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Alcohol and illegal drug use among adolescents in the world are major health problems facing society in the 21st century (3,29,37). Young adolescents tend to start their drug experimentation with inhalants (aersols, glue, petrol, or volatile solvents). However, the most chemicals widely used

Table 7 Factors in Adolescent STDs

High rate of coital rates

Multiple sex partners

Immature cervix (cervical ectropion)

Failure to use condoms

Use of needles for use of substance abuse

Other patterns of needle injury (self-mutilation, body piercing, tattoos) Magical thinking (feeling that high-risk behavior will not hurt one) Distrust of the "adult" world

Limited knowledge in dealing with the medical system and abused by youth remain marijuana, tobacco, and alcohol. Adolescents have many other illicit drugs to choose from, whether heroin, cocaine, methamphetamine, and others (37).

There is a 3% to 4% prevalence rate for substance abuse or dependence in American 14- to 16-year-olds; this rises to 10% in 17- to 19-year-olds. In 2005, a survey of over 50,000 high school adolescents noted that 15.8% reported a past-month use of illicit drugs in contrast to 19.4% in 2001 (38). Table 8 reports on a 2003 drug use survey of adolescents in Europe (39). High-risk sexual practices, violence, and injuries are noted especially in adolescent males using such drugs. Intravenous use leads to additional complications, such as the spread of HIV/AIDS.

Approximately 50% of adolescent males and 40% of females drink alcohol (40). Alcohol use contributes to approximately half of deaths in adolescents and young people due to motor vehicle accidents or suicides (40,41). Alcohol abuse leads to increased risk-taking behavior, increased sexual behavior, unplanned pregnancy, sexually transmitted diseases, violence, adult alcoholism, and disorders as adults: heart disease, cirrhosis, peptic ulcer disorders, and various cancers (37). The younger the individual begins using and abusing alcohol, the greater the risk for development of a clinical alcohol disorder as an adult (3.37).

Between 15% and 30% of adolescents in the world use tobacco, often leading to a life-long addiction and major health risks (37,42). As with alcohol, there is the widespread global advertisement of tobacco and society's acceptance of tobacco (42-45). There are over 150 million adolescents who smoke tobacco in the world and over half of these young individuals will eventually die a premature death from lung cancer, emphysema, and heart disease (45). Health-care professionals working with youth need to seek to educate their patients about the dangers of all drug use, including tobacco. This is particularly pertinent when rheumatologists prescribe methotrexate for rheumatic conditions during adolescence in view of the known risks of concurrent alcohol and tobacco use with this drug.

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