A 16-year-old girl, accompanied by her mother, is in your office for a well-adolescent visit. The mother asks about drug and alcohol abuse. You explain that the warning signs of abuse include which of the following?

When an adolescent shows evidence of declining school performance or truancy, a change for the worse in personal habits and grooming, exaggerated mood swings, change in friends to an older and unacceptable group, and frequent hostile reactions in relationships with others, the possibility that he or she is abusing drugs or alcohol, or both, should be considered strongly. Dependence on drugs is a progressive disorder; therefore, prompt identification and intervention are required if serious complications are to be avoided. Routine health assessment of adolescents should include inquiry about the use of cigarettes, alcohol, and other drugs, and about school performance and family and peer relationships.