Substance use disorders (SUDs) are among the most prevalent psychiatric disorders in young people. Although experimentation with alcohol and drugs is sometimes considered one of the rites of passage for American youth, there is a high risk for misuse, addiction, and serious negative consequences (legal, social, and safety). Additionally, the treatment of any other psychiatric disorders is complicated by concomitant substance use. See Table 18.1 for diagnostic criteria for substance abuse.

Compared to adults, adolescents with SUDs present with a greater number of drugs used at any time. While substance-dependent youth may present with symptoms of tolerance, they present less often with symptoms of withdrawal or other symptoms of dependence noted in Table 18.2.

In general, substance abuse is a disorder that starts in adolescence or early adulthood. In evaluating even a prepubertal child, however, you have a goal to understand if smoking or substance use is present, to understand the nature and severity, and to ensure that it is addressed in treatment. Minors tend to have a higher rate of risk-taking behaviors than adults. They may begin to steal, lie, and participate in criminal behavior to support a habit. SUD youth often have comorbid conduct disorders.