1 Introduction

The youth's relapse into substance use is extremely distressing (You et al. 2020). Young people are going through a transitional period in their development where they discover who they are, develop new abilities, form relationships with their peers and cultivate a positive body image. These changes are not always easy to make, though, and sometimes they include risk-taking behaviours like substance use when the brain is still developing (Arora et al. 2015; Ryan et al. 2019). Youth is the period of life when one is young, which is a period between childhood and maturity (adulthood). It is often defined in terms of the ages of leaving education compulsorily to when the person gets their first job (UNESCO 2019; Manyanda et al. 2021). Youth substance use is the unsafe indulgence in licit or illicit substances by young people for mood-altering purposes in a way that is a potential threat to their well-being, the well-being of their families and even the well-being of their communities (Mhaka-Mutepfa 2021). Youth substance usage increases the likelihood of developing a dependency on the substances in the future and relapsing into use (Kabisa et al. 2021; More et al. 2017). Considering this, youth substance use is characterised by recurrent relapses. There is abundant evidence that for those who use substances and want to stop, relapse is still a significant obstacle that prevents them from recovering and staying sober (Appiah 2022; Furzer et al. 2021; Volkow 2020; You et al. 2020). Sixty-five to eighty-five per cent of young persons with substance use disorders (SUDs) experience a relapse 12 months after starting treatment (Furzer et al. 2021; Lopes-Rosa et al. 2017). Substance use treatment has historically raised hopes that it would end the ‘revolving door’ that allowed patients with addiction issues to enter and exit institutions (White and Kelly 2011). Existing research, however, indicates that effective relapse prevention strategies and programmes are necessary and must take into consideration social, cultural, environmental and individual factors to prevent substance use relapse (Appiah et al. 2018; Kabisa et al. 2021; Maikano et al. 2021).

Programmes for preventing substance use relapses are crucial because they help substance users become more in control of their impulses, learn how to curb cravings and avoid relapsing into substance use, build new social skills and postpone gratification (WHO-UNODC 2020). Research on substance use relapse prevention programmes and recovery trajectories has just lately begun to gather, despite the awareness that young people participate in dangerous substance use with a high rate of relapse. Randomised controlled trials have been used to demonstrate the effectiveness of numerous substance use relapse prevention programmes, many of which have been developed, especially in Western countries, to prevent substance use relapse. These programmes include, among others, web-based preventative initiatives, recovery management examinations and cognitive behavioural-based programmes (Karno et al. 2021; Rooke et al. 2013; Scott et al. 2023; Trudeau et al. 2017). In a study conducted in the USA, the effectiveness of an online relapse prevention programme called Navigating my Journey (NmJ) was evaluated among young people aged 13–24. The study found that participants who used this programme experienced increased self-efficacy and reduced substance use over time. Still in the USA, a study conducted to test the effectiveness of a brief intervention programme known as SBIRT (Screening, Brief Intervention and Referral to Treatment) was effective in reducing the frequency of substance use in young people who were 18 years and older (Karno et al. 2021; Trudeau et al. 2017).

Substance use among young people is also a problem in Australia, where a neuroscience-based relapse/harm reduction programme was launched with a focus on school-age adolescents, namely, junior high school pupils (12–15 years old) (Debenham et al. 2020). However, according to reports, this relapse prevention programme's effectiveness is minimal to nonexistent (Debenham et al. 2020). Relapse prevention programmes involving expressive arts are becoming more common in Hong Kong, both in inpatient residential treatment facilities and community-based counselling centres (Tam, Shik, and Lam 2016). Nevertheless, in contrast to Western nations, no empirical randomised controlled trials have been carried out to determine the efficacy of these SUR programmes (Tam, Shik, and Lam 2016). Substance use relapse prevention programmes are lacking in African nations where access to empirically based treatments is limited (Gouse et al. 2016; Pasche et al. 2015). In Botswana, a middle-income country in sub-Saharan Africa, the absence of substance use relapse prevention programmes hinders the effective prevention of substance use relapse. Botswana has limited rehabilitation services, with the primary focus being on inpatient rehabilitation after a relapse. To the best of the researcher's knowledge, there are no specific programmes in place to prevent relapses to substance use after hospital discharge.

Conducting an integrative review related to SUR prevention for the youth in the current study is very important, given the high rate of SURs, the burden they place on society, the setback they impose on recovery successes and the limited understanding of SUR prevention (Kabisa et al. 2021; More et al. 2017). The report from the World Health Organisation (WHO) and the United Nations Office on Drugs and Crime (UNODC) shows young people as a particularly susceptible population in need of specialised care (WHO-UNODC 2020). The findings of this review will assist mental health nurses in understanding the components of a youth substance use relapse prevention programme and work to reduce substance-related relapses that impede successful recovery.

1.1 Rationale and Aim

Substance use has been a public health concern for decades, especially among the youth with harmful outcomes such as undesirable behaviour, compromised health status, legal and economic implications (Arora et al. 2015; Oladele 2021). Though substance use is common among youth, their relapse following abstinence causes great concern (Gonzales-Castaneda et al. 2022). However, despite the concern, substance use relapse prevention remains a challenge with literature suggesting a variety of relapse prevention programmes (Arora et al. 2015; You et al. 2020). Thus, this review aimed to identify, synthesise and present the findings of all relevant studies on substance use relapse prevention programme for the youth. The research question for the review was as follows:

• What is stated in the published literature on a substance use relapse prevention programme for the youth?

2 Methods

An integrative literature review (ILR) was conducted, guided by Whittemore and Knafl (2005). A step-by-step guide to conducting an ILR was followed (Toronto and Remington 2020). This is a guide that was expanded from the previous guidelines for conducting an ILR (Whittemore and Knafl 2005). An ILR allows the inclusion of diverse methodologies to explore different perspectives on the subject matter (Toronto and Remington 2020). Since our review required broad research evidence on substance use relapse (SUR) prevention for the youth, an ILR best served the purpose of our review. Thus, after problem identification, a comprehensive review of the literature was conducted guided by steps suggested by Whittemore and Knafl (2005) as follows:

2.1 Problem Identification

The identified problem for this integrative review emanated from study reports and anecdotal notes from experts that identified substance use relapse as a serious concern in Botswana and globally, with a lack of prevention strategies. The review was guided by the following research question: What is stated in the published literature on a substance use relapse prevention programme for the youth?

2.2 Literature Search Strategy

The search strategy for this review is discussed under the subheadings below.

2.2.1 Inclusion Criteria

In applying the inclusion criteria, the reviewers systematically examined the literature to critically appraise its quality in terms of its value, reliability and relevance to substance use relapse prevention programme for the youth (Toronto and Remington 2020). The review included literature published in the English language that spanned from 2013 to 2024. The literature used was from diverse methodologies (experimental and nonexperimental studies) that provided different perspectives on the prevention of SUR among the youths. The review also included the grey literature based on the information it yielded in response to the research question.

2.2.2 Exclusion Criteria

The review excluded all articles that were not appropriate in answering the research question, such as studies that did not address substance use relapse prevention programmes or strategies. Moreover, commentaries, letters and editorials were excluded from the review as the review focus was on theoretical, empirical and expert reports on the topic.

2.2.3 Database Searching

The first author (WG) conducted a comprehensive search that captured the most relevant literature. The robustness of the search was enhanced by involving the services of an experienced librarian in reviewing the literature for inclusion and exclusion criteria. The librarian suggested websites and databases that were included in the search. The literature search was conducted in a systematic and comprehensive approach on PubMed, Sabinet African Journals, EBSCOhost and Medline electronic databases. The Boolean operator literature search strategy was used, and it yielded the most appropriate literature for the study (Lubbe, ten Ham-Baloyi, and Smit 2020). The keywords used for searching the literature were ‘substance OR drug’ AND ‘use OR abuse OR misuse’; ‘relapse prevention OR addiction management’ AND programme OR check-ups' AND ‘youth OR young adults OR young people’.

The literature search resulted in 4283 studies. Then, the researchers embarked on the screening of titles for relevant publications. The researchers excluded duplicated publications and studies that could not be retrieved. Based on the inclusion and exclusion criteria, 4224 publications were excluded from the review. The screening resulted in 52 publications remaining for assessment of abstracts. The researchers assessed and analysed the abstracts to select publications that were directly related to SUR prevention, which further excluded 29 documents. Critical appraisal of the full text was conducted on the 23 remaining publications and 3 documents from the grey literature resulting in reviewing 26 documents. The grey literature consulted was from two websites being, the World Health Organisation (WHO) and the United Nations Office on Drugs and Crime (UNODC) website, and the International Society of Substance Use Professionals (ISSUP) website. The search was conducted from October 2023 to January 2024. The selection process of studies is shown in the Preferred Reporting Items for Systematic Reviews and Data Analysis (PRISMA) (Figure 1).

FIGURE 1

_{PRISMA flowchart for search strategy.}

2.3 Data Evaluation

All studies included in the ILR underwent a critical appraisal for quality using the Mixed Methods Appraisal Tool (MMAT) version 2018. Since ILR allows a broad search for evidence, the quality appraisal process enabled researchers to assess empirical studies from diverse methodologies. In the bid to ensure quality results, the reviewers independently conducted a quality appraisal of the studies. The quality ratings of each criterion and the overall score for each study were assessed. However, studies were not excluded from the review based on their methodological quality to avoid inadequate reporting practices and possible exclusion of valuable findings (Lubbe, ten Ham-Baloyi, and Smit 2020; Whittemore and Knafl 2005). Thus, the researchers were able to identify broad evidence regarding substance use relapse prevention programme for the youth.

2.4 Data Synthesis and Analysis

Data analysis involves organising and synthesising data to answer a research question (Polit and Beck 2017). Data analysis for this review was guided by the integrative review process of Whittemore and Knafl (2005). It is during data analysis that the researchers conducted data extraction and data synthesis using content analysis (Lubbe, ten Ham-Baloyi, and Smit 2020). The researchers developed a data extraction table for the identified articles and captured the author's names (first author), the aim of the study, the methodology used and the findings (Lubbe, ten Ham-Baloyi, and Smit 2020) (Table 1). During data synthesis, the researchers engaged in a creative process in which interrelated ideas from various studies were clustered to develop a new understanding of substance use relapse prevention (Grove and Gray 2022). The data from primary sources were ordered, coded, categorised and synthesised into a coherent, integrated conclusion about programme for the prevention of substance use relapse (Whittemore and Knafl 2005). The researchers independently reviewed the articles to avoid biases and for consensus on the identified themes and subthemes (Toronto and Remington 2020). Subsequently, this interactive process resulted in the identification of three themes and their subthemes for the review. The identified themes and subthemes are displayed in Table 2.

TABLE 1. Appraisal of documents for substance use relapse prevention programmes.

TABLE 2. Themes and sub-themes on the prevention of SUR.

2.5 Ethical Considerations

This article adhered to all ethical standards for research without direct contact with human or animal subjects. The article is a component of a larger study and aims to guide the development of a substance use relapse prevention programme for the youth in Botswana. The study has the ethical approval of the Institutional Review Board of North-West University (Ethics number: NWU-00174-23-S1) and permission from the Ministry of Health IRB (Ref: HPRD: 6/14/1). Permission to conduct the study was also solicited from Sbrana Psychiatric Hospital Institutional Review Board (Ref: 4/2/2 III (65)).

3 Findings

Twenty-six articles were selected using the identified search strategy based on keywords (‘substance OR drug’; AND ‘use OR abuse OR misuse’; ‘relapse prevention OR addiction management’ AND programme OR check-ups' AND ‘youth OR young adults OR young people’). The review has been reported using the Preferred Reporting Items for Systematic Reviews and Data Analysis. The PRISMA flow chart is an internationally recognised diagram that provides a visual summary of the process used to include and exclude studies in systematic reviews (Page et al. 2021). The PRISMA flow diagram (Figure 1) summarises the search and screening processes used to select the articles. From the 26 articles, 23 were peer reviewed articles and 3 were grey literature. The 23 articles used in this review spanned the period from 2013 to 2024 with most studies conducted between 2017 and 2023 (Figure 2). The studies were conducted in six countries, and more than half of the selected studies were conducted in USA (n = 12). Other studies were conducted in South Africa (n = 2), Taiwan (n = 2), Australia (n = 2), Hong Kong (n = 2) and Switzerland (n = 1). The majority of the studies were randomised controlled trials (RCT) (n = 13) followed by quantitative studies (n = 4). Mixed methods, qualitative and literature review were each two (n = 6) and three (n = 3) from grey literature. The details and characteristics of each study are provided in Table 1.

