Ryan S. Trim
Adolescent substance use and substance use disorders are topics of important clinical and public health concern because of their prevalence and associated negative consequences. Considering all age groups, recent estimates suggest that the use and misuse of alcohol, nicotine, and illegal drugs cost the United States approximately $257 billion per year—exceeding the costs associated with heart disease or cancer (Institute of Medicine, 1994a). Although many adolescents experiment with substance use without experiencing adverse consequences, the risks associated with substance use include mortality and morbidity as the result of impaired driving, increased risk for HIV infection, and risk for smokingrelated disease (Institute of Medicine, 1994a; National Institute on Alcohol Abuse and Alcoholism, 1997). Frequent and prolonged consumption among adolescents not only increases their risk for developing a substance use disorder, but can also impair emerging developmental competence and psychosocial functioning (Baumrind & Moselle, 1985; Chassin, Pitts, & DeLucia, 1999; see Newcomb & Bentler, 1988, for a review).
This chapter describes the features and epidemiology of adolescent substance use and substance use disorders, and examines etiological factors with an emphasis on recent evidence. The chapter is not intended to be comprehensive; for example, we do not consider issues of treatment or prevention (see Deas & Thomas, 2001; Hser et al., 2001; and Ozechowski & Liddle, 2000, for discussions of treatment, and Bukoski, 1997; Substance Abuse and Mental Health Services Administration, 1999; and U.S. Department of Health and Human Services [DHHS], 2000a, for discussions of prevention). Moreover, because many empirical studies consider only substance use, we include coverage of adolescent substance use as well as the substance use disorders, while noting the distinctions among them. Finally, our discussion spans developmental periods ranging from early childhood precursors of adolescent substance use disorders to the period of “emerging adulthood” (ages 18–25), when substance use disorders reach their peak.
The use and misuse of alcohol and other substances date to antiquity. The medical use of marijuana, and the use of beer and wine, were