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

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)

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 for delinquency; academic underachievement; teen pregnancy; sexually transmitted infections; perpetration of, or experience with, violence; injuries; and mental health problems (U.S. Department of Health and Human Services 2016). Preventing or delaying substance use initiation among youth (defined in this review as children and adolescents ages 10-17 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 (Hoots et al. 2023) include the following:

• Increased availability of illicit fentanyl and other synthetic opioids
• Increased misuse of prescription drugs
• Increased availability of e-cigarettes and vaping products
• Changes in the legal and regulatory landscape for cannabis

Research highlights parenting as a key protective factor that can be enhanced through skill-based training interventions (Ladis et al. 2019, U.S. Department of Health and Human Services 2016). Interventions designed to strengthen preventive skills and practices among parents and caregivers (e.g., communication, positive relationship interactions, monitoring and control) have the potential to protect youth from initiation of substance use and other risk behaviors (Stockings et al. 2016, U.S. Department of Health and Human Services 2016).

Detailed results from the systematic review are available in the CPSTF Finding and Rationale Statement.

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)

A systematic review of economic evidence has not been conducted.

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.

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 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 or gender 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?

• 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 (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.

Effectiveness Review

• Logic Model – Effectiveness Review (Print Only) [PDF – 147 KB]
• Text Description – Effectiveness Review [PDF – 61 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 – 2 MB]

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

Effectiveness Review

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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.

Becker SJ, Marceau K, Hernandez L, et al. Is it Selection or socialization? Disentangling peer influences on heavy drinking and marijuana use among adolescents whose parents received brief interventions. Substance Abuse: Research and Treatment 2019;13:1178221819852644.

Brody GH, Murry VM, Kogan SM, et al. The Strong African American Families Program: a cluster-randomized prevention trial of long-term effects and a mediational model. Journal of Consulting and Clinical Psychology 2006;74(2):356–66.

Brody GH, Chen YF, Kogan SM, et al. Family-centered program deters substance use, conduct problems, and depressive symptoms in black adolescents. Pediatrics 2012;129(1):108–15.

Chaplin TM, Mauro KL, Curby TW, et al. Effects of a parenting-focused mindfulness intervention on adolescent substance use and psychopathology: a randomized controlled trial. Research on Child and Adolescent Psychopathology 2021;49(7):861–75.

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Curry SJ, Hollis J, Bush T, et al. A randomized trial of a family-based smoking prevention intervention in managed care. Preventive Medicine 2003;37:617–26.

DeGarmo DS, Eddy JM, Reid JB, et al. Evaluating mediators of the impact of the Linking the Interests of Families and Teachers (LIFT) multimodal preventive intervention on substance use initiation and growth across adolescence. Prevention Science 2009;10:208–20.

Dembo R, Wothke W, Livingston S, et al. The impact of a family empowerment intervention on juvenile offender heavy drinking: a latent growth model analysis. Substance Use & Misuse 2002;37(11):1359–90.

Dishion TJ, Andrews DW. Preventing escalation in problem behaviors with high-risk young adolescents: immediate and 1-year outcomes. Journal of Consulting and Clinical Psychology 1995;63(4):538.

Estrada Y, Rosen A, Huang S, et al. Efficacy of a brief intervention to reduce substance use and human immunodeficiency virus infection risk among Latino youth. Journal of Adolescent Health 2015; S1054-139X (15) 00285-2 10.

Estrada Y, Lee TK, Huang S, et al. Parent-centered prevention of risky behaviors among Hispanic youths in Florida. American Journal of Public Health 2017;107(4):607–13.

Estrada Y, Lee TK, Wagstaff R, et al. eHealth Familias Unidas: efficacy trial of an evidence-based intervention adapted for use on the internet with Hispanic families. Prevention Science 2019;20(1):68–77.

Fang L, Schinke SP, Cole KCA. Preventing substance use among early Asian-American adolescent grls: initial evaluation of a web-based mother-daughter program. Journal of Adolescent Health 2010;47:529–32.

Fernandez A, Lozano A, Lee TK, et al. A family-based healthy lifestyle intervention: crossover effects on substance use and sexual risk behaviors. Prevention Science 2021;22:602–8.

Forman SG, Linney JA, Brondino MJ. Effects of coping skills training on adolescents at risk for substance use. Psychology of Addictive Behaviors 1990;4(2):67–76.

