Scotland faces a stark reality: the country currently lacks a coordinated, evidence-based prevention system for substance use among young people, according to a comprehensive new report from the Drugs Research Network Scotland (DRNS). The research, published in August 2025, reveals alarming gaps in protection for Scotland’s most vulnerable youth whilst highlighting the urgent need for systematic reform.

The Scale of Scotland’s Prevention Challenge

The DRNS report, “Preventing Substance Use-Related Harms Among Young People in Scotland,” presents troubling evidence about Scotland substance use prevention gaps. Despite growing recognition of prevention as a public health priority, current systems remain underdeveloped and poorly evaluated.

Research indicates that drug-related harms appear relatively high among young people in Scotland compared to UK and European averages, though detailed longitudinal data remains frustratingly limited. Hospitalisations among 15-34-year-olds rose steadily from 2010/11 to 2019/20, particularly for cannabis and cocaine use.

Between 2015 and 2020, drug-related death rates among individuals aged 15-29 increased following a steady decline from the mid-2000s. While these rates declined again between 2020 and 2023, they remain significantly higher than other UK nations.

Critical Gaps in Current Prevention Systems

The report identifies several concerning shortfalls in how Scotland substance use prevention currently operates. Despite Scotland allocating at least £12 million (7.5%) of total drug spending to prevention in 2023/24, investment remains low relative to treatment and harm reduction. More troubling is the limited evaluation of existing prevention programmes, creating a knowledge vacuum about what actually works.

Young people are defined in the report as individuals under 25 years, reflecting evidence of continued brain development into the mid-20s, particularly in areas related to decision-making and impulse control. This critical developmental period makes early substance use initiation particularly damaging, with links to poorer health, educational, and social outcomes.

Evidence Review: What Works and What Doesn’t

The comprehensive evidence review examined 79 sources to identify effective interventions for Scotland substance use prevention. The findings reveal a mixed picture of intervention effectiveness:

Family-Based Interventions Show Promise

Family-based interventions demonstrate the strongest evidence for reducing substance use and improving wellbeing. These programmes support family communication and parenting skills, though they require significant resources and sustained engagement from both staff and participants.

Psychosocial and Educational Approaches Have Limited Impact

Whilst psychosocial and educational interventions can improve knowledge and attitudes, their long-term behavioural impact remains mixed. Programmes work best when they include skill-building elements like coping strategies and emotional regulation, rather than simply providing information.

Digital Interventions Offer Scalability But Lack Evidence

Digital approaches, including apps and online programmes, provide scalable access to support and can reach underserved groups. However, current evidence of effectiveness is limited, with most studies focusing on feasibility rather than behavioural outcomes.

Community Mobilisation Approaches Show Promise

Community mobilisation approaches involve coordinated local action across sectors and show promise when locally tailored and collaborative. The Icelandic model, being trialled in six Scottish council areas, represents one such approach, though long-term effectiveness remains under-evaluated.

The Universal vs Selective Prevention Debate

The research reveals important insights about targeting prevention efforts. Selective approaches often show greater impact for high-risk groups, including care-experienced youth and those in contact with the justice system, compared to universal prevention. However, universal approaches remain important due to the “prevention paradox” – proportionately greater health harm may come from larger groups of lower-risk individuals.

The evidence suggests that Scotland substance use prevention should embrace a mixed model combining universal, selective, and indicated interventions to maximise reach and relevance.

International Context: Lessons from Abroad

The report examines international prevention models, particularly the Icelandic approach that focuses on reshaping the social environment through long-term, community-led action. This model targets four domains: family, school, peer groups, and leisure time, and has been linked to long-term reductions in youth substance use in Iceland.

Scotland’s feasibility study of the Icelandic model found strong support for its emphasis on family and community engagement but highlighted challenges including adapting to local drug trends, political short-termism, and resource constraints.

Risk and Protective Factors: A Multi-Level Challenge

The report identifies risk and protective factors operating across multiple levels. Structural factors include poverty and economic instability, whilst community factors encompass neighbourhood characteristics and peer networks. Family factors involve parenting practices and household dynamics, whilst individual factors include psychological traits and mental health.

Prevention interventions must address this range of influences, requiring coordinated approaches across health, education, justice, and community services under a shared strategy.

Current Policy Context and Future Directions

Public Health Scotland (PHS) is developing a whole-systems approach to prevention, and this report aims to contribute by synthesising evidence on effective interventions. The research focuses on non-school-based prevention, including community, family, digital, and service-based approaches, recognising that some young people are not in education or are beyond school age.

The development of effective drug prevention young people Scotland requires represents a significant challenge. Current approaches remain fragmented, with limited coordination between agencies and insufficient long-term funding to sustain effective programmes.

Key Recommendations for System Reform

The DRNS report provides specific recommendations across three areas:

Research Priorities

• Fund longitudinal studies and embed evaluation in all publicly funded programmes
• Explore targeted prevention for varied populations
• Use implementation science to identify core, evidence-based practices

Policy Changes

• Improve data collection on drug use trends, disaggregated by demographics
• Ensure stable funding and encourage cross-sector involvement
• Address structural inequalities including poverty and discrimination
• Support culturally adapted and community-led interventions

Practice Improvements

• Develop training pathways for a prevention workforce across sectors
• Scale up family-based interventions and community approaches
• Prioritise inclusive, youth-led activities
• Use trusted communicators to deliver prevention messages

The Cost of Inaction

The evidence suggests that substance use prevention Scotland currently provides falls short of what young people need and deserve. The consequences of inadequate prevention extend beyond individual health outcomes to affect families, communities, and society as a whole.

Early initiation of substance use creates cascading problems: poorer educational outcomes, increased involvement with criminal justice systems, and higher risks of problematic use in adulthood. The economic costs include healthcare expenses, reduced productivity, and social care interventions.

Towards a Whole-Systems Solution

The report emphasises that effective prevention requires sustained investment, long-term strategy, and strong coordination across sectors. This includes building structures, processes, and partnerships to plan, deliver, and sustain prevention over time, tailored to local needs and grounded in evidence.

A whole-systems approach must recognise prevention as a cross-cutting public health issue, aligning efforts with initiatives to reduce poverty, improve mental health, and support families. Success requires cultural change to embed prevention as a policy priority across government departments and agencies.

The Role of Communities

Community engagement emerges as crucial for effective substance use prevention Scotland should embrace. Local areas need support to develop prevention plans, access high-quality data, and receive technical assistance in selecting evidence-based approaches.

The research highlights the importance of embedding prevention in everyday community settings such as youth clubs, sports clubs, and arts organisations. This approach recognises that prevention happens not just through formal programmes but through the quality of relationships and opportunities available to young people.

A Prevention-First Approach

The DRNS report represents a watershed moment for substance use prevention Scotland has the opportunity to embrace. The comprehensive evidence base provides clear direction for policy makers, practitioners, and communities seeking to protect young people from drug-related harms.

However, translating this evidence into effective action requires political commitment, adequate resources, and sustained effort across multiple sectors. The stakes are high: failure to act condemns another generation of young Scots to preventable harm, whilst effective action could transform outcomes for thousands of young lives.

The research makes clear that prevention is not just about avoiding negative outcomes but about creating positive conditions for young people to thrive. This includes accessible leisure opportunities, strong family relationships, supportive communities, and hope for the future.

Source: dbrecoveryresources