by Ann B. Bruner and Marc Fishman

About the authors: Ann B. Bruner teaches at the Department of Pediatrics at the Johns Hopkins University School of Medicine, where Marc Fishman teaches at the Department of Psychiatry and Behavioral Sciences.

Plano, a small Texas community (population, 180,000; median family income, $54,000) just north of Dallas, has been shocked by the deaths of more than 12 adolescents from heroin overdoses during 1997-1998. In Fairfax County, Virginia (population, 900,000; median household income, $70,000), drug-related arrests of adolescents have increased more than 10-fold in 10 years. Across the country parents wonder, "How could it happen to our children"" Lifetime prevalence rates of adolescent drug use have been rising since 1992 (Figure 1), and the percentage of teens saying they would never try illegal drugs is decreasing: 86% in 1995, 51% in 1996, and 46% in 1997.

Adolescent substance abuse is an overwhelming public health problem in...