Today’s episode is the second in my series on adolescent substance use. You can go back to episode #175 if you want to start with why teens use substances, or you can stay right here and listen to me discuss the risk factors for adolescent substance use and go back and listen later.

You know, I’ve been thinking about why it took me almost 2 and a half years of this podcast to do a few solo episodes on substances. And I think I can safely say that it’s just one of those topics that hits me at my core.

My brother became a drug addict in his teens and died a drug addict several years ago.

That life experience impacted my relationship with my own son when he started smoking weed in high school.

Substance use leaves a legacy and if you’re like so many of us, you may have someone in your family that has left you just as terrified about your child developing a problem as my brother left me.

Listening to me talk today about some of the risk factors for substance use and substance use disorders might be difficult for you. But knowing whether or not your child is up against 1 or multiple risk factors can help you plan ahead and possibly prevent serious problems from developing. Just like knowing you have risk factors for certain cancers or heart disease prompts you to eat healthier and exercise.

So, please stay with me.

PODCAST INTRO

As I said in the last episode, believe it or not, the vast majority of adolescents do not use substances.

But the scientific research shows that people who start using substances (alcohol, nicotine, marijuana or other drugs) and end up misusing substances or developing a substance use disorder, go through certain stages of use: initiation, escalation, maintenance and finally, addiction.

But there are some people who can try a substance here and there and then never touch it again, or in moderation for many years and never escalate and still others who escalate then quit, and those who can go from initiation to addiction seemingly overnight.

People travel vastly different paths when it comes to substance use and this is really important to understand.

Behavioral scientists use a framework to look at the various factors that determine the different pathways to substance use and substance disorders.

The framework considers both the individuals characteristics like personality traits, mental health, neurological development, and genetics, as they interact with environmental factors (like the family environment and the broader environment like neighborhoods and media).

It appears that like so many other things about us - our use or misuse of substances is part nature and part nurture

Our brain starts out with certain predetermined genetic factors (some of which may make it more likely or less likely to be susceptible to substance use issues) and then as we interact with our environment in childhood and adolescence, our brain is molded based on our life experiences – our individual interactions with our environment.

These interactions literally change the structure and function of our brain.

So, whether someone develops a substance use problem during their lifetime, depends on the brain they start out with, and the environment in which they live during childhood and on through adolescence while the brain is still being formed – on up through the mid to late 20s.

And within that environment (for example someone’s home, school, neighborhood) – the experiences our kids and teens have are crucial because there are plenty of risk factors that can make it more likely for them to develop a substance use issue – especially when combined with their individual brain-based risk factors.

While there’s no single element alone that will definitively lead to substance use or a substance use disorder, there’s a threshold at which each individual, through a combination of these factors, may end up with a brain that’s primed for substance use or one that isn’t.

 

Let’s talk about individual genetic-based characteristics first.

These are the susceptibilities that tend to tip the scales a bit and make a person more at risk for substance use and substance use disorders than not.

Again, remember, it doesn’t mean they will develop a problem, these genetic factors combine with environmental factors and are influenced by other protective factors.

But it does mean you need to be aware so you can be more vigilant, talk to your teen about it, and make sure you provide all the support you can.

Now, because so much is said about how substance issues are inherited – let’s address that first.

A 2023 study done in association with the National Institutes of Health in the US with more than 150 co-authors worldwide, examined genomic data from over a million people and singled out specific genes that are inherited – no matter the type of addiction disorder or the substance being used.

This study is really significant in that it focused on addiction in general where most studies have focused on individual substances. They used a method that has just emerged in the last few decades that involves searching entire genomes to pinpoint areas where the genes vary among multiple people that have the same disease or condition - or in this case a disorder. (the variations are called single-nucleotide polymorphisms)

These scientists examined the genome that is associated with a general risk of addiction as well as the risk of alcohol, nicotine, cannabis and opioid use disorders from about 50/50 people of African and of European ancestry.

They also found that this genomic pattern predicted a higher risk of certain mental health disorders and physical illnesses – which also strengthens the argument that substance use, and mental health disorders should be treated in tandem.

The authors of the study are hoping their findings will give more people knowledge that can empower them to make more informed decisions about their own drug use and that it will eventually lead to more individualized treatment and prevention methods.

 

What about personality traits? Specific personality traits have been associated with substance use - people who seek out highly stimulating and risky situations – things that are new and fun and different - and they’re usually not as worried about the consequences of their behavior as other people. So, they’re much more likely to say, “yeah, let’s do it” than to be cautious about it or worry about getting in trouble. They have poor self-control, they’re impulsive, and they may even be more aggressive.

Now, here’s the problem – most adolescents have these traits on the low to mid-range of the spectrum – there are degrees of risk-taking and degrees of not worrying about the consequences and degrees of lack of self-control. So, a teen who is at the high end of the spectrum on all of these things, is more at risk for substance use and misuse.

