Substance Use: Community Interventions involving Coalitions or Partnerships to Prevent Substance Use among Youth

The CPSTF finding is based on evidence from a systematic review that examined the effectiveness of interventions in preventing substance use among youth. The review included 11 studies identified in a systematic search (search period January 1990-May 2023). The systematic review was conducted on behalf of CPSTF by a team of specialists in systematic review methods, and in research, practice, and policy related to substance use prevention among youth.

Youth substance use is associated with increased risk behavioral and academic problems; teen pregnancy; sexually transmitted infections; being involved in or experiencing violence; injuries; and mental health symptoms (such as anxiety and depression), among others (U.S. Department of Health and Human Services 2016). Preventing or delaying substance use initiation among youth (defined in this review as including adolescents ages 10-17 years and young adults ages 18-24 years) reduces later risk for substance use, substance use disorders, and overdose (U.S. Department of Health and Human Services 2016).

Recent trends in substance use among youth indicate stabilization or decreases for all substance categories; however, some youth continue to experience high rates of substance use (e.g., LGBTQ+ students) (CDC 2024). Changes in the legal and regulatory landscape for substances including cannabis and psychedelics as well as the increased availability of illegally-made fentanyl and other synthetic opioids can affect overdose morbidity and mortality.

While community efforts have often focused on alcohol and tobacco prevention, these approaches may apply to prescription drug misuse, initiation and use of illegal and synthetic opioids, and overdose prevention (SAMHSA 2023, Fishbein et al. 2023, U.S. Department of Health and Human Services 2016).

The systematic review included 11 studies.

Interventions reduced overall substance use among youth including:

• Initiation of use of one or more substances by 4.0% (6 studies)
• Rates or frequency of use of one or more substances by 7.0% (7 studies)

Interventions reduced initiation of use for a variety of substances among youth including:

• Cannabis by 4.0% (5 studies)
• Tobacco by 3.3% (5 studies)
• Alcohol by 3.7% (5 studies)
• Illegal substances by 6.7% (4 studies)

Interventions reduced measures of use among youth for the following substances:

• Cannabis by 8.6% (6 studies)
• Tobacco by 9.7% (5 studies)
• Alcohol by 5.0% (7 studies)
• Binge drinking by 6.8% (9 studies)

Interventions also reduced self-reported antisocial behaviors related to delinquency or violence (5 studies) and to alcohol use (2 studies).

A systematic review of economic evidence has not been conducted.

Based on results from this review, findings are applicable to community substance use prevention initiatives directed by coalitions or partnerships in the United States. Findings are applicable to community initiatives including general substance use prevention or focused on alcohol use prevention and initiatives that include two or more interventions delivered in schools, provided to families, and implemented in the community.

CPSTF identified several areas that have limited information. Additional research and evaluation could help answer the following questions and fill remaining gaps in the evidence base. (What are evidence gaps?)

CPSTF identified the following questions as priorities for research and evaluation:

• How effective are these interventions when implemented in urban communities?
• How effective are interventions when implemented in communities with historically disadvantaged racial and ethnic populations?
• How effective are interventions when implemented in communities with lower household incomes?
• How effective are interventions in reducing development of substance use disorders?
• How effective are interventions in reducing prescription drug misuse?

Remaining questions for research and evaluation identified in this review include the following:

• How effective are interventions in reducing polysubstance use among youth?
• How effective are interventions in reducing vaping initiation and use among youth?
• How effective are interventions when focused on substance use prevention in young adults?
• How effective are interventions in improving mental health outcomes?
• How effective are interventions in improving educational outcomes?
• How does effectiveness differ when evidence-based interventions selected by the coalition or partnership are modified to enhance cultural or community relevance?

• Studies were conducted in the United States (8 studies), Australia (1 study), and The Netherlands (1 study).
• Studies included randomized controlled trials (4 studies), controlled before-after evaluations (3 studies, and other designs with a concurrent comparison group (3 studies).
• Studies included rural communities (9 studies), suburban communities (4 studies) and urban communities (5 studies). Only two U.S. studies included urban communities.
• Study initiatives targeted general substance use prevention (7 studies) or focused on alcohol prevention (4 studies).
• Interventions selected by coalitions and partnerships included school-based programs (11 studies), family-based programs (9 studies), and community-based activities (7 studies).
• Study initiatives including or focused on alcohol prevention included interventions directed at retailers (5 studies), enforcement or underage sales restrictions (5 studies), and policy advocacy (4 studies).

