Anyone can begin abusing substances at any time. Though not a guarantee that one will struggle with substance abuse, there are certain risk factors that increase vulnerability. Common risk factors include genetic predisposition, using at a young age, lack of supervision, peer pressure, using highly addictive substances, low self-esteem, traumatic life experience, loss, and having a mental health disorder.1
Early Warning Signs and Symptoms of Substance Abuse
Substance abuse is a serious problem both within the United States and abroad. In 2018, the National Center for Drug Abuse Statistics approximated that 31.9 million (11.7% of the population) U.S. residents aged 12 and older were current illegal drug users with 53 million (19.4% of the population) reporting having used illegal drugs or misused prescription drugs in the previous year.2 Although there is some variance in terms of what substance abuse looks like, it can serve as a fast-track toward addiction.
In an attempt to prevent individuals from becoming addicted, it is important to recognize early warning signs and symptoms. Although prevention is the best means of avoiding a problem, early interventions are oftentimes much more effective than those attempted later. Every year there are millions of new incidents where children, teens, adults, and seniors either try substances for the first time or become addicted.2 By better understanding the unique characteristics of each population, more appropriate interventions may be designed and implemented.
Recognizing substance abuse in children and teens may prove challenging, as this is a period marked by substantial physical, social, emotional, and learning development. [3] Changes are rapid and drastic during this age. For the savvy child or teen abusing substances, it is likely that they will attribute signs of substance abuse to other things. Accordingly, it is important to pay close attention as possible, remain involved, and ask questions.
Common signs and symptoms for children and teens are as follows:
- Mood and personality changes:3
- Withdrawn or seemingly depressed
- Loss of motivation
- Increasingly silent
- Easily agitated or uncooperative
- Deceitful or secretive
- Struggles to focus on tasks or conversations
- Loss of inhibitions
- Unusually elated
- Behavioral changes:3
- Distanced, strained, or changed relationships
- Loss of interest in activities previously enjoyed
- Struggles to perform at school or work
- Avoids eye contact
- Locks doors around the house when in the room alone or with others
- Disappears for long periods of time
- Breaks curfew
- Begins engaging in illegal behavior (e.g., stealing)
- Overly protective of personal items such as phones, laptops, and other means of communicating with peers
- Has an excuse for everything
- Struggles with coordination and balance
- Sleeps more or less often and at unusual times
- Tries to cover up use by chewing gum, using eye drops, spraying cologne or perfume, etc.
- Appearance changes:3
- Poor hygiene
- Unkempt appearance
- Smells of smoke on clothes or alcohol on breath
- Flush cheeks
- Eyes are bloodshot, dilated, or constricted
- Track marks and or bruising on arms
- Unusual burns, marks, yellowing around fingers and lips
- Physical health changes:3
- Lowered immune system or frequently sick
- Dramatic weight loss or gain
- Slurred speech
- Chronic exhaustion
- Nosebleeds or runny nose
- Sores or other spots around mouth and other areas of the body
- Frequent perspiration
- Shortness of breath
- Seizures or vomiting
For adults and seniors many of the warning signs and symptoms mentioned are similar but may present differently. One significant indicator is a change of behavior that seems to either come out of nowhere or is precipitated after a major loss (e.g., loved one, work, finances, health, etc.).
Adults may also have easier access to substances. For instance, at age 21 alcohol and nicotine products become legal. At present time, 15 states have also legalized recreational cannabis for adults 21 and over. Adults and seniors may also schedule their own doctors’ appointments, which means they may be able to receive a particular prescription of choice. Accordingly, signs and symptoms may be even more easily hidden than for children and teens where parents and guardians are actively involved.
Risk Factors for Substance Abuse
By knowing the risk factors for substance abuse, one may take additional precautions toward preventing its occurrence both personally and with loved ones. Risk factors do not guarantee that one will abuse substances or ultimately develop an addiction but do place one at higher risk.