But I’ll also add, those personality traits can also be seen in many very high performing athletes, celebrities and CEOs. A lot of it is about routing those impulses and that need for speed in the right direction. This is why I tell people to help your teen experience new and different exciting things, help them find their passion if possible. If you can get a kid like this trained in the right direction, you may be able to avoid a lot of problems.

However, it is true that because of the way the adolescent brain develops (listen to the previous episode) that most people use substances for the first time – the initiation part of the path – during early to mid-adolescence. And for those who continue and escalate their use, it peaks at the transition into young adulthood.

Additionally, certain mental health disorders like anxiety, depression, post-traumatic stress disorder (PTSD), conduct disorder, oppositional defiance disorder, ADHD, and antisocial personality disorder are - as the literature puts it - “strongly and consistently related to the risk of harmful use of substances”. As a matter of fact, people with these conditions are also more likely to use at an earlier age. And those with mood and anxiety disorders are at double the risk of developing a substance use disorder.

This is why it’s so important to understand your teen’s moods and emotions and be connected enough to them that they will share how they’re feeling so you can get them the professional help that they need sooner rather than later. If you’re having trouble figuring that out, post in our Facebook group and we’ll help.

If your child has ADHD, work with your school for accommodations, work with an executive function coach, use medication if it’s recommended – this isn’t just about school work, it’s about being able to have better social interactions, self-control, emotional stability, adaptive behaviors – the very things they’re lacking that might lead to substance use.

Then there are those with emotional and physiological stressors or traumas, which can also lead to higher levels of impulsivity and maladaptive behaviors like substance use.

For example, adverse childhood experiences are traumatic events that happen between ages 1 and 17. Thing that leave a child feeling terrified, helpless, at risk of danger or physically hurt (like natural disasters, sexual abuse, parental divorce, bullying and on and on).

These experiences, especially in early childhood, have the potential to modify how a person’s environment, thereafter, interacts with their genetic makeup. So, ACE’s are associated with an increased risk of substance use and substance disorders. This does not mean all kids exposed to these types of stressors will develop a problem – remember, this is one risk factor.

Interventions and appropriate supports can reverse the negative impact. Kids who have experienced these things do need counseling – the earlier the better but even in adolescence it’s not too late.

Another individual factor that is often overlooked is adoption. Like substance use in general, I’ve rather avoided the link between adoption and substance use since we adopted our son at birth. But if you’re an adoptive or foster parent – you have to face it head on or possibly get caught off guard. All adopted kids have experienced trauma – whether they were adopted at birth or at any point thereafter. There may also be additional genetic factors at play. Unfortunately, research shows that adoptees are almost twice as likely to have substance use disorders as non-adoptees.

It's not that easy to find therapists or coaches who work with adoptees but it’s possible. I recommend checking out Beth Syverson’s website and podcast, Unraveling Adoption. She’s and adoptive mom and coach, has a support group and keeps a database of people who work with everyone in the adoption constellation. In interviewed Beth in episode 141 about trauma and substances. I’ll have the links in the show notes.

 

Again, none of this means that if you have a child with anxiety or one who’s a risk taker or you adopted your child that they will use substances or develop a problem.

However, it does mean that you should be more aware and vigilant if your teen has any of these attributes and certainly if they have several.

 

Now, let’s look at some of the environmental risk factors that can contribute to the likelihood of substance use or disorders – starting at the micro-level with families, schools and peers.

For example, it’s been shown that harsh, restrictive, inconsistent, hostile parenting or having lots of conflict in the family, often leads to negative and maladaptive behaviors in kids including substance use. And at the extreme – abuse, neglect, and domestic violence within families – we obviously see an increased risk regarding substances.

Additional family risk factors include:

1. A lack of family cohesion – this means a lack of emotional connection or total emotional disengagement – everyone just operates independently.
2. Poor family management – this refers to having a lack of clear expectations for behavior, lack of proper supervision – that kind of thing.
3. A chaotic home environment – meaning lots of confusion, disorganization, rushing around, crowded, cluttered, noisy
4. Ineffective parenting, includes focusing on kids’ negative attributes, giving kids orders and commands, use of coercive tactics, physical discipline or focusing on corrections
5. A lack of mutual attachment between the parents and kids, or
6. Lots of family stress

Studies also show that girls may be more susceptible to these types of family-centered issues than boys – they’re just more sensitive to these relational types of problems.

So, obviously, if these are the risk factors in families, the protective factors are just the opposite: extended family support, emotional connection and engagement with your kids, having clear expectations, consistent discipline, and proper supervision, having a calm, organized, quiet, uncluttered, uncrowded home (easier said than done – I know), keeping the stress to a minimum, and using effective parenting techniques (like those I teach in Parent Camp, kind but firm with attention to emotions).

https://youth.gov/youth-topics/risk-and-protective-factors

Schools also play a major role in whether or not a kid may turn to substances. Of course, truancy, suspension and expulsion are major factors but studies have also shown that ineffective teaching practices, unqualified teachers and poor-quality curricula are also factors in whether students end up turning to substances. These things stack up and can lead to lower levels of cognitive functioning, poor social skills, high stress and more – all of which are implicated in substance use.