Gonzales NA, Dumka LE, Millsap RE, et al. Randomized trial of a broad preventive intervention for Mexican American adolescents. Journal of Consulting and Clinical Psychology 2012;80(1):1–16.

Guilamo-Ramos V, Jaccard J, Dittus P, et al. The Linking Lives Health Education Program: a randomized clinical trial of a parent-based tobacco use prevention program for African American and Latino youths. American Journal of Public Health 2010;100(9):1641–7.

Hadley W, Brown LK, Barker D, et al. Work It Out Together: preliminary efficacy of a parent and adolescent DVD and workbook intervention on adolescent sexual and substance use attitudes and Parenting Behaviors. AIDS and Behavior 2016;20(9):1961–72.

Haggerty KP, Skinner ML, MacKenzie EP, et al. A randomized trial of Parents Who Care: effects on key outcomes at 24-month follow-up. Prevention Science 2007;8:249–60.

Komro K, Perry CL, Veblen-Mortenson S, et al. Cross-cultural adaptation and evaluation of a home-based program for alcohol use prevention among urban youth: the “Slick Tracy Home Team Program.” Journal of Primary Prevention 2006;27(2):137–54.

Lavner JA, Barton AW, Beach SRH. Direct and indirect effects of a couple-focused preventive intervention on children’s outcomes: a randomized controlled trial with African American families. Journal of Consulting and Clinical Psychology 2020;88(8):696–707.

Lei MK, Brody GH, Beach SRH. Intervention effects on self-control decrease speed of biological aging mediated by changes in substance use: a longitudinal study of African American youth. Family Process 2022;61(2):659–73.

Loveland-Cherry CJ, Ross LT, Kaufman SR. Effects of a home-based family intervention on adolescent alcohol use and misuse. Journal of Studies on Alcohol 1999;13S:94–102.

Mahabee-Gittens EM, Merianos AL, Stone L, et al. An emergency department intervention to increase parent-child tobacco communication: a pilot study. Journal of Child & Adolescent Substance Abuse 2008;17(2):71–83.

Marsiglia FF, Ayers SL, Han S, et al. The role of culture of origin on the effectiveness of a parents-involved intervention to prevent substance use among Latino middle school youth: results of a cluster randomized controlled trial. Prevention Science 2019;15; 20:643–54.

Marsiglia FF, Ayers SL, Kiehne E. Reducing inhalant use in Latino adolescents through synchronized parent-adolescent interventions. Journal of Prevention & Intervention in the Community 2019;47(3):182–97.

Martinez CR, Eddy JM. Effects of culturally adapted parent management training on Latino youth behavioral health outcomes. Journal of Consulting and Clinical Psychology 2005;73(4): 841–51.

Martinez CR, Eddy JM, McClure HH, et al. Promoting strong Latino families within an emerging immigration context: results of a Replication and extension trial of a culturally adapted preventive intervention. Prevention Science 2022;23:283–94.

Mason WA, January SA, Fleming CB, et al. Parent training to reduce problem behaviors over the transition to high school: tests of indirect effects through improved emotion regulation skills. Children and Youth Services Review 2016;61:176–83.

Mason MJ, Coatsworth JD, Russell M, et al. Reducing risk for adolescent substance misuse with text-delivered counseling to adolescents and parents. Substance Use & Misuse 2021;56(9): 1247–57.

Mello MJ, Bromberg JR, Baird J, et al. Feasibility and acceptability of an electronic parenting skills intervention for parents of alcohol-using adolescent trauma patients. Telemedicine and e-Health 2019;25:833–9.

Milburn NG, Iribarren FJ, Rice E, et al. A family intervention to reduce sexual risk behavior, substance use, and delinquency among newly homeless youth. Journal of Adolescent Health 2012;50:358–64.

Murry VM, Berkel C, Inniss-Thompson MN, et al. Pathways for African American success: results of three-arm randomized trial to test the effects of technology-based delivery for rural African American families. Journal of Pediatric Psychology 2019;44(3):375–87.

O’Donnell L, Myint-U A, Duran R, et al. Especially for Daughters: parent education to address alcohol and sex-related risk taking among urban young adolescent girls. Health Promotion Practice 2010;11(S1):70S–8.

Pantin H, Prado G, Lopez B, et al., A randomized controlled trial of Familias Unidas for Hispanic adolescents with behavior problems. Psychosomatic Medicine 2009;71(9):987–95.

