The initial use of tobacco, alcohol and illicit drugs typically occurs during adolescence and some experience with these substances is now normative among adolescents in the United States and throughout the developed world.1 While many youth who use drugs do so only infrequently and without experiencing any apparent adverse consequences, there are at least three principal reasons why substance use should be a major concern for child and adolescent psychiatrists: First, the acute effects of intoxication may have potentially serious long-term consequences, including increasing risks of motor vehicle and other unintentional injuries.2 Second, a substantial proportion of adolescents report meeting criteria for abuse and/ or dependence on these substances, and substance abuse/ dependence are among the most prevalent psychiatric disorders in adolescents3 while the majority of adults who develop a substance use disorder report onset during adolescence.4 Finally, the age of onset of substance use is prognostic of subsequent risks for the development of abuse/ dependence and other measures of drug related harm.5-8
