Research shows that the risk for substance abuse and other adverse behaviors increases as the number of risk factors increases, and that protective factors may reduce the risk of youth engaging in substance use that can lead to substance abuse. This interactive effect of risk and protective factors has substantial implications for the design and implementation of successful preventive interventions. The more a program reduces risk factors and increases protective factors, the more it is likely to succeed in preventing substance abuse among children and youth.1 Learn more about critical components and principles of effective adolescent substance abuse prevention programs.
Risk and Protective Factors
Early aggressive behavior, lack of parental supervision, academic problems, undiagnosed mental health problems, peer substance use, drug availability, poverty, peer rejection, and child abuse or neglect are risk factors associated with increased likelihood of youth substance use and abuse. Risk factors that occur during early childhood further increase the risk of youth substance abuse. Risk factors of prolonged duration, for example, those that continue on from childhood through adolescence, are also associated with increased likelihood of youth substance abuse. Risk factors frequently associated with substance abuse are common across multiple disorders.2
Not all youth will develop substance abuse problems, even if they have experienced these risk factors. Some individuals are exposed to protective factors that may keep them from using substances. The presence of multiple protective factors can lessen the impact of a few risk factors. For example, strong protection, such as parental support and involvement, could diminish the influence of strong risks, such as having peers who abuse substances.3
While risk and protective factors have been presented in different ways, the table below provides examples of risk and protective factors adapted from the National Research Council and Institute of Medicine.4
View risk and protective factors by developmental period:
- Preconception/Prenatal and Infancy
- Early Childhood
- MiddleSchool
- Adolescents
- Young Adulthood
Preconception/Prenatal
| Persons | Risk Factors | Protective factors |
|---|---|---|
Individual | Genetic disposition | --- |
Family | --- | --- |
School, Peers, Community | --- | --- |
Infancy/Early Childhood
| Persons | Risk Factors | Protective factors |
|---|---|---|
Individual | Difficult temperament | Self-regulation Secure attachment Mastery of communication and language skills Ability to make friends and get along with others |
Family | Cold and unresponsive mother behavior Parental modeling of drug/alcohol use | Reliable support and discipline from caregivers Responsiveness Protection from harm and fear Opportunities to resolve conflict Adequate socioeconomic resources for the family |
School, Peers, Community | Support for early learning Access to supplemental services such as feeding, and screening for vision and hearing Stable, secure attachment to childcare provider Low ratio of caregivers to children Regulatory systems that support high quality of care |
Middle School
| Persons | Risk Factors | Protective factors |
|---|---|---|
Individual | Poor impulse control Low harm avoidance Sensation seeking Lack of behavioral self-control/regulation Aggressiveness Anxiety Depression Hyperactivity/ADHD Antisocial behavior Early persistent problem behaviors Early substance use | Mastery of academic skills (math, reading, writing) Following rules for behavior at home, at school, and in public places Ability to make friends Good peer relationships |
Family | Permissive parenting Parent–child conflict Inadequate supervision and monitoring Low parental warmth Lack of or inconsistent discipline Parental hostility Harsh discipline Low parental aspirations for child Child abuse/maltreatment Substance use among parents or siblings Parental favorable attitudes toward alcohol and/or drugs | Consistent discipline Language-based, rather than physical, discipline Extended family support |
School, Peers, Community | School failure Low commitment to school Accessibility/ availability Peer rejection Laws and norms favorable toward use Deviant peer group Peer attitudes toward drugs Interpersonal alienation Extreme poverty for those children antisocial in childhood | Healthy peer groups School engagement Positive teacher expectations Effective classroom management Positive partnering between school and family School policies and practices to reduce bullying High academic standards |
Adolescence
| Persons | Risk Factors | Protective factors |
|---|---|---|
Individual | Behavioral disengagement coping Negative emotionality Conduct disorder Favorable attitudes toward drugs Rebelliousness Early substance use Antisocial behavior | Positive physical development Emotional self-regulation High self-esteem Good coping skills and problem-solving skills Engagement and connections in two or more of the following contexts: at school, with peers, in athletics, employment, religion, culture |
Family | Substance use among parents Lack of adult supervision Poor attachment with parents | Family provides structure, limits, rules, monitoring, and predictability Supportive relationships with family members Clear expectations for behavior and values |
School, Peers, Community | School failure Low commitment to school Associating with drug-using peers Not college bound Aggression toward peers Norms (e.g., advertising) favorable toward alcohol use Accessibility/ availability | Presence of mentors and support for development of skills and interests Opportunities for engagement within school and community Positive norms Clear expectations for behavior Physical and psychological safety |
Young Adulthood
| Persons | Risk Factors | Protective factors |
|---|---|---|
Individual | Lack of commitment to conventional adult roles Antisocial behavior | Identity exploration in love, work, and world view Subjective sense of adult status Subjective sense of self-sufficiency, making independent decisions, becoming financially independent Future orientation Achievement motivation |
Family | Leaving home | Balance of autonomy and relatedness to family Behavioral and emotional autonomy |
School, Peers, Community | Not attending college Substance-using peers | Opportunities for exploration in work and school Connectedness to adults outside of family |
All tables adapted from O’Connell, M. E., Boat, T., & Warner, K. E. (2009). Preventing mental, emotional, and behavioral disorders among young people: Progress and possibilities. Washington, DC: The National Academies Press and U.S. Department of Health and Human Services, Substance Abuse and Mental Health Administration (2009). Risk and protective factors for mental, emotional, and behavioral disorders across the life cycle. Retrieved from http://dhss.alaska.gov/dbh/Documents/Prevention/programs/spfsig/pdfs/IOM_Matrix_8%205x11_FINAL.pdf
Resources
Preventing Drug Abuse Among Children and Adolescents
This In Brief Web edition from NIDA provides highlights from the Preventing Drug Use Among Children and Adolescents: A Research-Based Guide for Parents, Educators, and Community Leaders, Second Edition booklet. It presents the updated prevention principles, an overview of program planning, and critical first steps for those learning about prevention.
Substance Use and Sexual Risk Behaviors Among Youth
This resource from the Centers for Disease Control and Prevention (CDC) provides information on substance use and sexual risk behaviors among youth and the related risk factors (PDF, 2 pages).
Centers for Disease Control and Prevention's Adolescent and School Health: High Risk Substance Use in Youth
This webpage from theCenters for Disease Control and Prevention (CDC) provides information and resources on high risk substance use in youth.
1 U.S. Department of Health and Human Services, 2010
2 Robertson, David, & Rao, 2003
3 Robertson, David, & Rao, 2003
4 National Research Council and Institute of Medicine, 2009
