Risk and Protective Factors Flashcards
Introduction
Substance use often begins during adolescence. Individuals who begin using at younger ages are at increased risk of developing a substance use disorder because early onset usage is associated with a host of other individual and social negative consequences. In the UK, over 90% of under 18s seeking substance use treatment do so for problematic use of alcohol or cannabis, or both. Problem Behaviour Theory and Peer Cluster Theory have been proposed to aid our understanding of adolescent substance use.
Peer Cluster Theory
Peer Cluster Theory proposes that engagement in behaviours such as substance use is supported or discouraged by interactions with peers. The peer cluster is distinct from the peer group and is defined as a small unit of peers that shape attitudes and influence behaviours to a greater extent than other social network factors. The peer cluster has a powerful effect on an individual, such that they may adopt the views of their peers. Peer socialization can be overt, as in peer pressure, or perceived, where the adolescent accepts or changes attitudes and behavior based on perceived group norms that may or may not be actual. Interventions targeting risky behaviours such as addiction to illicit drugs are effective when the individual is separated from the peer cluster or the intervention targets the peer cluster directly. In support of this suggestion, exposure to friends who take drugs has been firmly established as one of the most important risk-factors for adolescent substance misuse (Jaquith, 1981; Johnson et al 1987).
Findings support proposals by peer cluster?
e.g. Robinson et al, (2006)
However, it is debated as to whether such findings support proposals such as those made by peer cluster theory, that peer norms influence individual behavior, or whether peer substance use is due to the selection of peers who have similar attitudes. For example, Robinson et al (2006) conducted a study investigating whether adolescent cigarette smoking was related to peer influences. A survey was administered to 4461 seventh-graders assessing usual sources of cigarettes and related variables. Of the target population, 79% provided baseline data, and 64.2% participated in all surveys. At baseline, 30% of the 1144 smokers got cigarettes from peers, compared with 11% using stores, 6% using vending machines, and 17% who stole them. Adolescents are therefore much more likely to get their first cigarette from peers than from any other source, suggesting the important influence of peer socialisation on substance use onset. It was also found that the longer students smoked, the more likely they were to have friends who smoked. This suggests that the individual selected friends based on their own interest in smoking.
limitation of Robinson et al (2006)
One limitation of the study is that the sample was primarily African American, and authors noted that previous research has shown some ethnic differences in the methods through which teens obtain tobacco. Nonetheless, this may suggest that peer influences act as a risk factor for substance use onset via socialization, and may serve to further develop or maintain substance use through the subsequent selection of peers. Importantly, adolescents tend to report that peer pressure for smoking tends to be due to perceived norms of the group, rather than peer pressure (Nichter et al, 1997). Peer groups is only one of many risk factors for adolescent substance abuse. Another largely influential factor is parental substance abuse.
Risk factor
Parental drug use
Parental drug use is associated with initiation of substance use by adolescence. For example, Keeley et al (2015) conducted a study using self-report data from 2716adolescentsaged 15–17 years old in Irish schools. Parentalsubstancemisuse increased theriskofadolescentabuse of alcohol and drugs. The increasedriskwas marginally higher if theparentalsubstanceabuse was maternal rather than paternal. The risk for adolescent drug abuse in particular was even higher if theparentalsubstanceabuse affected both rather than one of the parents. The magnitude of the increasedriskwas similar for boys and girls.Parentalsubstancemisuse increased theriskofadolescentsubstanceabuse even after adjusting for other family problems and theadolescent’s psychological characteristics
Risk factor
Parental drug use 2
Mechanisms of parental substance use as a risk factor for adolescents have been shown to be genetic and psychosocial. One psychosocial mechanism which may underpin the parental substance use risk factor for adolescents is family conflict. Alcoholic families report higher levels of conflict than do nonalcoholic families (Moors and Billings, 1982). This may lead to decreased family cohesion and organization, such that family rituals (i.e. dinner together or Sundays at home) could be disrupted. Wolin et al (1980) showed that disrupted family rituals was associated with greater alcohol abuse in children of alcoholics.
