Substance abuse: an overview.

Substance abuse continues to be a major adolescent health risk. Despite encouraging trends toward decreased drug use in the late 1980s, an increase in use occurred in the early 1990s and only now is beginning to level off. A brief update on the status of the most commonly abused substances is provided. A discussion of current research is given in support of viewing drug addiction as a medical condition, i.e., a "brain disease." Reasons are suggested to explain why adolescents use and abuse drugs and why trends occur in their use. Two aspects of diagnosis are reviewed: psychiatric and medical comorbidity and drug screening and laboratory assessment of the adolescent. Prevention and early intervention are presented with an emphasis on drug education, behavioral wellness, family communication, doctor-patient discussion and assessment, and referral. Commentary is made on the ethics of care; issues of confidentiality and the right to privacy with regard to drug testing and sharing of information are explored. A review of various policy statements of the American Academy of Pediatrics and other medical organizations is presented.