TASK 3: Assess Intervening Variables Linked to the Problem Statement

Intervening variables are factors that have been identified through research as having an influence on substance misuse and abuse. They include, but are not limited to, risk and protective factors.

(Read more on why risk and protective factors for NMUPD should not be the sole basis for your assessment here.)

Risk factors are characteristics of school, community, and family environments―as well as characteristics of youth and young adults and their peer groups―that are known to be related to an increased likelihood of substance misuse and abuse.

Risk factors that have been specifically linked to NMUPD among 12–17 year olds include the following:

  • Perceived acceptability and safety of prescription drug misuse
  • Peer prescription drug misuse34
  • Experiencing multiple negative life events, and peer substance abuse or use35

Protective factors exert a positive influence or buffer against the negative influence of risks; they are related to reducing the likelihood that youth and young adults will engage in problem behaviors such as NMUPD. Protective factors include a high commitment to doing well in school, community norms against use,34 and a strong parental bond.35

See the CAPT Decision Support Tool: Prescription Drug Misuse: Understanding Who Is at Increased Risk for more on risk and protective factors identified through the research.36, 37

Intervening variables fall into two categories: (1) those that cannot be modified, and (2) those that can.

Factors that cannot be modified are useful for identifying the focus of prevention interventions (i.e., individuals or groups that may be at disproportionate risk). For example:

Factors that can be modified are generally the focus of prevention interventions. They include:


Evidence is mixed regarding gender differences and NMUPD. Some studies have found that adolescent females are more likely to report NMUPD.29, 38, 39 In particular, females may be more likely to report non-medical use of opioids or sedatives/anxiolytics16, 40 and are more likely to report non-medical use for the purpose of “self-treating,” compared to males who tend to report more “sensation-seeking” reasons (e.g., to get high).41

However, one study found that males reported more non-medical use of opioid analgesics than did females.30 Another study examining 2006 NSDUH data of all U.S. individuals age 12 or older found that males were more likely to report lifetime and past-year non-medical use of prescription opioids, but there were no gender differences for rates of abuse or dependence on prescription opioids.63

Additionally, males and females may gain access to prescription drugs for non-medical purposes differently. Adolescent females are more likely to obtain opioid prescription drugs for free or to steal them from a friend or relative, while adolescent males are more likely to purchase opioid prescription drugs or to acquire them from a physician.24, 34


Research has consistently found higher rates of NMUPD, including use of opioids, among individuals who identify as white, after accounting for other risk factors (availability, peer use, etc.).30, 38, 39, 40, 42 A larger percentage of white respondents reported sensation-seeking motives for NMUPD compared to non-white respondents.41

Access and Availability

Multiple studies have examined the relationship between access/availability and NMUPD.43 While causality has not been established, many studies suggest that increased availability is a contributing factor for NMUPD. Collins and colleagues, for example, found that a perception that prescription drugs were readily available was associated with increased levels of prescription drug misuse among a sample of middle and high school students in Tennessee.34

According to pooled estimates from NSDUH in 2013 and 2014, the most common source of pain relievers among 12–25 year olds during their most recent use within the past year was from a friend or relative, which they received for free (43.1% for 12–17 year olds, 50% for 18–25 year olds). The second and third most common sources were from a single doctor (22.9% for 12–17 year olds, 16.8% for 18–25 year olds) and by buying it from a friend or relative (9.4% for 12–17 year olds, 13.6% for 18–25 year olds). None of the other potential sources accounted for more than 8% for either age group.11

Perception of Risk or Harm

Ford and Rigg found a protective effect of having greater perception of risk of substance abuse on prescription opioid misuse outcomes based on an analysis of NSDUH data.44 Arria and colleagues found a similar relationship among college students.45

Parents and Family

Collins and colleagues found that greater parental disapproval toward prescription drug misuse had a protective effect on prescription drug misuse outcomes.34 Similarly, Schroeder and Ford found that stronger bonds with parents were associated with lower levels of prescription drug misuse.35 Ford and Rigg found that favorable parental attitudes toward substance use were associated with higher levels of prescription opioid misuse.44


Greater misuse of prescription drugs by peers, and peer attitudes favorable toward substance use have both been associated with prescription drug misuse.34, 44

Substance Use or Misuse

Current cigarette smoking, past-year alcohol misuse, past-30-day drunkenness, past-year marijuana misuse, past-year other illicit substance use, past-30-day other substance use, younger age of first prescription, and younger age of substance use initiation have each been associated with NMUPD.44, 46, 47

Prevention Planning