20 - Substance abuse and addiction

Summary

The management of children and adolescents with substance abuse or addiction is a common field for child and adolescent psychiatrists (Washton, 1996). More than 150 000 children and adolescents in Germany are involved with substance abuse or addiction. The estimated total number of individuals with alcohol addiction in Germany is between 1.5 and 2.5 million. Additionally, 200 000–500 000 individuals are addicted to medication and 100 000–120 000 to illicit drugs. The fact that individuals with substance abuse or addiction constitute the largest group of patients undergoing psychiatric treatment facilities highlights the enormous challenge to child and adolescent psychiatry in terms of preventive work. More than 700 000 children live with an alcohol-dependent parent. The risk of these children also becoming alcohol dependent is high. The percentage of those children and adolescents between 14 and 18 years old, associated with drug-related crimes, e.g. registered as suspects by the police, has ranged between 8% and 25% during the last 25 years. Psychiatric disorders due to substance abuse or addiction frequently require child and adolescent psychiatric treatment. It is likely that a high percentage of affected children and adolescents already had another disorder before the beginning of substance abuse or addiction. In many cases of substance abuse or addiction, co-morbidity is sufficiently severe that social work and psychological assistance alone are insufficient. Substance abuse and addiction, including co-morbid psychiatric disorders, require prevention, psychiatric treatment and rehabilitation, areas in which child and adolescent psychiatry services bear a significant responsibility.

The disorders associated with psychoactive substance abuse and addiction are complicated.