Experimentation with a variety of substances, especially alcohol, tobacco, and marijuana, is common among adolescents. Many adolescents use substances frequently, even daily, including legally available substances (alcohol, tobacco, inhalants, prescription drugs, wild plants) as well as illicit drugs (marijuana, cocaine, narcotics, numerous hallucinogens.) According to the 2009 Youth Risk Behavior Surveillance (Centers for Disease Control and Prevention), among U.S. high school students, 34% of females and 39% of males have used marijuana at least once, 18% of females and 23% of males have used it in the past month. Five percent of females and 10% of males report using marijuana for the first time before age 13 years. Inhalant use is reported by 13% of females and 10% of males, Ecstasy by 5% of females and 7% of males.
The most serious short-term risk of substance abuse is unintended overdose and even sudden death due to ignorance of the harmful effects of a specific amount of any substance, unawareness of unidentified additives, or misperceptions of safety in its use. Intoxication with any substance can produce drowsiness, inattention, or loss of coordination leading to risk of injury while driving or participating in any physical activity. Intoxication can affect judgment in sexual relationships, increasing the risk of unintended, often unprotected sexual intercourse and even acquaintance rape. Some substances increase aggressive behavior leading to interpersonal violence. Substance use can complicate underlying chronic illnesses such as hypertension or diabetes. Many substances pose risk to the fetus, especially in the pregnant adolescent who is not yet diagnosed or is in denial. Intravenous use, uncommon in adolescents, carries risk of infections (skin bacteria, hepatitis B or C, HIV). Buying, selling, or even using any illegal substance can lead to arrest and detention.
Adolescents may try one or more substances (experimentation), especially when coaxed or pressured by friends, but many do not continue use or use very infrequently. Adolescents may use substances to satisfy curiosity, to experience pleasurable feelings (“get high”), to be socially accepted, or to deal with boredom or stress. Risk factors for substance abuse (problem drug use) include substance abuse by parents, siblings, or peers, family problems, poor school performance, mood or anxiety disorders, use of tobacco and/or alcohol, history of physical or sexual abuse, and other behavioral problems.
ACOG recommends that Obstetricians/Gynecologists and other providers of health care to adolescents should ask about use of substances, as well as alcohol and tobacco, as part of the routine health history during any preventive health visit. If the adolescent admits use, the extent and potential risks of use of each substance should be addressed. The CRAFFT questionnaire has been validated for assessing alcohol and substance use in adolescents (Knight, 2002). A positive response of 2 or more items indicates that substance use is problematic due to frequency, extent, and/or health risks. The adolescent should be assisted in further evaluation and treatment and referred directly to a substance abuse treatment provider or to his or her primary care provider. In addition, female adolescents who are abusing substances should be counseled and assisted in using effective contraception. Parents who are concerned about possible substance use/abuse in their daughter or son should be directed to their child’s primary care provider or the state’s public health substance abuse agency for further discussion and appropriate evaluation and referral. To find an appropriate substance abuse provider within a geographic area, go to the SAMHSA substance abuse treatment finder: www.findtreatment.samhsa.gov.
The following resources are listed to assist health professionals in educating patients and their parents about the health risks of substance use, approaches to diagnosis and treatment, and strategies for reducing or preventing substance use. Resources also will inform health professionals about the extent of adolescent substance use, contributing factors, and strategies for clinical assessment, intervention and prevention. Additional related resources can be found in the ACOG Resource Guides: Adolescents and Alcohol and Adolescents and Tobacco.
The following resources are available from ACOG:
American College of Obstetricians and Gynecologists. Alcohol, tobacco, and other substance use and abuse. In: Guidelines for adolescent health care. 2nd ed. Washington, DC: American College of Obstetricians and Gynecologists; 2011. p. 97-110.
American College of Obstetricians and Gynecologists. Fact sheet: substance abuse. In: Tool kit for teen care. 2nd ed. Washington, DC: ACOG; 2009.
American College of Obstetricians and Gynecologists. Substance abuse: a fact sheet for parents. In: Tool kit for teen care. 2nd ed. Washington, DC: ACOG; 2009.
American College of Obstetricians and Gynecologists. Substance use: obstetric and gynecologic implications. In: Special issues in women's health. Washington, DC: ACOG; 2005. p. 105-50.
American College of Obstetricians and Gynecologists. Tobacco, alcohol, drugs, and pregnancy. ACOG Patient Education Pamphlet AP170. Washington, DC: ACOG; 2008.
At-risk drinking and illicit drug use: ethical issues in obstetric and gynecologic practice. ACOG Committee Opinion No. 422. American College of Obstetricians and Gynecologists. Obstet Gynecol 2008;112:1449-60.
Methamphetamine abuse in women of reproductive age. Committee Opinion No. 479. American College of Obstetricians and Gynecologists. Obstet Gynecol 2011;117:751-5.
Substance abuse reporting and pregnancy: the role of the obstetrician-gynecologist. Committee Opinion No. 473. American College of Obstetricians and Gynecologists. Obstet Gynecol 2011;117:200-1.
The resources listed below are for information purposes only. Referral to these sources and sites does not imply the endorsement of ACOG. Further, ACOG does not endorse any commercial products that may be advertised or available from these organizations or on these web sites. The lists are not meant to be comprehensive. The exclusion of a source or site does not reflect the quality of that source or site. Please note that sites and URLs are subject to change without notice.
References for Professionals
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Prescription and OTC Drugs
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Hertz JA, Knight JR. Prescription drug misuse: a growing national problem. Adolesc Med Clin 2006;17:751-69; abstract xiii.