FIGURE 2

_{Time span for the selected studies.}

3.1 Theme 1: Continuing Care

One of the main themes was continuing care. The initiation and sustenance of behavioural modifications in SUR prevention are discrete procedures that are regulated by certain circumstances (NIDA 2018). Accordingly, various authors concur that to keep young people from relapsing, it is necessary to provide ongoing care after release from the hospital to preserve the progress made during an admission (Bowen et al. 2014; Gonzales, Douglas Anglin, and Glik 2014; ISSUP 2020; Mpanza, Govender, and Voce 2022; NIDA 2018; Scott et al. 2018). The review also demonstrates that the aftercare programme (continued care) should not last for less than 3 months to achieve relapse prevention (Van der Westhuizen 2015). Check-ups following treatment, monitoring and evaluation, connections to therapy, engagement and retention and utilisation of recovery support programmes are all examples of continuing care.

3.1.1 Posttreatment Check-Ups

According to the review's findings, posttreatment check-ups, which are a component of continuing care or recovery management care (RMC), are beneficial for society's financial health and play a significant role in preventing substance use relapses (Dennis, Scott, and Laudet 2014; Gonzales-Castaneda et al. 2022; NIDA 2018; WHO-UNODC 2020). Dennis, Scott, and Laudet (2014) state that posttreatment check-ups are routine, ongoing assessments of substance users to identify relapses early and take appropriate action. According to the literature, posttreatment check-ups can be conducted through programmes that involve in-person interactions with youth substance users (YSUs) to strengthen their behavioural and cognitive abilities so they can withstand relapse temptations (Tam, Shik, and Lam 2016; ISSUP 2020). While YSUs are aware of where to turn for support, their biggest obstacle is finding the will to ask for it or to know when to do so (Debenham et al. 2020). To enable young people to participate in health-seeking behaviour at an early age, the relapse prevention programme with posttreatment check-ups would, thus, concentrate on increasing their motivation and setting positive, realistic health goals (Debenham et al. 2020; NIDA 2018; Trudeau et al. 2017; Wang et al. 2018).

Nonetheless, the results of this review make it clear that YSUs require assistance in becoming conscious of their cravings and triggers, or in identifying the cognitive, emotional and behavioural dysfunctions that cause them to relapse into substance use, as part of posttreatment check-ups (Bowen et al. 2014; NIDA 2018). Studies agree that one of the best strategies for treating individuals with substance use disorders is cognitive behavioural therapy (CBT) (Bowen et al. 2014; NIDA 2018; Wong, Zhuang, and Ng 2020). Thus, behavioural and cognitive strategies—either as individual or group therapies—are essential to reducing the likelihood of relapse and easing the cognitive dissonance that often follows in young people's positive behaviour change (Debenham et al. 2020; Tam, Shik, and Lam 2016). Therefore, developing skills to manage urges and postpone gratification, motivation for change, problem-solving abilities and the ability to engage in nonchemical substance use activities may be among the areas to be addressed at check-ups (NIDA 2018; WHO-UNODC 2020; Van der Westhuizen 2015; You et al. 2020).

3.1.2 Tracking and Assessment

The results of this review indicate that monitoring is part of continuous care that requires both assessment and tracking (Dennis, Scott, and Laudet 2014; Karno et al. 2021; NIDA 2018; Scott et al. 2023, 2018). YSUs are proactively tracked and screened (assessed) for early indications of issues, given incentives, and assisted in negotiating access for re-entry into treatment, among other various functions of continuing care (ISSUP 2020; Scott et al. 2018). The recovery management and relapse prevention manual, also known as the Universal Treatment Curriculum for Substance Use Disorders (UTC), demonstrates the significance of tracking and the proactive steps taken to stay in touch with substance users after they are discharged from treatment (ISSUP 2020).

Fieldwork, phone calls, mailings and other methods are all combined in the tracking process (ISSUP 2020). After that, the drug user is evaluated to rule out SUR and choose the best course of action. To improve outcomes, YSU assessments must be carried out quarterly as part of monitoring for approximately 4 years after discharge (ISSUP 2020; Scott et al. 2018). Consequently, monitoring and evaluation determine whether an individual with a substance use disorder has resumed substance use and allow for intervention to prevent a relapse or lessen its effects (ISSUP 2020).

3.1.3 Linkages to Treatment

During assessment, some YSUs may have relapsed or be on the verge of a relapse. Thus, YSUs in primary care settings require an assertive and robust linkage model that can effectively increase their participation in SUD treatment, leading to significantly greater reductions in drug use (Scott et al. 2018). In situations where relapse is imminent, linking YSUs back to treatment is necessary, thus increasing re-entry into treatment before a relapse can occur (Dennis, Scott, and Laudet 2014; Karno et al. 2021). Literature provides overwhelming evidence of the effectiveness and value of ‘referral back to treatment’ to prevent relapses to substances (NIDA 2018). In the cases where relapse is imminent, suspected or real, individuals are linked back to inpatient treatment, residential services, SUD outpatient services or community support services to prevent a relapse or minimise its impact (ISSUP 2020).

3.1.4 Engagement and Retention

The literature (NIDA 2018; Scott et al. 2023, 2018) also emphasises the significance of engagement and retention as a component of ongoing treatment to prevent SUR. The engagement component aims to avoid the common roadblocks found throughout the admissions process, allowing substance users to more easily ‘show’ up for treatment following evaluation and referral (ISSUP 2020). To increase the possibility that YSUs will attend treatment after assessment, the engagement process includes putting tactics in place to boost motivation for re-entry into treatment, expediting the admissions process, and overcoming some of the admissions course's drawbacks (ISSUP 2020; NIDA 2018). After a successful engagement process with the willingness of the YSU to show up to treatment, the primary healthcare linkage manager (focal person) must continue to maintain contact and follow-up with the substance user to ensure that motivation to participate in treatment is maintained to aid retention (ISSUP 2020; Scott et al. 2018). The linkage manager must provide assistance to overcome any environmental or organisational barriers to retention (Scott et al. 2018).

According to the review's conclusions, the retention component of relapse prevention aims to keep substance users in treatment for a minimum of 14 days, either through inpatient or residential treatment, or 14 sessions of outpatient therapy (ISSUP 2020). To minimise the harm associated with relapse or to sustain substance abstinence, engagement and retention methods are crucial (Scott et al. 2018). The treatment personnel must inform the linkage manager if the YSU makes threats to stop treatment or misses an outpatient visit. The linkage manager then sets up an intervention to encourage re-engagement in treatment (Scott et al. 2018). Mitchell et al. (2021) emphasised the need for appropriate pharmaceutical treatment postdischarge to prevent relapses and sustain retention to treatment.

3.1.5 Use of Recovery Support Services

According to the review, recovery support services are necessary and encourage healthy behaviours after completing a treatment programme to reduce the risk of a relapse (ISSUP 2020; Mpanza, Govender, and Voce 2022; NIDA 2018). Linking YSUs to recovery support services is crucial as part of reintegration (Van der Westhuizen 2015). The findings of this review indicate that reintegration can be social (social-reintegration) in which YSUs are assisted to re-establish themselves into the community through networking with families, schools, churches and support groups (NIDA 2018; WHO-UNODC 2020). Mpanza, Govender, and Voce (2022) emphasise the need for recovery support services to comprehensively reintegrate people with substance use problems into their families, workplaces and communities. According to the foregoing author, the goal of recovery support services is to provide tools and resources to sustain the recovery of YSUs after the formal treatment programme has been completed.

Additionally, it is evident from this review that participation in recovery support services with more rewarding activities is a key predictor of long-term recovery (Mpanza, Govender, and Voce 2022). Precisely, the use of recovery support services that aid social integration and participation in conventional pursuits, such as alcohol-free recreational/art-based activities and linkages to job placement programmes, is associated with a higher prospect of stable remission and recovery (Mpanza, Govender, and Voce 2022; Tam, Shik, and Lam 2016). Furthermore, the review shows that engagement in peer support groups such as the 12-step programme is associated with recovery because it provides a conducive environment for establishing positive social relationships, a space for learning new skills and information on health and employment (Mpanza, Govender, and Voce 2022; NIDA 2018). However, it is worth noting from this review that availing resources for recovery support services such as rehabilitation centres in communities is a crucial strategy that facilitates the prevention of relapses and offers an opportunity for the YSUs to effectively and sufficiently address their substance use problems (WHO-UNODC 2020).

3.2 Theme 2: Technology-Mediated Recovery Management Interventions

One of the themes from the review was technology-mediated aftercare intervention (TMAI). The use of TMAI, such as mobile aftercare interventions and internet-based relapse prevention, plays a critical role in preventing relapses among youths either as a standalone or as an adjunct to face-to-face interventions.

3.2.1 Mobile Aftercare Interventions

Mobile aftercare intervention is one of the subthemes that emerged in this review under technology-mediated management interventions. Mobile aftercare interventions can be delivered through smartphone applications or general text messages (SMS) (Gonzales et al. 2014; Gonzales-Castaneda et al. 2022; Guarino et al. 2016; Haug et al. 2023). From the results of the review, practitioners can continue offering care through text messages to motivate the YSUs to engage in recovery behaviours and to continue making positive life changes (Gonzales, Douglas Anglin, and Glik 2014). Furthermore, Gonzales, Douglas Anglin, and Glik (2014) found that the mobile texting intervention buffered the tendency towards relapse and significantly reduced the severity of substance use among youth who received the aftercare mobile texting intervention compared to the youth in the standard aftercare control condition. Finally, the findings of this review indicate that mobile texting aftercare programme offers several advantages that include personalised and targeted engagement, enhanced assessment and monitoring, increased convenience and better flexibility of service delivery (Gonzales, Douglas Anglin, and Glik 2014).

3.2.2 Internet-Based Relapse Prevention

Another subtheme that emerged in the review was internet-based relapse prevention. Internet-based relapse prevention programming is reported to be a promising modality to enhance treatment gains and recovery (relapse prevention), though Trudeau et al. (2017) argue that it lacks a strong evidence base (Debenham et al. 2020; Dennis, Scott, and Laudet 2014). However, the findings of this review show that digital or internet-based health interventions can offer frequent monitoring of YSUs and address some of the barriers to health delivery, such as the fear of stigma associated with face-to-face interventions (Dennis, Scott, and Laudet 2014; Guarino et al. 2016). Thus, internet-based interventions can positively impact the provision of substance use prevention or harm reduction initiatives (Debenham et al. 2020; Dennis, Scott, and Laudet 2014; Guarino et al. 2016; Haug et al. 2023; Trudeau et al. 2017). Moreover, the review reveals that internet-based smartphone applications can be used for engagement, personalised feedback and to provide digital programme modules to be carried out over a time frame (Guarino et al. 2016; Haug et al. 2023).

3.3 Theme 3: Relapse Prevention/Recovery Promotion Through Developmentally Engaging Activities

The results of this review indicate the need for relapse prevention through developmentally engaging activities. This involves engaging YSUs on undertakings that have the potential to aid their personal growth and development while also serving as a deterrent to substance use and SUR (Gonzales et al. 2013; ISSUP 2020). Three subthemes were derived from the review: physical activities, educational activities that promote literacy on substance use and self-monitoring strategies.

