Substance Use: Digital Interventions to Prevent Substance Use among Adolescents

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Findings and Recommendations

The Community Preventive Services Task Force (CPSTF) recommends digital interventions for substance use prevention based on sufficient evidence of effectiveness in reducing current or past month alcohol use, and binge drinking. Digital interventions also reduced the frequency of cannabis use, tobacco including electronic cigarette use, and prescription drug misuse among adolescents.

Evaluated interventions showed inconsistent effects on reported rates of initiation for all substances and current use for substances other than alcohol. Additional studies are needed to determine the effectiveness of digital interventions for these outcomes.

The full CPSTF Finding and Rationale Statement and supporting documents for Digital Interventions to Prevent Substance Use among Adolescents are available in The Community Guide Collection on CDC Stacks.

Intervention

Digital interventions to prevent adolescent substance use include tools to provide information, teach skills, and offer support for adolescents to avoid or reduce use of one or more substances. Adolescents participate through a computer, tablet, or smartphone. Resources may be provided as web-based programs, computer or tablet programs, smartphone applications, text messages, online forums, or a combination of formats. Interventions may provide general prevention content or focus on specific substances (such as alcohol, tobacco, or cannabis).

About The Systematic Review

The CPSTF recommendation is based on evidence from 45 studies (search period from January 2000 to July 2023). The systematic review team evaluated substance use measures reported in the included studies for the following outcome categories:

  • Use (prevalence, amount, or frequency) of one or more substances (40 studies)
  • Initiation of use for one or more substances (16 studies)

Study Characteristics

Studies included a median of 1,234 participants (45 studies).

  • The median age of study youth at baseline was 14.2 years (38 studies).
  • Studies evaluated adolescents in middle school (13 studies), high school (21 studies) and combined levels (11 studies).
  • Among the 20 studies conducted in the U.S., participants identified as White (median 64%; 15 studies), Black or African American (median 17%; 17 studies), Hispanic or Latino (14%; 18 studies), Asian (5%; 11 studies) American Indian (2%, six studies), or other (8%, 12 studies).
  • Studies used a variety of self-reported measures for substance use outcomes primarily collected through school-based surveys of students.
  • Substance use was typically measured as prevalence or frequency of use in the previous 30 days.

Summary of Results

Effects of Interventions on Substance Use and Frequency:

  • 22.2% decrease in the prevalence of alcohol use (8 studies)
  • 22.9% decrease in the frequency of alcohol use (13 studies)
  • 16.8% decrease in binge drinking (11 studies)
  • 46.3% decrease in the frequency of cannabis use (10 studies)
  • 38.8% decrease the frequency of tobacco use (9 studies)
  • 127.1% decrease in the frequency of prescription drug misuse (4 studies)

Additional Effects:

  • The effects of interventions on the initiation of substance use were inconsistent across studies
  • Interventions improved anxiety symptoms (3 studies) and perceived stress (3 studies)
  • Reduced alcohol-related harms and consequences (5 studies)

Summary of Economic Evidence

A systematic review of economic evidence has not been conducted.

Applicability

  • The CPSTF finding is applicable to the use of digital interventions providing general substance use prevention content or content focused on a specific substance to adolescents (ages 10-17 years at the time of intervention) and implemented in school, clinic, home, and online settings in the United States.
  • The intervention is applicable to urban and suburban areas, and likely applicable to rural areas, though more evidence for rural areas is needed.
  • The CPSTF finding is applicable to White, Black or African American, and Hispanic or Latino adolescents.

Evidence Gaps

  • How effective are interventions in reducing the number of adolescents who report the initiation or current use of one or more substances?
  • How effective are interventions for American Indian, Alaskan Native, Native Hawaiian, Pacific Islander, and Asian adolescents and for adolescents who identify as a sexual minority?
  • How effective are interventions in rural communities, or when provided to individuals with lower household incomes or family educational attainment?

Implementation Considerations and Resources

  • Programs implemented within schools often encounter logistical challenges. These include constraints on available time for program delivery (Griffin et al. 2022), competing academic demands, and limited access to resources such as computer labs (Buller et al. 2008, Champion et al. 2018, Vogl et al. 2014).
  • The median duration of intervention activities was 1.5 months, and most interventions provided multiple sessions or modules (median: 6 sessions, 4.5 hours).

Crosswalks

Healthy People 2030 iconHealthy People 2030 includes the following objectives related to this CPSTF recommendation.