Adolescent substance use is a significant public health concern within the United States that remains largely undertreated. The COVID-19 pandemic has exacerbated many preexisting risk factors for adolescent substance use, such as early life stress, social isolation, school connection, and boredom. Other effects include the potential for arrest in adolescent development, which can occur when there is disruption in expected developmental milestones. New cohorts of adolescents who may not otherwise initiate substances may now be at risk. The pandemic is also straining family systems, with potential for increased conflict and relapse that can occur in a bidirectional fashion. In parallel, the way in which we treat substance use disorders in youth has also shifted, with a dominance in digitally based platforms for delivery of most outpatient treatment. Challenges to utilizing virtual technology include fewer means of monitoring substance use remotely; privacy concerns; and ease of nonadherence with treatment by signing off the computer. Practitioners can utilize considerable opportunities for virtual care to reach adolescents at risk of developing a substance use disorder and/or those who may already have relapsed. Primary care providers and other general practitioners who frequently interface with youth should increase their baseline screening of youth.
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