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  2. Risk and Protective Factors

Risk and Protective Factors

Research shows that the risk for substance abuse and other adverse behaviors increases as the number of risk factors increases, and that protective factors may reduce the risk of youth engaging in substance use that can lead to substance abuse. This interactive effect of risk and protective factors has substantial implications for the design and implementation of successful preventive interventions. The more a program reduces risk factors and increases protective factors, the more it is likely to succeed in preventing substance abuse among children and youth.1 Learn more about critical components and principles of effective adolescent substance abuse prevention programs.

Risk and Protective Factors

Early aggressive behavior, lack of parental supervision, academic problems, undiagnosed mental health problems, peer substance use, drug availability, poverty, peer rejection, and child abuse or neglect are risk factors associated with increased likelihood of youth substance use and abuse. Risk factors that occur during early childhood further increase the risk of youth substance abuse. Risk factors of prolonged duration, for example, those that continue on from childhood through adolescence, are also associated with increased likelihood of youth substance abuse.  Risk factors frequently associated with substance abuse are common across multiple disorders.2

Not all youth will develop substance abuse problems, even if they have experienced these risk factors. Some individuals are exposed to protective factors that may keep them from using substances. The presence of multiple protective factors can lessen the impact of a few risk factors. For example, strong protection, such as parental support and involvement, could diminish the influence of strong risks, such as having peers who abuse substances.3

While risk and protective factors have been presented in different ways, the table below provides examples of risk and protective factors adapted from the National Research Council and Institute of Medicine.4

View risk and protective factors by developmental period:


Persons  Risk Factors Protective factors


Genetic disposition
Prenatal alcohol exposure





School, Peers, Community



Infancy/Early Childhood

 Persons  Risk Factors Protective factors


Difficult temperament


Secure attachment

Mastery of communication and language skills

Ability to make friends and get along with others


Cold and unresponsive mother behavior 

Parental modeling of drug/alcohol use

Reliable support and discipline from caregivers


Protection from harm and fear

Opportunities to resolve conflict

Adequate socioeconomic resources for the family

School, Peers, Community


Support for early learning

Access to supplemental services such as feeding, and screening for vision and hearing

Stable, secure attachment to childcare provider

Low ratio of caregivers to children

Regulatory systems that support high quality of care

Middle School

 Persons Risk Factors Protective factors


Poor impulse control

Low harm avoidance

Sensation seeking

Lack of behavioral self-control/regulation





Antisocial behavior

Early persistent problem behaviors

Early substance use

Mastery of academic skills (math, reading, writing)

Following rules for behavior at home, at school, and in public places

Ability to make friends

Good peer relationships


Permissive parenting

Parent–child conflict

Inadequate supervision and monitoring

Low parental warmth

Lack of or inconsistent discipline

Parental hostility

Harsh discipline

Low parental aspirations for child

Child abuse/maltreatment

Substance use among parents or siblings

Parental favorable attitudes toward alcohol and/or drugs

Consistent discipline

Language-based, rather than physical, discipline

Extended family support

School, Peers, Community

School failure

Low commitment to school

Accessibility/ availability

Peer rejection

Laws and norms favorable toward use

Deviant peer group

Peer attitudes toward drugs

Interpersonal alienation

Extreme poverty for those children antisocial in childhood

Healthy peer groups

School engagement

Positive teacher expectations

Effective classroom management

Positive partnering between school and family

School policies and practices to reduce bullying

High academic standards


Persons Risk Factors Protective factors


Behavioral disengagement coping

Negative emotionality

Conduct disorder

Favorable attitudes toward drugs


Early substance use

Antisocial behavior

Positive physical development

Emotional self-regulation

High self-esteem

Good coping skills and problem-solving skills

Engagement and connections in two or more of the following contexts: at school, with peers, in athletics, employment, religion, culture


Substance use among parents

Lack of adult supervision

Poor attachment with parents

Family provides structure, limits, rules, monitoring, and predictability

Supportive relationships with family members

Clear expectations for behavior and values

School, Peers, Community

School failure

Low commitment to school

Associating with drug-using peers

Not college bound

Aggression toward peers

Norms (e.g., advertising) favorable toward alcohol use

Accessibility/ availability

Presence of mentors and support for development of skills and interests

Opportunities for engagement within school and community

Positive norms

Clear expectations for behavior

Physical and psychological safety

Young Adulthood

Persons Risk Factors Protective factors


Lack of commitment to conventional adult roles

Antisocial behavior

Identity exploration in love, work, and world view

Subjective sense of adult status

Subjective sense of self-sufficiency, making independent decisions, becoming financially independent

Future orientation

Achievement motivation


Leaving home

Balance of autonomy and relatedness to family

Behavioral and emotional autonomy

School, Peers, Community

Not attending college

Substance-using peers

Opportunities for exploration in work and school

Connectedness to adults outside of family

All tables adapted from O’Connell, M. E., Boat, T., & Warner, K. E. (2009). Preventing mental, emotional, and behavioral disorders among young people: Progress and possibilities. Washington, DC: The National Academies Press and U.S. Department of Health and Human Services, Substance Abuse and Mental Health Administration (2009). Risk and protective factors for mental, emotional, and behavioral disorders across the life cycle. Retrieved from http://dhss.alaska.gov/dbh/Documents/Prevention/programs/spfsig/pdfs/IOM_Matrix_8%205x11_FINAL.pdf


Preventing Drug Abuse Among Children and Adolescents
This In Brief Web edition from NIDA provides highlights from the Preventing Drug Use Among Children and Adolescents: A Research-Based Guide for Parents, Educators, and Community Leaders, Second Edition booklet. It presents the updated prevention principles, an overview of program planning, and critical first steps for those learning about prevention.

Substance Use and Sexual Risk Behaviors Among Youth
This resource from the Centers for Disease Control and Prevention (CDC) provides information on substance use and sexual risk behaviors among youth and the related risk factors (PDF, 2 pages). 

Centers for Disease Control and Prevention's Adolescent and School Health: High Risk Substance Use in Youth
This webpage from the Centers for Disease Control and Prevention (CDC) provides information and resources on high risk substance use in youth. 

1 U.S. Department of Health and Human Services, 2010
2 Robertson, David, & Rao, 2003
3 Robertson, David, & Rao, 2003
4 National Research Council and Institute of Medicine, 2009

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