistent or repeated side effects.


Experimentation with alcohol and other drugs is common in adolescents; others consider this experiment to be "normal." Some argue that it should be prevented because substance abuse is a common cause of illness and death in adolescents (homicides, suicides and unintentional injuries). In any case, the health insurance company is responsible for discussing the facts about alcohol and drugs in an effort to reduce the risk of harm to minors and identify the need.

Children at risk of drug use include children with significant behavioral problems, learning disabilities, and family disorders. The most commonly used drugs are cigarettes and alcohol; Marijuana is the most common illegal drug. Some adolescents abuse common household products (inhaling glue or aerosol); others abuse drugs from siblings (methylphenidate, which is often used with cocaine).

Pediatricians may ask about their alcohol or drug use during the adolescent's annual health check, or if the adolescent has evidence of substance abuse. Direct questions identify drug or alcohol use and its impact on school performance, family relationships, and peer interactions. If problems are identified, an interview is needed to find out the level of drug use (experimentation, abuse or self-confidence).

Signs of a history of drug use include significant changes in household behavior, decreased performance at school or work, or involvement in the law. Additional cases of intentional or accidental injury may be related to alcohol or drugs. Activities that take risks (selling sex for drugs, driving in a wheelchair) may be more serious and may indicate serious drug problems. Alcohol or other drug users often have a normal diagnosis, especially if it is not a recent use. Needle marking and the presence of nasal mucosa are rare.

An adolescent with recent alcohol or drug use may have several findings (Table 2-1). A urine drug test (UDS) can help evaluate an adolescent who has (1) psychiatric signs, (2) signs and symptoms that are normally caused by drugs or alcohol, (3) has a serious accident, or (4) is part of a monitoring program recovery. It is paramount to try to obtain permission from minors and maintain confidentiality. The treatment of serious life-threatening problems related to alcohol or drug use is governed by ABC Emergency Care: Airway Management, Respiratory Control and Circulatory Assessment. Treatment is then targeted at the abusive agent (as is known). After stabilization, a treatment plan was developed. For some, outpatient drug disruption programs are for ongoing outpatient therapy. For others, an intensive outpatient treatment program can be launched to help develop a drug-free lifestyle. The skill needed to help a teenager go through these changes often exceeds that of a practical pediatrician. Helping this common problem of qualified health professionals in an institution worthy of improvement can increase the outcome. However, primary care providers can help families find appropriate community resources.

Understanding issues

The 14-year-old had ataxia. He was taken to the local emergency room, where he seemed euphoric, emotionally unstable, and somewhat ill. He had nystagmus and hypersalivation. Many noticed his offensive language. Which of the following agents is considered responsible for his condition?A. Alcohol

B. Amphetamines

C. Barbiturates

D. Cocaine

E. Phencyclidine (PCP)

Parents bring their 16-year-old daughter for a “well-child” checkup. She looks normal on examination. As part of your routine care you plan a urinalysis. The father pulls you aside and asks you to secretly run a urine drug screen (UDS) on his daughter. Which of the follow-ing is the most appropriate course of action?

A. Explore the reasons for the request with the parents and the ado-lescent, and perform a UDS with the adolescent’s permission if the history warrants.

B. Perform the UDS as requested, but have the family and the girl return for the results.

C. Perform the UDS in the manner requested.

D. Refer the adolescent to a psychiatrist for further evaluation.

E. Tell the family to bring the adolescent back for a UDS when she is exhibiting signs or symptoms such as euphoria or ataxia.

A previously healthy adolescent male has a 3-month history of increas-ing headaches, blurred vision, and personality changes. Previously he admitted to marijuana experimentation more than 1 year ago. On examination he is a healthy, athletic-appearing 17-year-old with decreased extraocular range of motion and left eye visual acuity. Which of the following is the best next step in his management?

A. Acetaminophen and ophthalmology referral

B. Glucose measurement

C. Neuroimaging

D. Trial of methysergide (Sansert) for migraine

E. Urine drug screen

An 11-year-old girl has dizziness, pupillary dilatation, nausea, fever, tachycardia, and facial flushing. She says she can “see” sound and “hear” colors. The agent likely to be responsible is which of the fol-lowing?

A. Alcohol

B. Amphetamines

C. Ecstasy

D. Lysergic acid diethylamide (LSD)



E. PCP is associated with hyperactivity, hallucinations, rough tongue and nystagmus.

A. Adolescent consent must be obtained before drug testing. Attempting to "conceal" in this situation can destroy the doctor's and the patient's relationship. C. Despite previous drug experiments, its current symptoms and physical findings make drug use a less likely etiology. An evaluation of a possible brain tumor is required.

D. LSD is associated with symptoms that begin 30 to 60 minutes after ingestion, peak 2 to 4 hours later, and resolve within 10 to 12 hours, including delusions, bodily distortion, and paranoia. "Bad trips" result in fear or confusion among the user; Treatment is normal to provide the user with a controlled and safe environment.

Clinical pearl

➤ Cigarettes and alcohol are the most commonly used drugs in adolescence.

➤ Marijuana is the most banned drug used in adolescence.

➤ Addictive substances include drug trafficking, prostitution, theft, unprotected sex, traffic accidents and physical violence.

➤ Children at risk of drug use include children with significant behavioral problems, learning disabilities, and limited family functions.


Heyman RB. Adolescent substance abuse and other high-risk behaviors. In: McMillan

JA, Feigin RD, DeAngelis CD, Jones MD, eds. Oski’s Pediatrics: Principles and Practice. 4th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2006:579-584. Jenkins RR, Adger H. Substance abuse. In: Kleigman RM, Behrman RE, Jenson HB,

Stanton BF, eds. Nelson Textbook of Pediatrics. 18th ed. Philadelphia, PA: WB Saunders; 2007:824-834.

Marcell AV, Irwin CE. Substance use and abuse. In: Rudolph CD, Rudolph AM,

Hostetter MK, Lister G, Siegel NJ, eds. Rudolph’s Pediatrics. 21st ed. New York, NY: McGraw-Hill; 2003:226-231.

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