Sir.—I have been involved in the treatment of adolescents with chemical dependency problems for over two years now, and the editorial review by Dr Macdonald1 is in my esteem the first good piece concerning this topic that has appeared in the pediatric literature. I was glad to see Dr Macdonald outline all the problems due to substance use and abuse and not spend too much time in the discussion of all the moral and legal issues as other articles have done. His discussion about the progression of substance abuse followed my experience in treating these patients, and the section entitled "Stage 3: Preoccupation With the Mood Swings" was especially helpful because this is the really dangerous stage that leads to true dependency.
The only areas that Dr Macdonald did not cover well were the family history and the use of Alcoholics Anonymous (AA) and similar self-help groups. As