Risk factors for adolescents developing substance use disorders; what should our prevention programs be targeting?

Abstract

This review identifies the main risk factors and high risk groups of adolescents with substance use disorders (SUD). Furthermore it presents the epidemiological data on SUDs in Malta and discusses possible ways of tackling prevention, whilst offering suggestions based seminal studies from published literature to service developers. Adolescence is a developmental period a high risk, more than half individuals with SUDs identify that the problem began before the age of 20. 18% of adolescents in Europe have reported a lifetime use of illicit drugs, the prevalence rates in Malta are similar. Risk factors for SUDs include; heritable factors; familial patterns and psychiatric disorders. Environmental factors include; family functioning, parenting practices, child maltreatment, peer influences, substance availability and consumption opportunities. One predictive phenotype for SUDs is psychological dysregulation characterised by cognitive, behavioural and emotional difficulties with daily challenges in childhood. The regular use of substances is associated with depression, anxiety, PTSD, behaviour problems. Highest risk groups as those having two parents with a SUD, living with single parents, sexual orientation differences, early use of substances, psychological dysregulation and an attitude of ambivalence towards the use of substances. Over 70% of adolescents receiving treatment for SUD had a history of trauma. Parental practices such as knowledge, communication and awareness are an important protective factor which may help reduce the influential negative influence from peers on substance use. Focusing on abstinence alone in treatment is insufficient as adolescents present with; lower problem recognition, higher rates of binge use and co-morbid psychiatric problems compared to adults. Preventative measures targeted to high risk adolescents were correcting misperceptions is a primary focus may have important benefits. This may reduce the general ambivalence with regards to drug use, thereby reducing the influence from friends. Secondly, correcting misconceptions may lead to adolescents changing the assumption that one’s friends are all positively predisposed to substance use. It’s estimated that for every dollar invested in addiction treatment, $4-7 are saved in drug related crime, theft and criminal justice costs.