Do you ever find yourself reflecting about why you did a certain thing or made a certain choice after the fact? Maybe it felt like instinct, or maybe an impulsive move, maybe you didn’t think much about it since you’ve seen others around you make the same choice countless times before. This is okay, this is the way all humans behave. See, we each have biological and psychological characteristics which can make us vulnerable at times and resilient at other times when faced with behavioral health issues.

These biological and psychological characteristics exist in multiple contexts since we humans are social creatures and our society and social structures have many layers. So let’s explore that:

Risk factors are characteristics at the biological, psychological, family, community, or cultural level that precede, and are associated with, a higher likelihood of negative outcomes.

Protective factors are characteristics associated with a lower likelihood of negative
outcomes or that reduce a risk factor’s impact. Protective factors may be seen as positive countering events.

Assessing these risks and protective factors are important when considering substance use disorders. We should recall here the earlier blog, The Here & Now, https://prevention-1st.org/2022/06/15/the-here-now/ which demonstrated that for ages 1 – 44 in the U.S. in 2020, the most recent full year of evaluated data, showed that Opioids use disorder led to the highest source of injury related deaths.

To address the Opioids problem requires interventions that address raising protective factors, and identifying adverse risk factors.

Some risk and protective factors are fixed: they don’t change over time. Other risk and protective factors are considered variable and can change over time. Variable risk factors include income level, peer group, adverse childhood experiences (ACEs), and employment status.

Individual-level risk factors may include a person’s genetic predisposition to addiction or exposure to alcohol prenatally. Individual-level protective factors might include positive self-image, self-control, or social competence.

In relationships, risk factors include parents who use drugs and alcohol or who suffer from mental illness, child abuse and maltreatment, and inadequate supervision. In this context, parental involvement is an example of a protective factor.
In communities, risk factors include neighborhood poverty and violence. Protective factors could include availability of faith-based resources and after-school activities.
In society, risk factors can include cultural norms and laws favorable to substance use, as well as racism and lack of economic opportunity. Protective factors in this context include hate crime laws or policies limiting availability of alcohol.

It should be clear from the list of risk factors above that early intervention and interventions that target multiple, not single, factors are needed.

For early intervention a brief clinical screening for school year physical exams, high school and middle school sports physical exams, emergency department visits or routine primary care visits can quickly help medical providers to identify risky substance use by adolescent patients. One example is the Screen 2 Brief Intervention (S2BI) which asks a single frequency question for past year’s use of the three substances most commonly used by adolescents: tobacco, alcohol, and marijuana. A confirmation of use response prompts questions about additional types of substances used. For each substance, responses are categorized into levels of risk. Each risk level maps onto suggested clinical actions summarized on the results screen. This process could help to identify diagnosis of underlying depression or anxiety not yet being treated or a need to help the adolescent to boost self-image, self-esteem and self-control. An example of a risk (depression or anxiety) to detect and a protective factor (raising life skills) to detect and improve through the screening process.

Not every person is at the same risk to develop behavioral health issues, and interventions are most successful when matched to the target population. Some categories of interventions:

Universal preventive interventions take the broadest approach and are designed to reach entire groups or populations. Universal prevention interventions might target schools, whole communities, or workplaces.

Selective interventions target biological, psychological, or social risk factors that are more prominent among high-risk groups than among the wider population. Examples include prevention education for immigrant families with young children or peer support groups for adults with a family history of substance use disorders.

Indicated preventive interventions target individuals who show signs of being at risk for a substance use disorder. These types of interventions include referral to support services for young adults who violate drug policies or screening and consultation for families of older adults admitted to hospitals with potential alcohol-related injuries.

Obviously there is much work to be done to address the challenges of Opioids use disorder. And this is just an overview summary of approaches. It is necessary to identify the injury problem specific to a community by collecting and evaluating injury data. Then selecting and tailoring any intervention through a community needs and services assessment. These are ways that consulting with an injury prevention professional can lead to promising results for any community to address injury problems.