3.3.1 Physical Activities

Evidence from the review shows that physical activities, for example, exercise programmes are efficacious in supporting substance use relapse prevention among the youth, especially as a complement to cognitive-behavioural/lifestyle interventions (Furzer et al. 2021; Gonzales et al. 2013; NIDA 2018; Wong, Zhuang, and Ng 2020). This review demonstrates that the youth who engage in a substance use programme that has physical activities (e.g., exercises) develop enhanced self-esteem, high relapse prevention efficacy, increased levels of exercise enjoyment and better physical health perceptions (Furzer et al. 2021; Mpanza, Govender, and Voce 2022). However, behaviour change for the youth requires joyful activities (recreational, art-based, etc.) that can replace substances (Tam, Shik, and Lam 2016; Van der Westhuizen 2015).

3.3.2 Self-Monitoring

Additionally, the review shows that YSUs need to be empowered with self-monitoring strategies, for example, use of a diary or technology-mediated self-monitoring interventions (Dennis, Scott, and Laudet 2014; Gonzales et al. 2014; Haug et al. 2023; NIDA 2018; Wiebe et al. 2018). Basically, self-monitoring activities as a relapse prevention and recovery promotion strategies have been found to assist the YSUs to self-regulate (self-control) specific and critical areas of their lives associated with relapse following inpatient treatment (Gonzales, Douglas Anglin, and Glik 2014; Guarino et al. 2016). Moreover, the self-monitoring reports are important to assess for discordance between the self-report data and sensitivity analyses (urinalysis) to compare if the self-report of a ‘no recent use’ is supported by substance-negative urinalysis (Karno et al. 2021).

3.3.3 Educational Activities That Promote Literacy on Substance Use

According to some sources of this review, YSUs need to be psycho-educated on key neuroscience principles to build their understanding of the brain functions, the impact of substances on the brain and substance use relapses (Debenham et al. 2020; Van der Westhuizen 2015). In a study by Debenham et al. (2020), YSUs who were provided with psychoeducation on neuroscience and the effects of drugs on the brain content found it interesting and these facts made it more believable, which can motivate them to quit and abstain. The psycho-education message has to be delivered in a creative way to stimulate interest in the YSUs, for example, a combination of art-based and cognitive-behavioural-based relapse prevention groups (Debenham et al. 2020; Tam, Shik, and Lam 2016).

4 Discussion

Youth substance use poses a significant problem since it causes dependency and makes it harder to stop using drugs later in life. Even after extended periods of abstinence, young people who begin using substances and attempt to stop generally relapse (Arora et al. 2015). Nevertheless, there is a paucity of empirical data about youth substance use relapse prevention programmes. However, the existing programmes have shown to be successful in preventing SUR and enhancing YSUs' general well-being. This is especially true in industrialised nations where several relapse prevention initiatives have been created and evaluated for effectiveness.

Surprisingly, this analysis shows that many nations in sub-Saharan Africa lack SUR preventive programmes, even though substance use is more widespread in this subregion. Consequently, more effort is invested in managing short-term addiction crises and offering limited aftercare programmes (Saba, Weir, and Aceves-Martins 2021). Recurring relapses and readmissions are, thus, a common result of such brief recovery therapies and the absence of SUR preventive programmes. While there are many different SUR prevention programmes, this review demonstrates that the most prevalent and effective are cognitive-behavioural-based programmes; nevertheless, other strategies, like mindfulness-based relapse prevention programmes, are also gaining traction.

Most of the authors in our review approached relapse and its prevention in a contextual manner, viewing cognitive and environmental processes as proximal antecedents of relapse. This perspective, however, is different from the one that links relapse to internal causes, such as desires, and views cravings as a sign of an underlying illness (Hendershot et al. 2011). According to Mitchell et al. (2021), the latter of the two perspectives suggests the necessity of pharmaceutical treatment for relapse prevention. The author highlights the importance of receiving proper pharmacological treatment after discharge to maintain treatment retention and prevent relapses.

Regarding the use of medicines for relapse prevention after discharge, the literature is, nevertheless, ambiguous. For example, in contrast to the American Academy of Paediatrics recommendations, the U.S. treatment system prioritises nonmedication treatment for young people (Mitchell et al. 2021). However, most of the programmes in our research focused on providing psychosocial support, like ongoing care to avoid SUR. Sustaining treatment beyond in-patient discharge is essential for preventing youth substance use relapse (Gonzales et al. 2014; ISSUP 2020; Mpanza, Govender, and Voce 2022). Face-to-face interactions can be used to provide ongoing care. It can be utilised to equip YSUs with the abilities to recognise the cognitive, emotional and behavioural dysfunctions that lead to relapse and to resist relapse temptations (ISSUP 2020; Tam, Shik, and Lam 2016). Health professionals in charge of the SUR prevention programmes ought to inspire YSUs to make changes and develop their capacity for problem-solving and postponing pleasure (NIDA 2018; WHO-UNODC 2020; Van der Westhuizen 2015). Nonetheless, Van der Westhuizen (2015) reported that a successful SUR prevention programme must be provided for a minimum of 3 months and ought to be sufficiently potent to assist the YSUs in fending off a relapse. People in charge of the SUR prevention programme must keep an eye on and sustain positive behaviour change during the continuing care phase to avoid a relapse. Therefore, the focus should be on strengthening the YSUs' ability to resist a potential relapse and connecting them even more to the resources that are out there for help.

According to the review's findings, connecting substance users with recovery-focused programmes is essential for their reintegration and support (ISSUP 2020; Van der Westhuizen 2015). Through networking with families, schools, churches and support groups, YSUs are helped to re-establish themselves into the community during reintegration to promote sustainable rehabilitation (WHO-UNODC 2020; Mpanza, Govender, and Voce 2022; Teko, Goliath, and Abdulla 2023). Research suggests that social integration support services, job/vocational placement programmes and participation in engaging activities all increase the likelihood of successful recovery and prevent relapses (Gonzales et al. 2013; Mpanza, Govender, and Voce 2022; Tam, Shik, and Lam 2016). Moreover, residential care and rehabilitation facilities are crucial in offering a variety of recovery support programmes that can adequately and successfully treat substance use disorders in individuals who are referred back to them for treatment (Dennis, Scott, and Laudet 2014; Scott et al. 2023; WHO-UNODC 2020).

The importance and efficacy of technology-mediated SUR prevention programmes are supported by a small but increasing body of research, particularly when combined with more conventional, in-person therapy approaches. According to our findings, services for young people who require support with substance use should be tailored to their individual needs. Gonzales-Castaneda et al. (2022) argue that due to their familiarity with technology, young people can be considered ‘digital natives’. Therefore, to effectively and significantly reach out to young people, technology can provide targeted, tailored interventions and links to therapy as an auxiliary to in-person interventions.

Technology-mediated aftercare interventions (TMAI) can be provided by text message, internet-based digital health care or smartphone applications (Gonzales, Douglas Anglin, and Glik 2014). The linkage manager or focal person in charge of the SUR prevention programme can provide individualised care through the use of text messages or online resources if the usage of TMAI is approved. TMAI can minimise the risk of relapses through active participation in technological recovery-oriented activities that foster positive life changes. Both personalised feedback and engagement are enhanced through TMAI. For example, YSUs can receive text messages on how to avoid a relapse, substance abuse education, daily self-monitoring, available community support resources, and they can even participate in digital programme modules (Dennis, Scott, and Laudet 2014; Gonzales, Douglas Anglin, and Glik 2014).

Programmes for the prevention of SUR in youth also need to encourage mental and physical growth (Furzer et al. 2021; ISSUP 2020). To replace the hedonic experience of substances, the programme activities need to be pleasurable (Furzer et al. 2021). According to our research, these kinds of activities ought to promote individual development and act as a disincentive to SUR (Gonzales et al. 2013; ISSUP 2020). Exercise programmes are effective in preventing youth substance use relapses, according to a body of research, especially when they are implemented in conjunction with cognitive-behavioural/lifestyle change interventions (Furzer et al. 2021; Wong, Zhuang, and Ng 2020). It is necessary to replace the hedonistic experience of drugs with such joyful activities if young people are to have better chances of changing their behaviour (Furzer et al. 2021). Engaging in physical exercise has been shown to improve perceptions of physical health and self-esteem (Furzer et al. 2021).

However, educational initiatives that promote literacy around substance use and SUR must be combined with physical activities (Van der Westhuizen 2015). YSUs should receive psychoeducation on the fundamental neurobiological concepts underlying habit and addictive behaviours in order to achieve this goal (Debenham et al. 2020). According to our review, youngsters find knowledge about brain processes and their connection to substance use and relapse to be motivating while trying to quit drugs (Debenham et al. 2020; Van der Westhuizen 2015). Like joyful activities, the psycho-education message needs to be presented in an original manner to pique certain young people's interest (Debenham et al. 2020; Tam, Shik, and Lam 2016). Additionally, self-monitoring techniques can be used to psycho-educate YSUs (Gonzales et al. 2014). Practitioners can evaluate whether there is a discrepancy between the self-report data and sensitivity analysis (urinalysis) using the self-monitoring reports that they generate (Karno et al. 2021). A drug-negative test must substantiate a self-report that excludes any recent substance usage.

4.1 Strengths and Limitations of the Review

With the use of this integrative literature review, which offered a strong and practical methodology, a thorough understanding of youth substance use relapse prevention was obtained by integrating the research findings from various study designs. This is the first review on the subject that we are aware of. Nonetheless, this review has certain methodological shortcomings. First, there was bias in the language. The publications that were written in English were the subject of the review. As a result, it is possible that the reviewers overlooked important and pertinent material written in another language. Second, it is possible that some important publications that were not indexed by the chosen databases escaped the reviewers' notice.

Therefore, to reduce this risk, all pertinent studies were found by doing an article search utilising interchangeable or alternative key terms, such as ‘substance OR drug’ and ‘use OR abuse OR misuse’. However, selection bias would have also happened as a result of human error brought on by handling a large number of search results because of the high search sensitivity. However, the reviewers took precautions by reviewing the search results again and screening again to make sure certain important items were not overlooked.

4.2 Strengths and Limitations of the Literature

The information gleaned from this analysis contributes to the expanding body of research on youth substance use relapse prevention programmes. The review provides some insight into the crucial steps required to create the SUR preventive programme's preventative tactics. The study makes it abundantly evident that the youth's programme entails ongoing evaluations, supervision and re-intervention to either lessen the severity of a relapse or maybe re-enter treatment before it happens. Nonetheless, there remained a paucity of research on youth relapse prevention programmes, particularly in Africa. Furthermore, the majority of the review's conclusions focus on American situations, which can lack the qualities of regional contexts. The review also included grey literature. Despite the lack of peer review, the grey literature and material can provide valuable information to address the study topic (Adams et al. 2016). Evidence syntheses on SUR prevention programmes for young people included information from grey literature and other sources that were deemed reliable and pertinent to address the study topic.

4.3 Implication for Practice

In the community, mental health workers such as psychiatric nurses provide care and assist in the rehabilitation of individuals with SUDs. They must comprehend how substance use relapse can be prevented, particularly among the young, since they oversee substance use prevention programmes and SUR prevention programmes (tertiary prevention). Particularly in Africa, where mental health professionals such as psychiatric nurses are sent to serve rural communities as the only mental health professionals in their catchment areas, they play a crucial role in the provision of mental health care. Therefore, mental health workers must comprehend the components of a youth substance use relapse prevention programme. The review's findings are critical to the field of mental health and psychiatry, and they are released at a critical juncture as mental health professionals around the world struggle to find effective ways to reduce drug-related relapses that impede successful recovery. The results hold the potential to offer well-informed and comprehensive preventive care, ending the never-ending cycle of treating recurrent cases of substance use.

5 Conclusion

The prevention of substance use relapse in young people with substance use disorders was the main emphasis of this review. Youth SUR prevention must be thorough and realistic enough to touch all facets of their lives. As a result, the youth SUR prevention programme needs to be comprehensive, sensitive to their needs and supportive of partnerships with families, community support agencies, and so on. The review emphasised important components of a successful substance use programme, including ongoing follow-ups after treatment and evaluations to identify relapses and take immediate action. The evaluations and check-ups provide connections for harm reduction in the event of a relapse or for re-entry into treatment before a relapse. In addition, the YSUs are equipped with the knowledge and abilities to resist psycho-social influences that may cause them to relapse.

