Substance Use Risk Factors and Protective Factors

A Review of Risk Factors and Protective Factors in Adolescent Substance Use Shauna Thompson 10017221 University of Calgary APSY 683 - Fall 2008

Substance Use Risk Factors and Protective Factors Though substance use is seen by many as a right of passage, a natural experience for most

adolescents, many times this innocent experimentation leads to issues of serious substance abuse. Substance use and abuse (including alcohol, illicit drugs, inhalants, and non-prescription use of prescription drugs) is incredibly costly to society on personal and social levels. For years, researchers have been working to determine how substance use begins, how it progresses, and why it affects some differently than others. While many have attempted to identify a particular personality type that could predict with certainty a persons risk for becoming a substance abuser, personality characteristics prominent in substance abusers are also prominent in those with a number of other maladaptive psychological conditions (Weinberg & Glantz, 1999). Therefore, while some behaviors and personality characteristics are relevant to substance use, no personality factors or behaviours reliably differentiate users from non-users (Graham & Strenger, 1988; Mulder, 2001; Nathan, 1988; Wills et al., 2006). In the absence of a predictive personality type to point us toward those who might be at greater risk for substance use, we turn to a review of factors that influence a persons susceptibility to use and abuse of addictive substances. As professionals working with children and adolescents in schools, we will evaluate this information with a focus on risk and protective factors as they relate to adolescents. Research shows us that many internal and external factors (referred to as risk and protective factors) work to increase or decrease that probability that a person will engage in substance use. Risk factors are things that increase the likelihood that a person will engage in substance use, while protective factors decrease that likelihood. Risks can be mitigated in childhood and adolescence through prevention and intervention by those within a childs family, school, and community circles. As professionals who work with children, we endeavor to determine how best to help young people in our communities navigate some of the difficulties of growing up,

Substance Use Risk Factors and Protective Factors including their experiences with substance use and abuse. Todays children are influenced by

many things and people from the different microsystems of their lives. Kliewer & Murrell (2006) define microsystems as those contexts in which individuals have face-to-face interactions with others. Microsystems that children and adolescents encounter in their daily lives include their homes, schools, and communities, where they interact with family members, teachers, peers, and those in their neighborhood. Prevention and intervention must focus on interactions adolescents have across these diverse systems (Kliewer & Murelle, 2006) and spheres of influence (Cleveland et al., 2008). It makes sense that if we could enhance the protective factors and reduce the risk factors that affect different areas of young peoples lives, they would have a better chance of maturing without being impacted by substance abuse. As professionals in schools, we have a unique opportunity to play a part in influencing adolescent choices and actions related to substance use and abuse. In order for this to be successful, we need to be knowledgeable about the risk factors and protective factors that exist in the lives of children and adolescents, which we will examine in this paper. We will review the risk factors and protective factors for substance use and abuse shown to be significant in recent studies from different peer-reviewed journals. Consideration will be given to the interaction of these factors across several spheres of influence as they affect individuals likelihood for engaging in substance use through adolescence. We will evaluate the possible usefulness of holding risk factors and protective factors as accurate projections for child and adolescent substance use, and draw attention to elements that could allow professionals in schools to make a great impact with adolescent substance use, with an eye toward prospective study and research possibilities for the future.

Substance Use Risk Factors and Protective Factors Overview of Articles Each of the articles mentioned in this section contribute valuable information toward our knowledge of risk factors and protective factors as they relate to adolescent substance use. With a variety of approaches for evaluating adolescent substance use, they bring different aspects of adolescent home, school, and community environments to light, as factors that help or hinder resilience toward substance use. Cleveland, Feinberg, Bontempo, and Greenburg used cross-sectional survey data from a large community sample (91,778 students) across grade levels that spanned early to late adolescence (grades 6, 8, 10, and 12) in Pennsylvania. They examined associations among three risk factor indices (individual, peer, and family) and three protective factor indices (individual, school, and community) with both recent and lifetime use of alcohol, cigarettes, and marijuana. The most frequently reported substance used was alcohol, and the least frequently used was marijuana. Gender appeared to be a factor only in older grades, where male adolescents were somewhat more likely than female adolescents to report higher levels of substance use. In general, these researchers found a stronger correlation for the risk factor indices compared to the protective factor indices, regardless of grade or substance measured. When risk factors and protective

