Mentoring for Preventing and Reducing Substance Use and Associated Risks Among Youth Outcome Review
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January 2020

This review examines research on youth mentoring as a strategy for preventing and reducing adolescent substance use, including opioids. The review is organized around four questions:


  1. What are the effects of mentoring on substance use and associated risks to personal health and well-being among youth?

  2. What factors condition or shape the effects of mentoring on substance use and associated risks for youth?

  3. What intervening processes are most important for linking mentoring to beneficial effects on substance use and associated risks for youth?

  4. To what extent have efforts to provide mentoring to youth with substance use prevention and intervention as priority outcomes reached and engaged the intended youth, been implemented with high quality, and been adopted and sustained by host organizations and settings?

Overall, there were few studies that focused primarily on the impact of youth mentoring on adolescent substance use prevention, and the studies mostly followed either a primary prevention (addressing problems before they occur; targeted to a broad population of youth) or a secondary prevention framework (focusing efforts on at-risk youth). The review found that the studies assessed more commonly used substances (e.g., alcohol and marijuana), with less attention paid to the impact of mentoring on preventing the initiation of hard drug use, including opiates. Therefore, the limited evidence that is available shows tentative promise for mentoring to have a positive effect on the prevention and reduction of substance use among youth. The review identified only two studies that utilized mentoring as an add-on intervention to an evidence-based substance abuse treatment. This is possibly due to the limited focus on the role of mentoring in tertiary prevention efforts (intervention or treatment to prevent harm among youth already abusing substances). The ways in which mentors can promote the recovery process of substance-misusing youth remains unexplored. Of note, studies of natural mentoring showed significant positive effects more frequently than did studies of the impact of programmatic mentoring. It seems that building on youth’s existing social resources and the presence of adult role models may play a meaningful role in preventing adolescent substance use.

The review suggests several take-home messages for mentoring researchers and practitioners. At intake, practitioners can incorporate a more thorough assessment of youth alcohol and illicit drug use and/or exposure to substance use in peer, school, and family contexts. Identifying youth’s risks and needs at early stages of the intervention will prepare mentors to be better equipped to support youth. Given the promising findings on the role of natural mentors, substance use preventative programs can also employ the Youth Initiated Mentoring practice where youth nominate mentors from their own social network. Such an approach may help to promote resilience among youth to resist substance use and associated problems. Finally, future research could explore how mentoring programs can be implemented from secondary and tertiary prevention frameworks. Outreach programs, in particular, can utilize mentoring components to engage and sustain youth in treatment programs.

  • Introduction

    Adolescence is a time for experimentation, sorting through problems with school and peers, and growing independence. Adolescents are neurologically wired to seek new experiences and take risks while they work to form their individual identities. These factors often put young people at risk for engaging in unhealthy behaviors, including substance use, that can have serious long-term consequences.1

    People are most likely to try and may begin abusing various substances—including tobacco, alcohol, marijuana, prescription, and illegal drugs—during adolescence. By the senior year of high school, almost 70 percent of students in the United States will have tasted alcohol, about half will have taken an illegal drug, and more than 20 percent will have used a prescription drug for a nonprescribed purpose.2 Opioid use is also of concern for youth, as 3.6 percent of adolescents ages 12–17 in the United States reported misusing opioids (primarily in the form of prescriptions) over the past year.3 While rates of opioid misuse have decreased in recent decades among youth because such pills are harder to obtain, deaths from overdose among adolescents is increasing.4

    Individual factors such as genetic vulnerability; a lack of impulse control; susceptibility to peer pressure; high sensation seeking; the presence of mental health conditions including depression, anxiety, or ADHD; or positive attitudes toward drugs influence whether a young person will initiate substance use. Social factors also heavily influence whether an adolescent uses substances, including the availability of drugs within their school or community, whether they have friends who use drugs, a history of being exposed to violence, experience of physical or emotional abuse, the presence of mental illness in the family, drug use in the household, and level of parental monitoring.5

    Those who work with youth often speculate about the positive impact a mentor can have on preventing the initiation of substance use, reducing use, or assisting a young person with a substance use disorder in getting treatment. This review takes stock of the research that addresses the potential for mentoring to serve as a strategy for preventing and reducing substance use (as defined below) and the negative effects on personal health and well-being that may stem from this behavior. We were particularly interested in the prevention and intervention of use of opioids among youth, as this is a priority for the U.S. government, including the Office of Juvenile Justice and Delinquency Prevention (OJJDP) and the National Institutes of Health (NIH). The review focuses on the following four questions:


    1. What are the effects of mentoring on substance use and associated risks to personal health and well-being among youth?

    2. What factors condition or shape the effects of mentoring on substance use and associated risks for youth?

    3. What intervening processes are most important for linking mentoring to beneficial effects on substance use and associated risks for youth?

    4. To what extent have efforts to provide mentoring to youth with substance use prevention and intervention as priority outcomes reached and engaged the intended youth, been implemented with high quality, and been adopted and sustained by host organizations and settings?