1 Introduction

Relapse into substance use among young people causes significant concern. During youth, individuals undergo a critical developmental period, characterized by self-discovery, skill development, peer relationship formation, and body image cultivation. These transitions can be challenging, sometimes leading to risk-taking behaviors, including substance use, especially while the brain is still developing. Youth is generally defined as the period between childhood and adulthood, often encompassing the years from compulsory education to the first employment. Youth substance use refers to the harmful consumption of legal or illegal substances by young people to alter their mood, posing a potential threat to their own well-being, their families, and their communities.

Substance use by young people increases the likelihood of future dependency and relapse. For individuals using substances who wish to stop, relapse remains a significant barrier to recovery and sustained sobriety. A high percentage, between 65% and 85%, of young persons with substance use disorders (SUDs) experience a relapse within 12 months of starting treatment. Historically, substance use treatment aimed to break the cycle of patients entering and exiting institutions due to addiction. However, current research indicates that effective relapse prevention strategies and programs are essential, requiring consideration of social, cultural, environmental, and individual factors.

Programs designed to prevent substance use relapses are vital. They help individuals control impulses, manage cravings, avoid returning to substance use, build new social skills, and postpone immediate gratification. Research on substance use relapse prevention programs for young people and their recovery paths has recently begun to accumulate, despite awareness of high relapse rates in this age group. Many effective relapse prevention programs, particularly developed in Western countries, have demonstrated their efficacy through randomized controlled trials. These programs include web-based initiatives, recovery management assessments, and cognitive-behavioral approaches. For example, in the USA, an online program called Navigating my Journey (NmJ) for young people aged 13–24 showed increased self-efficacy and reduced substance use. Another study in the USA found that a brief intervention program known as SBIRT (Screening, Brief Intervention, and Referral to Treatment) was effective in reducing substance use frequency in young people aged 18 and older.

Substance use among young people is also a problem in Australia, where a neuroscience-based relapse/harm reduction program for junior high school students (12–15 years old) has been implemented. However, reports suggest this program's effectiveness is minimal or nonexistent. In Hong Kong, relapse prevention programs using expressive arts are increasingly used in both inpatient and community settings. Yet, unlike Western nations, there have been no empirical randomized controlled trials to assess the effectiveness of these programs. African nations often lack substance use relapse prevention programs, with limited access to evidence-based treatments. For instance, in Botswana, rehabilitation services are limited, focusing primarily on inpatient care after a relapse, with no specific programs to prevent relapse after hospital discharge.

Conducting a comprehensive review on substance use relapse prevention for youth is important given the high rate of relapses, the societal burden, the hindrance to recovery success, and the limited understanding of effective prevention methods. Organizations such as the World Health Organization (WHO) and the United Nations Office on Drugs and Crime (UNODC) highlight young people as a particularly vulnerable population requiring specialized care. The findings of this review can help mental health nurses understand the components of youth substance use relapse prevention programs, thereby working to reduce relapses that impede successful recovery.

1.1 Rationale and Aim

Substance use has been a public health concern for decades, especially among young people, leading to negative outcomes such as undesirable behavior, compromised health, and legal and economic consequences. While substance use is common in youth, their relapse after a period of abstinence is a significant concern. Despite this, substance use relapse prevention remains challenging, though various relapse prevention programs are suggested in the literature. Therefore, this review aimed to identify, synthesize, and present findings from all relevant studies on substance use relapse prevention programs for youth. The review's research question was: What is stated in the published literature on a substance use relapse prevention program for the youth?

2 Methods

An integrative literature review (ILR) was conducted following established guidelines. This approach allows for the inclusion of diverse methodologies to explore various perspectives on the subject. Since a broad range of research evidence was needed on substance use relapse (SUR) prevention for youth, an ILR was the most suitable method. After identifying the problem, a comprehensive review of the literature was performed using a systematic step-by-step guide.

2.1 Problem Identification

The identified problem for this integrative review arose from study reports and expert observations indicating that substance use relapse is a serious concern globally and in Botswana, coupled with a lack of prevention strategies. The review was guided by the question: What is stated in the published literature on a substance use relapse prevention program for the youth?

2.2 Literature Search Strategy

The search strategy for this review is detailed in the following subsections.

2.2.1 Inclusion Criteria

To apply the inclusion criteria, reviewers systematically examined the literature to assess its quality regarding value, reliability, and relevance to youth substance use relapse prevention programs. The review included literature published in English between 2013 and 2024. It incorporated diverse methodologies, including experimental and non-experimental studies, to offer different perspectives on preventing SUR among young people. Grey literature was also included based on the information it provided in response to the research question.

2.2.2 Exclusion Criteria

The review excluded articles not relevant to the research question, such as studies that did not address substance use relapse prevention programs or strategies. Additionally, commentaries, letters, and editorials were excluded, as the review focused on theoretical, empirical, and expert reports on the topic.

2.2.3 Database Searching

A comprehensive search was conducted by the first author, supported by an experienced librarian who helped review literature for inclusion and exclusion criteria and suggested relevant websites and databases. The systematic search covered PubMed, Sabinet African Journals, EBSCOhost, and Medline electronic databases. The Boolean operator search strategy was used, yielding the most appropriate literature. Keywords included "substance OR drug" AND "use OR abuse OR misuse"; "relapse prevention OR addiction management" AND program OR check-ups" AND "youth OR young adults OR young people".

The initial literature search yielded 4283 studies. Researchers then screened titles for relevant publications, excluding duplicates and untrievable studies. Based on the inclusion and exclusion criteria, 4224 publications were excluded. The screening left 52 publications for abstract assessment. Abstracts were analyzed to select publications directly related to SUR prevention, which further excluded 29 documents. A critical appraisal of the full text was performed on the remaining 23 publications and 3 documents from grey literature, resulting in a total of 26 documents reviewed. The grey literature sources included the World Health Organization (WHO), the United Nations Office on Drugs and Crime (UNODC), and the International Society of Substance Use Professionals (ISSUP) websites. The search was conducted from October 2023 to January 2024.

2.3 Data Evaluation

All studies included in the integrative literature review underwent a critical appraisal for quality using the Mixed Methods Appraisal Tool (MMAT) version 2018. As an ILR permits a broad search for evidence, this quality appraisal process allowed researchers to assess empirical studies from diverse methodologies. To ensure quality results, reviewers independently conducted a quality appraisal of the studies. Quality ratings for each criterion and an overall score were assessed for each study. However, studies were not excluded based on methodological quality to avoid inadequate reporting practices and potential exclusion of valuable findings. This approach allowed researchers to identify broad evidence regarding substance use relapse prevention programs for youth.

2.4 Data Synthesis and Analysis

Data analysis involves organizing and synthesizing data to answer a research question. For this review, data analysis was guided by the integrative review process. During data analysis, researchers performed data extraction and data synthesis using content analysis. A data extraction table was developed for the identified articles, capturing the first author's name, study aim, methodology, and key findings. During data synthesis, researchers creatively clustered interrelated ideas from various studies to develop a new understanding of substance use relapse prevention. Data from primary sources were ordered, coded, categorized, and synthesized into a coherent, integrated conclusion about programs for the prevention of substance use relapse. Researchers independently reviewed the articles to minimize biases and reach consensus on identified themes and subthemes. This interactive process led to the identification of three main themes and their subthemes for the review.

2.5 Ethical Considerations

This article followed all ethical standards for research without direct contact with human or animal subjects. The article is part of a larger study aiming to guide the development of a substance use relapse prevention program for youth in Botswana. The study received ethical approval from the Institutional Review Board of North-West University (Ethics number: NWU-00174-23-S1) and permission from the Ministry of Health IRB (Ref: HPRD: 6/14/1). Permission to conduct the study was also obtained from Sbrana Psychiatric Hospital Institutional Review Board (Ref: 4/2/2 III (65)).

3 Findings

Twenty-six articles were selected using the specified search strategy based on keywords: "substance OR drug" AND "use OR abuse OR misuse"; "relapse prevention OR addiction management" AND program OR check-ups" AND "youth OR young adults OR young people". The review was reported using the Preferred Reporting Items for Systematic Reviews and Data Analysis (PRISMA). The PRISMA flow chart provides a visual summary of the process used to include and exclude studies in systematic reviews. Of the 26 articles, 23 were peer-reviewed, and 3 were from grey literature. The 23 articles spanned from 2013 to 2024, with most studies conducted between 2017 and 2023. The studies originated from six countries, with over half (12) conducted in the USA. Other study locations included South Africa (2), Taiwan (2), Australia (2), Hong Kong (2), and Switzerland (1). The majority of studies were randomized controlled trials (13), followed by quantitative studies (4). Mixed methods, qualitative, and literature review studies each numbered two, with three from grey literature. Details and characteristics of each study are provided in the relevant tables (not included in this text).

3.1 Theme 1: Continuing Care

One primary theme identified was continuing care. The initiation and maintenance of behavioral changes in substance use relapse prevention are distinct processes regulated by specific circumstances. Therefore, various authors agree that providing ongoing care after hospital discharge is necessary to preserve the progress made during an admission and prevent young people from relapsing. The review also indicates that an aftercare program (continued care) should last at least 3 months to effectively prevent relapse. Examples of continuing care include post-treatment check-ups, monitoring and evaluation, connections to therapy, engagement and retention, and utilization of recovery support programs.

3.1.1 Posttreatment Check-Ups

Findings from the review suggest that post-treatment check-ups, as a component of continuing care or recovery management care, are beneficial for societal financial health and play a significant role in preventing substance use relapses. Post-treatment check-ups involve routine, ongoing assessments of substance users to identify relapses early and facilitate appropriate action. The literature indicates that these check-ups can be delivered through in-person programs that strengthen young substance users' (YSUs) behavioral and cognitive abilities, helping them resist relapse temptations. While YSUs may know where to seek support, a major obstacle is finding the motivation or knowing when to ask for it. Therefore, relapse prevention programs with post-treatment check-ups should focus on increasing motivation and setting positive, realistic health goals to encourage health-seeking behavior from an early age.

Furthermore, the review highlights that YSUs require support in recognizing their cravings and triggers, and in identifying cognitive, emotional, and behavioral patterns that lead to substance use relapse, as part of post-treatment check-ups. Studies generally agree that cognitive behavioral therapy (CBT) is an effective strategy for treating individuals with substance use disorders. Thus, behavioral and cognitive strategies, whether in individual or group therapy, are crucial for reducing relapse likelihood and easing the cognitive dissonance that often follows positive behavior change in young people. Areas to address during check-ups may include developing skills to manage urges and postpone gratification, fostering motivation for change, improving problem-solving abilities, and encouraging engagement in non-chemical substance use activities.

3.1.2 Tracking and Assessment

The review's findings indicate that monitoring is a part of continuous care that involves both assessment and tracking. Young substance users are proactively tracked and screened (assessed) for early signs of issues, provided incentives, and assisted in navigating re-entry into treatment, among other functions of continuing care. Recovery management and relapse prevention manuals highlight the importance of tracking and proactive steps to maintain contact with substance users after treatment discharge.

Tracking methods combine fieldwork, phone calls, mailings, and other approaches. Subsequently, the individual using drugs is assessed to rule out substance use relapse and determine the best course of action. To improve outcomes, YSU assessments should be conducted quarterly for approximately 4 years after discharge as part of ongoing monitoring. Consequently, monitoring and evaluation determine whether an individual with a substance use disorder has resumed substance use, allowing for intervention to prevent a relapse or lessen its effects.

