Helplines, Resources, and Information for Patients and Families with Substance Use Disorder

Knowing what puts someone at greater risk — or what helps protect them — is key to preventing or addressing substance use disorder early. This information comes from SAMHSA's evidence-based research.

Many factors influence a person's chance of developing a mental and/or substance use disorder. Effective prevention focuses on reducing risk factors and strengthening protective ones.

What Are Risk and Protective Factors?

• Risk factors are characteristics at the biological, psychological, family, community, or cultural level that precede and are associated with a higher likelihood of negative outcomes.
• Protective factors are characteristics associated with a lower likelihood of negative outcomes — they may be seen as positive countering events.
• Variable risk factors (those that can change over time) include income level, peer group, adverse childhood experiences (ACEs), and employment status.
• Individual-level risk factors may include a person's genetic predisposition to addiction or exposure to alcohol prenatally.
• Individual-level protective factors might include positive self-image, self-control, or social competence.

Risk and Protective Factors Exist in Multiple Contexts

People don't exist in isolation — targeting only one context is unlikely to be successful. Here are examples across three contexts:

• In relationships: Risk factors include parents who use drugs and alcohol, child abuse and maltreatment, and inadequate supervision. Parental involvement is a key protective factor.
• In communities: Risk factors include neighborhood poverty and violence. Protective factors include the availability of faith-based resources and after-school activities.
• In society: Risk factors can include norms and laws favorable to substance use, racism, and lack of economic opportunity. Protective factors include policies that limit the availability of alcohol and substances.

Risk and Protective Factors Are Correlated and Cumulative

People with some risk factors have a greater chance of experiencing even more risk factors. Young people with multiple risk factors are at a greater likelihood of developing a condition that impacts their physical or mental health. This underscores the importance of:

• Early intervention
• Interventions that target multiple factors, not just single ones

Risk and Protective Factors Are Influential Over Time

Risk and protective factors can have influence throughout a person's entire lifespan. For example, factors such as poverty and family dysfunction can contribute to the development of mental and/or substance use disorders later in life. Effective parenting has been shown to mediate the effects of multiple risk factors, including poverty, divorce, parental bereavement, and parental mental illness. The more we understand how these factors interact, the better prepared we are to develop appropriate interventions.

Types of Prevention Interventions

Prevention interventions fall into three broad categories, each matched to a population's level of risk:

• Universal preventive interventions take the broadest approach and are designed to reach entire groups or populations — such as schools, whole communities, or workplaces.
• Selective interventions target biological, psychological, or social risk factors that are more prominent among high-risk groups than among the wider population. Examples include prevention education for immigrant families with young children, or peer support groups for adults with a family history of substance use disorder.
• Indicated preventive interventions target individuals who show signs of being at risk for a substance use disorder. These include referral to support services for young adults who violate drug policies, or screening and consultation for families of older adults admitted to hospitals with potential alcohol-related injuries.