    The scope of the present review was limited to mentoring as defined by the National Mentoring Resource Center (i.e., relationships and activities that take place between youth [i.e., mentees] and older or more experienced persons [i.e., mentors] who are acting in a nonprofessional helping capacity — whether through a program or more informally — to provide support that has its aim or realistic potential benefitting one or more areas of the young person’s development; for further details, see What is Mentoring?). This definition excludes services and supports that are offered in formal professional roles by those with advanced education or training (e.g., social work, counseling) as well as those that are exclusively or predominantly didactic in orientation (e.g., structured curriculum).

    The review’s scope was further limited to studies examining mentoring in relation to substance use, defined as the use of alcohol and/or drugs (licit and illicit) that have the potential to lead to dependence, overuse/abuse, and associated psychological, social, academic, relational, and physical health problems. In considering prevention and reduction, the review follows a public health framework of levels of prevention: primary prevention (prevention of problems before they occur; targeted to a broad audience), secondary prevention (early intervention to prevent development of more serious substance abuse problems; targeted to a more focused audience with identified risk factors or showing early signs of substance abuse), and tertiary prevention (intervention or treatment to prevent significant risks to health and well-being for those already abusing substances). Likewise, some efforts may be focused on reducing more significant levels of substance use and thus fall outside of a prevention framework.

    Using these definitions, a systematic literature search was conducted to identify journal articles, book chapters, and other types of documents that reported findings pertinent to one or more of the review’s four organizing questions. Search strategies included (a) using a set of relevant keywords to search PubMed, Proquest Dissertations and Theses, PsycINFO, and Google Scholar literature databases; (b) outreach to a listserv on youth mentoring research and practice as well as members of the National Mentoring Resource Center (NMRC) Research Board; and c) examination of research referenced in broader treatments of mentoring and delinquent behavior, such as chapters on this topic in multiple editions of the Handbook of Youth Mentoring, a recent synthesis of OJJDP-sponsored research on mentoring, and meta-analyses and systematic reviews of youth mentoring programs. Of the 50 youth mentoring studies with substance use as an outcome, a total of 19 studies met criteria for inclusion in the review; 13 studies were primarily or exclusively quantitative, and the remaining 6 were mixed methods (i.e., combination of quantitative and qualitative data). Below we summarize these studies in regard to the four questions. It should be noted that this review, while focused on mentoring and substance use research, is intended for a broad audience—both researchers and research-minded practitioners. As such, we attempt to describe the studies without getting too deep into the details of their methodologies, statistical analyses, or design limitations. Many of these details are summarized in Table 1 at the end of this review.

  • What Is the Effectiveness of Mentoring for Preventing or Reducing Substance Use and Associated Risks to Personal Health and Well-being among Youth?


    • BACKGROUND

      Adolescent Substance Use and Associated Risks

      With adolescence being a time of experimentation, it is also the time when initiation of substance use typically occurs, and this can happen as early as 10 or 12 years old.6,7 Many adolescents occasionally use substances, and a smaller number do so regularly. But by twelfth grade, about half of adolescents have misused an illicit drug at least once.8 There are several factors that contribute to a greater likelihood that adolescents will stay drug free: strong, positive connections with parents, other family members, their school environment, and religious institutions; having parents that monitor them consistently and with clear limits and consequences; and reduced access to illegal substances in the home, as well as legal substances that may have the potential for abuse, such as prescription medications, glues, and aerosols.9,10 Children in foster care,11,12 those with mental health concerns,13 those from low socioeconomic situations,14,15 and homeless youth16 are at particular risk for substance use. Specifically for opioids, risk factors for adolescent misuse include acute and chronic pain, physical health problems, a history of mental illness, and other substance use or misuse. Youth who have witnessed someone in their family overdose or whose peers misuse prescription painkillers are also at increased risk for opioid use.17

      There are many potential additional negative outcomes that have been shown to be predicted by substance use during adolescence. Adolescents who experiment with substances early in life are more likely to develop a substance use disorder as an adult.18,19 Adolescents who use substances, including alcohol, marijuana, and prescription drugs, have shown significantly higher rates of unprotected sex, multiple sexual partners, sex with intravenous drug users,20 inconsistent condom use, and sex in conjunction with use.21 Among male adolescents, use has been associated with aggression perpetration and victimization, including physical, psychological, and electronic aggression, and sexual coercion.22 Alcohol and marijuana use have been shown to predict physical aggression among high school students across racial backgrounds,23 while hard drug use has been found to be a predictor of sexual aggression in adolescents ages 14 to 17.24 Early substance use also predicts future perpetration of teen dating violence, even when controlling for other factors.25

      Mentoring to Prevent and Reduce Substance Use

      Mentoring has been cited by the Institute of Medicine as an example of a secondary preventive intervention, whereby prevention efforts focus on adolescents who are deemed “at-risk” for substance use but do not yet present behavioral health issues.26 However, the science of mentoring as prevention and its effects on adolescent health outcomes, including substance use, is still developing.27,28 Some mentoring programs have assessed their impact on substance use,29,30,31 but they are rarely empirically tested, leaving a gap in the literature as to the processes by which mentoring’s interpersonal nature can serve as an effective prevention tool. Big Brothers Big Sisters (BBBS) is a widely cited example of a successful large-scale mentoring program with evidence of effectiveness. Child participation was shown in one of the most widely reported studies of BBBS to be associated with a 46 percent lower likelihood of illicit drug use initiation, suggesting the potential value of mentoring as a primary prevention strategy.32 Furthermore, findings revealed in several controlled evaluations of other mentoring programs allow for cautious optimism about potential viability of mentoring interventions, but more rigorous evaluations with a focus on effect sizes are needed.33 In addition, little research specifically mentions the impact of mentoring on opioid misuse.

