Adolescent drug abuse. Diagnosis, treatment, and prevention.

There are clear temporal developmental stages in drug use beginning with cigarettes and alcohol, then progressing to marijuana and finally cocaine, hallucinogens, and other drugs. Of considerable interest is the decline in prevalence of marijuana use and the stabilization of alcohol use in the face of a rise in the incidence of cocaine use. This decline occurs in the face of a decrease in the age of first initiation into drug use. Cocaine use is accompanied by serious medical, psychological, and social consequences including seizures, depression, paranoia, and suspension from school. These findings have definite implications for designing treatment and prevention programs. Inpatient and outpatient programs must require abstinence from drug use. Dysfunctional development, poor interpersonal skills, learning deficits, and concurrent psychiatric illness must be addressed. Family involvement in treatment is mandatory. Every chemically dependent person has a significant impact on the lives of several other people. The social pressures model is the most recent approach to drug prevention and the one most likely to succeed. Direct informational appeals to adolescents are unlikely in themselves to produce immediate changes in drug-related behavior but may assist in gradually changing community norms. School prevention programs need to be designed to target adolescents before the onset of drug use. The seventh grade or before is the correct point to begin. Finally, methods to assess the success of such pilot programs can greatly assist future development efforts. More research into the biologic and behavioral consequences of current drug use patterns including marijuana, cocaine, and hallucinogens is greatly needed.

Diagnosis and treatment of adolescent substance abuse.

This paper has demonstrated the persistence of drug abuse as a problem among adolescents and describes cocaine abuse particularly, profiling the typical cocaine abuser. The stagewise progression of drug use has been described. Factors that make youngsters vulnerable to progression to further stages of drug abuse have been suggested. In treatment strategies, the appeal to fear and moral and religious arguments has for the most part necessarily been replaced by an appeal to reason and an educational approach. The coexistence of drug abuse and psychopathology occurs with sufficient frequency to require full medical and psychiatric evaluation in every adolescent who presents with a history of substance misuse. Inpatient and residential treatment, family involvement, and urine monitoring with sufficient aftercare programs seem to be important components of treatment approaches.