THE ARTICLE by Belcher and Shinitzky in this month's ARCHIVES is important if for no other reason than that it occupies a prominent place in a prominent pediatric journal. It validates the position taken by the American Academy of Pediatrics that pediatricians have an important role to play in the prevention, identification, and treatment of substance abuse in childhood and adolescence.
The authors make important points regarding risk factors in assessing a young person's likelihood of using tobacco, alcohol, and other drugs. They correctly point out the well-validated theory of the clustering of risk behaviors and note that school failure, trouble with the law, premature sexual activity and parenthood, and mental health disorders go hand in glove with the decision to take up the drug-using lifestyle. They allude to other risk factors including poor self-esteem, lack of religious commitment, and family dysfunction and abuse, and note that certain temperaments (such as moodiness, rebelliousness, and negativity) are associated with the choice to use tobacco, alcohol, and other drugs.
Heyman RB. The Old "Ounce of Prevention". Arch Pediatr Adolesc Med. 1998;152(10):943-944. doi:10.1001/archpedi.152.10.943