Daily use of marijuana and experimentation with a variety of compounds vary from year to year, but alcohol remains the principal substance of abuse. Heroin, cocaine, crack cocaine, crystal methamphetamine, and other stimulant abuse is less common but significant. Reported rates may be underestimates. There is commonly a progression of use from alcohol and tobacco, reflecting their relative accessibility, to marijuana and then to other compounds. Most persons begin serious abuse before age 20, despite the implementation of preventive programs in schools and communities.
Tobacco use continues to predict abuse of other substances.
Detailed information on alcohol and substance abuse should be sought in confidence during a routine examination, particularly when academic and behavioral problems are reported in previously well-adjusted youngsters or in families with a history of substance abuse. A recurrent or persistent pattern of behavior that includes aggression toward people and animals, destruction of property, deceitfulness or theft, and serious violation of rules. The prevalence of conduct disorder has apparently increased. Onset is usually in late childhood or early adolescence, and the disorder is much more common in boys than girls. Among adolescents with conduct disorder, there is a frequent finding of parental antisocial behaviors, antisocial personality disorder, and substance abuse.