Preventing Substance Use-Related Harms Among Young People in Scotland: Evidence, Knowledge Gaps, and Systems Solutions

Abstract

Young people are a diverse group with distinct developmental stages from childhood to young adulthood. This critical period of growth is marked by identity formation, brain development, social transitions, and increased risk-taking. Early initiation of substance use is linked to poorer health, educational, and social outcomes. While drug-related harms appear relatively high among young people in Scotland, detailed longitudinal data remains limited. This report explores how Scotland can strengthen its approach to preventing substance use and related harms among young people (defined here as <25 years). While prevention is increasingly recognised as a public health priority, Scotland currently lacks a coordinated, evidence-based prevention system. Public Health Scotland (PHS) is developing a whole-systems approach, and this report aims to contribute by synthesising evidence on effective interventions and conditions for sustainable prevention. The report focuses on non-school-based prevention which includes community, family, digital, and service-based approaches. Key findings Non-school based prevention interventions can be categorised into several types including environmental strategies, psychosocial education, family-based interventions, digital tools, and community mobilisation. Family-based interventions, which support family communication and parenting, show the strongest evidence for reducing substance use and improving wellbeing. Psychosocial and educational interventions, typically delivered in group settings, aim to build protective skills such as emotional regulation and decision-making. While they can improve knowledge and attitudes, their long-term behavioural impact is mixed. Digital interventions, including apps and online programmes, offer scalable access to support, but current evidence of effectiveness is limited. Community mobilisation approaches involve coordinated local action across sectors and show promise when locally tailored and collaborative, though they remain under-evaluated. While several approaches show promise, gaps remain in understanding what works best, for whom, and in which contexts. Recommendations Developing an effective prevention system for drug use and harms amongst young people in Scotland requires sustained investment, long-term strategy, and strong coordination across sectors. This includes building the structures, processes, and partnerships to plan, deliver, and sustain prevention over time—tailored to local needs and grounded in evidence. Recommendations • Invest in research: Fund longitudinal studies and embed evaluation in all publicly funded programmes. • Strengthen policy: Improve data collection, ensure stable funding, and encourage cross-sector involvement in prevention planning. Identify opportunities to embed prevention work into existing health and social care infrastructure. • Support practice: Develop a trained, cross-sectoral prevention workforce, scale up family and community-based approaches, and prioritise inclusive, youth-led activities.