Alcohol and other drug (AOD) use is common among adolescents, and its consequences pose important public health problems. Consequently, it is essential to understand the numerous factors that place adolescents at risk for AOD use. These factors include psychological and psychiatric influences (e.g., comorbid psychiatric disorders) as well as peer, environmental, and family factors. The impact of these factors may be moderated by other influences, such as the adolescents' previous AOD use experience and gender. A thorough understanding of the factors that influence adolescent AOD use, and how their effects may change as adolescents age, is critical for the development of effective prevention and treatment efforts. KEY WORDS: comorbidity; adolescent; AODU (alcohol and other drug use); behavioral and mental disorder; psychological AODU disorder theory; peer relations; environmental factors; family AODU history; risk factors; emotional depression; anxiety; conduct disorder; attention deficit disorder with hyperac tivity; genetic linkage; literature review
Alcohol and other drug (AOD) use among adolescents is a major been public health problem and has linked to such adverse consequences as car crashes, suicide, delinquency, criminal behaviors, and psychological difficulties. Furthermore, the presence of AOD use problems during adolescence is the single most predictive factor for adult AOD dependence (Swadi 1999). Therefore, an understanding of the factors that place adolescents at risk for AOD use and abuse is critical for the development of effective prevention efforts. Many variables influence adolescents' risk of AOD use, including psychological factors; psychiatric factors, such as coexisting psychiatric disorders; and peer, environmental, and family variables. Some of these influences are more powerful than others; furthermore, their relative impact may change over the course of adolescence. This article discusses the various risk factors and the roles they play in shaping adolescents' AOD use throughout adolescence, focusing specifically on psychiatric ri sk factors. For an in-depth discussion of risk factors in general, see Hawkins and colleagues (1992).
In general, the term "psychological factors" refers to patterns of thought and behavior that exist along a continuum in the general population--including, for example, personality taits, self-esteem, and coping skills. It is a somewhat all inclusive term that is used here to refer to all non-pathological factors related to thought patterns and behaviors that may impact an adolescent's risk of developing AOD use problems.
Several studies have identified one psychological factor that is consistently related to an increased risk of AOD use problems in both adolescents and adults--a personality pattern of high novelty seeking, low harm avoidance, and high reward dependence. This constellation of traits was first implicated in alcoholism risk in adults, but has also been shown to apply to adolescents at risk for AOD use (for a review see Swadi 1999).
Another psychological factor chat has been shown to be predictive of both the initiation and continuation of AOD use is high aggressivity (Swadi 1999). For example, Reinherz and colleagues (2000) found that both teacher-rated and self-rated aggressivity at age 9 was predictive of AOD use disorders at age 21.
Low self-esteem also has been implicated in many disorders in adolescents; however, surprisingly little evidence suggests that it is a risk factor for adolescent AOD abuse (Swadi 1999). Thus, although adolescents with AOD use disorders may experience low self-esteem, it is unlikely that this low self-esteem was a causal factor for the development of the disorder.
Stressful or traumatic life events also increase adolescents' risk for developing use problems. For example, Kilpatrick and colleagues (2000) found that adolescents who witnessed or experienced physical and/or sexual assault were at greater risk for developing AOD use disorders than were adolescents without such experiences. …