There is a wide range of factors that have been cited as risk factors for the development of substance use disorders. Table 1 presents a summary of the findings of risk factor research conducted with regard to such disorders. The contents of this table are drawn from a variety of sources (Botvin, 1999; Bukstein, 1995; Cicchetti & Rogosch, 1999; Glantz & Hartel, 1999; Hawkins et al., 1992; Hawkins, Kosterman, Maguin, Catalano, & Arthur, 1997; Kilpatrick et al., 2000; Weinberg & Glantz, 1999). As can be seen, identified risk factors can broadly be separated into two classes — contextual and individual-interpersonal. Contextual risk factors are those that operate within a social context and include such things as current laws and legislation, moral and societal norms, and economic well being. Individual-interpersonal risk factors encompass personal, interpersonal, and environmental characteristics. It is noted that a number of familial/contextual factors play a significant role in the development of substance use disorders, including parental drug problems, poor child management strategies, limited family support/closeness, and family conflict/discord.

Table 2 and Table 3 present a summary of the risk factors commonly cited for anxiety and depression problems in young people. The contents of these tables have been drawn from multiple sources (Bruch, 1989; Dadds, 1997; Essau & Dobson, 1999; Lonigan & Phillips, 2001; McCauley, Pavlidis, & Kendall, 2001; Rubin & Burgess, 2001).The most salient factors emerging in the literature as risk factors for anxiety problems are temperamental dispositions to be shy and fearful of novel people, objects, or situations (behaviour inhibition or reticence), the existence of parental anxiety or depressive problems, and exposure to traumatic environmental events. Secure attachment, an easy temperament, and social skills stand out as ongoing protective mechanisms. Those emerging most commonly for depressive problems include parental depression, poor child management strategies characterised by criticism and limited reinforcement of positive behaviours, conflict, and child emotion dysregulation. Family support and closeness, adaptive communication strategies among family members, and perceived social support represent protective factors.

Table 4 contains a summary of risk factors for externalising behaviour problems (Dadds, 1997). A range of risk factors from individual, family and social contexts interact to contribute to a range of possible outcomes. Low socio-economic status has been established as a marker for many possible risk factors including genetics, environmental toxicity, poor educational opportunities, poverty, social isolation, lack of employment, and modeling of violence (Dadds, 1997). Age of onset is also significant in that earlier age of onset is associated with poorer prognosis for boys (Loeber, 1990). Similarly, the extent to which problem behaviour is expressed across multiple settings (ie., home, school, and community) is also a predictor of severity and durability of conduct problems (Kazdin, 1993; Loeber, 1990).

In comparing these three tables, it can be seen that there is some overlap between the risk factors for substance use disorders and the risk factors for the common mental disorders of childhood. Most notable is that at a broad level, early familial and contextual factors appear to play a significant role in the development of all of these problems, particularly through the presence of parental psychopathology, problematic child management strategies, and difficulties in parent/child relationships. Given the presence of shared early environmental risk factors for these disorders, it could be predicted that when children are exposed to such conditions they are at risk of developing more than one of these problems at some point in their life. More specifically, the evidence for common early risk factors would indicate that internalising and externalising problems in children could represent part of the developmental trajectory of substance use disorders. There could be pathways to such disorders through behavioural problems and delinquency, potentially related but diverse pathways to substance use disorders through internalising problems (ie., anxiety and depression), as well as possible pathways involving interrelationships between the three problems (ie., substance use disorders, anxiety, depression and conduct disorders). It is to this issue of comorbidity among disorders that we now turn.Top of page

Table 1: Risk factors in the development of substance use disorders

Table 1 is presented as two lists in this HTML version for accessibility reasons. It is presented as a table in the PDF version.