3.1.3 Linkages to Treatment

During assessment, some young substance users may have relapsed or be on the verge of a relapse. Thus, YSUs in primary care settings require an assertive and robust linkage model that can effectively increase their participation in SUD treatment, leading to significantly greater reductions in drug use. In situations where relapse is imminent, connecting YSUs back to treatment is necessary, facilitating re-entry into treatment before a full relapse occurs. Literature provides extensive evidence of the effectiveness and value of "referral back to treatment" to prevent substance relapses. In cases where relapse is imminent, suspected, or confirmed, individuals are linked back to inpatient treatment, residential services, SUD outpatient services, or community support services to prevent a relapse or minimize its impact.

3.1.4 Engagement and Retention

The literature also emphasizes the importance of engagement and retention as components of ongoing treatment to prevent substance use relapse. The engagement component aims to avoid common barriers in the admissions process, enabling substance users to more easily attend treatment following evaluation and referral. To increase the likelihood of YSUs attending treatment after assessment, the engagement process includes implementing strategies to boost motivation for re-entry into treatment, expediting the admissions process, and overcoming some disadvantages of the admissions course. After successful engagement and the YSU's willingness to attend treatment, the primary healthcare linkage manager (focal person) must maintain contact and follow-up to ensure that motivation to participate in treatment is sustained, aiding retention. The linkage manager must assist in overcoming any environmental or organizational barriers to retention.

The review's conclusions state that the retention component of relapse prevention aims to keep substance users in treatment for a minimum of 14 days, either through inpatient or residential treatment, or 14 sessions of outpatient therapy. To minimize the harm associated with relapse or to maintain substance abstinence, engagement and retention methods are crucial. If a YSU threatens to stop treatment or misses an outpatient visit, the treatment personnel must inform the linkage manager, who then arranges an intervention to encourage re-engagement in treatment. Appropriate pharmaceutical treatment after discharge is also emphasized as necessary to prevent relapses and sustain retention in treatment.

3.1.5 Use of Recovery Support Services

According to the review, recovery support services are necessary and encourage healthy behaviors after completing a treatment program to reduce the risk of relapse. Linking YSUs to recovery support services is crucial as part of their reintegration. Findings indicate that reintegration can be social, where YSUs are assisted in re-establishing themselves within the community through networking with families, schools, churches, and support groups. The goal of recovery support services is to provide tools and resources to sustain the recovery of YSUs after formal treatment is completed.

Additionally, the review shows that participation in recovery support services, particularly those with more rewarding activities, is a key predictor of long-term recovery. Specifically, using recovery support services that aid social integration and participation in conventional pursuits, such as alcohol-free recreational/art-based activities and connections to job placement programs, is associated with a higher prospect of stable remission and recovery. Furthermore, engagement in peer support groups, like the 12-step program, is linked to recovery because it offers an environment conducive to establishing positive social relationships, a space for learning new skills, and information on health and employment. It is important to note that providing resources for recovery support services, such as community-based rehabilitation centers, is a crucial strategy that facilitates relapse prevention and offers opportunities for YSUs to effectively address their substance use problems.

3.2 Theme 2: Technology-Mediated Recovery Management Interventions

One theme emerging from the review was technology-mediated aftercare intervention (TMAI). The use of TMAI, such as mobile aftercare interventions and internet-based relapse prevention, plays a critical role in preventing relapses among young people, either as standalone interventions or as adjuncts to face-to-face interventions.

3.2.1 Mobile Aftercare Interventions

Mobile aftercare intervention was identified as a subtheme under technology-mediated management interventions. Mobile aftercare interventions can be delivered through smartphone applications or general text messages (SMS). Practitioners can continue offering care through text messages to motivate young substance users to engage in recovery behaviors and continue making positive life changes. Furthermore, mobile texting interventions have been found to buffer the tendency towards relapse and significantly reduce the severity of substance use among youth who received the aftercare mobile texting intervention, compared to those in the standard aftercare control condition. Finally, the findings indicate that mobile texting aftercare programs offer several advantages, including personalized and targeted engagement, enhanced assessment and monitoring, increased convenience, and greater flexibility in service delivery.

3.2.2 Internet-Based Relapse Prevention

Another subtheme that emerged was internet-based relapse prevention. Internet-based relapse prevention programming is reported as a promising way to enhance treatment gains and recovery (relapse prevention), though some argue it lacks a strong evidence base. However, the review's findings show that digital or internet-based health interventions can offer frequent monitoring of young substance users and address some barriers to health delivery, such as the fear of stigma associated with face-to-face interventions. Thus, internet-based interventions can positively impact the provision of substance use prevention or harm reduction initiatives. Moreover, the review reveals that internet-based smartphone applications can be used for engagement, personalized feedback, and to deliver digital program modules over a set timeframe.

3.3 Theme 3: Relapse Prevention/Recovery Promotion Through Developmentally Engaging Activities

The review's results indicate a need for relapse prevention through developmentally engaging activities. This involves involving young substance users in activities that promote their personal growth and development, while also deterring substance use and relapse. Three subthemes were derived: physical activities, educational activities that promote literacy on substance use, and self-monitoring strategies.

3.3.1 Physical Activities

Evidence from the review shows that physical activities, such as exercise programs, are effective in supporting substance use relapse prevention among young people, especially when complementing cognitive-behavioral/lifestyle interventions. This review demonstrates that youth who participate in substance use programs incorporating physical activities develop enhanced self-esteem, high relapse prevention efficacy, increased enjoyment of exercise, and improved perceptions of physical health. However, behavior change for young people requires enjoyable activities (recreational, art-based, etc.) that can replace substances.

3.3.2 Self-Monitoring

Additionally, the review shows that young substance users need to be empowered with self-monitoring strategies, such as using a diary or technology-mediated self-monitoring interventions. Self-monitoring activities, as relapse prevention and recovery promotion strategies, have been found to help YSUs self-regulate specific and critical areas of their lives associated with relapse following inpatient treatment. Moreover, self-monitoring reports are important for assessing discrepancies between self-reported data and sensitivity analyses (urinalysis) to compare if a "no recent use" self-report is supported by substance-negative urinalysis.

3.3.3 Educational Activities That Promote Literacy on Substance Use

According to some sources in this review, young substance users need to be psycho-educated on key neuroscience principles to build their understanding of brain functions, the impact of substances on the brain, and substance use relapses. In one study, YSUs who received psychoeducation on neuroscience and the effects of drugs on the brain found the information interesting and believable, which can motivate them to quit and abstain. The psycho-education message must be delivered creatively to stimulate interest in YSUs, perhaps through a combination of art-based and cognitive-behavioral relapse prevention groups.

4 Discussion

Youth substance use poses a significant problem, leading to dependency and making it harder to stop using substances later in life. Even after extended periods of abstinence, young people who start using substances and try to quit often relapse. However, empirical data on youth substance use relapse prevention programs remain limited. Nevertheless, existing programs have demonstrated success in preventing substance use relapse and enhancing the overall well-being of young substance users. This is particularly evident in industrialized nations, where several relapse prevention initiatives have been developed and evaluated for effectiveness.

Surprisingly, this analysis indicates that many nations in sub-Saharan Africa lack substance use relapse prevention programs, despite the widespread nature of substance use in this subregion. Consequently, more effort is invested in managing short-term addiction crises and offering limited aftercare programs. This often leads to recurring relapses and readmissions due to brief recovery therapies and the absence of robust SUR prevention programs. While various SUR prevention programs exist, this review shows that cognitive-behavioral-based programs are the most prevalent and effective, though other strategies, such as mindfulness-based relapse prevention programs, are also gaining traction.

Most authors in this review approached relapse and its prevention contextually, viewing cognitive and environmental processes as immediate precursors to relapse. This perspective differs from views that link relapse to internal causes, such as cravings, seeing them as a sign of an underlying illness. The latter perspective suggests the necessity of pharmaceutical treatment for relapse prevention, emphasizing the importance of proper pharmacological treatment after discharge to maintain treatment retention and prevent relapses.

However, the literature regarding the use of medications for relapse prevention after discharge is varied. For example, the U.S. treatment system often prioritizes non-medication treatment for young people, contrasting with some recommendations. Most programs in this research focused on providing psychosocial support, such as ongoing care, to prevent substance use relapse. Sustaining treatment beyond inpatient discharge is essential for preventing youth substance use relapse. Face-to-face interactions can be used to provide ongoing care, equipping young substance users with the abilities to recognize and resist the cognitive, emotional, and behavioral dysfunctions that lead to relapse. Health professionals managing SUR prevention programs should inspire YSUs to make changes and develop their capacity for problem-solving and delaying gratification. A successful SUR prevention program must be provided for a minimum of 3 months and be robust enough to help YSUs prevent relapse. Those in charge of SUR prevention programs must monitor and sustain positive behavior change during the continuing care phase to avoid relapse, focusing on strengthening YSUs' ability to resist potential relapse and connecting them to available resources.

According to the review's findings, connecting substance users with recovery-focused programs is essential for their reintegration and support. Through networking with families, schools, churches, and support groups, young substance users are helped to re-establish themselves within the community, promoting sustainable rehabilitation. Research suggests that social integration support services, job/vocational placement programs, and participation in engaging activities all increase the likelihood of successful recovery and prevent relapses. Moreover, residential care and rehabilitation facilities are crucial in offering a variety of recovery support programs that can adequately treat substance use disorders in individuals referred back to them for treatment.

The importance and effectiveness of technology-mediated SUR prevention programs are supported by a growing body of research, especially when combined with more conventional, in-person therapy approaches. Findings suggest that services for young people needing substance use support should be tailored to their individual needs. Given their familiarity with technology, young people can be considered "digital natives." Therefore, technology can provide targeted, tailored interventions and links to therapy as an auxiliary to in-person interventions to effectively reach young people.

Technology-mediated aftercare interventions (TMAI) can be provided via text messages, internet-based digital healthcare, or smartphone applications. If TMAI usage is approved, the linkage manager or focal person for the SUR prevention program can provide individualized care through text messages or online resources. TMAI can minimize the risk of relapses through active participation in technology-oriented recovery activities that foster positive life changes. Both personalized feedback and engagement are enhanced through TMAI. For instance, young substance users can receive text messages on how to avoid relapse, substance use education, daily self-monitoring, available community support resources, and can participate in digital program modules.

Programs for the prevention of substance use relapse in youth also need to encourage mental and physical growth. To replace the pleasurable experience of substances, program activities should be enjoyable. Research suggests these activities should promote individual development and act as a disincentive to SUR. Exercise programs are effective in preventing youth substance use relapses, especially when implemented with cognitive-behavioral or lifestyle change interventions. Engaging in physical exercise has been shown to improve perceptions of physical health and self-esteem.

However, educational initiatives that promote literacy about substance use and SUR must be combined with physical activities. To achieve this, young substance users should receive psychoeducation on the fundamental neurobiological concepts underlying habit and addictive behaviors. According to this review, young people find knowledge about brain processes and their connection to substance use and relapse motivating when trying to quit. Like enjoyable activities, the psychoeducation message needs to be presented creatively to engage young people's interest. Additionally, self-monitoring techniques can be used to psychoeducate young substance users. Practitioners can evaluate discrepancies between self-reported data and sensitivity analyses (urinalysis) using the self-monitoring reports generated by YSUs. A drug-negative test must corroborate any self-report that excludes recent substance usage.

4.1 Strengths and Limitations of the Review

This integrative literature review provided a strong and practical methodology, yielding a thorough understanding of youth substance use relapse prevention by integrating research findings from various study designs. This is believed to be the first review on the subject. Nevertheless, the review has certain methodological shortcomings. First, there was language bias, as only publications written in English were reviewed. As a result, important and pertinent material written in other languages may have been overlooked. Second, it is possible that some important publications not indexed by the chosen databases were missed.

To mitigate this risk, all pertinent studies were sought by using interchangeable or alternative key terms. However, selection bias could also have occurred due to human error from handling a large number of search results caused by high search sensitivity. Reviewers took precautions by re-reviewing search results and re-screening to ensure no important items were overlooked.

