Psych · Child and adolescent psychiatry — adolescent substance use
Adolescent substance use
Also known as Youth substance use · Adolescent SUD · Teen drug and alcohol use · CAMHS addiction · Adolescent cannabis alcohol stimulants · Youth dual diagnosis · Adolescent substance misuse · Paediatric substance use disorder
Exam-exhaustive fellowship reference on adolescent substance use — developmental epidemiology, cannabis/alcohol/stimulants, dual diagnosis, CRAFFT and comprehensive assessment with private interview plus family and school, motivational interviewing, family-based therapies (MDFT, CYT), brief interventions, harm reduction, youth pharmacotherapy limits including buprenorphine-naloxone evidence, disposition, and regional guideline framing. Distinct from adult AUD/OUD and adult dual-diagnosis topics. FRANZCP-primary, globally tagged.
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Target exams
Red flags
- Opioid overdose risk or reduced consciousness — ABC, naloxone, medical resuscitation before psychosocial detail
- Acute psychosis, severe agitation, or mania with ongoing high-THC cannabis or methamphetamine — dual formulation, medical exclusion of organic causes, do not withhold antipsychotics solely because toxicology is positive
- Active suicidal intent, high overdose risk, or sexual exploitation/safeguarding concern — same-day senior review and multi-agency plan
- Alcohol or benzodiazepine dependence with withdrawal risk — medical pathway; do not discharge untreated severe withdrawal
- Sequential service denial ('come back when clean' or 'come back when psych is stable') when both disorders are active — activate concurrent/integrated care
- Promising absolute confidentiality when safety, driving risk, or child protection requires carer or agency involvement
Meet the patient
A 16-year-old is brought to ED at 2am after a friend called an ambulance. He is drowsy, smells of alcohol, and his mother found a vape and a grinder in his bag last week. His school has already emailed about attendance.[1][4]
Interviewed alone once he is alert, he tells you he smokes high-potency cannabis most days, has been hearing his name called in empty rooms for a month, and stopped his ADHD medication in March.[7][10][11]
Three questions decide his care: is he medically safe?, is this substance-induced or an emerging psychosis?, and who is going to be told what? Everything below answers those three at consultant depth.[4][9][12]
References22ShowHide
- [1]Degenhardt L, Stockings E, Patton G, et al. The increasing global health priority of substance use in young people Lancet Psychiatry, 2016.PMID 26905480
- [2]Stockings E, Hall WD, Lynskey M, et al. Prevention, early intervention, harm reduction, and treatment of substance use in young people Lancet Psychiatry, 2016.PMID 26905481
- [3]Knight JR, Sherritt L, Shrier LA, et al. Validity of the CRAFFT substance abuse screening test among adolescent clinic patients Arch Pediatr Adolesc Med, 2002.PMID 12038895
- [4]Bukstein OG, Bernet W, Arnold V, et al. Practice parameter for the assessment and treatment of children and adolescents with substance use disorders J Am Acad Child Adolesc Psychiatry, 2005.PMID 15908844
- [5]Squeglia LM, Jacobus J, Tapert SF The influence of substance use on adolescent brain development Clin Psychol Rev, 2009.PMID 19278130
- [6]Silins E, Horwood LJ, Patton GC, et al. Young adult sequelae of adolescent cannabis use: an integrative analysis Lancet Psychiatry, 2014.PMID 26360862
- [7]Volkow ND, Baler RD, Compton WM, et al. Adverse health effects of marijuana use N Engl J Med, 2014.PMID 24897085
- [8]Arseneault L, Cannon M, Poulton R, et al. Cannabis use in adolescence and risk for adult psychosis: longitudinal prospective study BMJ, 2002.PMID 12446537
- [9]Moore TH, 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
- [10]Di Forti M, Marconi A, Carra E, et al. Proportion of patients in south London with first-episode psychosis attributable to use of high potency cannabis: a case-control study Lancet Psychiatry, 2015.PMID 26359901
- [11]Di Forti M, Quattrone D, Freeman TP, et al. The contribution of cannabis use to variation in the incidence of psychotic disorder across Europe (EU-GEI): a multicentre case-control study Lancet Psychiatry, 2019.PMID 30902669
- [12]Schoeler T, Petros N, Di Forti M, et al. Effects of continuation, frequency, and type of cannabis use on relapse in the first 2 years after onset of psychosis: an observational study Lancet Psychiatry, 2016.PMID 27567467
- [13]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
- [14]Waldron HB, Turner CW Evidence-based psychosocial treatments for adolescent substance abuse J Clin Child Adolesc Psychol, 2008.PMID 18444060
- [15]Rigter H, Henderson CE, Pelc I, et al. Multidimensional family therapy lowers the rate of cannabis dependence in adolescents: a randomised controlled trial in Western European outpatient settings Drug Alcohol Depend, 2013.PMID 23140805
- [16]Tanner-Smith EE, Lipsey MW Brief alcohol interventions for adolescents and young adults: a systematic review and meta-analysis J Subst Abuse Treat, 2015.PMID 25300577
- [17]Woody GE, Poole SA, Subramaniam G, et al. Extended vs short-term buprenorphine-naloxone for treatment of opioid-addicted youth: a randomized trial JAMA, 2008.PMID 18984887
- [18]Hettema J, Steele J, Miller WR Motivational interviewing Annu Rev Clin Psychol, 2005.PMID 17716083
- [19]Prochaska JO, DiClemente CC Stages and processes of self-change of smoking: toward an integrative model of change J Consult Clin Psychol, 1983.PMID 6863699
- [20]Mueser KT, Drake RE, Wallach MA Dual diagnosis: a review of etiological theories Addict Behav, 1998.PMID 9801712
- [21]Drake RE, Mercer-McFadden C, Mueser KT, et al. Review of integrated mental health and substance abuse treatment for patients with dual disorders Schizophr Bull, 1998.PMID 9853791
- [22]Hunt GE, Siegfried N, Morley K, et al. Psychosocial interventions for people with both severe mental illness and substance misuse Cochrane Database Syst Rev, 2019.PMID 31829430