Familial risk factors include childhood maltreatment (including abuse and neglect), parental or familial substance abuse, marital status of parents, level of parental education, parent-child relationships, familial socioeconomic status, and child perception that parents approve of their substance use. Child maltreatment has been classified for the purpose of this paper as a familial factor, though it is important to note that not all maltreatment is perpetrated by a family member. The federal Child Abuse Prevention and Treatment Act (CAPTA) defines maltreatment as child abuse or neglect, which encompasses any act or lack of an act by a child’s caretaker that results in physical or emotional harm [28]. Childhood maltreatment, including physical abuse and neglect, has been linked to increased risk for adolescent substance use, with one study reporting 29% of children who experienced maltreatment participating in some level of substance use and another reporting 16% of maltreated children abusing substances