From Screening to Sustained Recovery: A Multidomain Systematic Review and Evidence Map of Adolescent Substance-Use Rehabilitation with Nested Meta-analysis of Youth Opioid Treatment
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Background
Adolescent substance-use rehabilitation is a care-continuum problem spanning detection, engagement, active treatment, relapse prevention, aftercare, family support, and equity-oriented implementation. Existing reviews are often modality-specific and do not show how evidence aligns with substances, populations, outcomes, stages of care, or policy needs.
Objectives
To map and synthesise the 2015-2025 adolescent and transitional-age youth SUD rehabilitation literature across intervention domains, stages, substances, outcomes, equity/disadvantage, geography, and economics, and to perform meta-analysis only where pooling was clinically defensible.
Methods
PubMed, Scopus, and Web of Science records were harmonised to 2015-2025 and deduplicated. Two reviewer roles applied a predefined charting codebook for substance focus, technique family, rehabilitation stage, equity/disadvantage flags, outcome family, and study-design signal. Evidence was synthesised across AI/digital, psychiatric/psychotherapeutic, pharmacological, family/social, behavioural, residential/continuing-care, school/community, harm-reduction, and policy domains. Random-effects meta-analysis was restricted to comparative youth OUD medication-supported trials with extractable binary outcomes.
Results
The search identified 1,676 records; 554 duplicates were removed, leaving 1,122 unique records. Metadata screening retained 579 records for evidence-map charting: 112 high-confidence records and 467 conservative metadata-supported records requiring full-text verification before final selective-journal submission. The charted evidence was concentrated in active treatment (n=433) and relapse prevention (n=114); aftercare/follow-up was weak (n=8). Intervention-family signals were led by pharmacological/MOUD (n=72), psychotherapy/psychiatric care (n=65), school/community/brief interventions (n=46), residential/continuing care (n=41), family/social therapy (n=30), AI/digital/telehealth (n=25), harm-reduction/policy (n=24), and CM (n=22). The primary youth OUD retention/completion meta-analysis favoured medication-supported treatment (OR 7.67, 95% CI 3.98-14.78; I 2 =0%; k=2; n=188). An exploratory favourable-outcome analysis produced a similar estimate (OR 7.94, 95% CI 4.24-14.89; I 2 =0%; k=3; n=229).
Conclusions
The strongest pooled quantitative claim supports medication-supported treatment for youth OUD. For non-opioid substances, digital care, family therapy, CM, residential care, aftercare, and equity-oriented implementation, the literature is clinically important but not yet consistently synthesis-ready. Future trials should evaluate complete care pathways, adopt core outcomes, report age-banded and equity subgroup effects, and include economic and implementation endpoints.
Research in context
Evidence before this study
Existing adolescent SUD reviews are often organised by single intervention families: outpatient behavioural treatment, family therapy, brief interventions, alcohol-focused psychosocial treatment, pharmacological treatment for youth OUD, or digital interventions[1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12]. That work is valuable, but it does not fully answer rehabilitation-system questions: where young people are detected, how they are engaged, which treatment layer is matched to which substance, what happens after discharge, and whether evidence is equitable across gender, ethnicity, justice involvement, geography, and cost.
Added value of this study
We analyse adolescent SUD rehabilitation as a staged care-continuum and multidomain evidence system. The synthesis combines a harmonised search, PRISMA 2020-style flow, dual-reviewer charting supplement, technique-by-stage matrices, substance-by-technique matrices, outcome-gap matrices, geographic mapping, and nested meta-analysis for the only subgroup in which pooling is clinically defensible: medication-supported youth OUD treatment.
Implications
The clearest pooled quantitative signal supports medication-supported treatment for youth OUD. For alcohol, cannabis, stimulants, digital tools, family therapy, residential care, aftercare, and equity-oriented implementation, the major problem is not absence of ideas; it is fragmented outcomes, underpowered subgroup analyses, weak aftercare measurement, and limited economic and global-south evidence.
