Role of the Pediatrician in Prevention and Management of Substance Abuse

Abstract

The past three decades have been marked by an increasing recognition of the responsibility of pediatricians to their patients and their patients' families regarding the diagnosis and management of abuse of tobacco, alcohol, and other substances of abuse including prescription drugs. Because of the harmful consequences, substance abuse is an obvious concern for all those who care for infants, children, adolescents, and young adults. When it occurs during pregnancy, it has been associated with an increased incidence of prematurity; congenital defects, including brain damage; and even death. The pediatrician must be prepared to address this commonplace issue as a part of routine health care, starting with the prenatal visit and continuing as a part of all anticipatory guidance. Familiarity with the extent and nature of drug use, as well as the health and social consequences, has become a necessary part of the body of pediatric knowledge.1-9 The pediatrician should possess or develop the skills necessary to determine which young patients are at risk for substance abuse and chemical dependence and should also be able to offer appropriate prevention or treatment counseling to the child, adolescent, and his or her family, or make a referral to a source where such counseling can be obtained. PERVASIVENESS OF DRUG USE The pattern of substance abuse among teenagers has undergone significant change during the past 25 years. Prior to the late 1960s, the abuse of psychoactive drugs and alcohol was predominantly an adult phenomenon. In the late 1960s and early 1970s, substance abuse became widespread among adolescents and, more recently, preadolescents.