Effectiveness Review

• Logic Model – Effectiveness Review (Print Only) [PDF – 134 KB]
• Text Description – Effectiveness Review [PDF – 110 KB]

When starting an effectiveness review, the systematic review team develops an analytic framework. The analytic framework illustrates how the intervention approach is thought to affect public health. It guides the search for evidence and may be used to summarize the evidence collected. The analytic framework often includes intermediate outcomes, potential effect modifiers, potential harms, and potential additional benefits.

Effectiveness Review

• Summary Evidence Table – Effectiveness Review [PDF – 412 KB]

The number of studies and publications do not always correspond (e.g., a publication may include several studies or one study may be explained in several publications).

Effectiveness Review

Anderson-Carpenter KD, Watson-Thompson J, Chaney L, et al. Reducing Binge Drinking in Adolescents through Implementation of the Strategic Prevention Framework. Am J Community Psychol. 2016; 57(1-2): 36–46.

Bauman KE, Foshee VA, Ennett ST, et al. The influence of a family program on adolescent tobacco and alcohol use. American Journal of Public Health 2001;91(4):604–10.

Chilenski SM, Frank J, Summers N, et al. Public Health Benefits 16 Years After a Statewide Policy Change: Communities That Care in Pennsylvania. Prevention Science. 2019; 20:947–958.

Eddy JJ, Gideonsen MD, McClaflin RR, et al. Reducing Alcohol Use in Youth Aged 12-17 Years Using the Strategic Prevention Framework. Journal of Community Psychology. 2012; vol. 40, No. 5, 607–620.

Flewelling RL, Austin D, Hale K, et al. Implementing Research-based Substance Abuse Prevention In Communities: Effects of a Coalition-based Prevention Initiative in Vermont. Journal of Community Psychology. 2005; vol. 33, no. 3: 333–353.

Hallgren M, Andreasson S. The Swedish six-community alcohol and drug prevention trial: Effects on youth drinking. Drug and Alcohol Review. 2013; 32: 504–511.

Hawkins JD, Oesterle S, Brown EC, et al. Youth Problem Behaviors 8 Years After Implementing the Communities That Care Prevention System-A Community-Randomized Trial. JAMA Pediatrics. 2014;168(2):122-129

Jonkman H, Aussems C, Steketee M, et al. Prevention of Problem Behaviours among Adolescents: The Impact of the Communities that Care Strategy in the Netherlands (2008–2011). International Journal of Developmental Science. 2015; 9: 37–52.

Komro KA, Livingston MD, Wagenaar AC. Multilevel Prevention Trial of Alcohol Use Among American Indian and White High School Students in the Cherokee Nation. Am J Public Health. 2017;107:453–459.

Kuklinski MR, Oesterle S, Briney JS, Hawkins D. Long-term Impacts and Benefit–cost Analysis of the Communities That Care Prevention System at Age 23, Twelve Years After Baseline. Prev Sci. 2021; 22(4): 452–463.

Livingston MD, Komro KA, Wagenaar AC. Effects of Alcohol Interventions on Other Drug Use in the Cherokee Nation. Am J Public Health. 2018, Vol 108, No. 2: 259-261.

Oesterle S, Kuklinski MR, Hawkins JD, et al. Long-Term Effects of the Communities That Care Trial on Substance Use, Antisocial Behavior, and Violence Through Age 21 Years. Am J Public Health. 2018; 108:659–665.

Spoth R, Redmond C, Shin C, et al. PROSPER Community-University Partnership Delivery System Effects on Substance Misuse through 6½ Years Past Baseline from a Cluster Randomized Controlled Intervention Trial. Prev Med. 2013; 56(0): 190–196.