      In general, evaluations of mentoring programs and their impact on child and adolescent substance use vary in their designs and how substance use is measured: the studies define substance use in inconsistent ways, tend to use psychometrically weak instruments, have high attrition, often do not include a control or comparison group, have inconsistent sampling procedures, and data collection is often cross-sectional.33 With approximately 3 million youth in formal mentoring relationships in the United States,33 and the potential number of additional mentors available, the conceivable impact of evidence-based mentoring on substance use is significant. While the research to date may be inconclusive, it is in the best interest of researchers, practitioners, and youth themselves to continue to improve on the rigor of the research evaluating the effectiveness of mentoring on youth substance use and to particularly focus on the impact of mentoring on opioid misuse. While OJJDP has focused its attention on opioid affected youth and their families,34 and the National Institutes of Health are interested in research that addresses curbing use in youth through the HEAL (Helping to End Addiction Long-term) Initiative,35 results from these initiatives are still forthcoming.

    • RESEARCH

      Nineteen articles reported findings that address the effectiveness of mentoring for preventing or reducing substance use among youth, with mixed results. Only four studies focused on substance use as a primary outcome;36,37,38,39 it was much more common for substance use to be included as one of a set of “risk behavior” outcomes relevant to young people.

      The studies varied in how they defined “substance use”—some used a composite measure where they asked youth about their use of alcohol, tobacco, and illicit drugs; others looked at illicit drug use alone; while others differentiated between ever using a substance and using a substance within a given time frame (such as the past two weeks or one month). This makes it nearly impossible to compare the effectiveness of various mentoring models on substance use, as the outcomes, while all substance-focused, are so varied. For those that did assess substance use as a primary outcome, they tended to be divided into studies that looked at reduction in alcohol use, marijuana use, illicit substance use, and substance use defined more broadly (often lumping together alcohol, tobacco, and other substances). There was also a fairly even split between studies that looked at the effect of natural mentoring and those that looked at programmatic mentoring. However, no studies compared the two types of mentoring.

      In summarizing these studies, we chose to divide them by the type of outcome they assessed, specifically the type of substance. Some of these studies evaluated the impact on more than one substance, so they appear in more than one section below. Of note, no studies to date specifically evaluated the effectiveness of mentoring on opioid use.

      Effects of Mentoring on Alcohol Use

      Seven studies assessed the impact of mentoring on alcohol initiation or use. Four32,36,38,40 of these studies found a significant effect, whereby mentoring was associated with delayed initiation or reduction in use. The other three studies found no significant effect of mentoring on youth drinking.41,42,43

      One study of note36 assessed alcohol and marijuana use (along with other outcomes) in a sample of Massachusetts public-school students in sixth grade assigned to one of three conditions in the Across Ages program: a mentor, a curriculum (life-skills training and community service activities), or a control group. Those students in the mentor and curriculum groups showed significantly lower levels of alcohol use compared to those in the control group. This study did not find significant differences by group for marijuana use.

      Effects of Mentoring on Marijuana Use

      A total of four studies looked at the impact of mentoring on marijuana use.36,38,40,43 Two of these studies40,43 found that having a natural mentor (as opposed to a formal mentor through a program) was associated with lower levels of marijuana use. The first natural mentoring study40 was a secondary analysis of data from a convenience sample of 65 high schools from 8 states who were part of a larger trial of Project Towards No Drug Abuse (TND), an evidence-based substance abuse prevention program.44 The authors of this secondary analysis reported the impact of having a natural mentoring relationship on substance use prevention, but all children were part of this larger prevention program. They found that having a natural mentor was associated with a lower likelihood of marijuana use compared to youth who did not report having a natural mentor.

      The second natural mentoring study43 also assessed the impact on marijuana use. This study included 770 adolescents from a longitudinal study of school dropout and drug use rates. The authors of a subset analysis concluded that youth who reported having a supportive nonrelative adult in their life (i.e., a natural mentor) tended to have lower levels of marijuana use. This study also showed that having a natural mentor was predictive of less “problem behavior,” which was a composite measure of alcohol and marijuana use and both violent and nonviolent delinquency behavior.

      The other two studies36,38 focused on the impact of mentoring on marijuana use assessed youth in formal programs but saw no significant effects of the program on this outcome. It is notable that both studies of natural mentoring that assessed marijuana use did show positive effects, but neither of the two programmatic mentoring studies reported positive effects; however, because none of these studies compared the effects of natural mentoring to those of formal mentoring programs, it is unknown whether natural mentoring is a better way of preventing marijuana use than formal mentoring programs or if the positive effects of mentoring in the two studies described above are unique findings.

      Effects of Mentoring on General Substance Use

      Most studies (10 of the 19 reporting on the effectiveness of mentoring on substance use) looked at the effect of mentoring on substance use more generally, either by asking youth broadly whether they had used drugs or by compiling responses to several individual substance use items into one substance use score. Of the 10 studies assessing general substance use, 4 reported a positive effect of mentoring, such as a decrease in the number of days of substance use,45 a protective effect regarding substance use concerns,37 less use in the past month,42 or general reduction in use.46 The remaining six studies did not show a relationship between mentoring and substance use generally defined.