factors were considered together, risk factors appeared more likely to determine the likelihood of adolescent substance use. The individual risk index (that measured favorable attitudes toward antisocial behaviour and substance use, the perception that drug use poses little risk, behaviours of sensation-seeking and rebelliousness, as well as social skills) had the strongest association among all students, suggesting that these factors play a major role in adolescent substance use. These results make sense, as these foundational beliefs and characteristics emerge early in childhood, setting the stage for an individuals interactions with their family, school, peers, and

Substance Use Risk Factors and Protective Factors community. Family and community factors were more important among the younger students, while peer and school factors were highlighted among older grades. This is in line with

developmental theories that suggest family influences are most important for young children and adolescents, but that they recede in importance as older adolescents spend more time unsupervised in different situations outside their family. Of special interest from the perspective of a professional working in schools is the interplay of peer and school factors as a predictor of adolescent substance use. Most anti-substance use programming (such as the D.A.R.E. program administered by the police in Alberta schools) takes place with students in our elementary grades. The finding from this study that school factors were especially protective for older grades, suggests that we have an enormous opportunity to influence adolescent perspectives and choices around substance use if we implement developmentally relevant prevention programs that run throughout secondary school years. Kliewer and Murrelles cross-sectional study involved 17,215 students ages 12-20 from Panama, Costa Rica and Guatemala. They used a questionnaire to assess substance abuse problems, alcohol, tobacco, and other drug usage, along with a number of factors that are unrelated to this topic, and therefore not considered here. Variables of analysis included: lifetime use of alcohol, cigarettes, marijuana, and hard drugs (including inhalants, tranquilizers, cocaine, crack, and ecstasy), problems with alcohol and drugs, and lifetime drunkenness. Researchers investigated the interactions between six risk factors (dysregulation, family problems with drugs and alcohol, negative family interactions and communication, school disengagement, peer deviance, and exposure to violence) and four protective factors (belief in God, positive family interaction and communication, parental religiosity, and positive student-teacher interaction). Kliewer and Murrelle refer to dysregulation as a deficit in the ability to modulate affect, behaviour, and

Substance Use Risk Factors and Protective Factors

cognition in response to environmental subtext (p. 452). Risk factors most often associated with substance abuse problems included dysregulation, school disengagement, and peer deviance, with school disengagement showing the highest association. In general, all risk factors evaluated were associated with increased substance use and substance use problems. As the presence of risk factors increased, problematic outcomes also increased. Dysregulation was the strongest indicator for substance use and problems with alcohol. It is likely that those who experience dysregulation struggle in all spheres of influence, particularly younger adolescents the inability to regulate their emotions, behaviours, and cognitions according to context could lead to disciplinary problems with parents and teachers, disengagement from school, and alignment with a more negative peer group; all factors associated with increased risk for substance use. Additionally, results from this study showed that peer deviance significantly increased an adolescents risk for substance use. A positive relationship with a teacher was the protective factor most often associated with an absence of lifetime substance use and abuse. The protective factor that appeared of most influence to the likelihood of substance use in adolescence was a positive connection with teachers. Personal beliefs in God and along with parental religiosity were also impactful to a lesser degree. To some degree across all domains, the presence of protective factors appeared to attenuate the risk of substance use in adolescence, but causation cannot be inferred from these results. Once again, it is critical for professionals working in schools to note that the school disengagement is the most a critical risk factor for substance use, and positive student-teacher communication the most influential protective factor. The most important thing to note when looking at the results of this study is that in adolescent life, the school microsystem includes the most critical risk factor and a protective factor. This tells us

Substance Use Risk Factors and Protective Factors once again that professionals working with adolescents in schools have an excellent opportunity to influence adolescents toward a life free from substance use problems.