Spoth RL, Trudeau LS, Redmond C, et al. PROSPER partnership delivery system: Effects on adolescent conduct problem behavior outcomes through 6.5 years past baseline. Journal of Adolescence. 2015; 45:44-55.

Spoth R, Redmond C, Shin C, et al. PROSPER delivery of universal preventive interventions with young adolescents: long-term effects on emerging adult substance misuse and associated risk behaviors. Psychological medicine. 2017 Oct;47(13):2246-59.

Spoth R, Redmond C, Shin C, et al. Applying the PROSPER prevention delivery system with middle schools: Emerging adulthood effects on substance misuse and conduct problem behaviors through 14 years past baseline. Child development. 2022 Jul;93(4):925-40

Toumbourou JW, Rowland B, Williams J, et al. Community Intervention to Prevent Adolescent Health Behavior Problems: Evaluation of Communities That Care in Australia. Health Psychology. 2019; vol. 38, no. 6: 536-544.

Wagenaar AC, Livingston MD, Pettigrew D, et al. Communities Mobilizing for Change on Alcohol (CMCA): Secondary Analyses of an RCT Showing Effects of Community Organizing on Alcohol Acquisition by Youth in the Cherokee Nation. Addiction. 2018; 113(4): 647–655.

Wolfson M, Champion H, McCoy TP, et al. Impact of a Randomized Campus/Community Trial to Prevent High-Risk Drinking Among College Students. Alcoholism: Clinical and Experimental Research. 2012; vol. 36, no. 10: 1767-1778.

Effectiveness Review

The following databases were searched from database inception through May 2023: Medline, Embase, CINAHL, PSYCINFO, Cochrane Library, and Scopus. The types of documents searched in the databases included journal articles, books, book chapters, reports, conference papers, and dissertations in English.

The strategy was intentionally broad to search for all studies with MeSH terms for coalitions and partnerships, delinquency and violence prevention, and any substance (e.g., alcohol, tobacco, cannabis, illicit substances, prescription drugs). Through deduplication, the search yielded 6726 citations.

Teams of two reviewers independently screened search results and abstracted qualifying studies. Differences were reconciled first by the two abstractors, with unresolved differences brought to all review team members to reach consensus. Members of the review team also scanned the bibliographies of all reviewed studies to identify any additional relevant literature. The CPSTF finding included 11 unique studies.

The search strategy is specified below.

Ovid MEDLINE(R) ALL 1946-

1 Adolescent/ 2
2 (adolescen* or teen* or youth or underage).ti,ab.
3 1 or 2
4 ((community or community based or civic) adj3 (stakeholder* or coalition* or engagement or partnership* or implement* or practice or alliance* or collaboration* or participation)).ti,ab,kw,kf. or exp Community Networks/ or exp Community Participation/
5 ((coalition* or cooperative or coalition based or community based or evidence based or science based) adj3 (training* or clinical trial* or intervention* participatory or prevent* or implement* or strateg* or program* or practice*)).ti,ab,kw,kf.
6 4 or 5
7 ((alcohol* or drug or prescription or opiate* or substance) adj2 (abuse or misuse or addiction or overdos*)).mp.
8 (marijuana or smoking or opiate* or vaping or tobacco or violen* or cocaine or delinquen* or devian* or “problem behavior” or heroin or methamphetamine or amphetamine).mp.
9 exp Illicit Drugs/ or exp Tobacco Smoking/ or exp Substance-Related Disorders/ or exp Alcohol Drinking/ or exp Underage Drinking/ or exp Problem Behavior/
10 or/7-9
11 exp animals/ not humans.sh.
12 3 and 6 and 10
13 limit 12 to (english language and yr=”1990 -Current”)