The more factors present, the greater likelihood of developing a problem. Such risk factors may be conceptualized through various domains of being including psychological, physiological, and social/environmental.
Genetic Predisposition
Genetic predisposition, which entails a family history of substance abuse and addictive disorders, places one at significantly increased risk. Research has demonstrated that addiction is, in part, 50% due to genetic predisposition.4 Though these numbers slightly fluctuate from one study to the next, they are consistent.
The human genome project revealed that all human beings (past, present, and future) share about 99.9% of the same genetic makeup.5 Accordingly, the similarities from one generation to the next are an even closer match—meaning that many of the benefits or complications in one person’s genetic makeup are passed on from one generation to the next.4
Early Use
Continued substance use ultimately alters our brain chemistry as well as impacts other vital organs necessary for optimal functioning.4 Although human beings continually develop throughout the duration of a lifetime, most of this development occurs during the earlier stages of life composed by infancy, childhood, and adolescence.
During typical development, the body goes through rapid and significant changes. Introducing drugs and alcohol during these stages may compromise one’s ability to develop in healthy fashion. In fact, recent studies have revealed that about 70% of users who try an illegal drug before age 13 develop a substance abuse disorder within the next 7 years compared to 27% of those who try an illegal drug after age 17.2
There is a saying that one’s mental maturity stops at the age one becomes addicted to substances. Accordingly, a therapist working with a 24-year old who started using at age 14 may essentially be working with someone who presents with the mentality of a 14-year old. From a maturity standpoint, the young individual does not have a previous, more mature stage of life of which to refer.
Lack of Supervision
It is natural for children and adolescents to “test the waters” when it comes to what they can get away with. Although this is expected, consistent monitoring and support by parents/guardians may help redirect the younger individual toward a more appropriate way of thinking and behaving. Without supervision, these individuals have more freedom to engage in whatever actions they want with minimal risk of getting caught—all the while increasing the risk of becoming addicted.
Peer Pressure
Though one naturally thinks of adolescence when it comes to peer pressure, adults are also susceptible. When one is regularly in an environment where substance abuse is accepted and even encouraged, it becomes normalized. Here is where the thought, “Well, everyone is doing it!” comes from. Although the reality is that most people actually “aren’t doing it,” this narrow window of perspective leads one to feel left out if not participating. Here the individual uses with others while, again, increasing the likelihood of further complications.
Using Highly Addictive Substances
Although any substance has a potential for addiction, some are more addictive than others. Research has consistently found nicotine, barbiturates, cocaine, alcohol, and heroin to be among the top of the list.6 This is due to their euphoric response along the reward pathway and ability to bind with those receptors in our brain that provide the most pleasure and/or alleviate pain. Because the euphoric effect of using any of these even once is so strong for first time users, it is likely they will try it again. Continued use may ultimately lead to addiction.
Low Self-Esteem
Self-esteem entails one’s appraisal of worth or ability. High self-esteem leads to confidence, while low self-esteem leads to a host of negative thoughts and emotions that are mostly internalized yet presented through one’s words and actions. Low self-esteem may stem from continued perceived failures, being put down, bullied, or having a diagnosable mental health condition.
Given the euphoria experienced when using, an individual with low self-esteem may immediately escape the pain while temporarily feeling better about oneself. It is essentially an avoidant coping strategy. Further, using with others provides an added social element to boost self-esteem. One may associate “using buddies” as true friends rather than what they actually are. Once the substance use is removed, these individuals oftentimes go their own ways.
Traumatic Life Experience
A traumatic life experience can happen to anyone at any time. Trauma is defined as damage to the mind precipitated by a distressing event. Note that what is considered distressing may differ from one person to the next depending on predispositional factors and coping skills. Further, trauma may be something acute (single significant event) or chronic (ongoing).
