Though much attention is given to youth mental health, addressing unhealthy substance use is equally important for young people’s healthy social and emotional development and can prevent both short-term harms (such as negative impacts on educational goals or family and peer relationships) and lifelong chronic substance use disorders (Onrust et al. 2016; Volkow and Wargo 2022). Adolescents with substance use disorders also have high rates of co-occurring mental illness, and, as such, one cannot be addressed without the other (Clemans-Cope et al. 2022; SAMHSA 2021). This brief examines approaches to address youth substance use in schools that were implemented before the pandemic. Drawing on information from publicly available sources and interviews with key informants in the District of Columbia, Massachusetts, and New Mexico (box 1), we find that
- youth substance use services are mostly siloed from mental health care,
- Medicaid policy does not sufficiently support youth engagement and the provision of substance use prevention and early intervention services,
- variation in school wellness culture and resources makes implementing universal policies and substance use interventions challenging, and
- community partnerships and engagement are critical in extending supports and resources to youth within and beyond school walls.
In the remainder of this brief, we provide background on the role of schools in addressing substance use and describe key features of school-based behavioral health initiatives in the District of Columbia, Massachusetts, and New Mexico. We then present key cross-cutting findings and their implications for the education and health care systems, philanthropy, and communities that can inform the design and implementation of school-based substance use initiatives to improve equitable access to and the quality of substance use services for youth. (author introduction)