Perry CLWC, Williams CL, Veblen-Mortenson S, et al. Project Northland: outcomes of a communitywide alcohol use prevention program during early adolescence. American Journal of Public Health 1996;86(7):956–65.

Prado G, Pantin H, Briones E, et al. A randomized controlled trial of a parent-centered intervention in preventing substance use and HIV risk behaviors in Hispanic adolescents. Journal of Consulting and Clinical Psychology 2007;75:914–26.

Prado G, Cordova D, Huang S, et al. The efficacy of Familias Unidas on drug and alcohol outcomes for Hispanic delinquent youth: main effects and interaction effects by parental stress and social support. Drug and Alcohol Dependence 2012;125S:S18–25.

Riesch SK, Brown RL, Anderson LS, et al. Strengthening families program (10-14): effects on the family environment. Journal of Nursing Research 2012;34(3):340–76.

Schinke SP, Schwinn TM, Di Noia J, et al. Reducing the risks of alcohol use among urban youth: three-year effects of a computer-based intervention with and without parent involvement. Journal of Studies on Alcohol and Drugs 2004;65(4):443–9.

Schinke SP, Cole KC, Fang L. Gender-specific intervention to reduce underage drinking among early adolescent girls: a test of a computer-mediated, mother-daughter program. Journal of Studies on Alcohol and Drugs 2009;70(1):70–7.

Schinke SP, Fang L, Cole KC. Computer-delivered, parent-involvement intervention to prevent substance use among adolescent girls. Preventive Medicine 2009;49:429–35.

Schinke SP, Fang L, Cole KC. Preventing substance use among adolescent girls: 1-year outcomes of a computerized, mother-daughter program. Addictive Behaviors 2009;34(12):1060–4.

Schinke SP, Fang L, Cole KC, et al. Preventing substance use among Black and Hispanic adolescent girls: results from a computer-delivered, mother-daughter intervention approach. Substance Use & Misuse 2011;46(1):35–45.

Scull TM, Kupersmidt JB, Weatherholt TN. The effectiveness of online, family‐based media literacy education for substance abuse prevention in elementary school children: study of the Media Detective family program. Journal of Community Psychology 2017;45(6):796–809.

Simons-Morton B, Haynie D, Saylor K, et al. The effects of the going places program on early adolescent substance use and antisocial behavior. Prevention Science 2005;6(3):187–97.

Spirito A, Sindelar-Manning H, Colby SM, et al. Individual and family motivational interventions for alcohol-positive adolescents treated in an emergency department: results of a randomized clinical trial. Archives of Pediatric and Adolescent Medicine 2011;165(3):269–74.

Spirito A, Hernandez L, Marceau K, et al. Effects of a brief, parent-focused intervention for substance using adolescents and their sibling. Journal of Substance Abuse Treatment 2017;77:156–65.

Spoth R, Reyes ML, Redmond C, et al. Assessing a public health approach to delay onset and progression of adolescent substance use: latent transition and log-linear analyses of longitudinal family preventive intervention outcomes. Journal of Consulting and Clinical Psychology 1999; 67(5):619–30. (Study arm A)

Spoth R, Reyes ML, Redmond C, et al. Assessing a public health approach to delay onset and progression of adolescent substance use: latent transition and log-linear analyses of longitudinal family preventive intervention outcomes. Journal of Consulting and Clinical Psychology 1999;67(5):619–630. (Study arm B)

Spoth RL, Redmond C, Trudeau L, et al. Longitudinal substance initiation outcomes for a universal preventive intervention combining family and school programs. Psychology of Addictive Behaviors 2002;16(2):129–34.

Spoth R, Redmond C, Shin C, et al. Substance-use outcomes at 18 months past baseline the PROSPER Community–University Partnership Trial. American Journal of Preventive Medicine 2007;32(5):395–402.

Stanton B, Cole M, Galbraith J, et al. Randomized trial of a parent intervention: parents can make a difference in long-term adolescent risk behaviors, perceptions, and knowledge. Archives of Pediatric and Adolescent Medicine 2004;158(10):947–55.

Stormshak EA, Connell AM, VÊronneau M-H, et al. An ecological approach to promoting early adolescent mental health and social adaptation: family centered intervention in public middle schools. Child Development 2011;82:209–25.

Tingey L, Chambers R, Patel H, et al. Impacts of the respecting the circle of life teen pregnancy prevention program on risk and protective factors for early substance use among native American youth. Drug and Alcohol Dependence 2021;228:109024.