Contextual/societal factors

  • Laws and Norms
    • Decreased purchase cost
    • Decreased drinking age
    • No restrictions on sale
  • Availability
    • Increased availability
  • Extreme Economic Deprivation
    • Poverty (Not social class)
  • Neighbourhood Disorganisation
    • High population density
    • High residential mobility
    • Physical deterioration
    • Low levels of attachment to neighbourhood

Individual/interpersonal factors

  • Physiological Factors
    • Genetic risk for addictive behaviour
  • Psychological Factors
    • Comorbidity with other Psychological disorders (PTSD, Bipolar Disorder, Depression, Anxiety Disorders, Conduct and Antisocial Problems)
    • High sensation seeking, low harm avoidance
  • Family Drug Behaviour
    • Parental/sibling alcoholism
    • Parental use of illicit drugs
    • High drug salience in family
    • Modeling by older brother
    • Father's substance use and emotional stability
    • Perceived parental permissiveness
  • Family Management Practice
    • Inconsistent child management practices
    • Low parental education
    • Low aspirations for child
    • Parental non-directiveness/permissiveness
    • Negative communication patterns
    • Inconsistent, unclear behaviour limits
    • Unrealistic parental expectations
    • Perceptions of father as hostile
    • Parental interactions and psychological instability
  • Family Environment
    • Marital discord
    • High family conflict
    • Low parent-child closeness
    • Low maternal involvement
    • Low family bonding
    • Low family involvement and attachment
  • Academic
    • Intellectual ability
    • Poor school performance
    • Lack of commitment to school
    • Failure in school
    • Truancy
  • Peer
    • Low peer acceptance
    • Early aggression
    • Low inhibition
    • Peer substance use
  • Onset of Drug Use
    • Early onset predicts level of use and range of substances
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Table 2: Developmental risk for anxiety disorders and associated intervention strategies

Table 2 is presented as three lists in this HTML version for accessibility reasons. It is presented as a table in the PDF version.

Infancy developmental phase

  • Risk factors:
    • Child: Shy temperament, behavioural inhibition
    • Family: Neglect, or over-protection; parental psychopathology, especially anxiety
    • Society: Environmental stress, e.g. loss, divorce
  • Potential mechanism of prevention:
    • Early identification of high-risk children and anxious parents.
    • Parental support & parent training to foster responsive parenting, secure attachment, and positive parental coping strategies.

Childhood developmental phase

  • Risk factors:
    • Child: Reticence, behavioural inhibition, shyness; social isolation.
    • Family: Parental psychopathology; over-protection of child in the face of challenges; selective attention to threat, and avoidant solutions; parental over-control or criticism.
    • Society: Social isolation, insularity.
  • Potential mechanism of prevention:
    • Social problem-solving training encouraging proactive solutions.
    • Increasing focus on cognitive strategies as child matures.
    • Exposure programs to overcome fears.
    • Enhancement of social skills and opportunities for peer interaction.
    • Training parents to model effective cognitive and behavioural coping.
    • Positive parental strategies to manage child avoidance.
    • Responsive parenting.
    • Family connections to school and community.

Adolescence developmental phase

  • Risk factors:
    • Child: Reticence, behavioural inhibition, shyness; social isolation; possibility of comorbid disorders, especially depression and substance use.
    • Family: Parental psychopathology; over-protection of child in the face of challenges; selective attention to threat, and avoidant solutions; parental over-control or criticism.
    • Society: Peer pressure; regarding comorbidity: prevalence of substance use.
  • Potential mechanism of prevention:
    • Social problem-solving training encouraging proactive solutions.
    • Increasing focus on cognitive strategies as child matures.
    • Exposure programs to overcome fears.
    • Enhancement of social skills and opportunities for peer interaction.
    • Training parents to model effective cognitive and behavioural coping.
    • Positive parental strategies to manage child avoidance.
    • Responsive parenting.
    • Family connections to school and community.
    • Cognitive-behavioural training with increasing focus on adolescent and related issues (depression, substance use).
    • Increasing focus on issues of autonomy for family.
    • Parental training in balancing autonomy and independence with family support.
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Table 3: Developmental risk for depressive disorders and associated intervention strategies

Table 3 is presented as three lists in this HTML version for accessibility reasons. It is presented as a table in the PDF version.

Infancy developmental phase

  • Risk factors:
    • Child: Shy temperament, social inhibition; increased negative effect; insecure attachment — anxious, avoidant
    • Family: Parent practices characterised by rejection, abuse, neglect; and, or overly intrusive parenting; low parental warmth and support/availability; parental psychopathology, especially depression; family conflict
    • Society: Environmental stress, e.g. loss, divorce
  • Potential mechanism of prevention:
    • Early identification of high-risk children and depressed parents.
    • Parental support & parent training to foster responsive parenting, secure attachment, and positive parental coping strategies.

