Purpose of review: The present review examines the available literature to consider the impact of risk factors on young people who use and misuse substances. We discuss the existing evidence to argue that social exclusion and psychiatric disorders constitute the important risk factors in the development of substance misuse. We examine the role that risk factors play by considering recent studies of prevention and treatment. Taken together with previous research on comorbidity of substance use and misuse with psychiatric disorders, there is now strong evidence for indices of deprivation and social exclusion co-occurring with both psychiatric disorders and substance misuse as a triad of interlocking experiences.

Recent findings: Recent studies on risk factors and outcomes of interventions suggest that psychiatric disorders and social exclusion can significantly influence pathways not only to substance misuse but also to reduction in use and abstention. However, long-term research is required to substantiate these findings. Studies reviewed here include those conducted in Norway, Holland, USA, UK, Ireland and Australia.

Summary: The link between risk factors and effective intervention is clear; only treatments that take into account the diversity of influences on the development of substance use and misuse together with psychiatric disorders are likely to be effective. If the approaches of treatment services are isolated from considerations of broader social, personal and environmental factors, and interventions for those factors, then successful identification of outcomes and improvement in such outcomes in substance using and misusing adolescent persons are less likely.