      One study45 looked at a sample of 90 homeless adolescents randomized to either a community reinforcement approach (CRA) plus mentoring or treatment as usual at a drop-in center. For those who received CRA and a mentor, the percentage of substance use days in the past three months decreased over time. However, the number of mentoring sessions did not predict the variance of change in substance use, so it is unknown how many mentoring sessions were needed to see this meaningful decrease. The number of mentoring sessions did predict a decrease in problem consequences of substance use, such that attending more mentoring sessions was associated with greater decreases in problem consequences.

      Effects of Mentoring on Illicit Substance Use

      Four studies looked at the effect of mentoring on what they defined as “hard drugs” or “illicit substance use.”32,40,41,47 Three of the four studies reported a significant effect of mentoring, such that having a mentor predicted a reduction in illicit substance use47 or a lower likelihood of initiating use.32,40 One study of natural mentoring47 looked at youth recruited from a health clinic who identified as having a “significant adult” in their lives with those who did not, or the effect of natural mentoring. Results showed a significant effect of having a mentor on reported illicit drug use in the past 30 days. It should be noted that none of these four studies specifically looked at the effect of mentoring on opioid use, although it is possible youth who reported using “hard” or “illicit” drugs may have been reporting opioid painkiller or heroin use.

    • CONCLUSIONS


      1. There is promising evidence that natural mentoring may contribute to reductions in marijuana and illicit drug use, although without studies comparing the effects of natural to programmatic mentoring, it is difficult to draw firm conclusions.

      2. It is possible that programmatic mentoring may be more useful for primary prevention, where the goal is to delay substance use initiation or to reduce the use of substances until a young person is of legal age. Natural mentoring may be more useful for youth engaged in illicit drug use, although more research is needed to test these hypotheses.

      3. Due to the varied definitions of “substance use” in research to date and variations in the timeframe for when it is measured, it is difficult to compare the results of mentoring on substance use across multiple studies.

      4. Studies that ask youth more generally about substance use, particularly “illicit substance use” or hard drugs as one overarching variable, tend to show a positive impact from mentoring more consistently than do studies that ask about individual substances.

      5. While there is some support for the direct effects of formal and informal mentoring on adolescent substance use prevention, no research was found specifically reporting the effect of mentoring on opioid misuse.

  • What Factors Influence the Effectiveness of Mentoring for Preventing or Reducing Substance Use among Youth?


    • BACKGROUND

      Conceptually, mentee characteristics and mentoring components or practices may have an impact on the extent to which formal or informal mentoring programs are effective in preventing adolescent substance use. Meta-analytical studies suggest some evidence that youth mentoring may be more effective for boys48,49 and youth who have been involved in problem behaviors.48 Other demographic characteristics, such as age and ethnicity/race, have also been widely researched, but findings vary by special populations of youth as well as program setting and goals. Programs that serve youth with greater levels of individual and environmental risk and match youth and mentors based on similarity of interests have also shown more beneficial outcomes for youth.48

      The existing literature also points to higher estimated effects of mentoring programs when mentors endorse an advocacy role and have a helping profession background.49 Another key process that attenuates the effects of mentoring programs on adolescent delinquency, substance use, and related problem behavior is the program’s emphasis on providing emotional support (rather than teaching, modeling, and identification) for at-risk youth.50

    • RESEARCH

      There were 11 studies that examined factors attenuating the effects of youth mentoring on adolescent substance use. The majority of the studies were focused on the evaluation of formal mentoring programs at community and school settings, while two studies37,43 utilized large adolescent samples to examine the role of natural mentors in preventing or reducing substance use among adolescents. The samples tended to include adolescents who are deemed “high-risk,” such as homeless adolescents,45 foster youth with ongoing child maltreatment investigations,37 those with a history of early drug use and delinquency,38 and adolescents who dropped out of high school or were suspended.51 There were, however, some studies that took a primary prevention approach, such that they targeted low-risk urban youth who lacked adult role models41 or had some form of economic or social disadvantage.32,43,52,53 The moderators primarily examined included mentee characteristics (mainly demographics and risk factors) as well as program components and processes pertaining to match duration, program attendance, and intensity of the intervention.

      Mentee Demographics

      A study exploring the impact of the BBBS community-based mentoring program on prevention of alcohol and illicit drug use found that estimated effects of the program varied by mentee gender and ethnicity.32 While the overall program evaluation revealed longer delay of initiation of illicit drug use for the mentored youth at the 18-month follow-up, further evaluation of subgroups revealed that boys and youth of color benefited from the program more than girls or Caucasian youth. For instance, youth of color were 70 percent less likely to have started using drugs. The results were mixed for Caucasian mentees; the overall impact of the program was relatively low for Caucasian boys (37.6 percent less likelihood to initiate drug use), but the risk of initiation of illicit drug use increased for Caucasian mentored girls. The effects, however, were marginally significant for prevention of alcohol use.