Joffe A. Your role in curbing prescription and OTC drug abuse by adolescents. Contemp Pediatr 2006;23(10):97-8, 100-1.
Kaminer Y. Problematic use of energy drinks by adolescents. Child Adolesc Psychiatr Clin N Am 2010;19:643-50.
McCabe SE, Boyd CJ, Cranford JA, Teter CJ. Motives for nonmedical use of prescription opioids among high school seniors in the United States: self-treatment and beyond. Arch Pediatr Adolesc Med 2009;163:739-44.
McCabe SE, West BT, Cranford JA, Ross-Durow P, Young A, Teter CJ, et al. Medical misuse of controlled medications among adolescents. Arch Pediatr Adolesc Med 2011;165:729-35.
Rogers PD, Copley L. The nonmedical use of prescription drugs by adolescents. Adolesc Med State Art Rev 2009;20:1-8, vii.
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Wu LT, Ringwalt CL, Mannelli P, Patkar AA. Prescription pain reliever abuse and dependence among adolescents: a nationally representative study. J Am Acad Child Adolesc Psychiatry 2008;47:1020-9.
Books for Professionals
Essau C, editor. Adolescent addiction: epidemiology, assessment, and treatment. Boston (MA): Academic Press; 2008.
Gilvarry E, McArdle P, editors. Alcohol, drugs and young people: clinical approaches. London (UK): Mac Keith Press; 2007.
Kaminer Y, Bukstein OG, editors. Adolescent substance abuse: psychiatric comorbidity and high-risk behaviors. New York (NY): Routledge; 2008.
Keegan K, Moss HB. Chasing the high: a firsthand account of one young person's experience with substance abuse. New York (NY): Oxford University Press; 2008.
Winters KC, editor. Adolescent substance abuse: new frontiers in assessment [special issue]. J Child Adolesc Subst Abuse 2006;16(1).
Books for Parents/Older Adolescents
Babbit N. Adolescent drug and alcohol abuse: how to spot it, stop it, and get help for your family. Sebastopol (CA): O’Reilly & Associates; 2000.
Califano JA Jr. How to raise a drug-free kid: the straight dope for parents. New York (NY): Simon & Schuster; 2009.
Cermak TL. Marijuana: what’s a parent to believe? Center City (MN): Hazelden; 2003.
Karson J. Teen addiction. Detroit (MI): Greenhaven Press; 2006.
Ketcham K, Pace NA. Teens under the influence: the truth about kids, alcohol, and other drugs: how to recognize the problem, and what to do about it. New York (NY): Ballantine Books; 2003.
Merino N. Introducing issues with opposing viewpoints: marijuana. Detroit (MI): Greenhaven Press; 2011.
Nelson DE. Teen drug abuse. Detroit (MI): Greenhaven Press; 2010.
Sheff N. Tweak: growing up on methamphetamines. New York (NY): Atheneum Books for Young Readers; 2008.
Sheff N. We all fall down: living with addiction. New York (NY): Little, Brown; 2011.
Tardiff J, editor. Marijuana. Detroit (MI): Greenhaven Press; 2008.
Books for Adolescents
Clayton L. Working together against drug addiction. New York (NY): Rosen; 1996.
Croft J. Drugs and the legalization debate. Rev. ed. New York (NY): Rosen; 2000.
Lobo IA. Inhalants. Philadelphia (PA): Chelsea House Publishers; 2004.
Loonin M. Legalizing drugs. Detroit (MI): Lucent Books; 2006.
Magill E, editor. Drug information for teens: health tips about the physical and mental effects of substance abuse. 3rd ed. Detroit (MI): Omnigraphics; 2011.
Mass W. Teen drug abuse. San Diego (CA): Lucent Books; 1998.
Menhard FR. The facts about inhalants. New York (NY): Benchmark Books; 2005.
Packer AJ. Wise highs: how to thrill, chill and get away from it all without alcohol or other drugs. Minneapolis (MN): Free Spirit; 2006.
American Academy of Family Physicians
Information on Substance Abuse
American Academy of Pediatrics
Levy S, Knight JR. Office management of substance abuse. Adolesc Health Update 2003;15(3):1-8.
Pamphlets: Inhalant abuse: your child and drugs
Substance abuse prevention: what every parent needs to know
Testing your teen for illicit drugs: information for parents
Booklet: Prescription drug abuse: get the facts
Pamphlets: Drugs: talking with your teen
Prescription drug abuse
Pamphlet: Alcohol and drug use
National Center on Addiction and Substance Abuse at Columbia University
National Center on Addiction and Substance Abuse at Columbia University. Adolescent substance use: America’s #1 public health problem. New York (NY): CASA; 2011. Available at: http://www.casacolumbia.org/download.aspx?path=/UploadedFiles/enfchozt.pdf. Retrieved December 1, 2011.
National Institute on Drug Abuse
NIDA for Teens
National Institute on Drug Abuse. Preventing drug use among children and adolescents: a research-based guide for parents, educators, and community leaders. 2nd ed. NIH Publication No. 04-4212(A). Bethesda (MD): NIDA; 2003. Available at: http://drugabuse.gov/pdf/prevention/RedBook.pdf. Retrieved December 6, 2011.
Booklet: Drug facts: shatter the myths
The Prevention Researcher
Adolescent substance abuse: prevention, intervention, and recovery. Prev Res 2011;18(2).
Fullwood H, Ginther DW. Inhalant abuse: the silent epidemic. Prev Res 2000;7(3):1-3.
Adolescent Prescription Drug Abuse. Prev Res 2012;19(1).
Substance Abuse and Mental Health Services Administration
Booklet:What is substance abuse treatment: a booklet for families