Peer-based interventions for substance use among young people

ABSTRACT

Adolescents and young adults constitute a large proportion of the population in most low-to middle-income countries but face high levels of disability and mortality. This is influenced by unhealthy substance use, largely with friends, which is further driven by structural challenges such as widespread poverty. Key behaviours during this developmental period underpin well-being across the lifespan, including educational/ vocational attainment, developing healthy coping beyond substance use, and adoption of equitable gender norms. Peers play a key role in reinforcing both the health promoting and risk behaviors of young people, including substance use. The role of peers in such interventions have shown promise in in high-income countries, but evidence is limited in low-to middle-income countries. The aim of this presentation is to provide evidence of the feasibility and effectiveness of peers in substance use interventions, as well as exploring their specific role in these interventions.

Methods: A rapid literature review was conducted to identify studies that have utilized young people who use substances and their peers in interventions aimed to reduce substance use and related risk behaviours, as well as identify which studies were conducted in low-to middle-income countries. These were then grouped into various methods that these interventions utilized peers.

Results: The literature demonstrates that peers can be involved in substance use interventions in a number of ways, including delivering psychoeducation, modelling healthier behaviours, providing peer-to-peer support, and facilitating engagement with prevention and treatment services. However, such peer interventions have been tested in low- to middle-income countries much less frequently, especially on changes in substance use behaviour, indicating an important research gap. Examples of how peers have been used in studies with young people who use substances in Southern Africa are presented as examples to fill this gap.

Conclusion: Peer-based interventions offer a potentially acceptable and developmentally appropriate approach to addressing substance use among young people, but further research is needed to identify which peer models are effective, for whom, and under what conditions, particularly in low- and middle-income settings and among young people with more severe substance use conditions.