Substance use treatment is continuing to evolve to better meet the needs of struggling individuals and families. Once substance use treatment is initiated, it can be implied that an individual has already begun to face the many challenges of addiction. While treatment is highly beneficial and necessary, it is a response to an existing problem. What if we addressed these struggles and challenges preventatively, before they transform from a concern or fear to a difficult reality? It is important that people, particularly adolescents and young adults, are educated about the risk factors for developing a Substance Use Disorder (SUD). At Project Courage there are five core indicators that we look at to determine risk for a potential SUD: family history, adverse experiences, impaired control, age of initiation, and readiness to change. Educating our youth about these risk factors can serve as a tool for early intervention while it’s still a risk and not yet a reality.
First, it is important to gather information about an individual’s family history. Many people think genetics is the all-determining risk factor, but that isn’t necessarily true. Actually, we all have the genetic predisposition for addiction. Looking at addiction from a brain perspective, there is a rise in dopamine whenever we are reminded of something we enjoy such as sex or food. Therefore, as our dopamine levels increase so does our desire to act on such cravings. While everyone has the potential to develop an addiction, some people are more predisposed to SUD than others, bringing us back to family genetics. According to the National Council on Alcoholism and Drug Dependence, genetics make up 50% of the risk for developing alcohol and drug dependence. While there is no identified “addiction gene”, we’re looking at patterns of behavior and addiction that are inherited over generations. In addition to genetics, family history also sheds light on how family members view the possible problem. Favorable or ambivalent parental attitudes influence a young individual’s risk for developing a SUD as well.
Next, we explore an individual’s adverse experiences. Adverse experiences include stressors such as family conflict, loss, changes in the family composition, social stress, bullying, troubles in school, behavioral issues, and the presence of mental health issues or co-occurring disorders. The more stressors present over the course of an individual’s life span, the higher the risk is regardless of how long ago each stressor took place. Childhood through young adulthood are years of cognitive, physical, and emotional development. Adverse experiences have the potential to negatively impact one’s development resulting in a variety of consequences including increased risk of developing a SUD. For example, if an individual reports his or her parents divorced in the third grade and he or she was the victim of bullying in high school, the risk level increases. Further, if someone reports four or five adverse experiences, the risk level can be even more severe.
Third, we determine the extent of an individual’s impaired control. It is important to assess whether an individual has tried to cut down or stop use unsuccessfully. Alternatively, has the client desired to cut down or stop use for a prolonged period, but never taken steps towards change? According to research, either one of these increase risk more than family history. Questions asked during biopsychosocial assessments can help to determine one’s impaired control. Questions include: Have you tried to quit, or cut down your use and if so when and why? Do you use substances alone? How critical is it to you that you change your substance use? How confident are you that if you wanted to change your substance use you could? These questions give the clinician conducting the assessment insight into whether an individual has considered change before, and for what reasons, which may include both internal and external motivations. If an individual has tried to change their substance use multiple times without success, or has never attempted to change identified problematic behaviors, they are at an increased risk.
The fourth risk factor we look at is age of initiation. This is rather straightforward in that the younger an individual starts using alcohol or drugs the more their risk increases for being diagnosed with a SUD. Someone who started using alcohol or drugs at age thirteen is at a higher risk than someone who started at age sixteen.
Lastly, utilizing the Change Theory, we work to identify which stage of change an individual is in. The Change Theory assumes that all change in human behavior progresses through clear stages, and that it is significant to identify which stage of change an individual is in so that appropriate interventions can be selected. There are five stages of change: precontemplative, contemplative, preparation, action and maintenance. Precontemplative individuals may not view their use as problematic, feel others are overreacting or they may be in denial. Individuals in the contemplative stage of change are often still highly ambivalent but may be more willing to consider the possibility that they have a problem and weigh the pros and cons of changing their substance use. If an individual falls under one of these two identified stages, meaning they have not yet fully acknowledged the presence of an active problem or initiated change, they are at an increased risk. The more risk factors that are present, and the more precontemplative an individual is, the more at risk they may be.
Substance abuse can be a debilitating issue impacting individuals, families, schools, and communities. There are treatment options available to meet the unique needs of each affected individual, but there are also options available to potentially interrupt patterns or change the path of those at a higher risk for developing a SUD through education, early intervention, and support. Some of you may be familiar with the name Chris Herren; a former professional basketball player who is now a well-known public speaker, traveling to share his personal struggles with addiction, and to educate youth on the importance of healthy lifestyles and good decision-making. Speaking at over one hundred high schools annually, Chris Herren has said:
“I ask them: Why? I say this at every school – why do you feel the need to change who you are by putting substances in your body? It’s as simple as it gets. And it’s as deep as it gets. I don’t preach moderation, and I don’t preach abstinence. I tell them that in high school I wasn’t the worst kid, and I ended up a heroin addict. Don’t think it can’t happen to you. I grew up with two parents, middle class. And this was the result. Kids can take that and do what they want with it.” –Chris Herren.
I’ve seen firsthand the impact this speech has had on our youth. It raises questions, started conversations, evoked emotions, and for some it certainly hit home. These are positive outcomes. We want our youth to feel comfortable confronting their questions and their concerns. Risk factors do not define the path of an individual, but by raising awareness on what these core risk factors are for developing a SUD, we can help to positively influence young individuals to make one different choice; one that could change their path through their own self-determination.