Interventions to Prevent Illicit and Nonmedical Drug Use in Children, Adolescents, and Young Adults: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force
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Importance: Illicit and nonmedical (use in ways other than instructed) drug use is common in adolescents and young adults and increases the risk of harmful outcomes such as injuries, violence, and poorer academic performance. Objective: To review the benefits and harms of interventions to prevent illicit and nonmedical drug use in children, adolescents, and young adults to inform the US Preventive Services Task Force. Data Sources: MEDLINE, PubMED, PsycINFO, and the Cochrane Central Register of Controlled Trials (January 1, 2013, to January 31, 2019 [children and adolescents]; January 1, 1992, to January 31, 2019 [young adults <25 years]); surveillance through March 20, 2020. Study Selection: Clinical trials of behavioral counseling interventions to prevent initiation of illicit and nonmedical drug use among young people. Data Extraction and Synthesis: Critical appraisal was completed independently by 2 investigators. Data were extracted by 1 reviewer and checked by a second. Random-effects meta-analysis was used to estimate the effect sizes associated with the interventions. Main Outcomes and Measures: Number of times illicit drugs were used; any illicit drug or any cannabis use. Results: Twenty-nine trials (N = 18 353) met inclusion criteria. Health, social, or legal outcomes such as mental health symptoms, family functioning, consequences of drug use, and arrests were reported in 19 trials and most showed no group differences. The effects on illicit drug use in 26 trials among nonpregnant youth (n = 17 811) were highly variable; the pooled result did not show a clinically important or statistically significant association with illicit drug use (standardized mean difference, -0.08 [95% CI, -0.16 to 0.001]; 24 effects [from 23 studies]; n = 12 801; I2 = 57.0%). The percentage of participants using illicit drugs ranged from 2.3% to 38.6% in the control groups and 2.4% to 33.7% in the intervention groups at 3 to 32 months' follow-up. The median absolute risk difference between groups was -2.8%, favoring the intervention group (range, -11.5% to 14.8%). The remaining 3 trials provided a perinatal home-visiting intervention to pregnant Native American youth. One trial (n=322) found a reduction in illicit drug use at 38 months (eg, cannabis use in the previous month, 10.7% in the intervention group and 15.6% in the control group) but not at earlier follow-up assessments. Across all 29 trials, only 1 trial reported on harms and found no statistically significant group differences. Conclusions and Relevance: The evidence for behavioral counseling interventions to prevent initiation of illicit and nonmedical drug use among adolescents and young adults was inconsistent and imprecise, with some interventions associated with reduction in use and others associated with no benefit or increased use. Health, social, and legal outcomes were sparsely reported, and few showed improvements.
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Universal interventions were not effective to prevent illicit substance use in the general adolescent and young adult population, or to prevent common mental disorders in humanitarian settings.
“As noted above, universal interventions were not effective to prevent illicit substance use in the general adolescent and young adult population 154 , or to prevent common mental disorders in humanitarian settings 120”
From Preventive psychiatry: a blueprint for improving the mental health of young people (2021) · cites this paper as [154]
Mainstreaming universal approaches to reduce cannabis abuse holds only theoretical foundation, because these approaches are not empirically effective in children, adolescents and young adults.
“Furthermore, mainstreaming universal approaches to reduce cannabis abuse holds only theoretical foundation, because these approaches are not empirically effective in children, adolescents and young adults 154”
From Preventive psychiatry: a blueprint for improving the mental health of young people (2021) · cites this paper as [154]
A recent meta-analysis by the US Preventive Service Task Force found no evidence to favour selective (as well as population-level/universal) behavioural counselling to prevent illicit and non-medical drug use among adolescents and young adults.
“a recent meta-analysis by the US Preventive Service Task Force found no evidence to favour selective (as well as population-level/universal) behavioural counselling 154”
From Preventive psychiatry: a blueprint for improving the mental health of young people (2021) · cites this paper as [154]
There is a lack of evidence to favour several preventive interventions.
“The lack of evidence to favour several preventive interventions 113,115,154,156 may indicate that a one-size-fits-all approach is not effective and may obfuscate the efficacy for specific subgroups of individuals.”
