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Substance use disorder in adolescents: Epidemiology, pathogenesis, clinical manifestations, course, assessment, and diagnosis

Oscar Bukstein, MD
Section Editors
David Brent, MD
Andrew J Saxon, MD
Diane Blake, MD
Deputy Editor
Richard Hermann, MD


Substance use is pervasive and endemic among adolescents. By the time adolescents become adults in the United States, almost half will have tried an illicit drug, and over 80 percent will have used alcohol [1]. Most use by adolescents will attenuate over time, but many suffer negative health and social consequences [2]. Some adolescents advance to levels of use and consequences that meet criteria for substance use disorders (SUDs) and are at high risk for its continuation in adulthood.

The general approach to the assessment and treatment of adolescents with SUDs is similar in some respects to adults; however, developmental considerations require an approach tailored to the cognitive, social, and legal status of adolescents.

The epidemiology, pathogenesis, clinical manifestations, course, assessment, and diagnosis of substance use and substance use disorder in adolescents are reviewed here. Treatment for SUD in adolescents is described separately, as is tobacco prevention and cessation management in adolescents. (See "Prevention of smoking initiation in children and adolescents" and "Management of smoking cessation in adolescents".)


Substance use is pervasive and endemic among adolescents in the United States, European countries, and other countries (table 1).

Alcohol use — In a 2011 study, up to 90 percent of European students aged 15 or 16 years reported ever having consumed alcohol [3]. Among 10th grade United States students, 47 percent report lifetime alcohol use [1].


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