RNSystematic ReviewThe Journal of school health2026

Evaluating School-Based Substance Use Services: Insights From a Systematic Review.

Hannah L Maxey, Brittany J Daulton, Mykayla Moore and 1 others

PMID 41330400

WHAT IT FOUND

School-based substance use services generally produced lower self-reported use, improved attitudes, and sometimes fewer missed classes in nine included studies.

CRAFFT and motivational interviewing were common, but evidence was limited.

Key findings

01Nine studies were retained, and school-based services generally produced favorable action outcomes, typically lowering self-reported frequency of use.

02Screenings paired with interventions were typically more successful than screenings alone in studies where comparative analyses were conducted.

03CRAFFT was used in five studies, and motivational interviewing was the most reported intervention strategy, used in six studies.

STILL TO COME

How it was doneWhat they foundWhat it means for RNs

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What it does not show

Only nine studies were included, so the review cannot describe how common or effective school-based substance use services are across the US. The studies were heterogeneous and used different measures and definitions, so results could not be pooled in a meta-analysis. Most outcomes relied on student self-report, with only one study using a urine drug screen. Workforce roles and training were often not specified, so it is unclear which staff could deliver each service. Searches were limited to English-language human studies published between 2004 and 2024 and may have missed relevant studies. No studies described recovery high schools, and the review did not compare outcomes across school settings.

Declared interests

This work was supported by Pew Charitable Trusts, Grant Contract ID#37025. The authors declared no conflicts of interest.

The easy way to misread this

Do not conclude that school-based substance use services are proven to reduce use. The review included nine heterogeneous studies, most outcomes relied on self-report, and no meta-analysis was possible.

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