Background <p>Children and adolescents with personal and social problems are highly vulnerable to risky substance use and mental disorders. Children in special schools and adolescents in residential care or qualified withdrawal treatment are particularly at risk.</p> Objective <p>The article highlights the specific risk factors for substance use disorders in these groups at risk and their interdependence with socioeconomic and familial characteristics, including psychological comorbidity. The implications for treatment are derived.</p> Material and methods <p>Presentation of the state of research on the prevalence of substance use and addiction disorders in groups at risk. Quantitative analysis of substance use patterns and psychological comorbidity in adolescents in qualified withdrawal treatment.</p> Results <p>Adolescents with limited cognitive abilities who are exposed to socioeconomic and familial stressors have an elevated risk of substance abuse. Adolescents who are placed in residential youth care also demonstrate an increased prevalence of substance abuse in conjunction with previous traumatic experiences and family stress. In qualified withdrawal treatment comorbid mental disorders are evident, particularly behavioral and emotional disorders as well as hyperkinetic disorders.</p> Discussion <p>This article presents a&#xa0;discussion of the aforementioned findings. It is imperative that targeted support measures are provided for groups at risk in order to counteract the harmful effects of substance use and accompanying psychological stress at an early stage, thereby compensating for the disadvantages that these groups face.</p>