Werch CE, Pappas DM, Carlson JM, et al. Short- and long-term effects of a pilot prevention program to reduce alcohol consumption. Substance Use & Misuse 1998;33(11):2303–21.

Werch CE, Owen DM, Carlson JM, et al. One-year follow-up results of the STARS for Families alcohol prevention program. Health Education Research 2003;18(1):74–87.

Wolchik SA, Sandler IN, Millsap RE, et al. Six-year follow-up of preventive interventions for children of divorce: a randomized controlled trial. Journal of the American Medical Association 2002;288(15):1874–81.

Effectiveness Review

The CPSTF finding is based on a systematic review of 60 studies (published through July 2022). The review combined 39 studies of family-based interventions identified from a published systematic review (Allen et al. 2016; search period from database inception through March 2015) with 21 studies identified in an updated search that included the same search terms and added additional terms to capture prescription drug misuse and vaping (search period January 2015 to July 2022).

Databases searched for this review included PubMed, ERIC, CINAHL, PSYCINFO, and the Cochrane Library.

Database: Medline (OVID)

1 Adolescent/ 2181449

2 (adolescen* or teen* or youth).ti,ab. 389971

3 1 or 2 2281382

4 exp family/ or exp parents/ or family relations/ or parent-child relations/ or parenting/ 354978

5 (family or families or parent*).ti,ab. 1432228

6 4 or 5 1601091

7 ((parent adj2 training) or (clinical adj2 trials) or intervention*).mp. 1692029

8 ((alcohol* or drug or prescription or opiate* or substance) adj2 (abuse or misuse)).ti,ab. 67277

9 (marijuana or smoking or opiate* or vaping or tobacco or marijuana or cocaine or heroin or methamphetamine or amphetamine).ti,ab. 424613

10 exp Alcoholism/ or exp Illicit Drugs/ or exp Tobacco Smoking/ or exp Substance-Related Disorders/ 312055

11 exp animals/ not humans.sh. 5025441

12 (Andorra* or Antigua or Aruba or Australia or Austria or Bahamas or Bahrain or Barbados or Barbuda or Belgium or Bermuda or Brunei or Caicos or Canada or Cayman Islands or Channel Islands or Chile or Croatia or Curacao or Cyprus or Czech Republic or Darussalam or Denmark or England or Equatorial Guinea or Estonia or Faeroe Islands or Finland or France or French Polynesia or Germany or Greece or Greenland or Guam or Hong Kong or Iceland or Ireland or (Isle adj2 Man) or Israel or Italy or Japan or Korea or Kuwait or Latvia or Liechtenstein or Lithuania or Luxembourg or Macao or Macau or Malta or Monaco or Netherlands or Netherlands Antilles or Nevis or New Caledonia or New Zealand or Northern Ireland or Northern Mariana Islands or way or Oman or Poland or Portugal or Puerto Rico or Qatar or (Republic adj2 Korea) or Russia or Russian Federation or Saint Kitts or Saint Maarten or Saint Martin or San Marino or Saudi Arabia or Scotland or Singapore or Saint Maarten or Slovak Republic or Slovakia or Slovenia or Spain or (St adj2 Kitts) or (St adj2 Martin) or Sweden or Switzerland or Tobago or Trinidad or Turks or United Arab Emirates or United States or Uruguay or Wales).mp. 3682786

13 (lmic or (low* adj3 middle income countr*) or Afghanistan or Afghani or Algeria* or Angola* or “Guinea-Bissau” or Somalia or Bangladesh* or Belize or Benin or Bhutan or Bhutanese or Bolivia* or “Burkina Faso” or Burundi or “Central African Republic” or “Cabo Verde” or “Cape Verde” or Cambodia* or Cameroon or Chad or Tchad or Comoros or Congo or “Cote d Ivoire” or “Ivory Coast” or Djibouti or Egypt* or “El Salvador” or Salvadoran or Eritrea* or Eswatini or Ethiopia* or Gambia or Gaza or Ghana or Guinea or Haiti or Honduras* or India or Indonesia or Iran or Kenya or Kenyan or Kiribati or Kyrgyz or Laos or Lesotho or Liberia or Madagascar or Malawi or Mali or Mauritania or Micronesia or Mongolia or Morocco or Mozambique or Myanmar or Nepal or Nepalese or Nicaragua* or Niger or Nigeria or “North Korea” or “Papua New Guinea” or Pakistan or Philippines or Principe or “Sierra Leone” or “South Sudan” or Sudan or Syria or Syrian or Rwanda* or Samoa* or “Sao Tome” or Senegal* or “Solomon Islands” or “Sri Lanka” or Tanzania or Tajikistan or “Timor-Leste” or Togo or Tunisia or Uganda or Ukraine or Uzbekistan or Vanuatu or Vietnam or “West Bank” or Yemen or Zambia or Zimbabwe).mp. 904403

