Paeds · mental-behavioural-and-psychosomatic
Substance intoxication, withdrawal and use disorders in youth
Also known as Adolescent substance use disorder · Youth alcohol and other drug use · Cannabis use disorder in adolescents · Adolescent intoxication and withdrawal · Vaping and nicotine dependence in youth · Polysubstance use in adolescents
Fellowship guide to substance intoxication, withdrawal and use disorders in youth: separating the acute (intoxication, withdrawal) from the clinical diagnosis (DSM-5 use disorder), CRAFFT and S2BI screening, SBIRT stepped care with motivational interviewing, CBT and family-based therapy, the Dennis Cannabis Youth Treatment evidence and the Marsch buprenorphine trial, the cannabis-psychosis link, and the Australian context of cannabis, vaping and inhalant (chroming) use.
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Target exams
Red flags
- Reduced respiratory rate with pin-point pupils and falling consciousness — opioid intoxication: give naloxone titrated to respiratory effort, do not wait for a drug screen
- Agitation, tremor, autonomic hyperactivity, seizures or clouding consciousness after alcohol or benzodiazepine cessation — withdrawal can be fatal; treat as a medical emergency with benzodiazepine-based protocols
- Acute psychiatric symptoms (paranoia, hallucinations) with recent cannabis or stimulant use that do not settle as the drug clears — reassess for a primary psychotic or mood disorder and arrange urgent mental-health review
- Hyperthermia, rigidity, hypertonia or marked autonomic instability after stimulant or MDMA use — serotonin toxicity, malignant hyperthermia-like states or intracranial events need urgent ED assessment
- Intravenous drug use, sharing equipment, or signs of exploitation, trafficking or coercion — this is a safeguarding and blood-borne-virus emergency requiring a coordinated child-protection response
Life stages
Care settings
Clinical exam formats
Board mappings
- General and Community Paediatrics
- Mental and behavioural health
- Adolescent substance use and harm reduction
- Current 2026 PREP curriculum — Learning goal 5: Clinical assessment – essential general paediatrics
- Renewed curriculum for first-year trainees from 2027 — Learning goal 5: Clinical assessment – essential general paediatrics
- Renewed curriculum for first-year trainees from 2027 — Learning goal 12: Communication with patients, families, and health professionals
- Adolescent medicine and youth alcohol-and-other-drug competencies
- Clinical Applications
- Long Cases
- Short Cases
- Communication scenarios
- 4. Professional skills and knowledge: Patient management
- 5. Professional skills and knowledge: Health promotion and illness prevention
- General Paediatrics: Assesses adolescent substance use and risk behaviours and initiates appropriate management
- Foundation of Practice (FOP)
- Applied Knowledge in Practice (AKP)
- Substance misuse and adolescent risk-taking
- Clinical
- History
- Communication
- Adolescent risk-behaviour and substance-use assessment
- General Pediatrics Content Outline — Domain 1: Preventive Pediatrics/Well-Child Care
- General Pediatrics Content Outline — Domain 12: Adolescent Medicine
- General Pediatrics Content Outline — Domain 15: Mental and Behavioral Health
- General Pediatrics EPA: Screen for and counsel on substance use and risk behaviours
- Patient Care 1: History and Physical Examination
- Patient Care 4: Clinical Reasoning
- Medical Knowledge 1: Clinical Knowledge
- Interpersonal and Communication Skills 1: Patient- and Family-Centered Communication
- Systems-Based Practice: coordination with youth alcohol-and-other-drug and school systems
- Medical Expert
- Communicator
- Collaborator
- Pediatrics: Core EPA — Assessing adolescent health and risk behaviours
- Pediatrics: Core EPA — Managing substance use and co-occurring mental-health problems
Overview & Definition
Picture the fifteen-year-old brought to the emergency department agitated and smelling of cannabis, or the fourteen-year-old whose school has noticed a slide in grades, withdrawal from friends and a new vagueness about where evenings go. These are the two faces of youth substance use that the fellowship exam wants you to hold together: the acute medical state and the slowly-building clinical disorder. [4] [13]
The first move is to separate three related but distinct problems. Intoxication is the acute, time-limited effect of a drug on the body and mind. Withdrawal is the physiological syndrome that appears when a dependent brain is deprived of the drug. A substance use disorder is the persistent, maladaptive pattern of use that causes clinically significant impairment or distress. A young person can be intoxicated without having a disorder, can have a severe disorder without being intoxicated right now, and can be in withdrawal while meeting no other criteria — and the management of each is different. [1] [4]
The three things you must separate
A substance use disorder is not defined by how much a young person uses, nor by a positive drug screen. It is defined by loss of control, social harm, risky use and pharmacological change — the same DSM-5 framework used in adults, but read through the lens of a still-developing brain, an age of heightened reward-seeking, and a clinical picture that is usually hidden, denied and wrapped around comorbidity. [1]
References13ShowHide
- [1]Hasin DS, O'Brien CP, Auriacombe M, et al. DSM-5 criteria for substance use disorders: recommendations and rationale. Am J Psychiatry, 2013.PMID 23903334
- [2]Moore THM, Zammit S, Lingford-Hughes A, et al. Cannabis use and risk of psychotic or affective mental health outcomes: a systematic review. Lancet, 2007.PMID 17662880
- [3]Knight JR, Sherritt L, Shrier LA, Harris SK, Chang G. Validity of the CRAFFT substance abuse screening test among adolescent clinic patients. Arch Pediatr Adolesc Med, 2002.PMID 12038895
- [4]Levy SJ, Williams JF Substance use screening, brief intervention, and referral to treatment. Pediatrics, 2016.PMID 27325634
- [5]Silins E, Horwood LJ, Patton GC, et al. Young adult sequelae of adolescent cannabis use: an integrative analysis. Lancet Psychiatry, 2014.PMID 26360862
- [6]Vandrey R, Budney AJ, Kamon JL, Stanger C. Cannabis withdrawal in adolescent treatment seekers. Drug Alcohol Depend, 2005.PMID 15845324
- [7]Waldron HB, Turner CW. Evidence-based psychosocial treatments for adolescent substance abuse. J Clin Child Adolesc Psychol, 2008.PMID 18444060
- [8]Hall W, Degenhardt L. Cannabis use and psychosis: a review of clinical and epidemiological evidence. Aust N Z J Psychiatry, 2000.PMID 11185941
- [9]Burleson JA, Kaminer Y, Dennis ML. Absence of iatrogenic or contagion effects in adolescent group therapy: findings from the Cannabis Youth Treatment (CYT) study. Am J Addict, 2006.PMID 17182415
- [10]Marsch LA, Moore SK, Borodovsky JT, et al. A randomized controlled trial of buprenorphine taper duration among opioid-dependent adolescents and young adults. Addiction, 2016.PMID 26918564
- [11]Borodovsky JT, Levy S, Fishman M, Marsch LA. Buprenorphine treatment for adolescents and young adults with opioid use disorders: a narrative review. J Addict Med, 2018.PMID 29432333
- [12]Dennis M, Godley SH, Diamond G, et al. The Cannabis Youth Treatment (CYT) study: main findings from two randomized trials. J Subst Abuse Treat, 2004.PMID 15501373
- [13]Tims FM, Dennis ML, Hamilton N, et al. Characteristics and problems of 600 adolescent cannabis abusers in outpatient treatment. Addiction, 2002.PMID 12460128