Embase 1974-

1 Adolescent/
2 (adolescen* or teen* or youth or underage).ti,ab.
3 1 or 2
4 ((community or community based or civic) adj3 (stakeholder* or coalition* or engagement or partnership* or implement* or practice or alliance* or collaboration* or participation)).ti,ab,kw,kf. or exp Community Care/ or exp Community Participation/
5 ((coalition* or cooperative or coalition based or community based or evidence based or science based) adj3 (training* or clinical trial* or intervention* participatory or prevent* or implement* or strateg* or program* or practice*)).ti,ab,kw,kf.
6 4 or 5
7 ((alcohol* or drug or prescription or opiate* or substance) adj2 (abuse or misuse or addiction or overdos*)).mp.
8 (marijuana or smoking or opiate* or vaping or tobacco or violen* or cocaine or delinquen* or devian* or “problem behavior” or heroin or methamphetamine or amphetamine).mp.
9 exp Illicit Drugs/ or exp Tobacco Smoking/ or exp Drug Dependence/ or exp Drinking Behavior/ or exp Underage Drinking/ or exp Problem Behavior/
10 or/7-9
11 exp animals/ not humans.sh.
12 3 and 6 and 10
13 12 not 11
14 limit 12 to (english language and yr=”1990 -Current”)
15 limit 14 to “remove medline records”

APA PsycInfo 1806-

1 (adolescen* or teen* or youth or underage).ti,ab.
2 ((community or community based or civic) adj3 (stakeholder* or coalition* or engagement or partnership* or implement* or practice* or alliance* or collaboration* or participation)).ti,ab,hw. or community involvement/ or coalition formation/
3 ((coalition* or cooperative or coalition based or community based or evidence based) adj3 (training* or clinical trial* or intervention* or prevent* or participatory or implement or strateg* or program* or practice*)).ti,ab,hw.
4 2 or 3
5 ((alcohol* or drug or prescription or opiate* or substance) adj2 (abuse or misuse or addiction or overdos*)).mp.
6 (marijuana or smoking or opiate* or vaping or tobacco or violen* or cocaine or delinquen* or devian* or “problem behavior” or heroin or methamphetamine or amphetamine).mp.
7 Drug Usage/ or Drug Abuse/ or Alcohol Abuse/ or Underage Drinking/ or juvenile delinquency/
8 or/5-7
9 1 and 4 and 8
10 limit 10 to (human and english language and yr=”1990 -Current”)

Cochrane Library

#1 MeSH descriptor: [Adolescent] explode all trees
#2 (adolescen* OR teen* OR youth OR underage):ti,ab
#3 #1 OR #2
#4 ((community or community based or civic) NEAR/3 (stakeholder* or coalition* or engagement or partnership* or implement* or practice or alliance* or collaboration* or participation)):ti,ab
#5 ((coalition* or cooperative or “coalition based” or “community based” or “evidence based” or “science based”) NEAR/3 (training* or clinical trial* or intervention* participatory or prevent* or implement* or strateg* or program* or practice*)):ti,ab
#6 #4 OR #5
#7 ((alcohol* or drug or prescription or opiate* or substance) NEAR/2 (abuse or misuse or addiction or overdos*))
#8 (marijuana or smoking or opiate* or vaping or tobacco or violen* or cocaine or delinquen* or devian* or “problem behavior” or heroin or methamphetamine or amphetamine)
#9 #7 OR #8
#10 #3 AND #6 AND #9 with Cochrane Library publication date Between Jan 1990 and Apr 2023

CINAHL(EbscoHost)

(MH “Adolescence”) AND TI ( (adolescen* OR teen* OR youth OR underage) ) AND AB ( (adolescen* OR teen* OR youth OR underage) )
AND
TI ( ((community or community based or civic) N3 (stakeholder* or coalition* or engagement or partnership* or implement* or practice or alliance* or collaboration* or participation)) ) OR AB ( ((community or community based or civic) N3 (stakeholder* or coalition* or engagement or partnership* or implement* or practice or alliance* or collaboration* or participation)) )
OR TI ( ((coalition* or cooperative or “coalition based” or “community based” or “evidence based” or “science based”) N3 (training* or clinical trial* or intervention* participatory or prevent* or implement* or strateg* or program* or practice*)) ) OR AB ( ((coalition* or cooperative or “coalition based” or “community based” or “evidence based” or “science based”) N3 (training* or clinical trial* or intervention* participatory or prevent* or implement* or strateg* or program* or practice*)) )
AND
TI ( ((alcohol* or drug or prescription or opiate* or substance) N2 (abuse or misuse or addiction or overdos*)) ) OR AB ( ((alcohol* or drug or prescription or opiate* or substance) N2 (abuse or misuse or addiction or overdos*)) ) OR (marijuana or smoking or opiate* or vaping or tobacco or violen* or cocaine or delinquen* or devian* or “problem behavior” or heroin or methamphetamine or amphetamine) OR (MH “Substance Abuse”) OR (MH “Alcohol Drinking”) OR (MH “Juvenile Delinquency”) OR (MH “Alcohol Abuse”) OR (MH “Risk Taking Behavior”)
Limiters – Published Date: 19900101-20231231
Narrow by Language: – English

