Guwahati | More than one in five adolescents surveyed across six districts in India are at moderate-to-high risk of substance use, with schools in Guwahati emerging among the most vulnerable, according to a new study published in The Lancet Regional Health-Southeast Asia.

The study, conducted across 108 government and private schools involving over 6,000 adolescents, found that 21.4 per cent of participants fell into the moderate-to-high substance use risk category. Among them, 10.3 per cent were classified as being at moderate risk and 11.1 per cent at high risk, while 78.6 per cent were considered to be at low risk.

Researchers surveyed students from six districts-Kamrup in Assam, Gorakhpur in Uttar Pradesh, Nagpur in Maharashtra, Rajkot in Gujarat, Deoghar in Jharkhand and Puducherry-to assess regional variations in adolescent substance use risk. The findings revealed that schools in Guwahati and Deoghar recorded the highest proportion of adolescents in the moderate- and high-risk categories, while schools in Nagpur and Puducherry showed predominantly low-risk profiles.

According to the study, there was a 35.1 percentage-point difference in substance use risk between Guwahati and Nagpur. Researchers estimated that nearly 40 per cent of this gap could be explained by differences in school environments, socio-demographic and economic factors, and personality traits.

The research was carried out by scientists from institutions including the All India Institute of Medical Sciences (AIIMS), Gorakhpur, and the Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry.

The team assessed substance use risk using the World Health Organization’s Alcohol, Smoking and Substance Involvement Screening Test (WHO ASSIST), while personality traits were evaluated through the Substance Use Risk Profile Scale (SURPS).

The study identified several modifiable factors associated with a higher likelihood of substance use among adolescents. These included easier access to addictive substances, increased digital exposure and risky behavioural environments. Conversely, stronger social engagement and supportive peer networks were found to reduce the risk.

Researchers also observed that male adolescents had lower odds of higher substance use risk than females, a finding they said warrants further investigation. The authors noted that India has limited research examining adolescent multi-substance use through standardised assessment tools such as WHO ASSIST, resulting in insufficient evidence on how risk varies across regions and social settings.

The study recommended stricter enforcement of regulations to limit adolescents’ access to addictive substances, stronger media literacy programmes to counter harmful digital influences, and wider implementation of peer-led interventions such as the Community Based Peer-Led Intervention (CPLI) under the School Health Programme to help prevent substance use among schoolchildren.

The researchers said the findings underscore the need for targeted, evidence-based interventions, particularly in high-risk regions such as Guwahati, where a combination of social, environmental and behavioural factors appears to be driving greater vulnerability among adolescents.