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 childrens 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 childrens 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 childs 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.