A Global Systematic Review of Digital Game-Based Strategies Targeting Adolescent Substance Use

Background: Digital game-based interventions are gaining more attention as innovative approaches to addressing adolescent substance use and promoting appropriate attitudes toward substance use. Traditional treatments for adolescent substance use often replicate adult-focused models, overlooking youths’ unique developmental needs and digital engagement patterns. Given the widespread popularity of gaming among teens, gamification—integrating game elements such as challenges, goals, feedback, and rewards—offers a promising strategy to enhance learning, sustain engagement, and influence substance use attitudes. Research suggests that gamified interventions can effectively increase knowledge and foster negative perceptions of substance use. However, gaps remain in understanding their effectiveness and application. This study conducted a systematic review to examine the detailed components of digital game-based interventions (i.e., treatment, prevention, and assessment) targeting adolescent substance use and their impact on substance use knowledge and attitudes.

Methods: This systematic review analyzed studies from PubMed, PsycINFO, Scopus, and CINAHL. Studies were included if they were peer-reviewed, published in English, involved digital game-based interventions for substance use, examined the effectiveness of the intervention through RCTs or non-RCTs designs, provided complete data, and met “fair” or “good” quality standards per the NIH assessment tool. Following PRISMA, 26 studies were selected from 1,601 references. Data were coded for study characteristics, intervention types and contents, sample characteristics, substance type, measurement tools, and key findings, including intervention effectiveness and the associated facilitators and barriers.

Results: Among the 26 studies (2009–2024), most were conducted in the U.S. (57.7%) followed by the Netherlands (11.5%), Finland and Australia (7.7% each), and Hong Kong, Philippines, Iran, and Spain (3.8% each). The majority employed RCTs (57.7%), and focused on prevention (57.7%), followed by treatment (30.8%) and assessment (11.5%). A wide range of digital platforms was used—VR/AR (15.4%), mobile (19.2%), web-based (15.4%), and others (e.g., tablet). Game types included serious, interactive, avatar-based, educational, and gamified formats. Intervention durations ranged from 1 day to 7 months, with 4 weeks being the most common length and 30-minutes per session. The average gameplay time was 86.4 minutes. Approximately 50% of the studies reported that game-based intervention was effective in reducing substance use, and 65% reported improved attitudes. Few studies identified facilitators (e.g., specific game types, educational content), and even fewer reported barriers (e.g., short duration, small sample sizes). The statistical impact of these facilitators and barriers on the overall effectiveness was rarely examined.

Conclusion/Implication: This systematic review provides valuable insights into game-based digital interventions that address adolescent substance use and related attitudes. The review findings highlight the need for more rigorous research designs, broader inclusion of diverse substance types, the incorporation of culturally sensitive approaches, and systematic evaluations of facilitators, barriers, and potential side effects. While digital games could potentially be an effective tool, limitations such as methodological variability, limited technical assessments, and challenges in synthesizing heterogeneous study outcomes warrant further exploration. Addressing these gaps in future research may strengthen the development and implementation of effective and robust digital interventions for adolescents.