Addiction is a serious issue in the United States, and adolescents are not exempt from its destructive effects. Based on a national survey conducted in 2015, about 1.3 million adolescents, or about 1 in 20, needed treatment for a substance use disorder.1 Why some adolescents develop an addiction while others do not is not fully understood. There is no simple, single cause; rather, it is thought that a combination of social, environmental, and biological factors contributes to the onset of substance use behaviors and, eventually, addiction. Some major risk factors for adolescent substance abuse include:2
- Abuse, including childhood mistreatment and sexual abuse.
- Social problems, including dysfunctional peer relationships.
- Individual variables, including genetics and the presence of mental health issues.
- Family problems, including divorce and parental substance use.
As noted in numerous research studies, abuse is a major risk factor in the development of substance use and addiction. Abuse can take different forms, and while many adolescents experience it, only some abuse survivors go on to develop an addiction.2,3 For those who do, it is possible they turn to drugs and alcohol to cope with the trauma, depression, anxiety, and other emotions that can result from abuse.2 Abuse can occur on a number of levels. Some of the more commonly seen types of abuse associated with adolescent substance use disorders include:2,4
- Sexual abuse: A history of sexual abuse is highly correlated with the development of addiction; studies indicate that it may raise the risk of substance abuse 2 to 4 times more than that of adolescents who have not been abused. Childhood sexual abuse is also a strong predictor of alcohol use at an early age in females, with girls who have been sexually abused being 4 times more likely to drink before the age of 10 than girls who did not report sexual abuse. Between the ages of 10 and 14, girls who were sexually abused were 76% more likely to use alcohol than girls who were not.
- Physical abuse: Some researchers have concluded that physical abuse may be an even greater risk factor than sexual abuse. Similar to victims of sexual abuse, those adolescents with a history of physical abuse may turn to substances as a means of coping. Overall, the increased risk for substance abuse in youth who have experienced physical abuse is 2–4 times greater than for those who have not been abused.
- Emotional or psychological abuse: This risk factor has not been studied as thoroughly as physical or sexual abuse, and the association between this form of abuse and addiction is significantly weaker than for the other two. Nevertheless, emotional abuse increases the risk of adolescent substance abuse by as much as 2 to 3 times that for non-abused teens.
Of course, not all adolescents who develop an addiction have a history of abuse. Other factors, such as social influences that are present in childhood or adolescence, may also influence the risk of addiction. Some influential social risk factors are:2,6,7
- Bullying: Interestingly, this is a risk factor whether the adolescent is the perpetrator or the victim. Teens of both genders who are the victims of bullying are more likely to use marijuana, inhalants, and hard drugs. Overall, bullying victims are twice as likely to use substances as teens who have not been bullied.
- Negative peer influences: Teens’ friends play an important role in the development of addiction too. Associating with peer groups who use drugs and alcohol is a substantial risk factor associated with greater rates of substance abuse.
- Peer pressure: This risk factor contributes to higher rates of cigarette and alcohol use. Adolescents who reported using alcohol or other drugs prior to age 13 noted that the opinion of their peers was highly important to them, ranking it as higher than their parents’ opinions. Adolescents who used substances at an older age did not value the opinion of their peers as much.
- Gang affiliation: That this is a risk factor for drug abuse is not surprising given the antisocial and risk-taking behaviors that are prevalent among those in gangs. And while not all gang-involved youths use drugs, drug abuse is more likely with gang affiliation than with other types of negative peer groups.
Although abuse and social influences can be major risk factors for adolescents developing addiction, there are several individual variables, such as the presence of pre-existing mental health issues, that could also impact the likelihood of developing addiction, including:2,3,8-12
- ADHD: There are many studies that indicate that Attention Deficit Hyperactivity Disorder (ADHD) is a risk factor for substance abuse; in general, having childhood ADHD is associated with a 2.5 times greater likelihood of developing a substance abuse problem later in life than it is for those who do not have ADHD. While older studies have suggested that ADHD medications contribute to addiction later in life, recent research concludes that treating ADHD with medication actually reduces the later risk of a substance use disorder by as much as 85%.
- PTSD: Post-Traumatic Stress Disorder (PTSD) is a behavioral health disorder that can develop after a person experiences severe trauma. Some studies indicate that adolescents with substance abuse disorders are 5 times more likely to have PTSD than teens who do not have a substance abuse disorder. When a person has PTSD, they may try to self-medicate the symptoms related to their trauma with drugs or alcohol.
- Depression: The sad, lethargic, or angry feelings that may result from depression can impair a teen’s normal functioning in daily life. They may then choose to abuse drugs or alcohol in an attempt to alleviate these symptoms. Depression in males is more likely to result in substance abuse—particularly alcohol abuse—than it is in females. Overall, adolescents who experienced major depression were twice as likely to start using drugs or alcohol than those who did not.
- Genetics: This accounts for 40–60% of the predisposition for substance abuse, although having relatives who have addictions does not automatically mean an adolescent will have one.
- Having a risk-taking personality: Adolescents who have poor impulse control or who are thrill-seekers are at a significantly higher risk of substance abuse than adolescents who score low in these areas.
