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Ergogenic dietary supplement use is highly prevalent among adolescent and collegiate athletes, and use is increasing. To make appropriate recommendations for or against use by individual athletes, physicians who work with adolescent athletes should be knowledgeable about the most commonly used supplements and be able to access high-quality information about others. This article first discusses the legal and regulatory environment of dietary supplements. Several of the most commonly used supplements are then discussed in detail, including creatine, beta-hydroxy-beta-methylbutyrate, protein, amino acids, stimulants, alkalotic agents, glycerol, vitamins, and minerals. Finally, the "Gateway Theory" as it may relate to adolescent supplement and other drug use is discussed.

Unfortunately, perceptions that the club drugs can be safe endure. Some groups, such as the Multidisciplinary Association for Psychedelic Study, continue to lobby for the legalization of MDMA for research purposes [76]. DanceSafe is an organization that seeks to educate the "nonaddicted" user to decrease the risks [82]. The DanceSafe Web site offers tips on the safe use of MDMA, such as attention to hydration status and ambient temperature. It also offers free testing of tablets submitted by mail and sells home testing kits to determine the content of pills sold as "ecstasy." Although much remains unknown about the long-term consequences of MDMA and the club drugs, there are clearly enough short-term dangers to prompt more aggressive education and surveillance for its use. Scare tactics and exaggerations often are ignored [53], while Web sites full of anecdotal or incomplete information may lead the unaware user to increased use [113]. Organizations such as DanceSafe imply that proper education decreases addiction and that only uneducated users or addicts suffer the life-altering consequences of drug use. The fallacy in the mission of educating "nonaddicted" users is evident. Peer-based education, with a focus on both he short-term dangers and long-term consequences, may be a more effective approach [9]. Both new and established drugs of abuse continue to plague teens and young adults. Pediatric, family practice, and Med-Peds physicians, and pediatric pharmacologists need to remain vigilant about patterns and trends of drug abuse. MDMA and the other "club drugs" are not benign. Their effects target the brain, alter neurochemistry, and possibly cause irreversible structural damage. What may seem like a harmless drug in a weekend dance club has the potential for major public health problems in years to come [109]. Effective education and timely intervention may prevent these addictive drugs from becoming a way of life, a lifestyle that may have a literal "dead end."

Alcohol use has persisted over time as the number one drug problem among youth in the United States. Many primary care physicians underestimate the seriousness and prevalence of teenage alcohol use. The epidemiology of alcohol use among adolescents is discussed, as are its dangers and society's attitude toward drinking. The effects of alcohol on adolescents are listed. Several types of alcoholism are discussed.

When an adolescent has been identified as abusing drugs, alcohol, or both, a complete assessment of this young person must be completed by qualified health professionals before the level of treatment is chosen. With our present state of knowledge of substance-abusing adolescents, this assessment must focus on every sphere of the child's life, not just the quantity and frequency of the drug use. Most substance-abusing young people have experienced deep psychological trauma that must be identified and eventually treated. A family evaluation and psychological testing are crucial to the evaluation of these adolescents. When choosing a treatment facility for a substance-abusing adolescent, it is best to select a treatment program that requires family involvement. An adolescent treatment program should include treatment of both the family and the child, and it must include the goal of abstinence from mood-altering substances as a major component of recovery.

This article describes the range of indicators to observe when considering which teenagers may be at risk for development of substance abuse. Currently, the notion of what constitutes a problem among teenagers is a controversy--thus the subject is approached from several major viewpoints. First, one may look at longitudinal studies and then make an attempt to construct some sort of substance abuser profile. Also, genetic predisposition may be considered.

Alcohol is the drug of choice for most substance-abusing adolescents and is the drug most often associated with teenage deaths. This article summarizes what is known about the inheritance of alcohol abuse, as well as the physical, developmental, psychosocial, and behavioral factors related to adolescent alcohol use.