4.2 Strengths and Limitations of the Literature

The information gathered from this analysis contributes to the growing body of research on youth substance use relapse prevention programs. The review provides insight into the crucial steps required to develop preventative strategies for SUR programs. The study clearly demonstrates that programs for youth involve ongoing evaluations, supervision, and re-intervention to lessen the severity of a relapse or facilitate re-entry into treatment before a relapse occurs. However, there remains a scarcity of research on youth relapse prevention programs, particularly in Africa. Furthermore, most of the review's conclusions focus on American contexts, which may lack qualities relevant to regional contexts elsewhere. The review also included grey literature, which, despite not being peer-reviewed, can provide valuable information to address the study topic. Evidence syntheses on SUR prevention programs for young people incorporated information from grey literature and other sources deemed reliable and pertinent to the study topic.

4.3 Implication for Practice

In the community, mental health workers, such as psychiatric nurses, provide care and assist in the rehabilitation of individuals with substance use disorders. They must understand how substance use relapse can be prevented, particularly among young people, as they oversee substance use prevention programs and SUR prevention programs (tertiary prevention). Especially in Africa, where mental health professionals like psychiatric nurses are often the sole mental health providers in rural communities, they play a crucial role in delivering mental health care. Therefore, mental health workers must comprehend the components of a youth substance use relapse prevention program. The review's findings are critical to mental health and psychiatry, released at a time when mental health professionals worldwide seek effective ways to reduce drug-related relapses that impede successful recovery. The results have the potential to offer well-informed and comprehensive preventive care, helping to end the cycle of recurrent substance use cases.

5 Conclusion

This review primarily focused on preventing substance use relapse in young people with substance use disorders. Youth substance use relapse prevention must be comprehensive and realistic enough to address all aspects of their lives. Therefore, youth SUR prevention programs need to be thorough, sensitive to their needs, and supportive of partnerships with families, community support agencies, and other entities. The review highlighted important components of a successful substance use program, including ongoing follow-ups after treatment and evaluations to identify relapses and prompt immediate action. These evaluations and check-ups provide connections for harm reduction in the event of a relapse or for re-entry into treatment before a relapse. Additionally, young substance users are equipped with the knowledge and abilities to resist psychosocial influences that may lead to relapse.

Introduction

The return to substance use by young people is a serious concern. During youth, individuals are still developing, discovering their identity, learning new skills, and forming relationships. These changes can be challenging and sometimes involve risky behaviors, such as using substances, especially when the brain is still maturing. Youth is generally defined as the period between childhood and adulthood, often from leaving school to starting a first job.

Substance use by young people involves consuming legal or illegal substances to change mood. This can pose a threat to their well-being, their families, and their communities. Such use increases the risk of developing future dependence and experiencing repeated relapses. For those seeking to stop using substances, relapse is a major obstacle to lasting recovery. Between 65% and 85% of young individuals with substance use disorders experience a relapse within a year of starting treatment.

While substance use treatment has historically aimed to end the cycle of repeated entries into institutions, current evidence shows that effective relapse prevention strategies are essential. These strategies must account for social, cultural, environmental, and individual factors. Programs designed to prevent relapse help individuals gain control over impulses, manage cravings, avoid returning to substance use, build new social skills, and learn to delay gratification.

Research on these prevention programs has been growing, particularly in Western countries. Many effective programs, including online initiatives, recovery management, and cognitive behavioral approaches, have shown success in preventing relapse. Examples include online programs which increased self-efficacy and reduced substance use among young people aged 13–24 in the USA. Another brief intervention program was effective in reducing substance use frequency for those 18 and older.

However, in some regions, such as Australia, a neuroscience-based program for 12-15 year olds had limited effectiveness. In Hong Kong, expressive arts programs are used, but their effectiveness has not been fully tested with controlled trials. African nations often lack specific substance use relapse prevention programs, relying more on inpatient rehabilitation after a relapse. In Botswana, for example, there are no specific programs to prevent relapse after hospital discharge. Given the high rate of relapse and its societal impact, a comprehensive review of prevention programs for young people is important. This will help healthcare professionals understand and implement effective strategies to reduce relapse and support successful recovery.

Rationale and Aim

Substance use has been a public health concern for many years, especially among young people. It can lead to harmful outcomes, such as undesirable behaviors, poor health, and legal or economic problems. While substance use is common among youth, their return to using substances after stopping is a major concern.

Despite this concern, preventing substance use relapse remains a challenge. Existing literature suggests various relapse prevention programs. This review aimed to identify, summarize, and present findings from studies on substance use relapse prevention programs for young people. The main research question guiding this review was: What information exists in published literature about substance use relapse prevention programs for young people?

Methods

An integrative literature review (ILR) was conducted, following established guidelines to broadly explore research on substance use relapse (SUR) prevention for young people. The primary issue identified was the lack of effective prevention strategies for SUR in this population, both locally and globally. The review aimed to answer: What information exists in published literature on a substance use relapse prevention program for young people?

A comprehensive search was performed across electronic databases including PubMed, Sabinet African Journals, EBSCOhost, and Medline. Search terms combined concepts like ‘substance OR drug’ AND ‘use OR abuse OR misuse’; ‘relapse prevention OR addiction management’ AND ‘program OR check-ups’; and ‘youth OR young adults OR young people’. The search included English-language literature published from 2013 to 2024, covering diverse experimental and non-experimental methodologies, as well as relevant grey literature. Articles not focused on SUR prevention programs or those like commentaries were excluded.

The initial search yielded 4283 studies. After removing duplicates and screening titles and abstracts, 26 relevant documents remained for full review, including 23 peer-reviewed articles and 3 grey literature sources. This systematic selection process was completed between October 2023 and January 2024.

All included studies were critically appraised for quality using the Mixed Methods Appraisal Tool (MMAT) version 2018. While quality was assessed by independent reviewers, no studies were excluded based on their methodological quality. This ensured that all available evidence was considered.

Data analysis involved systematically organizing and synthesizing the extracted information. Using content analysis, interrelated ideas from the various studies were grouped, coded, and categorized. This process led to the identification of three main themes and their subthemes, providing a comprehensive understanding of youth substance use relapse prevention. The study maintained ethical standards throughout, being part of a larger ethically approved project without direct human or animal involvement.

Findings

Twenty-six articles were selected using the defined search strategy and keywords. The review was reported following the Preferred Reporting Items for Systematic Reviews and Data Analysis (PRISMA) guidelines, which provide a visual summary of the study selection process.

Of the 26 articles, 23 were peer-reviewed, and 3 were from grey literature. These studies covered the period from 2013 to 2024, with most conducted between 2017 and 2023. The research originated from six countries, with over half of the selected studies (12) conducted in the USA. Other studies were from South Africa (2), Taiwan (2), Australia (2), Hong Kong (2), and Switzerland (1).

The majority of the studies were randomized controlled trials (13), followed by quantitative studies (4). Mixed methods and qualitative studies each accounted for two, while literature reviews were three, plus the three from grey literature. The detailed characteristics of each study are available in relevant tables.

Theme 1: Continuing Care

A key finding emphasizes the importance of continuing care after young people are discharged from treatment. This ongoing support helps maintain the progress made during inpatient stays and is crucial for preventing relapse. Research suggests that aftercare programs should last at least three months to be effective. Continuing care encompasses regular follow-ups, monitoring, connections to therapy, efforts to keep individuals engaged in treatment, and utilization of recovery support programs.

Regular post-treatment check-ups are beneficial for identifying early signs of relapse. These check-ups involve ongoing assessments to promptly detect issues and allow for intervention. They can be conducted through in-person sessions that strengthen behavioral and cognitive skills to resist relapse triggers. While young people often know where to find support, a major hurdle is their willingness or ability to seek help. Therefore, check-ups aim to increase motivation and help set realistic health goals. This often includes cognitive behavioral therapy (CBT) strategies, focusing on managing urges, problem-solving, delaying gratification, and finding non-substance activities. Monitoring and tracking are essential aspects of continuous care, involving proactively keeping in touch with young individuals after treatment discharge through various methods like phone calls or field visits. Regular assessments, ideally quarterly for about four years, are then conducted to detect any signs of substance use and determine the best course of action, allowing for timely intervention.

When relapse is imminent or has occurred, strong connections back to treatment are necessary. Young people need effective systems to re-engage them in substance use disorder (SUD) treatment, which leads to significant reductions in drug use. This "referral back to treatment" is crucial for preventing full relapse or lessening its effects, linking individuals back to inpatient, residential, outpatient, or community support services. Ensuring engagement and retention in treatment is vital for ongoing success, removing barriers to admission and maintaining motivation through continued contact and follow-up. Retention goals typically involve a minimum period in treatment (e.g., 14 days inpatient or 14 outpatient sessions) to reduce harm or sustain abstinence. Appropriate medication after discharge can also aid retention and prevent relapse.

Utilizing recovery support services is another critical element for promoting healthy behaviors and reducing relapse risk after treatment. These services aid social reintegration, helping young people reconnect with families, schools, churches, and support groups. The goal is to provide tools and resources for sustained recovery beyond formal treatment. Participation in rewarding activities, such as alcohol-free recreational or art-based activities, and vocational programs, is strongly linked to stable remission. Engagement in peer support groups, like 12-step programs, also provides a supportive environment for positive social relationships, skill development, and access to health and employment information. Ensuring access to community rehabilitation centers is key to facilitating relapse prevention.

Theme 2: Technology-Mediated Recovery Management Interventions

One important theme identified in the review is the use of technology for aftercare interventions. Technology-mediated interventions, such as smartphone applications and internet-based programs, play a critical role in preventing relapses among young people, whether used alone or alongside traditional in-person therapies.

Mobile aftercare interventions, delivered via smartphone apps or text messages, allow practitioners to continue providing care. These messages can motivate young people to engage in recovery behaviors and make positive life changes. Studies have shown that mobile texting interventions can reduce the tendency toward relapse and significantly decrease the severity of substance use compared to standard aftercare. These mobile interventions offer several benefits, including personalized engagement, enhanced assessment and monitoring, increased convenience, and greater flexibility in service delivery.

Internet-based relapse prevention programs are also a promising way to enhance treatment gains and support recovery. While some argue they need more strong evidence, digital and internet-based health interventions offer frequent monitoring and can overcome barriers to care, such as the fear of stigma often associated with face-to-face interactions. Thus, these online tools can positively influence substance use prevention and harm reduction efforts.

The review shows that internet-based smartphone applications can be used for engagement, providing personalized feedback, and delivering digital program modules over time. This technological approach helps reach young people, who are often comfortable with digital tools, offering tailored interventions and linking them to ongoing support.

Theme 3: Relapse Prevention/Recovery Promotion Through Developmentally Engaging Activities

The review highlights the importance of preventing relapse and promoting recovery through activities that are engaging and supportive of young people's development. This involves encouraging participation in undertakings that foster personal growth and act as a deterrent to substance use and relapse.

Evidence suggests that physical activities, like exercise programs, are effective in supporting relapse prevention, especially when combined with cognitive-behavioral or lifestyle interventions. Young people who participate in substance use programs that include physical activities often report improved self-esteem, greater confidence in preventing relapse, increased enjoyment of exercise, and better physical health. For behavioral change to be successful, these activities should be enjoyable and provide an appealing alternative to substance use.

Empowering young people with self-monitoring strategies is also crucial. This can involve using a diary or technology-based tools to help them track and manage critical areas of their lives associated with relapse. Self-monitoring helps young individuals develop self-control following inpatient treatment. Reports from self-monitoring are also important for assessing consistency between self-reported information and objective tests like urinalysis, ensuring that claims of no recent use are supported by substance-negative results.

Additionally, young people benefit from education that improves their understanding of substance use. They need to learn about how the brain functions, the effects of substances on the brain, and the mechanisms of relapse. When young individuals are taught about the neuroscience of addiction, they often find this information compelling and motivating for quitting and staying sober. This psychoeducation should be delivered creatively to capture their interest, perhaps through a combination of art-based and cognitive-behavioral relapse prevention groups.

