Adolescents exhibit a high rate of use of alcohol and illicit drugs. Effect studies rarely describe the actual content of the interventions in detail. Less is known about what was actually done in the prevention than about their effects.Aim: This study is a review study grouping the qualitatively different content components of the various approaches into five categories. Methods: A systematic literature review from Western countries on the topic of school-based interventions and prevention initiatives targeting young people aged 12-20. A modified version of the narrative synthesis approach is used for analysis. The sample consisted of 33 peer-reviewed articles published between January 2010 and December 2014. Findings: Five categories of intervention and prevention programmes were identified: 'Information-based or testing-based primary prevention approaches', 'Primary prevention approaches incorporating skill-training components', 'Universal or primary prevention approaches that include family components', 'Targeted approaches incorporating skill-training components', and 'Approaches incorporating digital features'. Conclusion: Only four studies that employed any form of targeting or profiling of the subjects prior to the delivery of the prevention intervention or initiative were identified. The skewness towards primary prevention skill-training approaches should be addressed, given the diverse consumption patterns among adolescents.