• Prevention programs should be designed to enhance "protective factors" and move toward reversing or reducing known "risk factors."
• Prevention programs should target all forms of drug abuse, including the use of tobacco, alcohol, marijuana, and inhalants.
• Prevention programs should include skills to resist drugs when offered, strengthen personal commitments against drug use, and increase social competency (e.g., in communications, peer relationships, self efficacy, and assertiveness), in conjunction with reinforcement of attitudes against drug use.
• Prevention programs for adolescents should include interactive methods, such as peer discussion groups, rather than didactic teaching techniques alone.
• Prevention programs should include a parents' or caregivers' component that reinforces what the children are learning -- such as facts about drugs and their harmful effects -- and that opens opportunities for family discussions about use of legal and illegal substances and family policies and their use.
• Prevention programs should be long-term, over the school career with repeat interventions to reinforce the original prevention goals. For example, school-based efforts directed at elementary and middle school students should include booster sessions to help with critical transitions from middle to high school.
• Family-focused prevention efforts have a greater impact than strategies that focus on parents only or children only.
• Community programs that include media campaigns and policy changes, such as new regulations that restrict access to alcohol, tobacco, or other drugs, are more effective when they are accompanied by school and family interventions.
• Community programs need to strengthen norms against drug use in all drug abuse prevention settings, including the family, the school, and the community.
• Schools offer opportunities to reach all populations and also serve as important settings for specific subpopulations at risk for drug abuse, such as children with behavior problems or learning disabilities and those who are potential dropouts.
• Prevention programming should be adapted to address the specific nature of the drug abuse problem in the local community.
• The higher the level of risk of the target population, the more intensive the prevention effort must be and the earlier it must begin.
• Prevention programs should be age-specific, developmentally appropriate, and culturally sensitive.
• Effective prevention programs are cost-effective. For every dollar spent on drug use prevention, communities can save 4 to 5 dollars in costs for drug abuse treatment and counseling.

Source: Preventing Drug Use Among Children and Adolescents A Research Based Guide, National Institute on Drug Abuse, National Institutes of Health

Risk Factors

Risk factors are characteristics that occur statistically more often for those who develop alcohol and other drug problems, either as adolescents or as adults. Recent research points to a considerable number of such factors, including individual, family, and social/cultural characteristics.

Community Environment:

Living in an economically depressed area with:

• High unemployment
• Inadequate housing
• High prevalence of crime
• High prevalence of illegal drug use

Minority Status Involving:

• Racial discrimination
• Culture devalued in American society
• Differing generational levels of assimilation
• Cultural and language barriers to getting adequate health care and other social services
• Low educational levels
• Low achievement expectations from society

Family Environment:

• Alcohol and other drug dependency of parent(s)
• Parental abuse and neglect of children
• Antisocial, sexually deviant, or mentally ill parents
• High levels of family stress, including financial strain
• Large, overcrowded family
• Unemployed or underemployed parents
• Parents with little education
• Socially isolated parents
• Single female parent without family/other support
• Family instability
• High level of marital and family conflict and/or family violence
• Parental absenteeism due to separation, divorce, or death
• Lack of family rituals
• Inadequate parenting and little parent/child contact
• Frequent family moves

Constitutional Vulnerability of the Child:

• Child of an alcohol or other drug abuser
• Less than 2 years between the child and its older/younger siblings
• Birth defects, including possible neurological and neurochemical dysfunctions
• Neuropsychological vulnerabilities
• Physical disabilities
• Physical or mental health problems
• Learning disabilities

Early Behavior Problems:

• Aggressiveness combined with shyness
• Aggressiveness
• Decreased social inhibition
• Emotional problems
• Inability to express feelings appropriately
• Hypersensitivity
• Inability to cope with stress
• Problems with relationships
• Cognitive problems
• Low self-esteem
• Difficult temperament
• Overreacting

Adolescent Problems:

• School failure and dropout
• At risk of dropping out
• Delinquency
• Violent acts
• Gateway drug use
• Other drug use and abuse
• Early unprotected sexual activity
• Teen pregnancy/parenthood
• Unemployed or underemployed
• At risk of being unemployed
• Mental health problems
• Suicidal

Negative Adolescent Behavior and Experiences:

• Lack of bonding to society (family, school, and community)
• Rebelliousness and nonconformity
• Resistance to authority
• Strong need for independence
• Cultural alienation
• Fragile ego
• Feelings of failure
• Present versus future orientation
• Hopelessness
• Lack of self-confidence
• Low self-esteem
• Inability to form positive close relationships.
• Vulnerability to negative peer pressure

Risk factors are only indicators for the potential of problem occurrence. While they can be helpful in identifying children who are vulnerable to developing alcohol or other drug problems, they are not necessarily predicative for an individual child. Children growing up under adverse conditions often mature into healthy, well-functioning adults. In addition, the use of risk factors to label children poses its own risk. Consequently, there is increasing attention on those factors which seem to protect children from developing alcohol or other drug problems.

There are no simple solutions for helping youth at high risk for developing alcohol or other drug problems. Reducing risk factors and fostering resiliency are part of a comprehensive approach to prevention and are consistent with a public health approach to reducing problems.

Source: Breaking New Ground for Youth at Risk: Program Summaries. OSAP Technical Report 1 (1990) BK163

Protective Factors

Many youth, although living in high-risk environments, seem to possess resilience that helps them avoid alcohol and other drug problems. One current challenge to the prevention field is to identify these protective factors and determine how they can be instilled in all youth in high risk environments.

The following is a checklist of youth protective factors:

Community Environment:

• Middle or upper class
• Low unemployment
• Adequate housing
• Pleasant neighborhood
• Low prevalence of neighborhood crime
• Good schools
• Schools that promote learning, participation, and responsibility
• High-quality health care
• Easy access to adequate social services
• Flexible social services providers who put clients' needs first

Family Environment:

• Adequate family income
• Structured and nurturing family
• Parents who promote learning
• Fewer than four children in family
• Two or more years between the birth of each child
• Few chronic stressful life events
• Multigenerational kinship network
• Non-kin support network, e.g., supportive role models, dependable substitute child care
• Warm, close personal relationship with parent(s) and/or other adult(s)
• Little marital conflict
• Family stability and cohesiveness
• Plenty of attention during first year of life
• Sibling as caretaker/confidante
• Clear behavior guidelines

Constitutional Strengths:

• Adequate early sensorimotor and language development
• High intelligence
• Physically robust
• No emotional or temperamental impairments

Personality of the Child:

• Affectionate/endearing
• Easy temperament
• Autonomous
• Adaptable and flexible
• Positive outlook
• Healthy expectations
• Self-efficacy
• Self-discipline
• Internal locus of control
• Problem-solving skills
• Socially adept
• Tolerance of people and situations

If the high-risk environment is the family itself--for instance if children are growing up in an alcoholic or drug-abusing family--studies suggest that they have a better chance of growing into healthy adulthood if they:

• Can learn to do one thing well that is valued by themselves, their friends, or their community;
• Are required to be helpful as they grow up;
• Are able to ask for help for themselves;
• Are able to elicit positive responses from others in their environment;
• Are able to distance themselves from their dysfunctional families so that the family is not their sole frame of reference;
• Are able to bond with some socially valued, positive entity such as school, community group, church, or another family;
• Are able to interact with a caring adult who provides consistent caring responses.

Protective factors along with risk factors need to be more widely publicized for the use of parents, gatekeepers, and prevention planners. While many of the factors listed are the result of external forces, those factors that may be taught or instilled in children can provide some protection to youth at high risk for alcohol or other drug problems.

Source: Youth at High Risk for Substance Abuse, National Institute on Drug Abuse (1990), BKDO6

Hawaii Department of Health
Alcohol and Drug Abuse Division
601 Kamokila Blvd. Room 360
Kapolei, Hawai'i, 96707
(808) 692-7506