Risk Factors: How can health professionals mitigate these risks?

Risk can foreshadow potential substance abuse; thus, a physician noticing such factors is able to practice prevention. There are a variety of risk factors that have been linked to drug experimentation, abuse, or dependence by adolescents:

• Individual Factors: perinatal complications and brain damage (Hawkins, 2003); childhood ADHD (Hawkins, 2003); comorbid persistent ADHD and conduct disorders (Kaul and Coupey, 2002); sensation-seeking behavior (Hawkins, 2003; Kaul and Coupey, 2002); a pattern of conduct problems (Hawkins, 2003; Kaul and Coupey, 2002); younger age of initiation (Hawkins, 2003); a history of physical or sexual abuse (Kaul and Coupey, 2002).

• Family Factors: drug use by family members or permissive attitudes toward use (Hawkins, 2003; Kaul and Coupey, 2002); involving children in drug use behaviors (Hawkins, 2003); excessive or inconsistent punishment (Hawkins, 2003); high levels of family conflict (Hawkins, 2003); poor parental monitoring (Kaul and Coupey, 2002)

• School Factors: academic problems (Hawkins, 2003); low commitment to educational pursuits (Hawkins, 2003)

• Peer Factors: drug-using contemporaries (Hawkins, 2003; Kaul and Coupey, 2002)

• Contextual Factors: substance abuse in the community (Hawkins, 2003); ease of substance acquisition (Kaul and Coupey, 2002); social norms and permissive attitudes (Hawkins, 2003); lack of after-school supervision (Kaul and Coupey, 2002); poverty (Kaul and Coupey, 2002; Hawkins, 2003)

How can health professionals mitigate these risks?

• Health professionals who notice attention or behavioral problems early in a child's life may lessen the severity of possible future problems by referring the child to further treatment or increasing parents' knowledge and parenting skills by pointing them in the direction of appropriate resources (Hawkins, 2003). Practitioners should also espouse principles of prevention, especially with their young patients.

• To lessen family risk factors, make sure that parents and families are aware that involving children in drug or alcohol behaviors is detrimental to the child. Encourage parents to clearly vocalize expectations, to monitor their children, and to implement consistent punishment (Hawkins, 2003).

• Keep abreast of the child's academic progress and suggest additional help for the child if performance suffers (Hawkins, 2003).

• Contribute to community improvement groups and set high standards for patients, encouraging their parents to follow suit (Hawkins, 2003).

Similarly, other factors seem to protect an adolescent from succumbing to substance abuse. These include a resilient temperament; warm, supportive relationships; and norms or standards that strongly oppose the use of drugs (Hawkins, 2003). Other suggested protective factors are positive role models and growing up in a community with good schools (Kaul and Coupey, 2002).

Initiation of Use

Kaul and Coupey (2002) cite experimentation, thrill-seeking, bonding with contemporaries, and "social lubrication" as being some of the reasons that children or adolescents might initiate drug use. Use of a drug is likely to be followed by use of other drugs (Morrison, 1990). Adolescents' motivators for using drugs, as well as patterns of use, are different from those of adults. Adolescents are more likely than adults to use multiple drugs (Morrison, 1990). Furthermore, adolescents are less likely to use drugs to cope with outside stressors than are adults; adolescents' reasons are generally more internal (Morrison, 1990).