      The moderating effects of ethnicity and gender were also examined in a sample of high school students in an urban setting.43 The study found benefits of natural mentoring relationships to reduce only marijuana use, but not alcohol. The results were consistent across subgroups (boys and girls as well as youth of color and Caucasian youth) with no moderating effects. Similarly, an outcome evaluation of BBBS’s school-based mentoring54 found no differences in substance use outcomes in regards to mentee demographic characteristics (gender, race/ethnicity, and age).

      Mixed effects of age were found in an evaluation of a multicomponent program with group mentoring, parenting sessions, and individual counseling components targeting African-American adolescents at risk of deviance.38 The findings indicated that estimated program effects in reducing alcohol use were larger for younger mentees as compared to the older mentees, but there was no interaction of treatment group and mentee age for marijuana use. In a study with homeless youth,45 the estimated effect of a multicomponent program (community reinforcement approach + mentoring through a drop-in center) on substance use in the past three months was not associated with youth age; however, the mentored subsample was too small to capture variability among youth.

      Environmental and Individual Risks for Adolescents

      Differences in program effects on substance use were examined for youth exposed to varying levels of risk. Mentoring programs that enrolled youth who lacked natural mentors had lower estimated favorable effects on substance use outcomes than those that did not.53 In an evaluation of seven separate trials of youth mentoring programs,53 the authors noted there is no strong evidence that mentoring benefited youth differently based on their risk profile or other background characteristics; however, mental health screening was recommended to identify any unique needs of mentees during the enrollment phase.

      Other characteristics of the samples of participating youth considered whether the protective role of adult relationships compensate for the risks to which adolescents are exposed and result in reduced substance use. Foster youth with adverse childhood experiences self-reported less frequent substance use when they endorsed more protective adult relationships.37 Of note, protective adults were a composite of both parents and natural mentors, making it difficult to tease out the unique protective role of natural mentors for foster youth in that study. The benefits of natural mentors were noted in a study with an urban sample of low-risk adolescents;43 having a natural mentor alleviated the negative effects of friends’ problem behaviors as well as adolescents’ problem behavior norms and reduced adolescent substance use. Yet the link between natural mentoring and peer deviance and norms with adolescent marijuana or alcohol use were unclear, as the study utilized composite measures for substance use.

      Match Duration in Formal Mentoring Programs

      In research on the BBBS mentoring program with 10- to 16-year-old mentees from low-income backgrounds, findings indicated stronger favorable effects of the program on substance use among youth matched with mentors for 12 or more months.52 Another study examining the impact of the National Guard Youth Challenge Program did not find differences in binge drinking or marijuana outcomes as a function of match length.51 There were no differences between youth who were matched for less than 21 months, 21 to 38 months, or more than 38 months.

      Program Dose, Attendance, and Mentoring Quality

      Mixed effects were identified regarding the program intensity and youth outcomes in two different studies. An evaluation of the Across Ages intergenerational mentoring program found no differences between middle school students assigned to the mentoring and parenting intervention in their overall frequency of substance use in the past two months, as compared to the students in the parenting intervention only — and the results did not vary across groups by session attendance or intensity.39 However, further subgroup analysis revealed that although mentor relationship quality was not related to substance use on its own, adolescents whose mentors were assessed by program staff as more involved with youth and showed high fidelity to the program components attended more sessions in the program and reported significantly more knowledge on substance use.39

      Finally, the aforementioned study with homeless youth45 found no interaction between program intensity and attendance for estimated effects on overall frequency of substance use. However, attending more sessions of CRA and mentoring moderated the effects of the intervention and intensity of the treatment was associated with higher reductions in problems related to substance use.

    • CONCLUSIONS


      1. The review indicates some support for moderating effects of gender, age, and ethnicity/race in mentoring program outcomes. In particular, boys, youth of color, and younger youth were more likely to benefit from mentoring programs, but research is too limited to be able to draw firm conclusions.

      2. Natural mentoring relationships seem to be protective against substance use among a variety of subgroups (boys and girls as well as youth of color and Caucasian youth). These findings, although preliminary, illustrate that the presence of positive adult role models may compensate for the individual and environmental risks associated with adolescent substance use.

      3. There are some promising findings associated with a mentor’s level of involvement and adherence to the program. When program staff rated mentors as highly involved and loyal to the program implementation, there were some effects toward substance use knowledge, but not necessarily a link to substance use behavior.

  • What Pathways Are Important in Linking Mentoring to Prevention or Reduction of Substance Use among Youth?


    • BACKGROUND

      A variety of theoretical approaches have focused on the processes through which informal and formal mentoring relationships promote positive youth developmental outcomes and prevent problem behavior. Rhodes’ Developmental Model30 and Keller’s Systemic Model55 point to the role of mentors to foster youth’s connection to parents, teachers, and prosocial peers. Consistent with those conceptual models, studies exploring risk and protective factors related to adolescent substance use also emphasize the role of social context with particular attention to adolescents’ interactions with their peers and parents. For instance, a large body of research has focused on adolescents’ deviant peer associations and perceptions of peer substance use and found links to an increase in substance use.56,57,58 Indeed, peer substance use is considered to be one of the strongest predictors of adolescent substance use, and longitudinal studies suggest that such negative effects of peers are stable through early adulthood.58 These findings hold true across different adolescent substance use patterns, including alcohol59 and marijuana use.60,61 It appears that affiliation with substance-using peers is a context of socialization for adolescents who are reinforced to use alcohol or drugs and/or endorse related delinquent norms and activities to “fit in” with the peer group.62,63