Scopus

( ( INDEXTERMS ( adolescent ) ) OR ( TITLE-ABS ( adolescen* OR teen* OR youth OR underage ) ) ) AND ( ( TITLE-ABS ( ( communit* OR “community based” OR civic ) W/3 ( stakeholder* OR coalition* OR engagement OR partnership* OR alliance* OR collaboration* OR participation OR participatory ) ) ) OR ( INDEXTERMS ( “community networks” ) ) OR ( TITLE-ABS ( ( “coalition based” OR communit* OR “community based” OR “evidence-based” OR “evidence based” ) W/2 ( training* OR “clinical trial” OR intervention* OR randomized* OR prevent* OR implement* OR strateg* OR program* OR practice* ) ) ) ) AND ( ( TITLE-ABS ( ( alcohol* OR drug OR prescription* OR opiate* OR substance ) W/2 ( abuse OR misuse OR addiction OR overdos* ) ) ) OR ( TITLE-ABS ( marijuana OR smoking OR opiate* OR violen* OR delinquen* OR deviant OR vaping OR “problem behavior” OR tobacco OR cocaine OR heroin OR methamphetamine* OR amphetamine* ) ) OR ( INDEXTERMS ( “illicit drugs” ) OR INDEXTERMS ( “Tobacco Smoking” ) OR INDEXTERMS ( “substance-related disorders” ) OR INDEXTERMS ( “underage drinking” ) OR INDEXTERMS ( “alcohol drinking”)) AND ( LIMIT-TO ( LANGUAGE , “English” ) )
Limits:
PUBYEAR 1990-2023

Bo A, Goings TC, Evans CBR, et al. Culturally sensitive prevention programs for substance use among adolescents of color: A systematic review and meta-analysis of randomized controlled trials. Clinical Psychology Review. 2023; 99: 102233.

Centers for Disease Control and Prevention. Youth Risk Behavior Survey Data Summary & Trends Report: 2013–2023. U.S. Department of Health and Human Services; 2024.

Eddy JJ, Gideonsen MD, McClaflin RR, et al. Reducing Alcohol Use in Youth Aged 12-17 Years Using the Strategic Prevention Framework. Journal of Community Psychology. 2012; vol. 40, No. 5, 607–620.

Fishbein DH, Sloboda Z. A National Strategy for Preventing Substance and Opioid Use Disorders Through Evidence-Based Prevention Programming that Fosters Healthy Outcomes in Our Youth. Clinical Child and Family Psychology Review. 2023; 26:1–16.

Flewelling RL, Austin D, Hale K, et al. Implementing Research-based Substance Abuse Prevention in Communities: Effects of a Coalition-based Prevention Initiative in Vermont. Journal of Community Psychology. 2005; vol. 33, no. 3: 333–353.

Hutchinson M, Russell BS. Community Coalition Efforts to Prevent Adolescent Substance Use: A Systematic Review. Journal of Drug Education: Substance Abuse Research and Prevention. 2021;50:3–30.

Komro KA, Livingston MD, Wagenaar AC. Multilevel Prevention Trial of Alcohol Use Among American Indian and White High School Students in the Cherokee Nation. Am J Public Health. 2017;107:453–459.

Substance Abuse and Mental Health Services Administration (SAMHSA). Community Engagement: An Essential Component of an Effective and Equitable Substance Use Prevention System. SAMHSA Publication No. PEP22-06-01-005. Rockville, MD: National Mental Health and Substance Use Policy Laboratory. Substance Abuse and Mental Health Services Administration, 2022.

