The school is one of the most important contexts for carrying out health promotion programs related to the abuse of substances. Over the years, methods and intervention models have changed a great deal, both in relation to the evolution of health goals and to the role played by experts, students, parents, and teachers. We would like to offer a different perspective on health promotion at school by discussing the weaknesses and strengths of the most used methods, in order to identify the appropriate methodology, based on recent evidence research findings. We used Scopus as database for reviewing existing literature. The evolution in the methodology of health promotion programs can be synthesized through a sequence of three phases, from the 1960s to the present day. This method of prevention has been in vogue for many years and is still popular. It was based on the idea that an individual with medical and scientific expertise was the ideal partner for any prevention intervention. It envisages delegating to the expert the tasks of designing, implementing, conducting, and evaluating the program. It emphasized the medical and scientific knowledge of the individual who came from the Institute of Mental Health and Addiction into the school and was viewed as an expert in substance abuse, but who knew very little about the students.Since s/he was not an educator, often the external expert found difficulties when it came to mediating his/her technical language with the needs of the students he was talking to. These interventions were, therefore, mainly mini-conferences for giving information (often presented as "shock information", Toumbourou, 2007; Cimini et al., 2009), and were not adapted to the specific needs of the groups to which they were addressed. The interventions so developed are focused on "problematic" symptoms or behaviors, considered as "causes" and predictors of drug consumption that is conceived of as an internal and almost innate tendency. This methodological choice depends on the theoretical framework which considers "addiction" as coming from people of interior fragility and which is reducible by increasing awareness of the dangers and risks (Evans-Whipp et al., 2007). In contrast to this trend, the literature has been trying to prove how this choice of approach might be ineffective (Bangert-Drowns, 1988) for many reasons: it fully leaves out the personal student standpoints, beliefs, and meanings about these kinds of experience (Vander Leanen, 2011); students are passive and they do not participate in the construction of the program (Orsini et al., 2012), teachers are little involved