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INTRODUCTION

Adolescence is a vital period of neurodevelopment, and youth are particularly vulnerable to the neurodevelopmental consequences of substance use problems. Adolescence is also a time when many youth experiment with substance use, and more than 90% of individuals with substance use disorders (SUDs) started using substances by the age of 18 years. While most adolescents who experiment with substance use do not develop an SUD, many youth with frequent use do experience substance use problems, recently conceptualized as preaddiction by McLellan et al.

Adolescents with substance use problems are particularly at risk of accidental injury and physical or sexual violence related to substance use, in addition to risk of overdose and death. Further, an estimated 14% of 12- to 18-year-old youth will meet Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) criteria for a SUD (see section Diagnosis). Across the lifespan, SUDs are among the costliest health problems in the United States, with an annual economic impact of $249 billion for alcohol and $193 billion for other non-tobacco substance use. SUDs are also a contributing factor to the leading causes of morbidity and mortality among adolescents and young adults. In fact, adolescent-onset SUDs have been shown to prospectively predict early mortality.

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McLellan  AT, Koob  GF, Volkow  ND: Preaddiction—a missing concept for treating substance use disorders. JAMA Psychiatry 2022;79(8):749–751
[PubMed: 35793096]
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Thorpe  HHA, Hamidullah  S, Jenkins  BW, Khokhar  JY: Adolescent neurodevelopment and substance use: receptor expression and behavioral consequences. Pharmacol Ther 2020;206:107431
[PubMed: 31706976]

EPIDEMIOLOGY

ESSENTIALS OF ADOLESCENT SUBSTANCE USE EPIDEMIOLOGY

  • Nicotine, alcohol, and marijuana are the most commonly used substances in adolescence, with a dramatic increase in vaping since being systematically tracked in 2017.

  • Illicitly manufactured fentanyl is ubiquitous in the street drug market, often in combination with other drugs, resulting in unintentional exposure and a dramatic increase in adolescent and young adult opioid overdose deaths.

The best source of information on the epidemiology of substance use among American adolescents is the Monitoring the Future (MTF) study, an annual cross-sectional survey that tracks substance use–related behaviors in school youth in the United States, since its onset in 1975. This study probably understates the magnitude of the problem of SUD because it excludes high-risk adolescent groups—school dropouts, runaways, and those in the juvenile justice system. Table 5–1 includes the epidemiology of commonly abused mood-altering substances by agent from the 2022 MTF study, collected from 31,438 American 8th, 10th, and 12th graders.

Table 5–1.Epidemiology, pharmacology, and physiologic effects of commonly abused mood-altering substances by agent.

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