14 6 and 7 141401

15 8 or 9 or 10 692892

16 3 and 15 115299

17 14 and 16 4599

18 17 not 11 4597

19 12 and 18 1530

20 19 not 13 1503

21 limit 20 to (english language and yr=”2015 -Current”) 562

Database: ERIC (ProQuest)

noft((parent* OR famil*)) AND noft((“Clinical Trials+” OR Randomized OR “Parenting Education” OR “parent education”)) AND noft((Adolescen* OR teen* OR youth*)) AND noft((tobacco OR smok* OR alcohol OR substance OR marijuana OR cocaine OR heroin OR methamphetamine OR amphetamine OR prescription OR drug* OR vaping OR opioid))

Database: CINAHL (EbscoHost)</h5?

S1 TI ( parent* or family* ) OR AB ( parent* or family* )

S2 TI ( (“Clinical Trials” OR Randomized OR “Parenting Education” OR “parent education”) ) OR AB ( (“Clinical Trials” OR Randomized OR “Parenting Education” OR “parent education”) )

S3 TI ( (tobacco or smok* or alcohol OR substance or marijuana or cocaine or heroin or methamphetamine or amphetamine or prescription or drug* or vaping or opioid) ) OR AB ( (tobacco or smok* or alcohol OR substance or marijuana or cocaine or heroin or methamphetamine or amphetamine or prescription or drug* or vaping or opioid) )

S4 ( (Adolescen* OR teen* OR youth*) ) OR ( (Adolescen* OR teen* OR youth*) )

S5 S1 AND S2

S6 S3 AND S4

S7 S5 AND S6

S8 (MH “Animals+”) NOT (MH “Humans+”)

S11 S7 NOT S8 Limiters – English Language; Peer Reviewed; Exclude MEDLINE records

S12 TX (Andorra* or Antigua or Aruba or Australia or Austria or Bahamas or Bahrain or Barbados or Barbuda or Belgium or Bermuda or Brunei or Caicos or Canada or Cayman Islands or Channel Islands or Chile or Croatia or Curacao or Cyprus or Czech Republic or Darussalam or Denmark or England or Equatorial Guinea or Estonia or Faeroe Islands or Finland or France or French Polynesia or Germany or Greece or Greenland or Guam or Hong Kong or Iceland or Ireland or (Isle N2 Man) or Israel or Italy or Japan or Korea or Kuwait or Latvia or Liechtenstein or Lithuania or Luxembourg or Macao or Macau or Malta or Monaco or Netherlands or Netherlands Antilles or Nevis or New Caledonia or New Zealand or Northern Ireland or Northern Mariana Islands or way or Oman or Poland or Portugal or Puerto Rico or Qatar or (Republic N2 Korea) or Russia or Russian Federation or Saint Kitts or Saint Maarten or Saint Martin or San Marino or Saudi Arabia or Scotland or Singapore or Saint Maarten or Slovak Republic or Slovakia or Slovenia or Spain or (St N2 Kitts) or (St N2 Martin) or Sweden or Switzerland or Tobago or Trinidad or Turks or United Arab Emirates or United States or Uruguay or Wales)

