young people

MOUD to promote opioid abstinence (negative urine screens) and treatment retention in transition-age youth was investigated in a systematic review of four RCT, assessing a combination of buprenorphine (studies evaluated sublingual, short-term buprenorphine) plus cognitive behavioral therapy versus a comparison condition. It was found that buprenorphine or buprenorphine-naloxone was more effective than clonidine:

• to promote abstinence at the 1-month follow-up, measured as percent of patients with negative urine screens (OR = 4.00, 95% CI: 1.00, 16.00),
• when augmented by memantine at three months (OR 9.2 95% CI: 2.7, 31.5),
• when tapered over longer rather than shorter durations (in two studies, OR 7.1 95%CI: 2.9 , 17.3; Cohen's d = 0.57, 95%CI: 0.02, 1.13.

Because of ethical challenges, few trials with young people exist, yet further long-term studies are urgently needed to assess relapse after treatment and social functioning.

Culturally sensitive programs integrate positive youth development factors such as future orientation, problem-solving, communication, decision-making, and emotional regulation with specific cultural or ethnic factors related to socialisation, identity, and acculturation. Culturally sensitive prevention programs for substance use were assessed in a systematic review and meta-analysis (Bo et al., 2023, 30 studies) and found a small yet significant effect in:

• Preventing and reducing substance use (Hedges’s g = - 0.20, 95% CI = [-0.24, -0.16])

A narrative systematic review (Dalton et al., 2021) assessed the interventions for emerging adults (age 18 -25) showing more promise to retain these patients in treatment. The results indicate that the interventions with the most promise for retention in treatment were:

• behavioural therapy such as cognitive behavioural therapy and contingency management for cannabis and alcohol use disorders
• cognitive behavioural therapy paired with opioid-agonist-therapy for opioid use disorder

School health services were found in a systematic review with meta-analysis (Montgomery et al., 2021) to be effective (moderate quality evidence) in:

• reducing drinking alcohol (60.1% vs. 70.5%, p < .001),
• reducing using drugs (28.0% vs. 38.3%, p < .001)

School health services were also found to be associated with reductions in suicide planning (male: 7.1% vs. 7.7%, p < .01), hospitalization (relative risks 3.403, 95% confidence interval [CI] 1.536 to 8.473, p < .05), emergency department visits (odds ratio .85, 95% CI .75 to .95, p ¼ .006), school absence (odds ratio .78, 95% CI .69 to .87, p < .0001), carrying weapons (male: 16.1% vs. 25.1%, p < .01), fighting (male: 32.6% vs. 43.1%, p < .01), sexual activity (53.5% vs. 60.5%, p < .05) and physical activity (female: 57.4% vs. 50.4%, p < .01).

A narrative systematic review (Razaghizad et al., 2021, studies = 11 RCTs and 17 non-RCTs, N = 33,711 of 37,117 active research participants aged 15-25 yrs) investigated the effectiveness of prevention interventions for drugs-and-driving outcomes. The results found evidence to support the interventions that may improve drugs and driving knowledge, attitudes, and behaviours, specifically: 

• high quality evidence that cannabis packaging with health warnings increases the knowledge about drugged driving effects
• moderate quality evidence that roadside drug testing can reduce drugs-and-driving among cannabis users
• moderate quality evidence that for youth or previous offenders, motivational interviewing can prevent drug-and-driving and driver education programs can increase knowledge

The impact of such interventions on measures of drugs-and-driving morbidity and mortality outcomes is uncertain.

Online interventions, web or mobile-based, for young adults (defined as adolescents and young adults from 15 to 30 years), including peer-to-peer contact, patient-to-expert communication, or interactive psychoeducation/therapy to reduce cannabis use was found in a systematic review with meta-analysis (Beneria et al., 2021, 17 RCTs, N= 3 525) to have no effect in:

• reducing cannabis consumption (Hedge's g = -0.061, 95% CI [-0.363] to [-0.242], p = .695)

However, some of the more recent studies out of the 17 used in the analysis, reported positive results. These trials used structured interventions, daily feedback, young adults centred designs, peer support, and specifically targeting cannabis use (as opposed to generic interventions) and showed promise as potentially effective approaches to address cannabis use in this population.

Multiple health behaviour change interventions target risk factors in combination and are a promising method to improve lifelong health. This approach capitalises on evidence that changing one lifestyle behaviour could increase self-efficacy to improve others. Given that teaching time is often restricted, interventions that simultaneously address multiple risk behaviours are particularly advantageous in school settings. eHealth interventions (delivered via the internet, computers, tablets, mobile technology, or tele-health) offer increased student engagement, fidelity, and scalability, and internet technology is becoming increasingly embedded in school education.
School-based eHealth multiple health behaviour change interventions were found in a systematic review with meta-analysis (Champion et al., 2019, 18 studies, N = 18 873 students) to have no effect in:

• reducing alcohol use or smoking

The interventions significantly increased fruit and vegetable intake (standard mean difference 0·11, 95% CI 0·03 to 0·19; p=0·007) and both accelerometer-measured (0·33, 0·05 to 0·61; p=0·02) and self-reported (0·14, 0·05 to 0·23; p=0·003) physical activity, and reduced screen time (–0·09, –0·17 to –0·01; p=0·03) immediately after the intervention; however, these effects were not sustained at follow-up when data were
available.

Brief interventions for non-treatment seeking young adults (17-25 ys) were found in a systematic review with meta-analysis (Halladay et al., 2019) to have some promising but not conclusive effects when compared to no intervention or usual care in:

• improving short-term abstinence - 3 months follow-up (OR 1.73, 95 % CI 1.13 to 2.66, 3 studies, N=666)
• reducing the risk of cannabis use disorders (as measured by the CUPIT tool, a brief self-report screening instrument for detection of currently and potentially problematic cannabis use) (SMD -0.14, 95 % CI -0.26 to -0.01, 7 studies, N=1173)

The results were confirmed in a new systematic review with meta-analysis (Steele et al., 2020) that synthetised the evidence regarding the effects of brief behavioural interventions for adolescents (12–20 years) with problematic substance use. Brief interventions were categorized into motivational interviewing (MI), psychoeducation, and treatment as usual.  The analysis found that:

• use of MI did not reduce cannabis use days, with a net mean difference of 20.05 days per month (95% CrI: 20.26 to 0.14; moderate SoE)
• while it confirmed the effectiveness of brief interventions, especially MI, in reducing heavy alcohol use and alcohol use days

Another narrative systematic review (Chazal et al., 2022, 8 studies, N= 2 199) assessed the effectiveness of brief interventions realized in primary care in reducing cannabis use for adolescents and emerging adults. Brief interventions were all based on motivational interviewing techniques or personalized feedback. The results found:

• no significant reduction of cannabis use after brief intervention was found for most studies, especially in the long term. 

Mentoring (intended as a supportive relationship in which one person offers support, guidance and concrete assistance to a partner) is based on the sharing of experience and expertise without expectation of personal gain by the mentor - Center for Substance Abuse Prevention 2000) was found in a systematic review (Thomas et al., 2011) more effective than no interventions in:

• preventing alcohol use (3 RCTs) (RR 0.71, 95% CI  0.57 to 0.90, p = 0.005).

Ecological family-based treatments (including multidimensional family therapy) delivered in community settings were found in a systematic review without meta-analysis (Hogue et al., 2014, 8 RCTs) and a meta-analysis (Hartnett et al., 2016, 14 studies) to have significant effect in:

• reducing adolescent drug use (mainly cannabis and alcohol)
• reducing adolescent disruptive behaviours