Systematic review of the efficacy, effectiveness, and cost-effectiveness of stepped-care interventions for the prevention and treatment of problematic substance use

•Nineteen studies of mostly (68.4 %) good quality were reviewed.•Adaptive stepped-care approaches delivered in the context of other health programs are promising.•As are models that include motivation-focused interventions and psychosocial counselling•Lack of statistical power is a significant challenge in researching stepped-care models.•There is a need for research examining models that address drugs other than alcohol.