Discussion

Youth substance use poses a significant problem due to its high potential for dependence and relapse. Despite efforts, many young people who try to quit substances often return to use, with 65-85% experiencing relapse within a year of treatment. While some effective relapse prevention programs exist, particularly in Western countries with cognitive-behavioral therapy being common, such programs are notably lacking in sub-Saharan African nations. This often leads to a cycle of short-term treatment followed by recurring relapses and readmissions.

This review emphasizes the critical role of comprehensive, ongoing care for preventing relapse. Such care involves regular post-treatment check-ups and systematic monitoring to detect early signs of substance use. It also includes assertive efforts to link young people back to treatment when relapse is suspected, ensuring their re-engagement and retention in care. The goal is to equip individuals with skills to manage cravings, resist temptations, and make positive behavioral changes, often through psychosocial support that extends beyond initial discharge.

Technology-mediated interventions, such as mobile apps and internet-based programs, are a promising tool for recovery management. These digital platforms can provide personalized feedback, frequent monitoring, and tailored support, offering a convenient and stigma-reducing way to engage young people who are comfortable with technology. They serve as valuable complements to in-person therapies, helping to sustain positive life changes and reduce relapse risk.

Furthermore, integrating developmentally engaging activities into relapse prevention programs is crucial. This includes physical activities like exercise, which can enhance self-esteem and provide enjoyable alternatives to substance use. Psychoeducation on neuroscience principles helps young people understand the effects of substances on the brain, motivating them to maintain sobriety. Self-monitoring strategies, often supported by technology, empower individuals to track their progress and identify relapse triggers.

This integrative review provides a comprehensive overview of youth substance use relapse prevention strategies, offering valuable insights for program development. However, limitations include a focus on English-language publications and a potential lack of applicability of predominantly US-centric findings to diverse global contexts, particularly in Africa where more research is needed. Despite these limitations, the findings underscore the vital role of mental health professionals, especially psychiatric nurses, in implementing these comprehensive prevention programs within communities to break the cycle of recurring substance use cases and support lasting recovery among young people.

Conclusion

This review focused on preventing substance use relapse in young people with substance use disorders. Effective youth relapse prevention must be thorough and practical, addressing all aspects of their lives. Therefore, a youth substance use relapse prevention program needs to be comprehensive, sensitive to their specific needs, and supportive of partnerships with families, community support agencies, and other relevant groups.

The review highlighted several important components of a successful substance use program. These include ongoing follow-ups and evaluations after treatment to detect relapses early and enable immediate action. These evaluations and check-ups also help connect individuals to harm reduction services in case of a relapse or facilitate re-entry into treatment before a full relapse occurs. Additionally, young people are equipped with knowledge and skills to resist the psychological and social influences that might lead them to relapse.

Introduction

Relapse into substance use among young people is a concerning issue. During their development, young individuals undergo a period of significant change, exploring their identities, developing new skills, forming peer relationships, and cultivating a positive body image. These changes can be challenging, sometimes leading to risky behaviors like substance use while the brain is still developing. Youth refers to the period between childhood and adulthood, often defined from leaving compulsory education to securing a first job. Youth substance use involves the unsafe use of legal or illegal drugs to alter mood, posing a danger to the well-being of young people, their families, and communities. Such usage increases the chance of future dependency and repeated relapses.

For those who use substances and wish to stop, relapse remains a major challenge to achieving and maintaining sobriety. Studies show that between 65% and 85% of young people with substance use disorders (SUDs) experience a relapse within 12 months of starting treatment. Historically, substance use treatment aimed to break the cycle of patients repeatedly entering and exiting institutions. However, current research highlights the need for effective relapse prevention strategies and programs that consider social, cultural, environmental, and individual factors.

Programs designed to prevent substance use relapses are vital. They help individuals gain control over impulses, manage cravings, avoid relapse, build new social skills, and delay immediate gratification. While awareness of high relapse rates in young people engaging in dangerous substance use exists, research on relapse prevention programs and recovery paths has only recently begun to grow. Many effective programs, particularly in Western countries, have been tested using randomized controlled trials. These include web-based initiatives, recovery management evaluations, and cognitive behavioral therapy-based approaches. For example, an online program called Navigating my Journey (NmJ) for young people aged 13–24 in the USA led to increased self-confidence and reduced substance use over time. Another US study found that a brief intervention program known as SBIRT (Screening, Brief Intervention, and Referral to Treatment) effectively reduced substance use frequency in young people 18 and older.

Substance use is also a problem in Australia, where a neuroscience-based relapse/harm reduction program for junior high school students (12–15 years old) showed minimal to no effectiveness. In Hong Kong, expressive arts-based relapse prevention programs are becoming more common in both residential and community settings. However, unlike in Western nations, controlled trials have not been conducted to confirm their effectiveness. African nations, in contrast, often lack such programs, limiting access to evidence-based treatments. In Botswana, for instance, the absence of specific substance use relapse prevention programs after hospital discharge hinders effective relapse prevention, with rehabilitation services primarily focusing on inpatient care after a relapse has already occurred.

Given the high rates of relapses among young people, the societal burden, and the impact on recovery, an integrative review of youth substance use relapse prevention is crucial. Reports from organizations like the World Health Organization (WHO) and the United Nations Office on Drugs and Crime (UNODC) identify young people as a vulnerable group needing specialized care. The findings of this review can help mental health nurses understand the components of effective youth substance use relapse prevention programs, thereby reducing substance-related relapses that block successful recovery.

Rationale and Aim

Substance use has been a public health concern for many years, especially among young people, leading to negative behaviors, health problems, and legal and economic consequences. While substance use is common in youth, relapse after a period of not using causes significant concern. Despite this concern, preventing substance use relapse remains a challenge, with various prevention programs suggested in the literature. Therefore, this review aimed to identify, combine, and present findings from all relevant studies on substance use relapse prevention programs for young people. The review's research question was:

• What is stated in the published literature on a substance use relapse prevention program for the youth?

Methods

An integrative literature review (ILR) was conducted using established guidelines. This type of review allows for gathering diverse research evidence and perspectives. The review focused on the issue of substance use relapse, identified by studies and experts as a major concern globally, particularly in Botswana, due to a lack of prevention methods. The review aimed to answer a specific research question about youth substance use relapse prevention programs.

A detailed search strategy was employed, with assistance from an experienced librarian. Electronic databases such as PubMed, Sabinet African Journals, EBSCOhost, and Medline were systematically searched using Boolean operators. Keywords included "substance OR drug" AND "use OR abuse OR misuse"; "relapse prevention OR addiction management" AND "programme OR check-ups"; AND "youth OR young adults OR young people." Studies were included if published in English between 2013 and 2024, representing diverse methodologies. Grey literature from the World Health Organization (WHO), United Nations Office on Drugs and Crime (UNODC), and International Society of Substance Use Professionals (ISSUP) was also considered. Articles were excluded if they did not directly address substance use relapse prevention programs or strategies, and commentaries, letters, and editorials were also removed.

The initial search yielded 4283 studies. After screening titles and removing duplicates and untrievable publications, 52 publications remained. Abstract review led to 29 more exclusions. A full-text review of the remaining 23 publications and 3 grey literature documents resulted in 26 documents for the final review. The search was conducted from October 2023 to January 2024.

All included studies underwent a quality appraisal using the Mixed Methods Appraisal Tool (MMAT) 2018. Reviewers independently assessed study quality for each criterion and assigned an overall score. Studies were not excluded based on their methodological quality, ensuring all valuable findings were considered.

Data analysis involved organizing and combining findings through content analysis, guided by the integrative review process. A data extraction table recorded details such as author, study aim, method, and findings. During synthesis, related ideas from different studies were grouped to develop a new understanding of substance use relapse prevention. Reviewers independently examined articles to avoid bias and reach a consensus on the identified themes and subthemes, which are presented in a table in the full report.

The article followed all ethical standards for research without direct contact with human or animal subjects. This work is part of a larger study aiming to develop a youth substance use relapse prevention program in Botswana. Ethical approval was obtained from North-West University, the Ministry of Health IRB, and Sbrana Psychiatric Hospital Institutional Review Board.

Findings

Twenty-six articles were selected using the identified search strategy. These included 23 peer-reviewed articles and 3 grey literature documents. The studies spanned from 2013 to 2024, with most conducted between 2017 and 2023. Research took place in six countries, with the majority (12 studies) from the USA. Study types included randomized controlled trials, quantitative studies, mixed methods, qualitative, and literature reviews, along with the grey literature pieces.

Theme 1: Continuing Care

A major theme identified was continuing care, which involves ongoing support for young people to maintain positive behavioral changes in substance use relapse (SUR) prevention. Experts agree that consistent care after hospital discharge, lasting at least three months, is essential to preserve treatment progress and prevent relapse. Key elements of continuing care include regular post-treatment check-ups, continuous monitoring, connecting individuals to further therapy, ensuring engagement and retention in programs, and utilizing recovery support services.

Post-treatment check-ups serve as routine assessments to identify early signs of relapse. These sessions, often incorporating Cognitive Behavioral Therapy (CBT) strategies, aim to strengthen coping skills, boost motivation, and help young people recognize cravings, triggers, and behavioral patterns that could lead to relapse. Proactive tracking through various methods like phone calls and assessments, ideally quarterly for up to four years, allows for timely intervention if substance use resumes.

When relapse is imminent or suspected, a strong linkage model is crucial to connect young people back to appropriate treatment services, such as inpatient, residential, or outpatient care, or community support. Engagement strategies aim to remove barriers to accessing treatment and increase motivation for re-entry. Once engaged, maintaining contact and follow-up is vital for retention, ensuring young people stay in treatment for a recommended minimum duration and receive appropriate pharmaceutical support when needed.

Finally, integrating young people back into their families, workplaces, and communities is supported by recovery services. These services offer tools and resources for sustained recovery, encouraging participation in healthy, rewarding activities like alcohol-free recreation, art, or job placement programs. Engagement in peer support groups, such as 12-step programs, also fosters recovery by building positive social relationships and providing vital information and skills. Accessible community rehabilitation centers are key to effective relapse prevention.

Theme 2: Technology-Mediated Recovery Management Interventions

One identified theme focused on technology-mediated recovery management interventions (TMAI). These interventions, such as mobile aftercare and internet-based programs, play a crucial role in preventing relapse among young people, either on their own or alongside face-to-face support.

Mobile aftercare interventions, delivered via smartphone apps or text messages, allow practitioners to provide ongoing care. Texting interventions can motivate young people towards recovery behaviors, reduce relapse tendencies, and lessen substance use severity. Such mobile programs offer personalized engagement, improved assessment and monitoring, and greater convenience and flexibility in service delivery.

Internet-based relapse prevention, despite some debate on its strong evidence base, is considered a promising way to boost treatment outcomes and recovery. Digital health interventions can offer frequent monitoring and help overcome barriers to care, like the fear of stigma associated with in-person interactions. These online tools can positively impact substance use prevention efforts, providing digital program modules, personalized feedback, and engagement features over time.

Theme 3: Relapse Prevention/Recovery Promotion Through Developmentally Engaging Activities

Relapse prevention can also be achieved through activities that support a young person's growth and development while discouraging substance use. These developmentally engaging activities offer alternatives that replace the pleasure associated with substance use.

Physical activities, such as exercise programs, effectively support relapse prevention, especially when combined with cognitive-behavioral or lifestyle interventions. Young people engaging in such programs often experience improved self-esteem, greater confidence in preventing relapse, increased enjoyment of exercise, and better physical health perceptions. These activities should be enjoyable to encourage sustained behavior change.

Empowering young people with self-monitoring strategies, like using a diary or technology-based tools, helps them regulate critical areas of their lives linked to relapse after inpatient treatment. Self-monitoring reports are valuable for assessing consistency between self-reported substance use and objective tests like urinalysis.

Furthermore, educational activities promoting understanding of substance use are important. Young people benefit from learning about basic neuroscience principles, including how the brain functions, the effects of substances on the brain, and the dynamics of relapse. Presenting this psychoeducation creatively, such as through art-based or cognitive-behavioral groups, can stimulate interest and motivate individuals to quit and remain abstinent.

