What are the risk and protective factors for drug misuse? What attitudes and beliefs do people hold about the development of drug misuse? Summary of findings from two systematic reviews

Next update: Update not planned

Contact for queries or feedback

Introduction

Drug misuse is a serious public health problem worldwide. Around 275 million people used drugs in 2016, with cannabis the most common, and opioids causing the greatest harm. It is understood that individuals who begin using drugs at an early age are at increased risk of being dependent on them or developing a substance use disorder in later life.

In England and Wales, about 1 in 11 adults used drugs in 2018. In Wales, hospital admissions and deaths from drug poisoning have increased in recent years, particularly involving opioids. Drug‑related harm is much higher in more deprived communities.

We conducted two separate systematic reviews; one quantitative systematic review examining risk and protective factors for drug misuse, and one qualitative systematic review examining attitudes and beliefs surrounding the development of drug misuse.

Main points

How up to date is this evidence?

We carried out the searches for this scoping review in 2019 and identified studies published between 2000 and 2019.

What we found

Both reviews showed that drug misuse is influenced by many factors that interact, rather than a single cause. The quantitative review identified several risk factors that prevention efforts could address. While these studies cannot prove cause and effect, some findings were consistent across multiple studies.

• We are confident that these findings show a higher risk among people who start using cannabis at a young age, have friends who use substances, or have experienced childhood maltreatment.
• We are moderately confident that there is an increased risk linked to earlier use of alcohol, cigarettes or other drugs, being male, certain personality traits, bullying, and parental factors such as substance use or poor mental health.
• We are moderately confident that parental education level and parental monitoring were not clearly linked to drug misuse.

The qualitative findings suggest that prevention programmes should include multiple approaches, addressing individual, family, social, and wider community factors. People often described using drugs to cope with mental health problems, difficult life experiences (such as bereavement), social norms where drug use is common, or pressures such as academic stress. Limited support for managing pain or difficult circumstances was also linked to misuse of prescription and over‑the‑counter medicines.

What this means

These systematic reviews provide a useful overview of potential factors that could contribute to increased risk of substance use among the general population and synthesise qualitative evidence of risk and protective factors for the initiation of substance misuse.

Most identified risk factors are extremely complex, and it is likely many act as a multifaceted network rather than in isolation. However, we identified several potential risk factors that could be targeted in future prevention programmes to help reduce the number of people using drugs.

The interconnected nature of people’s reasons for initiation across all levels of the socioecological model suggest that any interventions aimed at discouraging the initial use of illegal drugs or stopping the likelihood of misuse of prescription medications should include multiple components that address these intertwined reasons.

Technical information

We carried out two systematic reviews: one looked at quantitative evidence on risk and protective factors for drug misuse, and the other examined qualitative research on people’s attitudes and beliefs about how drug misuse develops.

In the quantitative review, we rated each study’s strength and quality, then grouped similar results to identify the main factors linked to drug use.

In the qualitative review, we analysed themes in the findings and mapped them to levels of the socioecological model to show how different influences may affect someone’s decision to use or avoid drugs.

We then brought the results together in a summary report outlining the key findings from both reviews.

Glossary

Socioecological model: a model which views an individual’s behaviour as being determined by a mix of intrapersonal, interpersonal, institutional, community and public policy factors. This was used in the qualitative review to help demonstrate how different factors may influence an individual’s decision to use or not use drugs.