Background: Adolescent substance use is a dynamic public health problem.
Adolescence is a unique developmental period involving overlapping biological,
psychological, and social factors which increase the rates of initiation of substance use. The
developing adolescent brain is particularly susceptible to the effects of substances and most
adults with substance use disorders began to have symptoms and problems in their
adolescent years. Yet, for various reasons, most adolescents who use, misuse, abuse, or are
addicted to substances do not perceive the need for treatment.
Objective: Drug and alcohol use among adolescents is a common presentation in hospital
Emergency Departments (EDs) and presents in different forms including in association with
intoxication, withdrawal states, or trauma associated with drug-related events. For many
adolescents with substance use, the Emergency Department (ED) is the first point of contact
with medical personnel and thus also serves as a potential entry point into treatment.
Methods: This article reviews the common ways drug and alcohol problems present in the
ED, clinical assessment of the patient and family, screening, laboratory testing, brief
interventions in the ED, and referral to treatment beyond the ED.
Conclusion: Guidelines on how to manage the shifting terrain of adolescent substance use
presenting in EDs across the nation continue to evolve. We highlight that considerable
further research is needed to inform effective ED protocols to address this important
individual and public health safety concern. Systems of care models which include
collaborative teams of diverse stake holders are needed to effectively manage adolescents
with substance use disorders.