by Mayer, Gwendolyn ¹, Perlea, Victor ¹

• ¹ Universitätsklinikum Heidelberg

This is the abridged version, for the extended version click here
The introduction and overview can be found here

Disclaimer: We have compiled this information to the best of our knowledge based on current scientific literature (as of May 2026). However, we do not provide diagnosis or treatment recommendations. If you notice any mental health concerns in yourself or in a child or adolescent in your care, please consult a medical doctor.

Diagnostic criteria

Substance use disorder involves a maladaptive pattern of use causing impairment or distress, with at least two of eleven criteria within 12 months. These include taking larger amounts than intended, unsuccessful attempts to cut down, craving, role failure, social problems, and hazardous use. Continued use despite harm, tolerance, and withdrawal may also be present, with severity ranging from mild to severe (Hasin et al., 2013; Kölch et al., 2020).

Prevention measures

School-based life-skills programs reduce substance use and related risk factors. Multi-component approaches combining school bonding, classroom curricula, parental involvement, prosocial involvement, and community policies show stronger and more durable effects (Griffin et al., 2022; Kulis et al., 2007).

Risk factors

· Individual factors include early onset, impulsivity, externalizing problems, sensation seeking, depressive or anxiety symptoms, and poor school performance (De Micheli et al., 2020).
· Family factors include parental substance use, low monitoring, family conflict, and permissive attitudes (Horigian et al., 2020).
· Peer and community factors include substance-using peers, pro-use norms, and high availability of substances (Horigian et al., 2020; Nieri et al., 2025).

Treatment approaches

· CBT, functional analysis, coping skills, and relapse prevention are first-line psychosocial approaches (Fadus et al., 2019). Motivational interviewing is especially useful for ambivalent youth and brief interventions (Gersib et al., 2024; Marshall et al., 2025).
· Family-based treatments can reduce substance use and improve family functioning (Horigian et al., 2020).
· Moderate to severe cases may require integrated care across school, primary care, and addiction services, with pharmacotherapy in selected older adolescents and young adults (Fadus et al., 2019; Marshall et al., 2025).

References for this article are here