Mentoring for Preventing and Reducing Substance Use and Associated Risks Among Youth

Introduction

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?

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

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. Four^32,36,38,40 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 studies^40,43 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 studies^36,38 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?

Meta-analytical studies suggest some evidence that youth mentoring may be more effective for boys^48,49 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

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

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

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?

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

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

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:

References

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Tables

Table 1: Substance Abuse and Associated Risks (SAR)