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Risk & Protective Factors

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Risk and Protective Factors


While anyone who uses a prescription opioid can become addicted, several risk factors are associated with higher rates of misuse, abuse and addiction. These risk factors include:

  • Past and current substance use
  • Mental illness
  • Male gender
  • Younger age

It is important to consider these risk factors when planning prevention activities.  Some risk factors, such as previous substance use, may warrant a closer look when prescribing opioids, as alternative treatments may be more suitable to prevent addiction.  For other risk factors, such as age, there may be evidence-based school- or college-based prevention activities to consider.


Cragg, A., Hau, J. P., Woo, S. A., Kitchen, S. A., Liu, C., Doyle-Waters, M. M., & Hohl, C. M. (2019). Risk factors for misuse of prescribed opioids: A systematic review and meta-analysis. Annals of Emergency Medicine, 74(5).

Katz, C., El-Gabalawy, R., Keyes, K. M., Martins, S. S., & Sareen, J. (2013). Risk factors for incident nonmedical prescription opioid use and abuse and dependence: Results from a longitudinal nationally representative sample. Drug and Alcohol Deppendence, 132(1-2).

McCabe, S. E., Veliz, P. T., Dickinson, K., Schepis, T. S., & Schulenberg, J. E. (2019). Trajectories of prescription drug misuse during the transition from late adolescence into adulthood in the USA: A nationally longitudinal multicohort study. The Lancet, 6(10).

Webster, L. R. (2017). Risk factors for opioid-use disorder and overdose. Anesthesia and Analgesia, 125(5).



Access to opioids is a primary environmental risk factor associated with opioid misuse and addiction. Environmental strategies that limit access to opioids, while keeping them available for appropriate medical uses, are necessary to address this risk factor.  Examples include prescription drug monitoring programs, pharmacy lock-in programs, and drug disposal programs.

Other Risk/Protective Factors

While the above characteristics are linked with increased risk of opioid misuse, there are many factors that are linked with an increased risk of substance abuse in general. Other factors are protective in nature and are linked with a decreased risk of substance abuse. In Wyoming, the Prevention Needs Assessment (PNA) measures some of these risk and protective factors in local communities.

The tables below list some of the general risk and protective factors associated with substance abuse.

Risk FactorsProtective Factors
Early initiation of substance useSocial, emotional, behavioral, cognitive, and moral competence
Early and persistent problem behaviorSelf-efficacy
Favorable attitudes toward substance useResiliency
Peer substance use
Genetic predictors
FamilyFamily, School, and Community
Family management problemsOpportunities for positive social involvement
Family conflictRecognition for positive behavior
Favorable parental attitudes toward substance useBonding
Family history of substance misuseMarriage or committed relationship
SchoolHealthy beliefs and standards for behavior
Poor grades in school
Lack of commitment to school
Low cost of alcohol
High availability of substances
Community laws and norms favorable to substance use
Media portrayal of alcohol use
Low neighborhood attachment
Community disorganization
Low socioeconomic status
Transitions and mobility


Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health