School- and family-based intervention prevented substance use escalation in teens living in rural communities

A school- and family-based intervention significantly reduced the rates of alcohol and cannabis use and prescription opioid misuse among White and American Indian teenagers living in rural Tribal communities in northeastern Oklahoma when compared to a control condition, according to a National Institutes of Health-funded study.

The investigation was a collaboration between Oklahoma-based Cherokee Nation Behavioral Health and a team at the Rollins School of Public Health at Emory University, Atlanta. Findings highlight the feasibility of delivering an effective, low-cost intervention to help prevent the escalation of substance use among teens. A report on the intervention tested among 919 students at 20 rural schools was published August 6 in the American Journal of Public Health.

Schools were randomly assigned to the intervention or control group. Students at intervention schools received a digital brief intervention with motivational interviewing facilitated by a coach from the youth services branch of Cherokee Nation Behavioral Health once per semester for four semesters beginning in 10th grade.

Each student’s coaching session was tailored based on an assessment of their substance use risk in 10th grade. For low-risk students, the intervention affirmed drug-free decisions and set personal goals. Students at moderate to high-risk were encouraged to avoid risky situations and drug use and received a follow up coaching session to reassess their risk and encourage change. Parents and guardians of teens in the intervention group also received multiple informational kits annually with resources and tips for limiting their teens’ exposure to drugs and alcohol.

Compared to students in the control schools, students at the schools that received the intervention had lower alcohol and other substance use. Every six months, these students reported: 18% less alcohol use, 26% less binge drinking, 11% less cannabis use, and 40% less prescription opioid misuse.

Teenagers in the control group generally followed expected trajectories of escalating substance use based on model predicted patterns, while those in the intervention group followed a flat or declining use pattern. The authors suggested that their findings may be generalizable to similar, low-resource communities and highlight the importance of primary prevention in addressing the overdose epidemic.

The current trial was funded by the National Institute on Drug Abuse through the Preventing Opioid Use Disorder in Older Adolescents and Young Adults Initiative, part of the National Institutes of Health’s Helping to End Addiction Long-Term Initiative.

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Reference:

Kelli AK et al. Primary prevention of drug overdoses in rural low-resource and tribal communities; a cluster randomized trial. Published August 6, 2025 in the American Journal of Public Health. https://doi.org/10.2105/AJPH.2025.308205