Other Risk Behaviors
As adolescents begin individuation from their parents and become increasingly concerned about peer acceptance, they are especially vulnerable for engaging in risky behaviors. In the sections above, we have discussed concepts related to sexual behaviors. In this section, we will add key concepts related to substance use and eating disorders
More info: stages of drug use
Alcohol, nicotine (cigarettes or chewing tobacco) and marijuana are the substances used most commonly by teens. Other drugs are used by less than 10% of the adolescent population. Drug use can be divided into phases: experimentation, active seeking, preoccupation, and burn out. Determining the stage or pattern of use can help the provider determine what additional intervention is appropriate.
Signs of possible substance abuse
Parents are often the first to be concerned as the teen withdraws from family activities or begins flouting family rules. Declining grades, truancy and withdrawal from extracurricular activities are other signs of drug use. Some medical conditions may become exaggerated, such as asthma from smoking marijuana. Dysphoria, confusion, irritability and low tolerance of frustration may occur along with self-destructive behaviors. Stealing and other criminal behaviors may get the teenager in trouble with the law.
A good history and physical exam are the most sensitive tools for diagnosing substance use. Substance users are often seductive liars, making it is important to corroborate the history with a family member. Parents are usually unaware of the specifics of use but can detail associated behaviors such as truancy or changes in behavior.
Drug testing is specific but not very sensitive and does not reveal the pattern of use. A positive test for marijuana does not discern the teen who smoked it once from the one who smokes seven times a day.
The pattern of use determines the treatment. When caught, teens try many different ploys. It is best to warn the parents beforehand. Common statements from teens include, "You don't really think I would use that stuff do you," "Someone put it in my drink," "I was holding it for a friend," "It was second hand smoke," and "Everyone else does it." Parent reactions vary from denial, outrage aimed at the physician, sadness, guilt and fear. Substance use may be a chronic problem requiring long term follow up with periods of exacerbation and improvement.