      Adolescents’ interactions with their parents also play a role in their substance use initiation or use patterns. Exposure to adverse family environments including parental drug use, poor and inconsistent parenting, and negative communication patterns have been linked to adolescent drug use.64,65 Prospective studies have shown that adolescents who grew up in highly conflictual families had a greater risk for developing substance use disorders in late adolescence and emerging adulthood.66 Childhood maltreatment, including physical abuse, violence, and neglect, has been linked to increased risk for adolescent substance use.67,68 Family risk factors are also associated with illicit drug use; youth whose parents have an attitude that favors substance use, have a history of addiction, or youth who witnessed a family member’s overdose are at higher risk of misusing opioids and other illicit drugs.17,69

      Parents may be also protective agents for adolescent substance use. Studies document direct and indirect links of parental warmth, parental support, and family cohesion in reducing the risk of substance use. Presence of close and trusting relationships with parents may mitigate the risks of affiliation with substance-using peers and decrease the risk for alcohol and drug use.70 When adolescents have quality relations with their parents, they may be more open to hearing parental advice on peer relationships.52 The Centers for Disease Control and Prevention (CDC) reports that aforementioned factors are also protective against illicit drug miuse, including opioids; parental engagement, monitoring, and support buffer the effects of risks associated with adolescent substance misuse.69

      In sum, interventions that aim to improve parent-adolescent relationships and overall family functioning may be promising to reduce the risk of substance use among adolescents. Rhodes and colleagues52 argue that mentoring can provide a safe context for at-risk adolescents to step out of those relationships, develop new skills to navigate peer pressure, and negotiate problems that arise from conflicts with parents. An evaluation of the BBBS mentoring program has supported that claim, showing that mentoring was associated with improvements in parent-child relationships which, in turn, promote better youth developmental outcomes.71 Taken together, connections to positive adult models, outside of one’s peer group and family, may function as a corrective experience for adolescents and reduce the risk of substance use.

    • RESEARCH

      There is limited research that tests the processes that link youth mentoring to adolescent alcohol and drug use. An analysis of data from 3,320 high school students40 found that school attachment mediated the longitudinal relationship between school-based natural mentoring and a wide range of substance use outcomes (any alcohol, marijuana, or hard-drug use; ever getting drunk in the past 30 days; having a binge-drinking episode in the past two weeks). However, the aforementioned indirect effect of having natural mentors was small. In another study, there were also indirect longitudinal effects of natural mentors for 770 high school students.43 The reported presence of a natural mentor predicted lower adolescent and peer problem behavior and norms, which, in turn, were associated with lower overall adolescent substance use (composite of alcohol and marijuana use).

      The review found only one study that examined the mechanisms of change in formal youth mentoring programs to prevent substance use.52 The researchers found empirical support for the benefits of parent-child relationship quality in a BBBS program. Specifically, mentee reports of their communication, level of trust, and (reverse coded) alienation to primary caregiver mediated the effects of mentoring on alcohol and drug use frequency, but only for those matched for more than 12 months. Interestingly, in that study positive and negative peer relationships and perceived self-worth were not significant paths to reduce substance use among mentees.

      Of note, some studies reported secondary effects of formal mentoring programs to promote resiliency and socioemotional competence among at-risk youth. Unfortunately, those secondary outcomes, each of which has been found in other research to be related to lower levels of substance use, were not investigated further as potential pathways to reduce substance use. For example, a randomized controlled trial examining the effects of the Across Ages Mentoring program36 over three years in a sample of ethnically diverse, low-income adolescents found improvements in self-control, self-confidence, and family bonding among mentored adolescents, but did not link any of these outcomes to substance use.

    • CONCLUSIONS


      1. Research has demonstrated limited but promising positive effects of mentoring on school, peer, and parent attachment. Because these factors have been found in previous research to be related to reductions in substance use, mentoring programs that are specifically designed to prevent adolescent substance use may incorporate components to target those contextual and relational processes.

      2. The review lends some support for the benefits of natural mentoring relationships to alleviate peer and adolescent problem behaviors which, in turn, may reduce adolescent substance use.

  • To What Extent Have Mentoring Initiatives with Potential to Prevent or Reduce Substance Use Reached Youth Most Likely to Benefit, Been Implemented with High Quality, and Been Adopted and Sustained?


    • BACKGROUND

      Successful implementation of mentoring programs requires a careful evaluation of the targeted youth’s characteristics and risk profiles.53 Youth who have already experimented with alcohol and drugs (as compared to those who report no use), and those who are affiliated with substance-using peers and have ongoing conflictual family relationships may be more vulnerable to having substance abuse issues.58 Those youth may present additional needs for further services and could be more challenging to recruit and retain in mentoring programs. Other challenges may include difficulties in securing primary caregiver approval for the participation of their children in the mentoring programs and facilitating regular and consistent contact with the mentee. Meta-analytical studies have pointed to the critical importance of training and supporting mentors to increase the likelihood that the relationship lasts for at least one year.48,49

