Elsevier

The Lancet

Volume 369, Issue 9570, 21–27 April 2007, Pages 1391-1401
The Lancet

Series
Interventions to reduce harm associated with adolescent substance use

https://doi.org/10.1016/S0140-6736(07)60369-9Get rights and content

Summary

A major proportion of the disease burden and deaths for young people in developed nations is attributable to misuse of alcohol and illicit drugs. Patterns of substance use established in adolescence are quite stable and predict chronic patterns of use, mortality, and morbidity later in life. We integrated findings of systematic reviews to summarise evidence for interventions aimed at prevention and reduction of harms related to adolescent substance use. Evidence of efficacy was available for developmental prevention interventions that aim to prevent onset of harmful patterns in settings such as vulnerable families, schools, and communities, and universal strategies to reduce attractiveness of substance use. Regulatory interventions aim to increase perceived costs and reduce availability and accessibility of substances. Increasing price, restricting settings of use, and raising legal purchase age are effective in reducing use of alcohol and tobacco and related harms. Screening and brief intervention are efficacious, but efficacy of a range of treatment approaches has not been reliably established. Harm-reduction interventions are effective in young people involved in risky and injecting substance use.

Section snippets

Patterns and trends

Data from clinical populations are clearly inadequate for monitoring population trends in adolescent substance use. Representative household surveys are done in several countries19, 20, 21, 22 and offer the prospect of including young people who are not in school, but have weaknesses such as low response rates and failure to include homeless young people.20

In developed nations, universal schooling provides quite comprehensive capture of student populations, offering the potential to monitor

Intervention conceptual models and frameworks

In 1998 the UN called for a balanced approach to drug policies aimed at reducing both supply and demand.31 Efforts to reduce supply, primarily through law enforcement punishment for possession and distribution (ie, the War on Drugs), have remained the primary focus in many countries including the USA and UK.32, 33, 34 Other countries, such as Australia, have achieved better balance, implementing supply-reduction strategies designed to disrupt production and supply of illicit drugs,

Evidence for different interventions

In the following sections, we present the major interventions that have evidence for successful reduction of adolescent substance use and related harm. These interventions address different developmental stages and motives for substance use. We assess evidence for supply-reduction (regulatory) interventions, the demand-reduction strategies of developmental prevention intervention, early screening and brief intervention, and treatment and harm-reduction interventions. Table 3 summarises the main

Conclusions

Substance use, especially heavy use of alcohol and illicit drugs, contributes substantially to the burden of disease in adolescents. Evidence suggests that rates of tobacco use, harmful alcohol use, and illicit drug use in young people can be reduced through the concerted application of a combination of regulatory, early-intervention, and harm-reduction approaches. Reviews have called for a more concerted effort to address harms associated with youth alcohol use through regulatory strategies

Search strategy

We aimed to complete an integrative summary of current knowledge of the effectiveness of interventions designed to prevent and reduce the major harms associated with adolescent substance use. The co-authors, selected because of their expertise in specific areas of work in this area, supplemented recently completed comprehensive systematic reviews53, 57 using the PubMed, Psychlit, and Google scholar electronic databases, and keyword and text searches relevant to (adolescen*) and (alcohol or drug

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