Substance Use: Family-based Interventions to Prevent Substance Use Among Youth

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Findings and Recommendations

The Community Preventive Services Task Force (CPSTF) recommends family-based interventions to prevent substance use among youth. Evidence from the systematic review came from interventions delivered primarily to families of youth ages 10-14 years and showed reductions in both initiation and use of the following.

  • Cannabis
  • Alcohol
  • Tobacco
  • Illicit substances
  • Prescription drug (misuse)

Studies also reported reductions in sexual risk behaviors among youth and improvements in mental health symptoms and school-related outcomes.

The CPSTF finds that economic benefits exceed the cost of family-based interventions to prevent substance use among youth.

The full CPSTF Finding and Rationale Statement and supporting documents for Substance Use: Family-based Interventions to Prevent Substance Use Among Youth are available in The Community Guide Collection on CDC Stacks.

Intervention

Family-based interventions provide instruction or training to parents and caregivers to enhance substance use preventive skills and practices for children and adolescents. Interventions include individual or small group sessions, web-based modules, printed instruction manuals and workbooks, or a combination of formats.

Intervention content may address the following skills and practices:

  • Parent-child communication
  • Rule setting
  • Monitoring

Interventions may be:

  • Delivered or supported by health professionals or trained family providers
  • Conducted in home, school, and community-based locations
  • Offered with additional substance use prevention activities for youth

About The Systematic Review

The CPSTF finding is based on evidence from a systematic review of 60 studies conducted in the United States. Studies were identified from two sources:

  • A broader systematic review published in 2016 (Allen et al., 39 studies, search period through March 2015)
  • An update search (21 studies, search period January 2015–July 2022)

Study Characteristics

  • All studies were randomized controlled trials conducted in the United States (60 studies)
  • Studies were conducted in urban and suburban communities (25 studies), rural communities (12 studies), and a mix of community types (6 studies)
  • Interventions were delivered in community settings (12 studies), homes (10 studies), schools (6 studies), and multiple locations (29 studies)
  • Most interventions included sessions, modules, or activities for both parents and caregivers and participating youth (54 studies)
  • Studies evaluated interventions delivered face-to-face in group sessions (27 studies), individual sessions (3 studies), or both (16 studies)
  • Some studies did not include face-to-face sessions (12 studies) and instead used printed workbooks, websites, or digital modules

Summary of Results

The systematic review included 60 studies conducted in the United States. Interventions were delivered primarily to families of youth ages 10-14 years.

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

  • Cannabis by 36.6% (4 studies)
  • Alcohol by 12.1% (7 studies)
  • Tobacco by 12.1% (7 studies)
  • Illicit substances by 13.8% (4 studies)
  • Prescription drug misuse by 58.1% (3 studies)

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

  • Cannabis by 39.0% (13 studies)
  • Alcohol by 33.8% (22 studies)
  • Tobacco by 40.8% (9 studies)
  • Illicit substances by 76.7% (3 studies)
  • Prescription drug misuse by 91.4% (6 studies)

Interventions also led to the following outcomes:

  • Reduced sexual risk behaviors and sexually transmitted infections (14 studies)
  • Improved mental health symptoms (13 studies)
  • Improved school-related outcomes (8 studies)

Summary of Economic Evidence

The economic review included 11 peer-reviewed studies and two government reports, one from the Washington State Institute for Public Policy (WSIPP) and the other from the Substance Abuse and Mental Health Services Administration (SAMHSA 2008). WSIPP evaluated 14 programs and SAMHSA 2008 evaluated eight programs. All monetary values are reported in 2012 U.S. dollars.

Intervention cost:

  • Peer-reviewed studies: Median per family $1,672 (6 interventions); median per participant or youth $753 (7 interventions)
  • WSIPP: Median per family $655 (5 programs); median per participant or youth $680 (9 programs)
  • SAMHSA 2008: Mean per family $988 (3 programs); median per participant or youth $677 (5 programs)

Cost-Benefit:

  • Peer-reviewed: Median benefit to cost ratio 5.8 (5 interventions)
  • WSIPP: Median benefit to cost ratio 3.9 (14 programs)
  • SAMHSA 2008: Median benefit to cost ratio 8.9 (8 programs)

Applicability

Based on results from this review, findings are applicable to families of school-aged children and adolescents (ages 10-14 years at the time of the intervention) in the United States. Findings are applicable to interventions delivered in-person in home, school, and community locations in urban, suburban, and rural communities or remotely through printed, digital, or web-based modules.

Evidence Gaps

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

  • How effective are interventions for families of American Indian, Alaskan Native, Native Hawaiian, Pacific Islander, and Asian youth?
  • How effective are interventions for families of youth who identify as a sexual minority?
  • How effective are interventions in reducing development of substance use disorders?
  • How effective are interventions for families of adolescents ages 15 years and older?

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

  • How effective are interventions in reducing vaping initiation and use?
  • How effective are interventions in reducing polysubstance use among youth?
  • How effective are interventions when focused just on parents and caregivers?
  • Does intervention effectiveness differ by household income or parents’ and caregivers’ educational attainment or race/ethnicity?
  • Does intervention effectiveness differ based on characteristics of implementers recruited from the community or schools?
  • How can interventions improve recruitment and retention of fathers and male caregivers?

Economic Evidence Gaps

The following question is proposed as a priority for economic research and evaluation:

  • What are economic outcomes for programs implemented for historically disadvantaged groups, particularly American Indian or Alaska Native groups?

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

  • What are the economic outcomes in urban areas?
  • Is the intervention cost-effective based on more recent data?

Implementation Considerations and Resources

Studies used several strategies to increase family recruitment and retention including the following:

  • Community engagement
  • Tailored intervention content and recruitment strategies
  • Social and peer support including group meals and babysitting services
  • Ongoing telephone contact

CPSTF also recommends intervention approaches related to the following:

Several organizations offer implementation guidance for family-based prevention strategies and interventions to address substance use:

The following resources address issues that may be useful for implementing these interventions in specific communities:

Tribal families:

Military families:

Foster families:

The following resources address specific substance use issues:

Crosswalks

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