 While virtually all children have the potential
for becoming substance abusers, we now know that some youngsters are at much
greater risk of becoming seriously involved than others. Identifying these
"high risk" children early may help to avert their developing substance abuse
problems. Alerting your young patients and their parents to the possibility of developing
problems may deter or delay substance use and make early detection more likely.Risk
Factors for Substance Use, Abuse and Dependence
Both animal and human research provide evidence that abused substances derive their
dependency producing properties from their reinforcing effects on the Central Nervous
System. If a dependence producing substance is taken often enough and in large enough
quantities, most people will become dependent on it. However, there are also large
individual differences in susceptibility to the development of a substance use disorder.
Differences in Susceptibility
The basis of these differences is probably both biological and psychosocial. Although a
detailed technical discussion is beyond the scope of this website, a brief review of the
known "risk factors" for children and adolescents becoming substance abusers may
be helpful in making you aware of the increased possibility that a young person has or is
likely to develop drug-related problems. Risk factors are patient (and/or family)
characteristics associated with a significant likelihood of developing specific problems.
Presence of one or more of those factors associated with drug abuse does not, of course,
mean the patient will invariably become a drug abuser. Moreover, the absence of such risk
factors provides no assurance that a particular child is not, or will not become, a drug
user. Given the extent of substance abuse in our contemporary culture, virtually any young
person can become involved. The risk factors described here are based on studies of
children and adolescents.
Family factors
- Alcoholism in parents or other siblings: children whose parents or other siblings are
alcoholics or drug users are at greater risk of developing a substance use disorder than
those without such a history. Having an alcoholic family member, for example, doubles the
risk of a male child later become alcohol or drug dependent. Genetic factors play a
significant role in determining this; there is evidence that children born of an alcoholic
parent, even when raised by non-alcoholic foster parents, have much higher rates of
alcoholism than those with non-alcoholic origins.
- Children with a family history of criminality or anti-social behavior are more likely to
use drugs and alcohol than those without such a history.
- Inconsistent parental direction or discipline, unclear and/or inconsistent parental
rules and reactions to children’s behavior, unusual permissiveness, lax supervision
or, conversely, excessively severe discipline, constant criticism, and an absence of
parental praise or approval, are all associated with higher rates of alcohol and drug use
in children.
- Parental drug use or parental attitudes approving drug use appear to predispose children
to substance abuse. Since parents serve as models for their children’s behavior in so
many ways, it is not surprising that children whose parents smoke, drink heavily or use
illegal drugs are more likely to do so than children whose parents do not.
 Peer factors
Children whose friends (and/or siblings) smoke, drink or use other drugs are much more
likely to do so than those whose peers do not. Initiation into these activities is usually
through friends. The local drug "pusher" is far more likely to be a child’s
acquaintance who wants to share the drug experience, or who "deals" as a way of
supporting his or her own drug use, than some mysterious stranger lurking near the school.
Achievement, social and developmental
factors
- Children who are poor academic achievers are more likely to begin using drugs early and
to become regular smokers, drinkers and drug users than are their more successful
classmates.
- Adolescents who are bored by schoolwork and disinterested in academic achievement are
much more likely to become drug involved than those who are more academically oriented.
Cocaine use, for example, is less common among teenagers with college plans than those who
do not plan for higher education.
- Children who feel "at odds," strongly rebellious against adult authority, and
alienated from the dominant social values of their community, are more likely to use
alcohol and other drugs than those with strong bonds to family and to traditional
religious or ethical institutions.
- Early antisocial behavior, evidence of a lack of social responsibility, fighting and
other types of aggressive behavior are predictive of later alcohol and other drug use.
- The earlier a child begins to smoke, drink or use other drugs, the greater the
likelihood of heavy drug use, beginning with alcohol and tobacco. Young people who smoke
and drink are more likely to use marijuana than those who avoid tobacco and alcohol.
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