Substance Abuse and Mental Health Services Administration: Engaging Community Coalitions to Decrease Opioid Overdose Deaths Practice Guide. Rockville, MD: National Mental Health and Substance Use Policy Laboratory. Substance Abuse and Mental Health Services Administration, 2023.

U.S. Department of Health and Human Services (HHS), Office of the Surgeon General, Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health. Washington, DC: HHS, November 2016.

The following considerations for implementation are drawn from studies included in the existing evidence review, the broader literature, and expert opinion.

Most interventions provided training sessions for recruited coalition and partnership members. Training sessions covered a range of topics including member roles and process steps, substance use issues, use of data for identifying local prevention priorities, and guidance on evidence-based prevention (Flewelling et al. 2005, Eddy et al. 2012).

Involvement of community members in decision-making roles may enhance health equity relevance of the community response (Komro et al. 2017). Initiatives should consider cultural relevance of the interventions selected for implementation (Bo et al. 2023).

CPSTF also recommends intervention approaches related to the following:

• Family-based interventions to prevent substance use among youth
• Preventing Excessive Alcohol Use
• Reducing Tobacco Use

The following resources provide implementation guidance for community-wide initiatives including coalitions and partnerships:

• Brandeis Opioid Resource Connector, a frequently updated selection of community-focused programs on interventions that address the opioid crisis
• State/Tribal Opioid Response Network (SOR/TOR-TA)
• CTC PLUS | The Center for Communities That Care
• How It Works | PROSPER (iastate.edu)
• Apply for DFC Funding | Overdose Prevention | CDC
• Engaging Community Coalitions to Decrease Opioid Overdose Deaths Practice Guide 2023 | SAMHSA
• Six Elements of Effective Coalitions Resource Toolkit | Prevention Technology Transfer Center (PTTC) Network
• Implementing Community-Level Policies to Prevent Alcohol Misuse | SAMHSA
• Community Engagement: An Essential Component of an Effective and Equitable Substance Use Prevention System | SAMHSA

The following resources provide technical assistance and guidance for specific intervention options and address issues that may be useful for implementing these interventions for specific communities:

• Blueprints for Healthy Youth Development is a registry of scientifically rigorous and accessible prevention and intervention programs aimed at addressing youth health and behavior issues.
• Products and Resources | Prevention Technology Transfer Center (PTTC) Network (pttcnetwork.org)
• Strategic Prevention Technical Assistance Center (SPTAC) | SAMHSA
• Prevention Intervention Resource Center – High Intensity Drug Trafficking Areas (hidta.org)
• Evidence-based Prevention and Intervention Support (EPIS) Center (psu.edu)
• Resources Center | Community Anti-Drug Coalitions of America (CADCA)
• Applied Prevention Science International (APSI) | apsintl.org
• Tribal Training and Technical Assistance Center | SAMHSA
• Tribal Youth Resource Center – Resource Library

Healthy People 2030

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

• Reduce the proportion of adolescents who drank alcohol in the past month — SU 04
• Reduce the proportion of adolescents who used drugs in the past month — SU 05
• Reduce the proportion of adolescents who used marijuana in the past month — SU 06
• Reduce the proportion of people under 21 years who engaged in binge drinking in the past month — SU 09
• Increase the proportion of adolescents who think substance abuse is risky — SU R01
• Reduce the proportion of lesbian, gay, or bisexual high school students who have used illicit drugs — LGBT 07
• Reduce the proportion of transgender high school students who have used illicit drugs — LGBT D03
• Reduce current tobacco use in adolescents — TU 04
• Reduce current e-cigarette use in adolescents — TU 05
• Reduce current cigarette smoking in adolescents — TU 06
• Reduce current cigar smoking in adolescents — TU 07
• Reduce current use of smokeless tobacco products among adolescents — TU 08
• Reduce current use of flavored tobacco products in adolescents who use tobacco — TU 09
• Eliminate cigarette smoking initiation in adolescents and young adults — TU 10