focuses on the general population or population subgroups that are not currently at high risk for SUDs. Selective prevention targets individuals and groups at greater risk of developing SUD-related problems. Finally, indicated prevention focuses on those who are already in the early stages of problematic substance use. Each type of prevention is integral to a robust and comprehensive prevention strategy.

Risk and Protective Factors for SUDs

Effective prevention programs are intended to diminish risk factors and promote protective factors for substance use. Risk factors can be divided into three categories: individual, social, and environmental. Examples include a genetic predisposition to SUD, low self-confidence, low self-efficacy, poor decision-making skills, negative peer influences, and permissive attitudes toward substance use by parents and the community, among others (Lowinson, 2005; NRC and IOM, 2000). Protective factors include, for example, having emotionally supportive parents with open communication styles who are aware of their children’s potential for substance use, a strong family orientation, religion/spirituality, involvement in organized school activities, and a strong sense of connection to teachers and school. The National Institute on Drug Abuse’s (NIDA’s) (2009b) Prevention Research Review Work Group advocates the use of a biopsychosocial approach to identifying risk and protective factors, which involves assessing context (e.g., school, workplace, military) and stage of development (e.g., early childhood, adolescence, young adulthood) (see also NRC and IOM, 2009, and Robertson et al., 2003). This section reviews evidence on risk and protective factors for SUDs by domain (i.e., individual, social, environmental) and developmental stage (i.e., childhood, adolescence, adulthood).

Risk Factors

Most individual risk factors are identified in children and adolescents (e.g., childhood maltreatment/abuse) (Horwitz et al., 2001; Hussey et al., 2006; Mayes and Suchman, 2006; NRC and IOM, 2009; Sternberg et al., 2006; Trickett et al., 2011). Some individual risk factors, however (e.g., intimate partner violence, including physical, sexual, or emotional abuse and/or coercion and degradation) (Campbell, 2002), apply more specifically to adults. While genetic susceptibility to SUD is not modifiable, recent research on executive cognitive function and arousal mechanisms in the prefrontal cortex portions of the brain suggests that sensation seeking can be controlled and redirected by pharmacotherapeutic agents (Kalivas and Volkow, 2005). There is also evidence that prevention activities can ameliorate genetic risk (Brody et al., 2009). Social (or group) risk factors include family risk factors (e.g., modeled family drug use behavior, family



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