by Mayer, Gwendolyn ¹, Perlea, Victor ¹

• ¹ Universitätsklinikum Heidelberg

This is the extended version, for the abridged 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

• Maladaptive pattern of substance use leading to impairment or distress, with at least 2 of 11 criteria in 12 months (e.g. larger amounts/longer than intended; unsuccessful efforts to cut down; much time spent obtaining/using/recovering; craving), recurrent use causing failure to fulfill role obligations (school, work, home), social/interpersonal problems, or use in physically hazardous situations (Kölch et al., 2020).
  
• Continued use despite physical or psychological problems; giving up important social, occupational, or recreational activities (Hasin et al., 2013).
  
• Tolerance and withdrawal (pharmacological criteria); severity specified as mild, moderate, or severe based on number of criteria (Hasin et al., 2013).

Prevention measures

• Universal school‑based life‑skills/competence programs reduce both substance use (tobacco, alcohol, cannabis, and other drugs), with effects persisting into young adulthood and related risk factors (Griffin et al., 2022; Kulis et al., 2007).
  
• Multi‑component approaches combining strong school bonding, classroom curricula, parental involvement, pro‑social involvement and community policies show larger and more sustained reductions in substance use (Griffin et al., 2022).

Risk factors

• Individual: early onset of use, impulsivity, externalizing problems, sensation seeking, depressive/anxiety symptoms, and poor school performance (De Micheli et al., 2020).
  
• Family: parental substance use/abuse, low monitoring, family conflict, and permissive attitudes toward substance use (Horigian et al., 2020).
  
• Peer and community: affiliation with substance‑using peers, perceived norms supporting use, and high availability of substances (Horigian et al., 2020; Nieri et al., 2025).

Treatment approaches

• Psychosocial first‑line: CBT, functional analysis, coping skills, relapse prevention can reduce adolescent substance use (Fadus et al., 2019).
  
• Motivational interventions (Motivational Interviewing/Motivational Enhancement Therapy) are effective, especially for ambivalent youth and in brief or early‑intervention formats (Gersib et al., 2024; Marshall et al., 2025).
  
• Family‑based treatments (e.g. multidimensional family therapy, family behavior therapy) show superior outcomes compared to several individual approaches, reducing substance use and improving family functioning (Horigian et al., 2020).
  
• Multicomponent care (integration of school, primary care, and specialized addiction services; possible pharmacotherapy for specific SUDs in older adolescents/young adults) is recommended for moderate–severe cases (Fadus et al., 2019; Marshall et al., 2025).