In addition to the numerous social and individual risk factors for developing a substance use disorder, family problems can increase the risk of a teen developing an addiction too. Specific risk factors include:2,7,13-16
- Divorce: Reasons related to divorce that contribute to an increased risk of an addiction include less supervision in single-parent families, more financial strain, and emotional distress. One study indicated that teens in a single-parent home were 20% more likely to use marijuana than teens in a 2-parent home.
- Domestic abuse: Teens who witness domestic violence are 2 to 3 times more likely to smoke cigarettes, drink alcohol, and use illicit drugs than those who do not. Researchers believe that children exposed to domestic violence experience extreme stress and use substances to cope.
- Neglect and a lack of supervision: Parents who do not pay attention to what a child is doing increase the risk that they will engage in substance abuse. Adolescents who are unmonitored by parents and left to supervise themselves are more likely to use illicit substances. Conversely, parents who supervise their teens and enforce rules can reduce the risk of substance use. A recent study showed that adolescents with authoritative mothers (high in empathy and maintaining healthy boundaries) are 43% less likely to use marijuana and 38% less likely to binge drink alcohol.
- Parental substance use: Parents who abuse substances to cope with stress are more likely to have children who follow their example, and having alcohol or drugs in the house makes it easier for kids to access them too. Adolescents were about 2.5 times more likely to use drugs if a parent used drugs or alcohol.
- Permissive attitudes toward drugs and alcohol: Parents who view experimenting with drugs or alcohol as normal teenage behavior more often have children who use drugs and alcohol. Parents who know their children are using drugs but make little effort to intervene also increase the risk of substance abuse in adolescents. Teens who perceive their parents as permissive toward drugs and alcohol were about 30% more likely to use these substances than teens who felt their parents disapproved.
- Center for Behavioral Health Statistics and Quality. (2017). Results from the 2016 National Survey on Drug Use and Health. Rockville, MD: Substance Abuse and Mental Health Services Administration.
- Whitesell, M., Bachand, A., Peel, J., & Brown, M. (2013). Familial, Social, and Individual Factors Contributing to Risk for Adolescent Substance Use. Journal of Addiction, 2013, 1–9.
- Youth.gov. (n.d.). Substance Abuse: Risk & Protective Factors.
- Sartor, C.E., Waldron, M., Duncan, A.E., Grant, J.D., McCutcheon, V.V., Nelson, E.C., et al. (2013). Childhood Sexual Abuse and Early Substance Use in Adolescent Girls: The Role of Familial Influences. Addiction, 108(5), 993–1000.
- Chen, W.Y., Propp, J., & Corvo, K. (2011). Child Neglect and its Association with Subsequent Juvenile Drug and Alcohol Offense. Child and Adolescent Social Work Journal, 28(4), 273.
- Ttofi, M.M., Farrington, D.P., Lösel, F., Crago, R.V., & Theodorakis, N. (2016). School Bullying and Drug Use Later in Life: A Meta-Analytic Investigation. School Psychology Quarterly, 31(1), 8–27.
- Kingston, S., Rose, M., Cohen-Serrins, J., & Knight, E. (2017). A Qualitative Study of the Context of Child and Adolescent Substance Use Initiation and Patterns of Use in the First Year for Early and Later Initiators. PLOS One, 12(1), e0170794.
- Harstad, E., Levy, S., & Committee on Substance Abuse. (2014). Attention-Deficit/Hyperactivity Disorder and Substance Abuse. Pediatrics, 134(1), e293-e301.
- Deykin, E.Y. & Buka, S.L. (1997). Prevalence and Risk Factors for Post-Traumatic Stress Disorder Among Chemically Dependent Adolescents. The American Journal of Psychiatry, 154(6), 752.
- Youth.gov. (n.d.). Mental Health: Co-Occurring Disorders.
- Bartlett, R., Brown, L., Shattell, M., Wright, T., & Lewallen, L. (2013). Harm Reduction: Compassionate Care of Persons with Addictions. Official Journal of the Academy of Medical-Surgical Nurses, 22, 349–358.
- Chakravarthy, B., Shah, S., & Lotfipour, S. (2013). Adolescent Drug Abuse—Awareness & Prevention. The Indian Journal of Medical Research, 137, 1021–1023.
- Hemovich, V., Lac, A., & Crano, W.D. (2011). Understanding Early-Onset Drug and Alcohol Outcomes Among Youth: The Role of Family Structure, Social Factors, and Interpersonal Perceptions of Use. Psychology, Health & Medicine, 16(3), 249–267.
- Shakya, H.B., Christakis, N.A., & Fowler, J.H. (2012). Parental Influence on Substance Use in Adolescent Social Networks. Archives of Pediatrics & Adolescent Medicine, 166(12), 1132–1139.
- Murray, M.A. (2015). An Exploration of Negative Family Factors and Substance Use Amongst Adolescents: The Lasting Effects of Family Substance Use, Parental Criminality, and Parental Corporal Punishment.
- Becoña, E., Martínez, Ú., Calafat, A., Fernández-Hermida, J.R., Juan, M., Sumnall, H., … et al. (2013). Parental Permissiveness, Control, and Affect and Drug Use Among Adolescents. Psicothema, 25(3).