Discussion

Youth substance use and subsequent relapse pose a significant challenge, making it difficult for young people to sustain abstinence. While effective relapse prevention programs exist, particularly in industrialized nations, there remains a notable lack of empirical research in this area, especially within sub-Saharan Africa. In these regions, the focus is often on short-term addiction crisis management and limited aftercare, which contributes to recurrent relapses and readmissions. Cognitive-behavioral-based programs are common and effective, with other strategies like mindfulness-based prevention also gaining recognition.

Most research views relapse prevention through cognitive and environmental factors rather than solely internal causes or cravings. While some literature suggests the need for pharmaceutical treatment post-discharge, the overall evidence on medication for youth relapse prevention is mixed, with non-medication approaches often prioritized in some treatment systems. The emphasis in reviewed programs is largely on psychosocial support, highlighting the critical role of continuous care beyond inpatient discharge.

Sustained support, lasting at least three months, is crucial for preventing youth substance use relapse. This ongoing care involves equipping young people with skills to recognize and resist relapse triggers, motivating them for change, and fostering problem-solving abilities. Professionals managing these programs must actively monitor and reinforce positive behavioral changes, connecting young people to essential resources.

Reintegration into society is a key component of recovery, facilitated by recovery-focused programs and community support. Connecting young people with their families, schools, churches, and support groups helps them re-establish themselves. Social integration services, job placement programs, and participation in engaging, rewarding activities like alcohol-free recreation significantly increase the likelihood of stable recovery. Residential care and rehabilitation facilities play a vital role in providing comprehensive recovery support.

Technology-mediated substance use relapse prevention programs are increasingly recognized for their effectiveness, particularly when combined with traditional therapy. As young people are often comfortable with technology, digital interventions can offer personalized, targeted support. Mobile aftercare through text messages or smartphone applications, and internet-based programs, enhance engagement, provide customized feedback, and offer digital modules for education, daily self-monitoring, and access to community resources, thereby reducing relapse risks.

Strengths and Limitations of the Review

This integrative literature review provided a thorough understanding of youth substance use relapse prevention by combining research findings from various study designs. However, the review has certain limitations. A language bias existed, as only publications written in English were included, potentially overlooking important content in other languages. Additionally, some relevant publications not indexed by the chosen databases might have been missed. Despite efforts to use interchangeable keywords to reduce this risk, the high volume of search results could have led to human error and selection bias during the screening process, though precautions were taken through repeated review.

Strengths and Limitations of the Literature

The information from this analysis adds to the growing body of research on youth substance use relapse prevention programs, offering insight into crucial steps for creating preventative strategies. The review clearly shows that youth programs require ongoing evaluations, supervision, and re-intervention to lessen relapse severity or enable re-entry into treatment before a full relapse occurs. However, there remains a shortage of research on youth relapse prevention programs, especially in Africa. Most conclusions primarily reflect American contexts, potentially lacking relevance to regional specificities. While the review included grey literature, which can offer valuable information despite not being peer-reviewed, further evidence is needed from diverse sources.

Implication for Practice

Mental health workers, such as psychiatric nurses, are key in preventing substance use relapse, particularly among young people, as they often oversee prevention and tertiary care programs in the community. It is crucial for them to understand the components of effective youth substance use relapse prevention programs. This is especially true in areas like Africa, where these professionals might be the sole mental health providers in rural communities. The findings of this review are highly relevant for the field of mental health and psychiatry, offering informed and comprehensive preventive care to help break the cycle of recurrent substance use cases.

Conclusion

This review primarily focused on preventing substance use relapse in young people with substance use disorders. Effective youth substance use relapse prevention must be comprehensive, realistic, and address all aspects of their lives, fostering partnerships with families and community support agencies. The review highlighted essential program components, including continuous post-treatment follow-ups and evaluations for early relapse identification and intervention. These evaluations help connect individuals back to harm reduction strategies or re-entry into treatment. Additionally, young people need to be equipped with knowledge and skills to resist psychosocial influences that could trigger relapse.

Introduction

When young people start using substances again after trying to stop, it causes great sadness. Being young is a time of big changes, where people learn about themselves and make friends. During this time, the brain is still growing. Sometimes, young people take risks, like using drugs or alcohol. This can lead to a habit that is hard to break. Many young people who try to stop using substances will start again. In fact, most young people (65% to 85%) who get help for substance use will start using again within a year.

It is clear that ways to stop young people from starting substance use again are needed. These programs should look at many things, like a young person's social life, culture, surroundings, and personal needs. Programs can help young people learn to control their urges, manage cravings, and build new social skills. While many helpful programs exist in Western countries, like online tools or counseling that changes how people think, other parts of the world, like Africa, do not have many such programs. This lack of support makes it hard to keep young people from using substances again. This writing is important because it helps people understand what works to stop young people from relapsing, which can help health workers better support them.

Rationale and Aim

Substance use among young people is a serious health concern. It can lead to bad choices, health problems, and legal or money troubles. Even when young people try to stop, starting again is a major worry. There are many ideas about how to stop this from happening, but more clear information is needed. This paper looked at different studies to find out what has been written about programs that help prevent young people from using substances again. The main question was: What do published writings say about programs that stop young people from relapsing into substance use?

Methods

This writing shares information from many past studies. The goal was to bring together different ideas about how to stop young people from using substances again. The main problem found was that young people often go back to using substances, and there are not enough good ways to prevent this.

To find the right information, a wide search was done in online libraries. Only studies written in English from 2013 to 2024 were included. Stories, letters, and opinion pieces were not used. The search looked for words like "substance," "drug," "relapse prevention," and "youth."

Out of many studies found, only 26 were chosen that directly answered the question. Each chosen study was carefully checked to make sure it was good quality. Even if a study was not perfect, it was still used if it gave useful information. Then, all the useful information was sorted and put into groups to find common ideas and clear answers. Two people worked on this part to make sure it was fair and correct. This review is part of a larger study that has already received approval from ethics boards.

Findings

The search found 26 helpful articles. Most of these were published between 2017 and 2023. The studies came from six different countries, with most (12 studies) from the USA. Other studies were from places like South Africa, Australia, and Hong Kong. Many of the studies were a type called "randomized controlled trials," which are good for testing if something works.

Theme 1: Continuing Care

A main idea from the studies is that young people need ongoing care to prevent them from using substances again. This means they need support even after they leave a treatment center. This continued care should last at least three months to be helpful. It includes regular check-ups, keeping track of their progress, connecting them to more help if needed, making sure they stay involved, and helping them use other support services.

Regular check-ups after treatment are very helpful. These check-ups are like routine visits to see how a young person is doing. They help to find early signs of a problem so action can be taken right away. During these check-ups, young people can learn how to understand their cravings and triggers, which are the thoughts, feelings, or situations that make them want to use substances. They can also learn ways to manage these urges and set healthy goals.

Keeping track of young people and checking on them often is also part of ongoing care. This means staying in touch through calls, mail, or visits. This helps to see if they are having problems and need more help. If a young person is close to using substances again, or has already done so, it is very important to connect them quickly back to treatment or support groups. It is key to make it easy for them to get back into treatment and to keep them motivated to stay there. This helps them avoid or lessen the harm of using substances again.

Finally, connecting young people to support services is very important for their recovery. These services help them fit back into their community with family, school, and friends. Getting help to find a job or taking part in fun, drug-free activities also makes it more likely they will stay sober. Having local places like recovery centers easily available is also important.

Theme 2: Technology-Mediated Recovery Management Interventions

Another important way to help young people avoid using substances again is through technology. This includes using phones, apps, and the internet. These tools can be used on their own or along with in-person help.

Mobile apps and text messages can keep helping young people after treatment. Messages can encourage them to stay sober and make good choices. Studies show that getting text messages can help reduce how much young people use substances and can help stop them from relapsing. Using technology for support is helpful because it can be personal, easy to get, and flexible for the young person.

Using the internet for relapse prevention also shows promise. Online tools can check on young people often and help them feel less worried about being judged, which can happen with in-person meetings. Internet programs can give personal feedback and offer lessons that young people can do over time, helping them stay on track with their recovery.

Theme 3: Relapse Prevention/Recovery Promotion Through Developmentally Engaging Activities

Programs that help young people avoid using substances again should also include activities that help them grow as a person. These activities can keep them busy and away from substance use.

Physical activities, like exercise, are a good example. When young people take part in exercise programs, especially along with counseling, they often feel better about themselves. They are more likely to avoid relapsing, enjoy being active, and feel healthier. It is important that these activities are fun and do not involve substances, giving young people better ways to enjoy themselves.

Young people also need to learn how to check on themselves. This means using a diary or apps to keep track of their feelings, triggers, and progress. This helps them gain control over parts of their lives that might lead to relapse. What they report about themselves can also be checked with drug tests to make sure they are staying sober. Learning about how substances affect the brain is also very helpful. When young people understand how their brain works and how drugs change it, it can give them a strong reason to quit and stay sober. This type of learning should be given in fun and interesting ways, perhaps through art or group discussions.

Discussion

Using substances in youth is a major problem, and starting again after trying to stop is very common. Not many studies have looked at how to prevent this in young people, especially in places like Africa, where there are few programs. In many developed countries, however, programs have been shown to work well.

Some people debate whether medicines are needed to prevent relapse, but this review mostly looked at support methods that do not involve drugs. The studies strongly suggest that providing continuous support after a young person leaves treatment is key. This support should be strong and last for at least three months. Health workers need to help young people stay motivated and build skills to resist using substances again.

Connecting young people with services that support their recovery is also very important. This helps them fit back into their daily lives with family, school, and friends. Getting help to find a job or taking part in fun, drug-free activities also makes it more likely they will stay sober. Having local places for recovery and support helps a lot.

Technology is becoming a powerful tool for preventing relapse. Since young people often use technology every day, phone apps and online programs can give them personal help and reminders. These tools can send text messages about how to avoid relapse, share information about drugs, help with self-monitoring, and connect young people to community help.

Finally, programs should include activities that help young people grow both in their minds and bodies. These activities should be enjoyable to replace the pleasure that substances might have given. Exercise programs, for example, have been shown to help young people stay sober, especially when combined with counseling that helps change their thinking and lifestyle. Learning about how substances affect the brain can also motivate young people to stay sober, especially when taught in interesting ways.

Strengths and Limitations of the Review

This review brought together information from many different studies, which helps to get a full picture of how to prevent young people from using substances again. It is believed to be the first review of its kind on this topic.

However, there were some limits. Only studies written in English were included, so some important information in other languages might have been missed. Also, even with a careful search, some studies might not have been found if they were not in the databases used. Because so many studies were found at first, there was also a small chance of human error during the selection process. Steps were taken to check the results again and avoid missing important information.

Strengths and Limitations of the Literature

The information gathered in this review helps us learn more about programs that prevent young people from using substances again. It shows important steps needed to create these programs, like the need for ongoing checks and quick help if a relapse is about to happen.

Still, there is not much research on relapse prevention programs for young people, especially in Africa. Most of the findings come from studies in the USA, which may not always apply to other parts of the world. Some of the information in this review came from "grey literature," which means it was not checked by other experts in the same way regular scientific papers are. However, this information was still useful and reliable for answering the questions of the review.

Implication for Practice

Workers who help with mental health, like nurses, play a big part in caring for people who use substances and helping them get better. They need to understand how to stop young people from using substances again, especially since they often lead prevention programs. This is even more important in places like Africa, where these health workers might be the only ones providing mental health care in small towns.

This review’s findings are very important for mental health care. They can help health workers give informed and full care, hopefully stopping the cycle of young people repeatedly using substances.

Conclusion

To stop young people from using substances again, programs must be complete and practical, touching all parts of their lives. These programs need to be sensitive to young people's needs and work closely with families and community groups.

The review showed that important parts of a successful program include regular check-ups after treatment. These checks help to spot relapses early so that help can be given right away, or so young people can get back into treatment before a full relapse happens. Also, young people should be given the knowledge and skills to stand strong against anything that might make them use substances again.