Identification and management of the toxic adolescent.

Experimentation with alcohol and drugs is prevalent in adolescence. The clinical caring for older children, adolescents, and young adults must include substance misuse or abuse whenever behavioral, family, or related medical problems occur. A systematic approach using checklist and questionnaires, a directed physical examination, selected laboratory testing, and a 3-visit (or more) evaluation protocol will provide the clinician with the opportunity to assess patients and provide both them and their families with appropriate referrals. Most if not all clinicians seeing adolescents have these patients in their practices. Making the diagnosis is a result of recognition of symptoms and signs, evaluation, and appropriate referrals. The foregoing discussion should provide one approach to patient management that can result in the retrieval of a substantial number of our youth from an alcohol and drug-dominant lifestyle with its irreversible medical, social, and emotional residue.