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Management of Substance Abuse

Caroline J. Barangan, MD^*
Elizabeth M. Alderman, MD

^* Fellow, Division of Adolescent Medicine, Department of Pediatrics
Associate Professor, Clinical Pediatrics, Albert Einstein College of Medicine/Montefiore Medical Center, New York, NY

	Objectives

1. Characterize the degree of use of illicit substances among adolescents.
   
2. Describe the most important treatment of substance abuse among adolescents.
   
3. Discuss the process required to make a diagnosis of substance abuse.
   
4. Explain the appropriate use of laboratory tests in the management of substance abuse.
   
5. Delineate the conditions for referral for treatment of an adolescent who is abusing drugs.
   

	Introduction

 
Substance abuse among adolescents continues to be a serious problem. It affects all age groups, including the newborn of the addicted mother, the preadolescent exposed to various forms of drug use through the media, and the adolescent who is experimenting or addicted. Pediatricians can make a difference in the lives of all who are affected by substance abuse. First, they have an important responsibility in the prevention, diagnosis, and treatment of substance abuse. This should be fulfilled at every routine office visit with the preadolescent and adolescent and at prenatal visits with expectant parent(s). Second, they are role models and sources of information and support to patients and their families. Third, they can be leaders in their communities by participating in prevention programs that provide education in the schools.

Some pediatricians may avoid dealing with this issue because they feel that they are not sufficiently knowledgeable. Many may be uncomfortable with this topic because they fear alienating the patient or the family. Some also may be in denial that substance abuse could be a problem in their patients. Because it is well known that the patterns of lifetime substance abuse are established during adolescence, the necessity of becoming educated in its management is apparent.

	Epidemiology

 
To manage substance abuse properly in the individual patient, it is important to know about the epidemiology of cigarette, alcohol, and illicit drug use. Two national surveys often are . . . [Full Text of this Article]

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