    • RESEARCH

      The review identified one large scale feasibility study of Project Amp,46 in which trained staff across six sites (three school-based and three health clinics) and mentors screened 1,192 adolescents in their substance use patterns and referred those who were at low to moderate risk of substance use to a preventative mentoring program. Qualitative interviews with the participating staff and mentors suggested high levels of staff buy-in to the utility of the program to reach adolescents at risk as well as high satisfaction with the training and program objectives. Mentors reported good adherence to the program curriculum and met the majority of session goals set out in the intervention, but they recommended adding more mentoring sessions to the program. There were, however, several issues related to sustainability of the screening, referral, and overall mentoring program implementation procedures. Mentors found it challenging to obtain parental consent to recruit adolescents, commute to the mentoring sites, and handle scheduling conflicts. Staff raised concerns over a lack of funding and resources to continue the program. Taken together, the findings were promising that the Project Amp was feasible and acceptable for mentors and staff to screen, refer, and intervene with adolescents at moderate risk of substance use.

      Mentee recruitment and engagement were common issues raised in mentoring programs and were also linked to program fidelity and adherence.41,51,72,73 Difficulties in engagement were reflected in treatment completion rates, which were as low as 51 percent in one study41 where authors mentioned the program was not implemented as intended. However, mentoring relationship quality among program completers was high, suggesting some promising evidence that building strong connections with the mentees is one of the first steps to sustain mentoring relationships throughout the program. Additionally, one strategy to address aforementioned recruitment issues was to utilize after-school programs as potential contexts of engaging at-risk youth in mentoring programs.72 This strategy was discussed in a mentoring program targeting girls of color and appears to be important to explore further in future research. We did not identify any studies that empirically tested the role of recruitment setting in participant engagement and program completion.

      Adherence to the program and links to sustainability were further discussed in an evaluation of the National Guard Youth Challenge Program.51,73 While fidelity to the program core elements was relatively high across sites, the last phase (which included a Youth Initiated Mentoring phase) had lower fidelity to the program.73 Sites differed from one another in terms of training, support, and other resources they offered the mentors. Qualitative interviews with participating youth showed that mentors’ encouragement and support to continue the program motivated youth to persevere despite the challenges they faced during the residential phase. Authors also underscored the utility of engaging and training natural mentors in formal mentoring programs as a means of catalyzing their ongoing connection with youth. For instance, the Youth Initiated Mentoring practice was associated with longer match length and higher likelihood of maintaining the relationship at the completion of the program, even after controlling for mentee demographic characteristics and risk factors (school suspension, conviction, or drug/alcohol use).

    • CONCLUSIONS


      1. Integrating a substance use screening and referral process to the mentee recruitment phase of mentoring programs could be promising to reach substance misusing adolescents.

      2. Ongoing support of mentors throughout the program and providing needed resources are necessary for sustainability of mentoring programs for adolescent substance use.

      3. While the empirical research is still growing, Youth Initiated Mentoring appears to be a promising practice to promote long-lasting mentoring relationships.

  • Implications for Practice

    (Mike Garringer, MENTOR: The National Mentoring Partnership)

    While one certainly wishes that there was more direct research from which to draw regarding mentoring and substance use prevention and recovery (particularly around opioids given the critical importance of that topic to the nation’s health at this time), there is some empirical evidence available to suggest mentors can play a meaningful role in preventing the onset of use in adolescents and reducing the harm once they have started on a path toward misuse. Indeed, there is a long history of using mentor-like roles in recovery programs (e.g., the “sponsor” in Alcoholics Anonymous and its variants) and one might expect that the emotional and moral support of a mentor might really boost resiliency and keep youth from turning to substances to deal with the stressors of the world. Given that mentors can also play a role in supporting youth alongside a more clinical provider’s role (for example, see the NMRC review of mentoring for youth with mental health needs) it is similarly easy to see roles for mentors in helping youth stick to treatment plans or in processing trauma and negative experiences from their youth.

    But what exactly is the right role for mentors on this topic? Unfortunately, there is little evidence in the preceding pages about whether mentors are better deployed purely in service of primary prevention or whether their role is better positioned in reducing harm once use has begun. We certainly need more research about the specific actions and types of support mentors might offer at these various stages. It is also unclear whether mentors can be effective against specific substance misuse issues, such as opioids, which may operate via unique processes as compared to other substances and respond better to different treatment paths.

    But the reality is that the nation’s mentors are being asked to support youth in both prevention and interventions for misuse. A 2017 MENTOR study74 found that about 3 percent of the nation’s mentoring programs listed this as a top four focus for their matches, but it is clear that substance misuse can potentially impact the youth in 100 percent of programs, either directly or through misuse in the home.

    So what should mentoring programs keep in mind, since they are diving into these waters anyway? There are several hints at good practice recommendations in the evidence review offered here:

    • 1. CONSIDER SCREENING FOR OPIOID USE AND/OR RISK DURING YOUTH INTAKE.