From Preventive psychiatry: a blueprint for improving the mental health of young people (2021) · cites this paper as [154]
The lack of evidence to favour several preventive interventions may indicate that a one-size-fits-all approach is not effective.
“The lack of evidence to favour several preventive interventions 113,115,154,156 may indicate that a one-size-fits-all approach is not effective and may obfuscate the efficacy for specific subgroups of individuals.”
From Preventive psychiatry: a blueprint for improving the mental health of young people (2021) · cites this paper as [154]
The lack of evidence to favour several preventive interventions may obfuscate the efficacy for specific subgroups of individuals.
“The lack of evidence to favour several preventive interventions 113,115,154,156 may indicate that a one-size-fits-all approach is not effective and may obfuscate the efficacy for specific subgroups of individuals.”
From Preventive psychiatry: a blueprint for improving the mental health of young people (2021) · cites this paper as [154]
Behavioural counselling to prevent illicit substance use in adolescents and young adults has no evidence of efficacy.
“Behavioural counselling to prevent illicit substance use in adolescents and young adults (no evidence of efficacy) 154 ***”
From Preventive psychiatry: a blueprint for improving the mental health of young people (2021) · cites this paper as [154]
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Bonnaire, C., Har, A., Serehen, Z., & Phan, O. (2023) · European Review of Applied Psychology · doi:10.1016/j.erap.2023.100902 · Cited by 6 · see citing works
Davis, A. K., Arterberry, B. J., Xin, Y., Hubbard, S. M., Schwarting, C. M., & Bonar, E. E. (2023) · Cannabis · doi:10.26828/cannabis/2023/000180 · Cited by 4 · see citing works
A review on advanced formulations strategies to prevent prescription drug abuse and their impact
Chandegra, B., Raval, J., & Prajapati, P. (2024) · Discover Medicine · doi:10.1007/s44337-024-00141-4 · Cited by 4 · see citing works
Adolescents' drug use patterns and associations with psychological factors for alcohol prevention
Sancho-Domingo, C., Carballo, J. L., Coloma‐Carmona, A., Muñoz, A. P., & Hofstadt, C. V.-D. (2025) · Journal of Applied Developmental Psychology · doi:10.1016/j.appdev.2025.101813 · Cited by 4 · see citing works
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Screening for Young Adults for Illicit Drug Use: A Good Idea Although Evidence Is Lacking
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Drug Misuse as an Epidemic: A Focus on the Synthetic Opioid Fentanyl
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- Authors
- O’Connor, E., Thomas, R., Senger, C. A., Perdue, L., Robalino, S., & Patnode, C.
- Affiliations
- Kaiser Permanente (US)
- Oregon Health & Science University (US)
- Corresponding author
- O’Connor, Elizabeth
- Venue
- JAMA
- Publisher
- American Medical Association (AMA)
- Published
- 2020-05-26
- Volume
- 323
- Issue
- 20
- Pages
- 2067
- ISSN
- 0002-9955 (ISSN-L)
- 0098-7484
- PMC
- PMC13585201
- OpenAlex
- W3028859518
- Cited by
- 32
- References
- 64
- Citations by year
- 2026: 2 · 2025: 3 · 2024: 3 · 2023: 5 · 2022: 10 · 2021: 7 · 2020: 2
- FWCI
- 0.88
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- JAMA (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (submittedVersion)
- Funders
- U.S. Department of Health and Human Services
- Kaiser Permanente
- Agency for Healthcare Research and Quality
- Topics
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
- Social Sciences › Demography › Youth, Drugs, and Violence
- Keywords
- non-medical drug use, cannabis use, adolescents, young adults, children, harm reduction, substance use initiation, USPSTF recommendations, family functioning, arrests, psychiatric symptoms, academic performance, school-based prevention
- MeSH terms
- Adolescent, Alcohol Drinking, Behavior Therapy, Marijuana Abuse, Child, Clinical Trials as Topic, Counseling, Health Education, Humans, Primary Health Care, Illicit Drugs, Practice Guidelines as Topic, Substance-Related Disorders, Prescription Drugs, Young Adult, Tobacco Use
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