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
| Persons |
Risk Factors |
Protective factors |
|
Individual
|
Genetic disposition
Prenatal alcohol exposure
|
---
|
|
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 the Centers 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