      It can be challenging to deploy mentors in a prevention or intervention capacity if it is unclear how many youth in the program are struggling with misuse issues (either themselves, in the home, or among their peer group). There are many valid and reliable scales available to programs that assess youth exposure to and consumption of drugs and alcohol, and a simple Google search will identify hundreds of options of varying value. One shortcut for mentoring programs is to consult the National Mentoring Resource Center’s Measurement Guidance Toolkit, which offers several tools that might be helpful in this assessment: a general assessment of drug and alcohol use and potential for use, as well as two opioid-specific scales just added this year—one focused on youths’ direct use of opioids and one assessing their risk for misuse based on a number of factors research suggests facilitate access to and misuse of opioids. Of course, youth may not always be willing disclosers of this information, but these tools can help identify youth who are likely to need substance misuse support from their mentor, especially if included as part of a broader assessment that looks at individual and environmental risk. The characteristics discussed in relation to Question 2 in the review can help practitioners clarify what to look for in terms of elevated risk factors.

    • 2. LEAN ON NATURAL MENTORS, EVEN IN PROGRAMMATIC CONTEXTS.

      If there is a clear thread in much of the research covered in the main review here, it is that natural mentors can have as much impact, if not more so, on youth substance use than programmatic mentors. This might be for a number of reasons: informal mentors might be more available during critical moments, might be able to keep a closer eye on a youth’s behavior and activities, and might be able to relate better to stressors in the child’s life. It might also be that programmatic mentors are often asked to focus on other things (remember, only 3 percent of programs had substance use as a top four area of emphasis). But whatever the reasons, it seems that natural mentors are key players in supporting youth around this issue.

      That means mentoring programs should consider ways of involving natural mentors in their work. One obvious way of doing this is tasking program-provided mentors with doing some additional relationship mapping with youth so that they can identify other supportive adults that they can turn to if they feel like they are struggling with issues related to substance misuse. These individuals can enhance the mentoring provided through the program and provide support in situations where the formal mentor is unavailable. Some programs may even arrange for their mentors to meet with this broader support team so that they can share information and ideas about the young person’s challenges and progress.

      The other way of bringing natural mentors into programs is to explore Youth-Initiated Mentoring models where youth nominate someone from their existing circles to step up into a more formal mentor role through a program. This can strengthen an existing relationship and may provide the youth with a mentor who is more familiar, available, and knowledgeable about the challenges they are facing.

      But really, when it comes to addressing issues of substance misuse and chemical dependency, especially with substances that are as immediately deadly as newer variants of opioids, it is “all hands on deck,” and programs should maximize the mentoring youth receive both through their program services and by rallying other community adults who can support the young person.

    • 3. TRAIN MENTORS ON WHAT TO LOOK FOR AND HOW TO RESPOND.

      Unless they are volunteering in a program that is recovery-focused for youth who are trying to break cycles of misuse, the reality is that most mentors hope they never have to deal with issues related to their mentee’s use or misuse of drugs and alcohol. While all mentors expect some ups and downs and challenges their mentee will have to overcome, it is safe to say that most mentors would rather avoid something as complicated and scary as substance abuse. But, this is a challenge for today’s young people, and the best way for mentors to be helpful around this issue is to be knowledgeable and know how to respond to warning signs. There are hundreds of websites offering guidance for parents and other caring adults on how to recognize substance misuse in adolescents, but this guide from the National Institute on Drug Abuse offers an excellent starting point for programs and mentors. Mentor training should include role plays and scenarios where mentors respond to a number of scenarios about youth and substance use, ranging from a mentee expressing interest in drugs or recent peer pressure all the way to disclosures of serious misuse.

      It is up to programs to determine how they want mentors to respond to these scenarios based on the goals and support offered by the program. But programs should not leave mentors to figure out these things on their own in stressful situations. In fact, one of the most critical aspects of this training is getting mentors to recognize where their role ends with regards to substance abuse and when the services of more experienced professionals and evidence-based interventions are needed. Mentors may struggle to understand the limitations of their role and those subjective “handoff points,” perhaps even downplaying youth admissions of substance use as a way of avoiding breaking confidentiality with the youth or not wanting to overreact to what can be normal adolescent experimentation. But programs must ensure that mentors are prepared for whatever their mentee may bring forward around this critical topic and know when the potential for harm is great enough that they should seek support from the program or the youth’s parents/guardians. This preparation is critical — no one has ever been helped with a substance misuse issue by pretending it did not exist.

    • 4. CONSISTENT MENTORING EXPERIENCES CAN KEEP RESILIENCY HIGH.

      Noted mentoring researcher Jean Rhodes once said, “Mentoring is like a vitamin, not an inoculation . . . it works while you are taking it. . . .” That sentiment applies here to the resiliency needed over the long journey through childhood and adolescence if youth are to avoid imitation of substance use or the descent into misuse. It is not like having a great mentor in fifth grade will inherently pay off when offered drugs at a party in tenth grade. The reality is a really caring mentor might not be able to make much difference to a youth who is deep into opioid misuse by the time they enter their life. This means that we need to keep youth’s lives full of mentors the whole way through if we are to win this long-term struggle. Mentoring programs should think carefully about how they transition youth out of their programs and into their next mentoring relationship. Ensuring that there are handoffs — to natural mentors, to other programs, to extended family or religious leaders or coaches — can help extend the impact of programmatic mentors when those relationships inevitably come to an end. Practitioners should think about who can help keep resiliency high once their mentors have built it up.

    • 5. ADDITIONAL LEARNING

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  • Tables

You can also find several tools and activity guides that can support mentoring in the Resources section of the NMRC website. And remember that you can always request NMRC technical assistance to help start or improve a mentoring program.

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