Schinke, Fang, and Cole also used a cross-sectional design, surveying 781 mother-daughter pairs in the greater New York City area. Their rationale for focusing on girls substance use experiences was that current research suggests that adolescent girls are beginning to surpass the boys with substance use. Todays girls start smoking earlier, smoke more regularly, drink, and abuse substances more often than boys (Johnston et al., 2005). Within their study, the researchers examined girls use of alcohol, prescription drugs, and inhalants for relationships to their afterschool destinations, body images, depression, peer substance use, maternal substance use, mother-daughter interactions, and family rules and agreements surrounding substance use. These dimensions are unique to many others measured in the literature on risk factors and protective factors, though they cover the familiar domains of home, school, and community involvement. Risk factors evaluated in this study included unstructured, unsupervised time after school, depression, peer substance use, and maternal cigarette and alcohol use. Protective factors that were looked at included structured programming after school, positive body image, maternal supervision and involvement, as well as family rules and expectations about substance use. Girls who had unstructured and unsupervised time after school and those with close friends who used substances had significantly higher rates of substance use with all substances. Those whose mothers used alcohol were more likely to do so themselves, as well as to use inhalants; those whose mothers smoked had a higher incidence of prescription drug use. Those least likely to report substance use were girls with a positive body image that were in a formal program after school. Accountability appears to be the most significant protective factor reported in this study. When mothers urged abstinence, knew where there daughters were and who their friends were,

Substance Use Risk Factors and Protective Factors and were available to their daughters any time they were needed (as opposed to those who were

unavailable at times), girls were also significantly less likely to report issues of substance use. In homes where parents had clear expectations and rules about abstinence, girls were much less likely to use alcohol, prescription drugs, or inhalants. It was suggested by the authors that this could be because these girls integrate family rules and messages into their own behaviour, reducing their risk. While this study did not report effects directly related to school attitudes and experiences, the dramatic affect that body image (which could be extrapolated to cover selfesteem) had on substance use and non-use should be given special attention by professionals working in schools. Those who engage with girls on a daily basis should work to help girls build and support a positive self-esteem and body image, leading to an overall decreased risk for substance use in adolescence. Limitations The biggest limitation for these studies lies in their research design: though they all had the benefit of a large sample size, cross-sectional data collected at one point in time precludes the inference of causation regarding the risk and protective factors. Additionally, findings cannot be generalized to all adolescents, as data collected in each study came from a student population. It is likely that those who drop out of school use more substances and are less attached to school, which may produce an underestimate of the severity of effect that risk and protective factors have in adolescent lives. Mother-daughter pairs who participated in Schinke et al.s study selfselected by means of an online survey tool; they could therefore likely to be more technologically inclined, motivated, and have a better relationship than those who chose not to participate (therefore are not likely to be representative of the population). These demographics could suggest misleading results if applied to the general adolescent population. As well, though

Substance Use Risk Factors and Protective Factors it is useful to have information specific to adolescent girls, it is a definite limitation that boys were not also included in the study. Summary We set out to review significant risk factors and protective factors in recent research, and to

consider the interactions of risk and protective factors across spheres of influence related to their effect on an individuals likelihood for engaging in substance use through adolescence. The findings from this collection of research contribute to our knowledge about risk and protective factors in adolescence in several ways: All three studies support the idea that factors across multiple spheres of influence (between family, peer, school, and community) affect adolescent substance use. Results reliably show that schools play a crucial role in decreasing the likelihood of a substance use problem in adolescence (especially in late adolescence). This indicates that along with implementing developmentally appropriate prevention and intervention strategies that endure throughout secondary school, it is important for teachers to maximize the potential for positive relationships and connection with their students. Insofar as whether risk factors and protective factors can be considered predictive of adolescent substance use and abuse, we cannot be sure from these studies. While risk factors appear to be more reliably linked with adolescent substance use, the research design used for most of these types of studies does not allow causative statements to be made. For professionals working in schools, it is obvious that there is a significant opportunity to influence students through positive relationships, and encouraging students to have a positive experience in the schools. Developmentally appropriate prevention and intervention programs that continue throughout high school and target adolescents at home, at school, and in the community have a great potential for decreasing the number of adolescents that engage in substance use and abuse.