S13 (TX ( (Andorra* or Antigua or Aruba or Australia or Austria or Bahamas or Bahrain or Barbados or Barbuda or Belgium or Bermuda or Brunei or Caicos or Canada or Cayman Islands or Channel Islands or Chile or Croatia or Curacao or Cyprus or Czech Republic or Darussalam or Denmark or England or Equatorial Guinea or Estonia or Faeroe Islands or Finland or France or French Polynesia or Germany or Greece or Greenland or Guam or Hong Kong or Iceland or Ireland or (Isle N2 Man) or Israel or Italy or Japan or Korea or Kuwait or Latvia or Liechtenstein or Lithuania or Luxembourg or Macao or Macau or Malta or Monaco or Netherlands or Netherlands Antilles or Nevis or New Caledonia or New Zealand or Northern Ireland or Northern Mariana Islands or way or Oman or Poland or Portugal or Puerto Rico or Qatar or (Republic N2 Korea) or Russia or Russian Federation or Saint Kitts or Saint Maarten or Saint Martin or San Marino or Saudi Arabia or Scotland or Singapore or Saint Maarten or Slovak Republic or Slovakia or Slovenia or Spain or (St N2 Kitts) or (St N2 Martin) or Sweden or Switzerland or Tobago or Trinidad or Turks or United Arab Emirates or United States or Uruguay or Wales) )) AND (S11 AND S12)

S14 TX ( (lmic or (low* N3 middle income countr*) or Afghanistan or Afghani or Algeria* or Angola* or “Guinea-Bissau” or Somalia or Bangladesh* or Belize or Benin or Bhutan or Bhutanese or Bolivia* or “Burkina Faso” or Burundi or “Central African Republic” or “Cabo Verde” or “Cape Verde” or Cambodia* or Cameroon or Chad or Tchad or Comoros or Congo or “Cote d Ivoire” or “Ivory Coast” or Djibouti or Egypt* or “El Salvador” or Salvadoran or Eritrea* or Eswatini or Ethiopia* or Gambia or Gaza or Ghana or Guinea or Haiti or Honduras* or India or Indonesia or Iran or Kenya or Kenyan or Kiribati or Kyrgyz or Laos or Lesotho or Liberia or Madagascar or Malawi or Mali or Mauritania or Micronesia or Mongolia or Morocco or Mozambique or Myanmar or Nepal or Nepalese or Nicaragua* or Niger or Nigeria or “North Korea” or “Papua New Guinea” or Pakistan or Philippines or Principe or “Sierra Leone” or “South Sudan” or Sudan or Syria or Syrian or Rwanda* or Samoa* or “Sao Tome” or Senegal* or “Solomon Islands” or “Sri Lanka” or Tanzania or Tajikistan or “Timor-Leste” or Togo or Tunisia or Uganda or Ukraine or Uzbekistan or Vanuatu or Vietnam or “West Bank” or Yemen or Zambia or Zimbabwe)

S15 S13 NOT S14 170

Database: PsycINFO (OVID) 1806-2022

1 (adolescen* or teen* or youth).ti,ab. 329575

2 exp family/ or exp parents/ or family relations/ or parent-child relations/ or parenting/ 332706

3 (family or families or parent*).ti,ab. 588607

4 2 or 3 674898

5 ((parent adj2 training) or (clinical adj2 trials) or intervention*).mp. 498544

6 exp Parent Training/ or exp clinical trials/ or exp Family Intervention/ or exp Intervention/ 145285

7 ((alcohol* or drug or prescription or opiate* or substance) adj2 (abuse or misuse)).ti,ab. 60823

8 (marijuana or smoking or opiate* or vaping or tobacco or marijuana or cocaine or heroin or methamphetamine or amphetamine).ti,ab. 117482

9 exp Alcoholism/ or exp Drug Abuse/ or exp Tobacco Smoking/ or exp “Substance Use Disorder”/ 169757

10 exp animals/ not humans.sh. 368483

11 (Andorra* or Antigua or Aruba or Australia or Austria or Bahamas or Bahrain or Barbados or Barbuda or Belgium or Bermuda or Brunei or Caicos or Canada or Cayman Islands or Channel Islands or Chile or Croatia or Curacao or Cyprus or Czech Republic or Darussalam or Denmark or England or Equatorial Guinea or Estonia or Faeroe Islands or Finland or France or French Polynesia or Germany or Greece or Greenland or Guam or Hong Kong or Iceland or Ireland or (Isle adj2 Man) or Israel or Italy or Japan or Korea or Kuwait or Latvia or Liechtenstein or Lithuania or Luxembourg or Macao or Macau or Malta or Monaco or Netherlands or Netherlands Antilles or Nevis or New Caledonia or New Zealand or Northern Ireland or Northern Mariana Islands or way or Oman or Poland or Portugal or Puerto Rico or Qatar or (Republic adj2 Korea) or Russia or Russian Federation or Saint Kitts or Saint Maarten or Saint Martin or San Marino or Saudi Arabia or Scotland or Singapore or Saint Maarten or Slovak Republic or Slovakia or Slovenia or Spain or (St adj2 Kitts) or (St adj2 Martin) or Sweden or Switzerland or Tobago or Trinidad or Turks or United Arab Emirates or United States or Uruguay or Wales).mp. 780084