Risk factor
genetic heritability
Another mechanism by which parental alcoholism could be a risk factor for adolescent alcoholism is genetic heritability. Findings about the genetic transmission of substance use disorders such as alcoholism have shown that genetic risk can mediate environmental influences on adolescent SUD’s. Blomeyer et al 2008 Used 280 ps aged 15, who were genotyped and filled out a self-report questionnaire of alcohol consumption. Increased severity of adolescent Stressful Life Evenets was associated with earlier initiation of drinking alcohol and heavier alcohol consumption, but only in carriers of theCRHR1rs1876831 CC major homozygote (gene conferring to corticotroping-releasing-factor). Therefore heritability of risk genes from parents could be one mechanism by which parental substance abuse is a risk factor for adolescents.
Risk factor
genetic heritability - study limitations
However, this study has limitations. While the results appear robust, the sample size is relatively small for a genetic association study. Further research with larger samples would be required to support the reliability of this finding. As well as being a risk factor, parents can also be a protective factor against substance use in adolescents.
Risk factor
genetic heritability
Chaoyang et al (2002)
For example, Chaoyang et al (2002) conducted a study in which they surveyed students at high-school in the US. Self-efficacy of refusing drug offers were measured, as well as measures of how many friends and parents the individual has who were using drugs. Results showed that, as peer group substance use did not affect individual use when parents were non-users. However, this study excluded 14% of their participants due to missing data, thus it is a possibility that results are biased and should therefore be replicated to be considered reliable. Nonetheless, other studies have supported that parents can serve as protective factors against adolescent substance use.
Protective factor
Strict parental control
Research shows that strict parental control is a protective factor against adolescent substance use. Yu (2003) measured parents’ reports onalcoholuse and attitudes towardalcoholand examined their impact onchildren’salcoholuse. 642 dyads of parents andchildren(ages 15-18) were interviewed by telephone in New York. Parentalalcoholuse,children’salcoholuse,parentalattitudes toward underagedrinkingand parent-childinteraction were measured. While this study found thatparentaluse and attitudes do not seem to significantly affectchildren’salcoholuse, the extent to which parents prohibitchildrenfrom usingalcoholat home tends to reducechildren’s alcoholinvolvement. In addition, the greater the amount of time spent withalcohol-using parents, the more likely thechildrenare to usealcohol.
Protective factor
Strict parental control
Limitations
However, a possible confound in this study is that, parents who use substances, even when they spend a lot of time with their children, may impose less strict rules about substance use for their children, and equally those who do not may impose more strict rules, thus making it difficult to disentangle the effects of parental use and parental control. That being considered, the importance of parental control as a protective factor has been supported in many studies
Protective factor
Strict parental control
Further support
Engels and van der Vorst (2003)
For example, Engels and van der Vorst (2003) indicated that providing rules decreases the likelihood of adolescents’ drunkenness. These findings were more pronounced for boys than for girls. For both sexes, harsh discipline affected drinking behavior positively. In summary this shows that imposing rules against substance use can actually work to decrease adolescent substance use. This may be because the rules shape the adolescents perceived norms, similar to the socialization process that occurs with peers. This occurs not only in the context of parental control, but also in terms of laws on substance use.
Protective factor
Laws and regulations
Cook and Tauchen (1982)
Research on the effects of laws on alcohol consumption found that alcohol consumption is affected by price, specifically the amount of tax placed on alcohol at purchase. Cook and Tauchen (1982) found that increases in taxes on alcohol led to immediate and sharp decreases in liquor consumption and cirrhosis mortality.
Protective factor
Laws and regulations
Cook and Tauchen (1982) additional examination
Additionally, (Cook & Tauchen, 1984) studies examining the relationship of minimum drinking age and adolescent drinking and driving have generally shown that lowering the drinking age increases teen drinking and driving and teen traffic fatalities while raising it decreases teen intoxicated driving reports and deaths.
Protective factor
Laws and regulations
explanation
One explanation of how laws affect the use of substances is that laws reflect social norms and that, as discussed, use is largely a function of group norms. Alcohol consumption rates vary among different ethnic groups for example, in association with differences in the extent to which members find consumption socially acceptable. Another explanation focuses on supply and demand, legal restrictions that influence the price of alcohol or other drugs, such as taxation or laws regarding sales, appear to limit consumption. Legal restrictions on the purchase of alcohol and norms unfavorable towards alcohol use clearly are associated with a lower prevalence of alcohol abuse in adolescence.
