As with many other health issues, strong, supportive relationships, social-emotional and practical skills, policies that reduce harm, and communities where young people are able to thrive help most to prevent and reduce youth substance use.
š³ āThis is your brain on drugs.
From the mid-1980s through the early 2000s, several widely promoted drug-prevention efforts in the U.S. told kids to ājust say no,ā offered lots of detailed information about drugs, or often relied on fear-based messaging (like this famous Public Service Announcement).
It turns out that assumptions about what would work were often wrong. These approaches were well-intentioned, but when researchers looked at their long-term impact, they generally didnāt reduce youth substance use. For example, multiple reviews found that the original version of the D.A.R.E. program (1983ā2009) had no meaningful lasting effect on whether young people used alcohol, tobacco, or other drugs.
ā The Good News: Now We Know What Works
Today, instead of relying on fear or guesswork, itās possible to use approaches grounded in research to truly support young peopleās health and reduce the likelihood that they will use drugs and alcohol as teenagers.
Prevention science has grown into a strong field with decades of solid research. One clear lesson has emerged: like other aspects of health, youth substance use isnāt just about personal choices or genetics. Itās influenced by young peopleās relationships, the places they spend time in, and policies in their communities and countries. When we strengthen those environments, we help young people make healthy decisions.
That means prevention works best when we:
ā ļøAddress risk factors (things that increase the chance of harm) AND
š±Support protective factors (things that help promote health)
ā”ļø at individual, family, school, community, and policy levels.
Public health specialists, social workers, clinicians, community organizers and safety experts often use a risk and protective factor framework to prevent heart disease, depression, traffic injuries, and many other health challenges.
š«A helpful comparison: Heart health
Think about heart disease for a moment. We donāt prevent heart attacks and promote heart health by telling people to ājust say no to heart attacks.ā We work on multiple levels to:
- Help individuals build healthy habits, so theyāre more likely to eat a healthy diet, exercise, and quit smoking.
- Support families to create positive routines and awareness of family history and needs.
- In communities, increase access to safe places to walk, play, and exercise, and places to buy healthy, affordable food.
- Pass laws and policies, like food labeling and limits on trans fats, and work to reduce stigma about what obesity looks like, with more focus on health.
Youth substance use prevention works the same way: healthier environments lead to fewer youth using drugs and alcohol.
š§© So what actually works to prevent and reduce youth substance use?
Prevention research shows that there are proven ways to reduce risk factors and support protective factors at multiple levels: individual, family, community, and larger scale change, like laws, policies, and societal attitudes. The great news is that many of the risk and protective factors for youth substance use also influence the risk of violence and the likelihood of mental well-being, so strengthening them helps young people in multiple parts of their lives.
šFind more about risk and protective factors for substance use from the National Institute on Drug Abuse (NIDA).
š£Equity alert: Youth substance use risk and harm are not the same for all young people. National data shows differences by race, gender identity, sexual orientation, and social and economic conditions because of the different environments young people grow up in and how systems affect people differently. Things like discrimination, access to supportive spaces, and community stress all matter.
Prevention works best when it fits individual and community culture, needs, and strengths. The strategies mentioned in this post often work well because they reflect these ideas. If youād like to read more about these concepts, Those Nerdy Girls has a post on social factors and iron levels, and weāll share a new post soon on the concept of āupstream preventionā which is addressing root causes of health problems.
š§ Individual Level
Young people are less likely to use substances when they have tools to handle:
- stress
- peer pressure
- conflict or big feelings
- decisionāmaking during challenging situations
Evidenceābased programs teach decisionāmaking, emotional regulation, social skills, and build confidence.
šIn addition to the CDCās ENGAGE: Evidence-Based Strategies to Prevent Youth Substance Use, find more about individual level strategies at the Substance Abuse and Mental Health Services Administrationās (SAMHSA) Risk and Protective Factors Overview [archived link]
š Family Level
One of the strongest protective factors for kids and youth is the combination of feeling safe and connected to a caring adult in the family and having clear rules along with ongoing communication about substance use. Helpful practices include:
- shared routines and fun (like eating meals together regularly, doing household chores, and doing fun activities together)
- open dialogues (not lectures)
- clear expectations about not using substances
š Find more about family level strategies at CDCās page on general Risk & Protective Factors for children and youth [archived link] and on substance use prevention[archived link]
š«School Level
Students who feel connected to at least one adult at school, safe in their environment, and valued are significantly less likely to use substances, attempt suicide or have other mental health challenges, experience violence, or disengage from school.
