Prevention, treatment and care of substance use disorders among adolescents. Statement by the UNODC-WHO Informal Scientific Network, 2024
Members of the UNODC-WHO ISN include E. Adjei-Acquah, M. al'Absi, S. Al Emadi, O.A. Alibrahim, P. Arwidson, S. Ben-Ezra, J.G. Bramness, M. Branting, E. Bryun, M. Chakali, C. Damin, G. Fischer, E. Krupitsky, R. Lal, C. Leonardi, Z. Liu, M.A. Mahfouz, I. Maremmani, M.T. Matar, S. Maua, M.E. Medina-Mora, E. Neumeier, I. Obot, S. Onen, K.M. Ostaszewski, T.M. Ronzani, P. Roska, M.P. Schaub, O. Scoppetta, V. Skryabin, M. Torrens, J. Toufiq, G. Vilar, J.A. Villatoro-Velázquez, N. Volkow, K. Vyshinsky, M. Zhao and S.T. Zhenkova. The authors thank T. Clarke, E. Einstein, C. Gamboa-Riano, J. Hobin, A. Lee, W. Wagner and E.M. Wargo for their editorial work. The authors alone are responsible for the views expressed in this letter and they do not necessarily represent the views, decisions or policies of the institutions with which they are affiliated.
Since 2014, the United Nations Office on Drugs and Crime (UNODC) - World Health Organization (WHO) Informal Scientific Network (ISN) has brought the voice of science to international drug policy discussions at the Commission on Narcotic Drugs, the drug-control policy-making body of the United Nations (UN). The public health dimensions of substance use, including prevention and treatment of substance use disorders, have become prominent in policy debates within the UN system.
Adolescence, which is the focus of this ISN statement, has been defined as individuals aged between 10 and 19 years1. While no global data on substance use within this full age range could be located, global data among more limited subsets are available. Alcohol is the most commonly used substance among all people 15+ years of age2: 155 million, i.e. more than a quarter (26.5%) of all those aged 15-19, are current drinkers. In addition, the 15-19 age group exhibits higher rates of heavy episodic drinking when compared to the total population of drinkers3. Cannabis is the internationally controlled substance most widely used by adolescents, and its use among 15-16-year-olds varies by region, from less than 3% annual prevalence in Asia to over 17% in Oceania. In most geographical areas, the proportion of adolescents using cannabis is higher than in the general population aged 15-643.
Consistent with Sustainable Development Goals4 and other international commitments5, UN Member States called for comprehensive, evidence-based prevention of substance use, including early prevention6 and available, accessible, diverse, evidence-based treatment and care for children and young people with substance use disorders7. There is a joint responsibility for policy makers, scientists, service providers, and communities to implement effective demand-reduction strategies and to adequately address prevention, treatment and recovery support, as well as measures to reduce the negative health and social consequences of substance use disorders among adolescents.
- Expand the availability and use of evidence-based prevention, treatment and care strategies and interventions for adolescents, and ensure sustainable funding for their implementation.
- Facilitate the availability of evidence-based prevention programs in the public domain with reimbursement schemes, thus allowing for preventive interventions to be inclusive and to address the needs of socio-economically disadvantaged groups, ensuring that minoritized populations, Indigenous groups; and lesbian, gay, bisexual, transgender, queer and questioning (LGBTQ+) people are included.
- Promote population-based and environmental prevention measures, such as enforcing restrictions on commercial or pub-lic availability of legally available psychoactive substances; restricting advertising, sponsorship and promotion of such substances; and addressing the role of social and commercial determinants of health and their impact on substance use.
- Strengthen the meaningful engagement of priority groups in prevention initiatives and overcome barriers to participation, such as stigmatization. As an important youth-empowerment strategy, include adolescents not only as recipients but also as trained actors leading prevention initiatives.
- Incentivize the deployment of effective, evidence-based preventive interventions in different settings, including health care, educational systems, communities, and juvenile justice settings.
- Widely implement screening for mental health conditions among adolescents to help prevent and treat associated substance use disorders and improve overall health outcomes.
- Implement evidence-based treatment interventions for adolescents along a continuum of care that includes screening, brief interventions, and treatments such as family therapy, con-tingency management, and cognitive behavioral therapies. These interventions may address mental health conditions and pharmacological treatment options in appropriate cases.
- Ensure that, when engaging with treatment and care services, adolescents are reassured that they will receive quality treatment and safe support without fear of discrimination or negative repercussions, as it should be for any other health condition.
- Adolescents with a history of substance use and substance use disorders face an increased risk of contact with the criminal justice system and, in some contexts, might be more vulnerable to exploitation by organized crime groups. Therefore, strengthen interventions aimed at fostering safer living environments, proven to protect against organized crime involvement.
- Implement evidence-based and ethically sound digital interventions that are continuously monitored for outcomes and un-intended negative consequences, while being mindful of the digital gap and associated inequalities.
- Ensure that humanitarian emergency preparedness and response plans consider how to address substance use and sub-stance use disorders, including among adolescents, to strengthen the resilience of support systems during these emergencies, including in conflicts, war settings, natural disasters, forced migration, and other situations of displacement.
- Expand and improve capacities to ensure a qualified and diverse workforce to deliver health interventions for adolescents with substance use disorders, and thus improve service coverage and reduce health disparities. Apply online and remote learning elements to strengthen the prevention and treatment workforce.
- Ensure sufficient resource allocation to develop or maintain comprehensive and differential (e.g., age and gender disaggregated) data collection systems to analyze adolescent substance use trends and evaluate the effectiveness of prevention and treatment programs.
- Invest in evidence-based prevention and treatment of substance use disorders among adolescents, and in related research to enhance the understanding of these disorders among adolescents (including biopsychosocial risk and protective factors), to inform effective prevention and treatment strategies for adolescents in different circumstances.
Children and young people, including adolescents, are a precious asset for all countries and must be protected from the health and social effects of substance use disorders. Scientists, policy mak-ers, practitioners and communities must work together to implement the most effective prevention and treatment strategies, policies and interventions, such as those outlined in the UNODC-WHO International Standards for Drug Use Prevention and the UNODC-WHO International Standards for Treatment of Drug Use Disorders. The ISN recommends that policy makers put evidence-based and ethical policies for adolescent substance use and substance use disorders into practice, with the necessary resources, so that every adolescent can attain the highest level of health.