Another key factor with schools is whether or not a kid has a feeling of belonging or connection to their school. If they don’t or experience conflict with their peers at school, they are more likely to develop mental health problems and more likely to use substances. Schools have simply got to do a better job of helping all students feel like they belong and have allies at their school. We’ve got to make schools less like prisons and more like places where kids feel safe, welcome, and supported.

Unfortunately, there’s also a strong association between adolescent substance use and hanging out with friends who use substances. Of course, we know this. If they hang out with friends who’re drinking or doing drugs or vaping, they’ll have more access to these things, more opportunities to use and built in reinforcement to keep using. And teens simply tend to do what their friends do (because of that deep need for acceptance and perhaps also because teens choose friends who are most like them).

And actually, the closer the friend is, the more likely a teen is to change their behavior to please that friend. They spend more time together so there’s simply more emulating going on.

There’s also this phenomena among adolescents called “pluralistic ignorance”. Teens are often convinced that more of their peers are actually using substances than they actually are. This is because, if they’re hanging out in a group who tends to use substances, they think all teen groups are using substances, which makes it more likely that they themselves will continue using substances. Many teens start drinking or vaping or using weed because they’re under the incorrect assumption that everyone else is doing it.

This is why some prevention programs now stress the statistics that show the majority of teens do not use substances. But it may be a hard to convince them – so many teens who do use, simply believe everyone does.

It may be easier to convince younger teens of this, so they know they can find other people who are going to feel the same way they do and avoid drinking or doing drugs.

Here again girls are more at risk for substance use with peers on several fronts.

Girls are more sensitive overall to peer approval than boys so they’re more likely to use substances when a friend or partner is using. They’re also more likely to suffer from depression and body image issues – both of which ramp up their risk for using.

Unfortunately, girls who go through puberty and mature earlier are at even higher risk because they’re more likely to hang out with older boys, who may introduce them to substances.

Additionally, when girls are going through puberty, they’re more likely than boys to be in conflict with their parents – there are arguments about their friends, dating, and other typical control issues that arise when parents fail to realize their shifting parental role. Again, learn proper methods to strengthen your connection and decrease the conflict with your teens.

Of course, there are also environmental factors that can increase the risk for substance use or misuse, on a macro scale. For example, a teen’s neighborhood. The social conditions in a person’s neighborhood are a huge factor in substance use. The neighborhood influences social norms, stress responses, and even influences the perception of the risk of using substances.

One aspect of this influence is social cohesion, meaning the satisfaction and attachment level with the neighborhood and the residents – it involves trust and support for each other in the community.

It appears that the higher levels of social cohesion are associated with lower levels of substance use among adolescents and fewer drug-related deaths. Not surprisingly, the opposite is also true. Kids living in urban low-income housing marked by drug activity and those living in impoverished communities are at higher risk for drug use as are those impacted by discrimination and social exclusion.

 

And, of course, the media is also a huge influence on risk of use – substance use is often glamorized or made to seem quite normal in movies, TV, music and on social media. All of which has been linked to the initiation of or increased use of substances in young people. For example, at least one U.S. study found a link between the portrayal of cannabis use in popular music and the initiation of use in kids who listen to it.

 

In wrapping it up here, one of the main points I want to drive home about these risk factors is…now that you understand them, your teen needs to as well. They need to understand, if they have one or more of these risk factors, they need to be especially cautious about ever trying substances. They need to understand how their brain works and where things can go wrong and what a huge difference it can make in the trajectory of their life.

Unfortunately, we can’t just wish these risk factors away. We have to be proactive, get ahead of it, if possible, get them the support they need, and stay on top of things supervision-wise.

Do whatever you can to work on your relationship with them, strengthen your connection and learns the skills you need to decrease the conflict.

I also mention many of things in episode 175 that you can do to create a supportive environment to support your teen in not using substances, so go back and give it a listen before we continue the series in the next episode.

Alright, that’s it today for Speaking of Teens. I certainly hope you got something out of today’s episode and will come back for more. I’m happy you found me, I hope I can help you parent your teen the way you’d like to, and I hope you’ll pay it forward by sharing the podcast with a few of your friends. My goal is to help as many parents as possible and I can only do that with your help. We don’t want anyone left out there struggling or wondering what to do about a situation with their teen, right?

And if you need more support, please come join us in the Facebook Group. The link is at the bottom of the episode description, right where you’re listening.

Until next time, remember to connect in at least some small way with your teen, each and every day.