Depending on one’s ability to cope naturally, substance abuse may appear to be the solution. Rather than experience the mental pain and torment, one may use it to feel relieved. Doing this, though, does not make the trauma go away. Instead, it layers on top of the problem. Over time, this produces even more negative feelings such as depression, anxiety, or post traumatic stress disorder (PTSD). For children, trauma oftentimes entails child abuse, bullying, or separation from or loss of a parent.
Loss
Loss and trauma tend to go hand-in-hand. Loss may entail losing a loved one, losing a job, declaring bankruptcy, acquiring a disability later in life, being fired or laid off from work, having grown up children move on, retiring, and so on. When the loss is too much to bear and appropriate coping skills are not used, a person is at risk. The mentality here may be along the lines of, “I have nothing else to lose.”
At this point one may intentionally partake in self-destructive behavior because it provides a sense of euphoria and or relief that is better than constantly focusing on the loss. Hopelessness and helplessness may also be experienced here, especially when the loss is something outside of one’s control.
Having a Mental Health Disorder
Mental health disorders present additional challenges in the lives of those afflicted. They may impact one’s ability to think clearly, make sound decisions, and cope with everyday stressors. When one is low on overall life satisfaction, the individual may try whatever it takes to feel better. When one struggles with mental health and a substance use disorder, it is referred to as a co-occurring disorder. In the U.S. alone it was estimated that some 9.2 million adults (about 3% of the population) had a co-occurring disorder in 2018.7
Further, lifetime incidence for individuals being diagnosed accordingly is in the area of 20-50%, which is quite substantial.8 If one is prescribed medication for said condition, there may be additional considerations as to how the medication and recreational substances contraindicate one another. There is also potential for prescribed medications to be abused.
Protective Factors for Substance Abuse
Fortunately, there are many protective factors for substance abuse. Although some things, such as genetic predisposition, cannot be prevented, there are other ways to reduce the likelihood of one developing a problem and becoming addicted. Many of these protective factors are the exact opposite of the risk factors stated above.
Family Connectedness
Not enough can be said about the benefits of family connectedness. Especially at a young age, children need to feel loved and have adult role models of whom to emulate. When basic needs are met, children are able to develop higher functioning capacities (e.g., healthy emotional development, coping skills, creativity, problem solving).
When parents/guardians are appropriate role models, there is a model of behavior to emulate. This higher standard of being, then, becomes the norm and something to follow. Children may adapt these examples into their own lives to ultimately grow up in healthy fashion.
Supervision
When children and teens are supervised there is less opportunity for them to engage in substance use. This may include sneaking out with substance using peers or using in various parts of the house. Strong supervision entails parents/guardians regularly checking in, spending ample time together, asking questions, providing support, and having consequences for unacceptable behavior.
Not only does this lessen opportunities for use but also increases the likelihood of recognizing problems before they escalate. The same principles may be applied with adult relationships. Adults may hold one another accountable while questioning or calling out destructive behaviors.
Positive Social Support
When individuals associate with peers who do not engage in substance use, that behavior becomes the standard. Further, it becomes reinforced. Here individuals may enjoy their time with others without introducing substances. Should one begin using or struggle with a particular something (e.g., trauma or loss), positive social support is there to actively listen, console, and provide useful advice. Individuals know they are not alone, may have higher self-esteem, and do not need to use it to feel fulfilled.
Healthy Coping Skills
Healthy coping skills are what help people work through difficult situations. Even the most tragic of circumstances and loss may be ultimately alleviated through the use of healthy coping skills. Such skills tend to be learned and acquired throughout life. This is why children and teens oftentimes struggle more with this than adults. Preferred coping skills do vary by individual but essentially lead toward similar positive outcomes.
