To address the wider challenges presented by drug abuse, drug addiction and substance use disorder, it is vital for stakeholders in communities to work together so that risk factors can be mitigated. These mitigation efforts are generally referred to as “protective factors” by health professionals, prevention specialists, educators and public policy experts. As we will explore in our brief discussion below, some risk factors are applicable to communities and some are even applicable to society-at-large. However, the risk factors that possess the most immediate relevance are those specific to individuals, especially young people. If you are a parent, educator, or an employer, it is important to be cognizant of the numerous risk factors of drug abuse and substance use disorder, the domains in which they occur, and how they interrelate. Again, I will remind readers of the need to contact a health professional as soon as possible if you or someone you care for are at an elevated risk of substance use disorder. Individualized treatment is necessary for a response or prevention strategy to be truly effective.
As this is such a large topic, we will only be scratching the surface here. If you would like to explore risk factors and protective factors more thoroughly, the National Institute on Drug Abuse (NIDA) publication, “Preventing Drug Use among Children and Adolescents (In Brief),” is an excellent resource.
It is not inevitable, of course, that someone who is exposed to one or more risk factors will acquire a substance use disorder. As the Partnership for Drug Free Kids states, “It is important to keep in mind that risk factors do not determine a child’s destiny — instead, they provide a general gauge as to the likelihood of drug or alcohol use. But it is safe to say that addressing risk factors early and paying careful attention to children at higher risk can reduce that child’s likelihood of a future problem with drugs or alcohol.”
The most obvious risk factor in developing a substance use disorder is experimenting with illicit drugs or misuse of pharmaceutical drugs (i.e. drug abuse). The greatest protective factor to mitigate this is to refrain from drug abuse entirely. This works for many people, but biological, environmental, and social risk factors, in an oftentimes complex combination, make this insufficient to contain the problem of substance use disorder. We must look further. For example, in their October 2018 Newsletter, Medical News Today points out that “many substances that form the basis of addiction are not chemically addictive. This means that other elements can lead to substance use disorders.”
Scientists have spent decades researching why some people’s involvement with drugs escalates to substance use disorder and other people’s involvement does not. A biological influence has long been suspected. Increasingly, scientists believe that a person’s genes play a critical role in their risk factor. These fixed types of risk factors are considered “individual-level risk factors” by the Substance Abuse and Mental Health Administration (SAMHSA). The label stresses the lack of involvement from external sources, particularly other people. This underlines an important truth about how individuals are influenced by others when it comes to drug abuse.
There are other, variable, risk factors for children close to home, such as early exposure from a family member or a family history of drug abuse, or an apathetic and inattentive home-life in general. Adolescents are at risk from the cruel cycle where abusing drugs leads to affiliation with peers who abuse drugs, which then leads to further exposure to drug abuse and more dangerous drugs. In general, the earlier an individual abuses drugs or is exposed to drug abuse, the greater their risk factor. Protective factors require extra attention and early intervention from parents and other caregivers.
Social and situational risk factors present a challenge because they often occur at times fraught with anxiety. Key risk periods for children occur during major transitions, for example, when a child graduates into a larger school with more peers. The period when young adults transition from living at home to living without parental supervision at college is an especially risky time for drug experimentation, drug abuse, and ultimately substance use disorder. During major life transitions, intervention is vital. As NIDA makes clear, “because risks appear at every life transition, prevention planners need to choose programs that strengthen protective factors at each stage of development.”
Societal risk factors become hard to mitigate unless a consensus can be gained and maintained with vigilance. These involve how drug abuse is portrayed in mass media and how it is treated in the public policy realm. They can also touch on socio-economic status, access to treatment, information, or any number of factors that are not directly related to illicit drugs.
Finally, there are risk factors involved with the drugs themselves. As we discussed in part five of this series, tolerance, dependence, and addiction are not the same, although they are associated. If an individual develops a tolerance to a drug, it increases their risk factor of developing substance use disorder because of the desire to continually increase the dosage.
The method of delivery can even impact the development of an addiction. For example, snorting a drug results in quick receptor exposure with the “high” wearing off quickly, while orally ingesting a drug can result in a longer duration, depending on the individual’s metabolic tolerance. Nicotine, crack cocaine, and heroin use involve particularly high-risk factors because they contain compounds that can trigger addictive responses in the body from just one use.
There are many reasons people choose to abuse drugs, among them: to feel happier, relieve sadness, temporarily enhance performance, or just through curiosity. Whatever the reason, it is often influenced by the social context in which the choices were made. The domains of the individual, family, community, and society-at-large are inexorably linked. The risk factors and protective factors that will mitigate them require us all to work together to face the challenges that drug abuse and substance use disorder present. One of the greatest challenges facing our communities and the nation over the last decade is the Opioid Crisis. In part seven of this series, we will focus on why this challenge stands out and how it affects people across the country.