Substance Use and Misuse in Adolescents
Screening
Use a brief validated screen such as CRAFFT: Car, Relax, Alone, Forget, Family/Friends, Trouble. A score of 2 or more suggests a problem and warrants brief intervention and further assessment. SBIRT-screening, brief intervention, and referral to treatment-fits routine visits. Ask about alcohol, cannabis, nicotine and vaping, prescription misuse, and other substances. Confidentiality is important but yields to imminent danger.
Clinical issues
Cannabis hyperemesis presents with cyclic vomiting and compulsive bathing. Nicotine vaping can cause dependence and acute lung injury. Opioid use requires naloxone education and medication for opioid use disorder, including buprenorphine. Alcohol withdrawal can be dangerous. Co-occurring depression, anxiety, ADHD, and trauma are common.
Traps
A positive screen is not a diagnosis. A yes to riding in a car driven by someone using substances still counts. Legalization does not mean safety. Do not assume vaping is harmless or that all cannabis use is occasional. Do not promise unconditional confidentiality.
Worked example
A 16-year-old scores 4 on CRAFFT. Provide brief motivational feedback, assess safety and co-occurring symptoms, offer treatment referral, and involve caregivers if there is immediate risk. Do not simply lecture or discharge. Document the intervention and follow-up plan.