Substance Use Risk Factors and Protective Factors Future Research

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Further research on gender-specific issues in substance abuse risk factors and protective factors would be useful in assisting school and community programs develop successful prevention and intervention programs. A research design that sets out to evaluate lifetime substance use over time (studies using longitudinal vs. cross-sectional design) would allow us to have more insight into causational relationships for adolescent risk factors and protective factors. Studies that draw from a more random sample of adolescents (as opposed to those who focus on students in schools) would present a more complete picture of adolescent substance abuse. The issue of religion and religiosity and their effects on substance use in Kliewer and Murrelles study is an interesting one, and it would be worthwhile to investigate the impact of these factors on children in our own country. Further research that evaluates risk factors and protective factors as they relate to adolescent spheres of influence may also be warranted.

Substance Use Risk Factors and Protective Factors

References

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Cleveland, M.J., Feinberg, M.E., Bontempo, D.E. et al. (2008).The role of risk and protective factors in substance use across adolescence. Journal of Adolescent Health, 43:157-164. Corrigan, M.J., Loneck, B., Videka, L. et al. (2007). Moving the risk and protective factor framework toward individualized assessment in adolescent substance abuse prevention. Journal of Child & Adolescent Substance Abuse, 16(3):17-34. Graham, J.R. & Strenger, V.E. (1988). MMPI Characteristics of Alcoholics: A review. Journal of Consulting and Clinical Psychology, 56(2): 197-205. Hawkins, J.D., Catalano, R.F., and Miller, J.Y. (1992). Risk and protective factors for alcohol and other drug problems in adolescence and early adulthood: Implications for substance abuse prevention. Psychological Bulletin, 112(1):64-105. Jessor, R., Costa, F., Krueger, P.M. et al. (2006). A developmental study of heavy episodic drinking among college students: The role of psychosocial and behavioural protective and risk factors. Journal of Studies in Alcohol, 67:86-94. Johnston, L.D. et al. (2006). Monitoring the Future National Results on Adolescent Drug Use: Overview of Key Findings, 2005. Bethesda, MD; NIH Publications No. 06-5882. As referenced in Schinke, S.P., Fang, L., and Cole, K.C. (2008). Substance use among early adolescent girls: Risk and protective factors. Journal of Adolescent Health, 43:191-194. Kliewer, W., Murrelle, L. (2006). Risk and protective factors for adolescent substance use: Findings from a study in selected Central American countries. Journal of Adolescent Health, 40:448-455. Mathias, R. (2002). Risk and protective factors in drug abuse prevention. NIDA Notes: Drug Abuse Prevention Research Update, 16(6):217-247. McGue, M., Slutske, W., Taylor, J. et al. (1997). Personality and substance use disorders: Effects of gender and alcoholism subtype. Alcoholism: Clinical and Experimental Research, 21(3): 513520. Mulder, R.T. (2001). Alcoholism and personality. Australian and New Zealand Journal of Psychiatry, 36: 44-52. Nathan, P.E. (1988). The addictive personality is the behaviour of the addict. Journal of Consulting and Clinical Psychology, 56(2): 183-188. Schinke, S.P., Fang, L., and Cole, K.C. (2008). Substance use among early adolescent girls: Risk and protective factors. Journal of Adolescent Health, 43:191-194. Smith, C. et al. (1995). Resilient youth: Identifying factors that prevent high-risk youth from engaging in delinquency and drug use. In: Hagan, J. ed. Delinquency and Disrepute in the Life Course. Greenwich, CT: JAI Press, pp217-247. Weinberg, N.Z., Glantz, M.D. (1999). Child psychopathology risk factors for drug abuse: Overview. Journal of Clinical Child Psychology, 28(3):290-297. Wills, T.A., Sandy, J.M., and Yaeger, A. (2000). Temperament and adolescent substance use: An epigenetic approach to risk and protection. Journal of Personality, 68(6): 1127-1151.