Connection can come from a trusted teacher, coach, club advisor, or feeling recognized and included in school activities. School policies that promote connection include:
- fair discipline policies with consistent responses that teach skills and address root causes, rather than āzeroātoleranceā – automatic, harsh punishments with no flexibility
- effectively implemented restorative practices – school-wide systems based on Indigenous practices that build and maintain meaningful relationships, with processes to repair relationships when harm has occurred
- evidence-based classroom management approaches
- opportunities for youth empowerment and peer connections
š Find more about school level strategies at the CDC School Connectedness Page[archived link]
š¬Community Level
Teens are less likely to start using substances or use them regularly when they have:
- safe, welcoming spaces
- meaningful activities (arts, sports, volunteering)
- chances to lead and contribute, and to be recognized for positive contributions
Programs that give young people meaningful roles at school or in the community, help them feel connected, and recognize their efforts are especially effective at reducing substance use. This is sometimes called the āSocial Development Strategy.ā
š Find more about community level strategies at the Communities That Care modelās page on the science behind the Social Development Strategy
šļø Local and State Policy: Powerful Tools
Policy may feel distant, but it has some of the strongest effects, such as:
- Raising the legal age for tobacco to 21 reduced youth smoking.
- Higher alcohol taxes reduce underage drinking and related injuries.
- Fewer retail stores in the same area selling alcohol, nicotine, and cannabis, and stronger ad restrictions reduce youth exposure to substances.
š Find more about policy options for youth substance use prevention in the Policy Considerations section of the CDC ENGAGE Guide, CDCās Evidence-Based Guides for States on tobacco control, and a global perspective from the World Health Organizationās SAFER program.
š Does prevention actually work on a large scale?
Yes, and we now have decades of research to show that it does.
One of the biggest success stories is youth tobacco use. Since the 1990s, youth cigarette smoking has declined by more than 85% in the U.S. This drop is strongly linked to coordinated prevention strategies ā taxes, ad restrictions, smoke-free laws, media campaigns, and school/community efforts.
SAMHSAās Substance Use Prevention landing page has lots of links to resources and evidence-based programs.
š Staying Current: Why Prevention Work Has to Keep Adapting
Prevention works, but the landscape is always changing.
š° Companies that profit from addictive substances have a long history of shifting strategies to target young people, because the earlier someone starts, the more likely they are to develop dependence. For example, after youth cigarette smoking had declined for decades, e-cigarette companies used many of the same old tactics in new ways. JUULās early marketing included colorful ads with models who looked young, industry-sponsored educational programs, sweet or fruity flavors, and social media influencer campaigns. These strategies contributed to a sharp rise in teen vaping, with rates peaking in 2018ā2019. Since then, after the combination of a congressional investigation, successful lawsuits against the company by multiple State Attorneys General, policy changes that restrict flavored products, and educational campaigns, youth vaping has declined nationally over the last several years. There is continued work to further reduce vaping rates among youth.
š§© The Bottom Line
Weāve made major progress in reducing youth substance use. As the products, marketing, and environment keep changing, prevention needs to stay flexible and responsive.
Youth substance use prevention works best when we:
- Support strong relationships
- Teach real coping and decision-making skills through evidence-based education
- Create school cultures where students feel connected
- Build communities where teens have meaningful things to do
- Use policies to reduce exposure and access
- Stay flexible and responsive to new challenges
Youth substance use prevention is not about scaring young people or lecturing them. Itās about creating environments where they can thrive.
š” Further reading:
Blueprints for Health Youth Development: Evidence-based programs for youth development
The site lists wellāstudied programs and the research on each so you can choose what fits your community and culture.
World Health Organization: Hooking the next generation: how the tobacco industry captures young customers:
CDC: ENGAGE: Evidence-Based Strategies to Prevent Youth Substance Use [archived link]
SAMHSA: The Substance Use Prevention landing page has lots of links to resources and evidence-based programs
Policy Brief from the Chicago Strategic Action Council: Prevention Makes Cents: highlighting the need for increased investment in substance misuse prevention and the economic and societal benefits.
There are many more great resources about these topics! Community-based youth substance use prevention coalitions can be fantastic resources for youth substance use data in your region, with knowledge about what is being done already in your area, and ways to get involved. Search ā[your town/county] substance use prevention coalitionā or contact your local school district to see if they partner with a coalition.
