Clinical Review

Use and misuse of drugs and alcohol in adolescence

BMJ 2008; 337 doi: (Published 30 June 2008) Cite this as: BMJ 2008;337:a306
  1. Paul McArdle, consultant child and adolescent psychiatrist
  1. 1Fleming Nuffield Unit, Northumberland Tyne and Wear NHS Trust, Newcastle upon Tyne NE2 3AE
  1. mcardlep{at}

    Substance misuse is one of a group of linked behaviours that has recently become more common among young people in westernised societies.w1 This rise has paralleled increasing rates of anxiety and depressive symptoms and of deaths related to substance misuse.1 w1-w3 Substance use disorders are potentially treatable and should be managed as chronic, relapsing diseases of complex origin.2 This review examines the scale of these disorders among young people and how healthcare practitioners can intervene.


    We searched Medline, Google, and the websites of the UK National Treatment Agency, US National Institute on Drug Abuse, and European Monitoring Centre for Drugs and Drug Addiction for suitable evidence based material. We also consulted colleagues working with young people with substance misuse, as well as consulting young people themselves and their carers.

    What constitutes substance misuse?

    Substance misuse and dependence are a subset of “substance use,” which includes phenomena such as experimentation and intermittent recreational use. “Substances” include alcohol as well as illicit or (if deliberately misused) prescribed drugs. See box 1 and 2 for definitions. (Substance misuse is also referred to as substance abuse—for example, by the Diagnostic and Statistical Manual of Mental Disorders.)

    Box 1 Definitions of misuse and dependence*

    Substance misuse

    Substance misuse is a maladaptive pattern of use leading to clinically important impairment or distress, manifested by one or more of the following over 12 months:

    • Failure to fulfil major obligations at work, school, or home

    • Use of a substance in situations in which it is physically hazardous

    • Persistent or recurrent use of the substance despite persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance

    • Persistent or recurrent use despite legal problems related to use of the substance

    Substance dependence

    Substance dependence is broadly equivalent to addiction and generally suggests physiological changes related to chronic drug administration. Dependence is associated with three or …

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