Research has shown that the most vulnerable years for initiating drug abuse are between the ages of 12 and 20. During this period, substance abuse has been shown to be associated with antisocial and dysfunctional behaviors, including truancy, academic failure, criminal behavior, and suicide or suicidal behaviors (Hawkins et al. 1987, pp. 81-131; Kumpfer 1987, PP. 1-72; Eggert and Nicholas 1992; Eggert and Herting 1993; Powell-Cope and Eggert 1994, pp. 23-51). Many research studies have shown that a significant precursor of substance abuse among youth is association with antisocial and substance-using peers. Lack of school bonding, as manifested by poor school achievement, truancy, alienation from school, and few extracurricular school-based activities also are factors associated with involvement with such friends. Therefore, youth who are poorly bonded to school are an obvious group to target for indicated prevention programs to help them connect with peers who are positive role models and teachers within the school setting (Huba et al. 1984a, pp. 11-23; Huba et al. 1984b, pp. 111-116; Newcomb and Bentler 1986; Eggert et al. 1990; Eggert and Herting 1991; Kumpfer et al. 1991; Eggert et al. 1994a, 1994b, 1994c).
Once youth have begun to use drugs, universal and selective prevention programs become less effective in dissuading them from continued use because these programs target the general population, most of whose members are not involved in drug abuse. Therefore, indicated prevention activities, as well as treatment programs are needed to curb continued drug abuse and reduce further substance abuse risks. Consequently, beyond the widely embraced prevention mission of educators, school and health professionals must become more aggressive in reaching out to youth who are at risk and intervening to reduce the prevalence of drug abuse and its adverse consequences.
Drug abuse problems affect persons of all ages and backgrounds, regardless of their risk factors. But research has shown that not all individuals with the same risk factors develop substance abuse problems. Genetic, family, peer and psychosocial, biological, and community factors also have been shown to influence an individual’s risk of becoming involved with substance abuse (Dupont 1989; Eggert and Herting 1993; Powell-Cope and Eggert 1994).
A risk factor is an association between some characteristic or attribute of an individual, group, or environment and an increased probability of certain disorders or disease-related phenomena (Berman and Jobes 1991). Clearly defined risk factors help prevention practitioners assess, identify, and treat at-risk individuals. Risk factors for substance abuse comprise an array of traits or characteristics that have been shown to increase the likelihood that a person will become involved in substance abuse.

The number of risk factors, however, may be offset by protective factors (Eggert et al. 1994a). It is important that a determination of risk for drug abuse assesses both risk and protective factors (Dupont 1989; Eggert et al. 1994c.)
The spectrum of risk factor characteristics or traits that render individuals vulnerable to substance abuse is presented in Table 1 (below). The elements included in this table are based on a review of the available literature by Hawkins and colleagues (1992a) and recent empirical research evidence (Powell-Cope and Eggert 1994; Thompson et al. 1994). For each risk factor an example is presented to describe the kinds of circumstances that contribute to the risk.

• Attributes of temperament such as self-esteem, feelings of autonomy and control, and a view of life as predictable and basically positive;

• Family cohesion and warmth and the absence of family discord and neglect; and

• Availability and utilization of external supports and resources (Berman and Jobes 1991; Eggert et al. 1994c; Powell-Cope and Eggert 1994).

For example, a youth may live in a neighborhood characterized by high crime rates and community disorganization but have a positive and supportive relationship with a parent, teacher, or peer who promotes abstinence from drug abuse. Thus, when the youth’s individual risk for drug abuse is assessed, both the risk and protective factors must be considered.

Prevention program strategies that are used to increase  protective  factors are presented in Table 2 (opposite). For each program strategy presented, an example describes the particular focus and expected goal of the program (Hawkins et al. 1992a).
 
 
Table 1
 Risk Factors for Substance Abuse

RISK FACTORS	Example
Family Traits
Family history of alcohol and drug abuse	Modelling of substance abuse behaviour by familymembers as well as genetic predisposition for substance abuse.
Poor and inconsistent family management practices	Low level of parental involvement in activities with their children, poor and inconsistent parental discipline, and low parental educational aspirations for children.
Family confilict	Parental discord, recent family breakups, and family member disagreements and serious fighting.
Low bonding in family	Lack of closeness and a lack of parental involvement in their children’s activities.
School traits
Academic failure	Poor school performance and poor grades
Low degree of comittment to school	Students dislike of school, little time spent on homework, low perceptions of relevance of course work, and truancy.
Peer rejection in elementary grades	A student’s low acceptance by positive peers;  appears to increase a student’s risk of delinquency, criminality, and substance abuse.
Friendship Network
Deviant peer bonding	Association with drug using peers has been shown to be the strongest predictor and also the final pathway to drug abuse amongst youth.
Personal Traits
Alienation and rebelliousness	Intolerance for conventional values of society, lack of spiritual belief system, and rebelliousness.
Attitudes favourable to substance abuse	Positive attitudes and beliefs by youth regarding substance abuse, onset and frequency of substance abuse, and beliefs and values about reasons for using substances.
Early onset of substance abuse	A predictor of continued and increasing drug involvement.

 
 

Table 2
Strategies to increase Protective Factors

Prevention Strategy	Example
Early childhood education programs	Focus on intellectual and social development to reduce academic failure, childhood behavior problems, and family management problems—all substance abuse vulnerabilities for youth.
Family programs for parents of children and adolescents	Focus on parenting skills training and family therapy to reduce family management problems and child behavior problems—risk factors for substance abuse in youth.
Social competence skills training	Focus on social competence skill building that encourages anger control, mood management, and decisionmaking in social situations to overcome aggression and other problem behaviors of youth.
Social support enhancement	Focus on expanding the social networks of youth to enhance their social bonds and potential social resources for help with school and enjoyment of pleasant recreational activities as alternatives to drug use and/or depression
Academic achievement promotion	Focus on three strategies known to increase academic achievement: Early childhood education as cited above. Modifications in classroom instructional practices to increase school         achievement (particularly understanding of mathematics) and levels of commitment to school,  as well as to reduce suspensions and  expulsions from school. Innovative teaching methods that improve school climate include: interactive  teaching, proactive classroom management, and cooperative learning. Tutoring on an individualized basis for low-achieving at-risk youth, accompanied by social competency-skills training to increase positive learning gains.
Organizational changes in schools	Focus on establishing and enforcing school substance abuse policies, holding teacher retreats, and recognizing teacher and student achievements to reduce substance abuse risk factors. A school challenged with high levels of substance abuse may have a difficult time implementing recommended prevention approaches without addressing organizational needs of the school. For example, a school principal may need to include in the teacher’s course load an indicated prevention program such as the Reconnecting Youth Program.
Youth involvement in positive activities	Focus on school-based activities, such as experience-based learning, tutoring programs, peer-group work, and skill mastery programs, which promote academic achievement and student involvement in school to reduce the likelihood of substance abuse vulnerability.
Comprehensive risk-focused programs	Address multiple risk factors that have been shown to be more effective than single-issue programs (Eggert et al. 1994a, 1994b; Eggert et al., in press).