12 (lmic or (low* adj3 middle income countr*) or Afghanistan or Afghani or Algeria* or Angola* or “Guinea-Bissau” or Somalia or Bangladesh* or Belize or Benin or Bhutan or Bhutanese or Bolivia* or “Burkina Faso” or Burundi or “Central African Republic” or “Cabo Verde” or “Cape Verde” or Cambodia* or Cameroon or Chad or Tchad or Comoros or Congo or “Cote d Ivoire” or “Ivory Coast” or Djibouti or Egypt* or “El Salvador” or Salvadoran or Eritrea* or Eswatini or Ethiopia* or Gambia or Gaza or Ghana or Guinea or Haiti or Honduras* or India or Indonesia or Iran or Kenya or Kenyan or Kiribati or Kyrgyz or Laos or Lesotho or Liberia or Madagascar or Malawi or Mali or Mauritania or Micronesia or Mongolia or Morocco or Mozambique or Myanmar or Nepal or Nepalese or Nicaragua* or Niger or Nigeria or “North Korea” or “Papua New Guinea” or Pakistan or Philippines or Principe or “Sierra Leone” or “South Sudan” or Sudan or Syria or Syrian or Rwanda* or Samoa* or “Sao Tome” or Senegal* or “Solomon Islands” or “Sri Lanka” or Tanzania or Tajikistan or “Timor-Leste” or Togo or Tunisia or Uganda or Ukraine or Uzbekistan or Vanuatu or Vietnam or “West Bank” or Yemen or Zambia or Zimbabwe).mp. 107084

13 4 and (5 or 6) 113745

14 7 or 8 or 9 250053

15 1 and 14 34728

16 13 and 15 3099

17 16 not 10 3095

18 11 and 17 689

19 18 not 12 676

20 limit 19 to (english language and yr=”2015 -Current”) 220

Database: Cochrane

1 (adolescen* or teen* or youth):ti,ab 36562

#2 (family or families or parent*):ti,ab 76885

#3 ((“parent training”) or intervention*):ti,ab 472271

#4 #2 OR #3 507387

#5 ((alcohol* or drug or prescription or opiate* or substance) NEAR/2 (abuse or misuse)):ti,ab 6952

#6 (marijuana or smoking or opiate* or vaping or tobacco or marijuana or cocaine or heroin or methamphetamine or amphetamine):ti,ab 43076

#7 #5 OR #6 48488

#8 #1 AND #4 AND #7 1955

#9 (Andorra* or Antigua or Aruba or Australia or Austria or Bahamas or Bahrain or Barbados or Barbuda or Belgium or Bermuda or Brunei or Caicos or Canada or Cayman Islands or Channel Islands or Chile or Croatia or Curacao or Cyprus or Czech Republic or Darussalam or Denmark or England or Equatorial Guinea or Estonia or Faeroe Islands or Finland or France or French Polynesia or Germany or Greece or Greenland or Guam or Hong Kong or Iceland or Ireland or (Isle Near/2 Man) or Israel or Italy or Japan or Korea or Kuwait or Latvia or Liechtenstein or Lithuania or Luxembourg or Macao or Macau or Malta or Monaco or Netherlands or Netherlands Antilles or Nevis or New Caledonia or New Zealand or Northern Ireland or Northern Mariana Islands or way or Oman or Poland or Portugal or Puerto Rico or Qatar or (Republic Near/2 Korea) or Russia or Russian Federation or Saint Kitts or Saint Maarten or Saint Martin or San Marino or Saudi Arabia or Scotland or Singapore or Saint Maarten or Slovak Republic or Slovakia or Slovenia or Spain or (St Near/2 Kitts) or (St Near/2 Martin) or Sweden or Switzerland or Tobago or Trinidad or Turks or United Arab Emirates or United States or Uruguay or Wales):ti,ab,kw 195209