Childhood developmental phase

  • Risk factors:
    • Child: Shyness; insecure attachment
    • Family: Parent practices characterised by rejection, abuse, neglect; and, or overly intrusive parenting; low parental warmth and support/availability; parental psychopathology, especially depression; family conflict
    • Society: Social isolation, poor social skills; environmental stress.
  • Potential mechanism of prevention:
    • Social problem-solving training encouraging proactive solutions.
    • Increasing focus on cognitive strategies as child matures.
    • Enhancement of social skills and opportunities for peer interaction.
    • Parental support and strategies for managing/regulating own mood.
    • Positive parental strategies to manage child behaviour, encourage responsive parenting, and foster positive parent/child relationships.
    • Family connections to school and community.

Adolescence developmental phase

  • Risk factors:
    • Child: Shyness; insecure attachment; maladaptive cognitive style — negative view of self, others, and the future; deficits in active problem-solving; possibility of comorbid disorders, including anxiety and substance use; being female
    • Family: Parent practices characterised by rejection, abuse, neglect; and, or overly intrusive parenting; low parental warmth and support/availability; parental psychopathology, especially depression; family conflict
    • Society: Social isolation; regarding comorbidity: prevalence of substance use.
  • Potential mechanism of prevention:
    • Social problem-solving training encouraging proactive solutions.
    • Increasing focus on cognitive strategies as child matures.
    • Enhancement of social skills and opportunities for peer interaction.
    • Parental support and strategies for managing/regulating own mood.
    • Positive parental strategies to manage child behaviour, encourage responsive parenting, and foster positive parent/child relationships.
    • Family connections to school and community.
    • Cognitive-behavioural training with increasing focus on adolescent and related issues (e.g. emotion regulation and substance use).
    • Increasing focus on issues of autonomy for family.
    • Parental training in balancing autonomy and independence with family support.
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Table 4: Developmental risk factors for externalising disorders and associated intervention opportunities

Table 4 is presented as three lists in this HTML version for accessibility reasons. It is presented as a table in the PDF version.

Prenatal - infancy developmental phase

  • Risk factors:
    • Child: Environmental toxicity; temperamental difficulties
    • Family: Poverty, low SES, social isolation; family violence, conflict, separation; parental psychopathology; poor health, nutrition
    • Society: Economic hardship, unemployment; family breakdown, isolation; cultures of violence
  • Potential interventions:
    • Environmental safety e.g. lead minimisation.
    • Early identification of children at risk through temperamental and behavioural problems, and families at high risk through socio-economic adversity and psychopathology.
    • Provision of adequate health care/parental and infant support programs, home visiting programs.
    • Promotion of social equality/support/community connectedness.
    • Provision of family support, education and therapy services, pre-marital and pre-parenting education programs.
    • Promotion of non-violent cultures and communities.

Toddlerhood - late childhood developmental phase

  • Risk factors:
    • Child: Learning & language difficulties; impulsivity.
    • Family: Coercive family processes/violence; low care and nurturance; inadequate monitoring of child.
    • Society: Inadequate child care & parental support; Lack of educational opportunities; negative parent-school relationship.
  • Potential interventions:
    • Early remediation of learning and language difficulties.
    • Provision of parent training and broader family interventions.
    • Family and marital support programs.
    • After-school care and monitoring of children.
    • Peer social skills programs.
    • Provision of positive school environments and educational opportunities.
    • Promotion of quality parent-school relationships.

Adolescence developmental phase

  • Risk factors:
    • Child: School — employment failure; cognitive bias to threat/hostility; peer rejection/deviant peer group; substance abuse/depression
    • Family: Conflict/individuation problems; rejection/homelessness
    • Society: Lack of education/employment; culture of violence
  • Potential interventions:
    • Cognitive-behavioural skills programs for teenagers.
    • Academic and work transition skills programs.
    • Crisis support for family/youth individuation problems, breakdown & homelessness.
    • Family-adolescent therapy services.
    • Substance abuse prevention programs.
    • Cultures of community respect and connectedness.