The first critical step for developing effective prevention interventions is to understand how substance use disorders (SUDs) develop. A person's risk for both substance use and SUD is associated with genetic, individual, and environmental factors. What are risk factors? Risk factors are biological and psychological characteristics of a child or attributes of a child's family, culture or community that make him or her more susceptible to substance use. They include a child's personality traits, such as early aggression, as well as undiagnosed mental illness. They also include factors that directly affect a child, changing their behavior, such as parental neglect, limited or poor supervision, mental or physical abuse, friendships with children misusing substances, poor or limited schooling, living in poverty, and easy access to drugs in their community. According to Substance Abuse and Mental Health Services Administration (SAMHSA), many children who are at risk have faced adverse childhood experiences including:
Intimate partner violence
Mother treated violently
Substance misuse within household
Household mental illness
Parental separation or divorce
Incarcerated household member
These risk factors, though challenging to overcome, do not on their own cause SUDs. The good news is that even with an abundance of risk factors, a child with strong, counterbalancing protective factors can emerge healthy from an at-risk childhood. What are protective factors? Protective factors include those qualities of children and their surrounding environments that enable them to develop the coping and adaptation skills necessary to manage challenging life situations and transitions. At the individual level, protective factors include positive self-image, self-control and good social skills. At the family, school and community level, they include external factors, such as parental involvement in their lives, positive mentoring relationships, participation in after-school activities and policies limiting substance availability in their neighborhood. It is the balance between risk and protective factors that determine a person's risk of initiating substance use and of developing a SUD. Robust prevention programs aim to reduce risk factors and strengthen protective factors in a person's immediate environment, including his or her home, school, workplace or community. The areas that are most important to address vary with age, as exposure to substance use occurs in different environments depending on development stages. As people transition from childhood through adulthood, these programs can be modified and directed towards individuals, groups or the entire community, depending on the approach most likely to be effective. Risk and protective factors include a constellation of genetic, individual and environmental elements.
While we cannot change our genetics, having some understanding of genetic risk can be an empowering piece of information. If addiction runs in a family, it can give parents a "heads up," letting them know that their children may benefit from targeted interventions to reduce their risk factors and improve their protective factors.
Many of the genetic constellations that can make a person more likely to engage in risky behaviors, like using drugs, can, under a different set of circumstances, nudge them toward taking the kinds of risks that might make them a great public speaker or salesman, a brilliant scientist, a competitive runner, a creative entrepreneur or a deep-sea explorer. High genetic risk does not mean that a child is destined to have a SUD. Parents who recognize risks early on can direct a child's risk-taking tendencies away from self-destructive behaviors and towards more positive activities—like gymnastics, theater or science and technology competitions—helping them find an outlet for their risk-taking impulses.