#10 #8 AND #9 534

#11 (lmic or (low* Near/3 middle income countr*) or Afghanistan or Afghani or Algeria* or Angola* or “Guinea-Bissau” or Somalia or Bangladesh* or Belize or Benin or Bhutan or Bhutanese or Bolivia* or “Burkina Faso” or Burundi or “Central African Republic” or “Cabo Verde” or “Cape Verde” or Cambodia* or Cameroon or Chad or Tchad or Comoros or Congo or “Cote d Ivoire” or “Ivory Coast” or Djibouti or Egypt* or “El Salvador” or Salvadoran or Eritrea* or Eswatini or Ethiopia* or Gambia or Gaza or Ghana or Guinea or Haiti or Honduras* or India or Indonesia or Iran or Kenya or Kenyan or Kiribati or Kyrgyz or Laos or Lesotho or Liberia or Madagascar or Malawi or Mali or Mauritania or Micronesia or Mongolia or Morocco or Mozambique or Myanmar or Nepal or Nepalese or Nicaragua* or Niger or Nigeria or “North Korea” or “Papua New Guinea” or Pakistan or Philippines or Principe or “Sierra Leone” or “South Sudan” or Sudan or Syria or Syrian or Rwanda* or Samoa* or “Sao Tome” or Senegal* or “Solomon Islands” or “Sri Lanka” or Tanzania or Tajikistan or “Timor-Leste” or Togo or Tunisia or Uganda or Ukraine or Uzbekistan or Vanuatu or Vietnam or “West Bank” or Yemen or Zambia or Zimbabwe):ti,ab,kw 48593

#12 #10 NOT #11 with Cochrane Library publication date Between Jan 2015 and Jul 2022 306

Allen ML, Garcia-Huidobro D, Porta C, et al. Effective parenting interventions to reduce youth substance use: A systematic review. Pediatrics 2016;138(2):e20154425.

Hoots BE, Li J, Hertz MF, et al. Alcohol and other substance use before and during the COVID-19 pandemic among high school students — Youth Risk Behavior Survey, United States, 2021. MMWR Suppl 2023;72(Suppl-1):84–92.

Ladis BA, Macgowan M, Martinez MJ, et al. Parent-focused preventive interventions for youth substance use and problem behaviors: a systematic review. Research on Social Work Practice 2019;29(4):420–42.

Stockings E, Hall WD, Lynskey M, et al. Prevention, early intervention, harm reduction, and treatment of substance use in young people. Lancet Psychiatry 2016;3:280–96.

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.

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:

• Preventing Excessive Alcohol Use
• Reducing Tobacco Use

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

• University of Colorado, 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.
• Office of Juvenile Justice and Delinquency Prevention’s (OJJDP’s) Model Programs Guide offers a database of evidence-based juvenile justice and youth prevention, intervention, and reentry programs that covers issues including substance abuse, mental health, and trauma.
• California Evidence-Based Clearinghouse is a registry tool that can help organizations identify, select, and implement interventions for children and families affected by the child welfare system.
• Prevention Technology Transfer Center (PTTC) Network provides technical assistance resources to improve implementation and delivery of effective substance abuse prevention interventions.
• SAMHSA’s National Youth Substance Use Prevention Campaign provides resources for parents and caregivers, educators, and community members to prevent substance use.

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

Tribal families

• Tribal Training and Technical Assistance Center | SAMHSA
• Tribal Youth Resource Center – Resource Library

Military families

• Clearinghouse Continuum of Evidence (Continuum)

Foster families

• Title IV-E Prevention Services Clearinghouse

The following resources address specific substance use issues:

• Preventing Marijuana Use Among Youth | samhsa.gov [PDF – 7.2 MB]
• Opioid Prevention Programs & Tools | HHS.gov
• E-Cigarette Resources | American Lung Association
• Reducing Vaping Among Youth and Young Adults | samhsa.gov [PDF – 2.9 MB]
• Tobacco Prevention Program Resources | ncdhhs.gov [PDF – 1.3 MB]
• Stop Alcohol Abuse Resources (Communities Talk Meetings) | stopalcoholabuse.gov

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 people under 21 years who engaged in binge drinking in the past month — SU‑09
• 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
• 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 cigarette smoking in adolescents — TU‑06
• Reduce current use of smokeless tobacco products among adolescents — TU‑08
• Reduce current cigar smoking in adolescents — TU‑07
• Eliminate cigarette smoking initiation in adolescents and young adults — TU‑10
• Reduce current e-cigarette use in adolescents — TU‑05
• Reduce current tobacco use in adolescents — TU‑04
• Reduce current use of flavored tobacco products in adolescents who use tobacco — TU‑09