Common techniques for coping and managing substance abuse include:
- Engaging in healthy and enjoyable activities
- Picking up a new hobby or reviving an old one
- Learning something new
- Enrolling in a course or program of study
- Working out
- Eating healthy
- Reading, writing, listening to music, playing video games, or watching TV
- Prayer, meditation, introspection, or reflection
- Distancing from “using buddies” and other toxic relationships
- Keeping one’s space clear of drugs and paraphernalia
- Working toward and achieving a goal
- Exploring one’s life meaning
- Getting in touch with one’s spiritual and/or religious side
- Speaking to someone when experiencing difficulties
- Having an optimistic perception of life
This list is by no means comprehensive but does provide insights into what types of activities may promote healthy coping.
Accepting Help
There are certain conditions that require professional help. Diagnosable mental health and substance use disorders as well as other medical conditions are included here. Speaking with a mental health professional allows for a third-party, unbiased appraisal of your life and situation. Here one has someone to not only listen and provide empathic support but also collaborate toward devising healthier approaches.
Trained professionals have undergone much training and oftentimes have significant experience. In other cases, support groups may be led by those who have experienced situations similar to what one is experiencing. Such support is cathartic and helps an individual realize that one is not alone. As such, accepting assistance may help people actualize their goals more rapidly and effectively than doing so alone.
Abstinence
Perhaps the most obvious protective factor toward substance abuse is abstinence. If one does not engage in substance use, then there is nothing to abuse. Further, this protective factor limits the potential dangers of all other risk factors combined—including genetic predisposition. That is, one may have a genetic predisposition but never activate the “addiction genes” because no substances were ever introduced.
Here, an individual may go on living life like anybody else. At the same time, abstinence may prove the most challenging protective factor. If abstinence is seemingly impossible for one’s situation, then it is important to regulate one’s use at all times. Should any problems arise, it is important to immediately seek assistance.
Substance Abuse Risk Factor Statistics
Substance abuse risk factor statistics are plentiful. Some of the numbers are alarming, indicating that the problem is much more severe than what we tend to offer in response.
An overview of recent statistics provided by the National Center for Drug Abuse Statistics from 2018 revealed the following regarding substance use in the U.S.:2
- 31.9 million (11.7%) of the population over age 12 were current illegal drug users (had used within the previous month).
- 53 million (19.4%) of people aged 12 years and older used illegal drugs or misused prescription drugs in the previous year.
- If alcohol and tobacco are included, the number of Americans who were current substance users climbs to 165 million (60.2%).
- 20.3 million people aged 12 or older had a substance use disorder.
- 70% of users who try an illegal drug before age 13 develop a substance abuse disorder within the next 7 years compared to 27% of those who try an illegal drug after age 17.
- The most common substance exposure reported to poison control centers was illegal or misused prescription opioids, with nearly 284,000 cases of exposure.
- 67,376 drug overdose deaths occurred, which was a 4.1% decline from the previous year.
- Substance abuse disorders (SUD) affected over 20 million Americans aged 12 and over.
These numbers are a strong indication that if not careful, one may become yet another statistic.
Coping With Substance Abuse
It is important to separate substance abuse from addiction. Although addiction is considered treatable but incurable, substance abuse is not an actual condition. Rather, it may serve as a pathway toward addiction. This means that by taking the appropriate course of action, one may remain on the right track while living a healthier life.
Common ways to live a healthy life while facing concerns with substance abuse include:
- Abstaining from substance use all together
- Minimizing and monitoring substance use
- Avoid using substances known to cause dependence and have the risk of addiction such as controlled prescription medications, nicotine, cocaine, alcohol, and heroin
- Socializing with people and at places where substances are not being used
- Engaging in healthy habits and activities
- Building and maintaining a positive support group
- Becoming educated on substance abuse and addiction
- Talking about problems with trusted others and/or professionals
Though relatively general and straightforward, consistently following these recommendations will help minimize risks associated with substance abuse. Note that continued motivation to remain on track is of utmost importance. Whenever one begins struggling, professional intervention is always recommended.
Additional Resources for Risk Factors for Substance Abuse
If you or a loved one is dealing with substance abuse, these resources may be helpful:
