BACKGROUND: Substance use and its related disorders represent a significant global health concern. Risk propensity refers to the general tendency to respond more positively to uncertain situations that involve a trade-off between positive and negative outcomes. Risk propensity has been identified as a factor influencing substance use.

METHODS: Multilevel meta-analysis was applied to quantitatively synthesise studies examining the associations between risk propensity and substance use and to identify potential factors that influence these relationships.

RESULTS: A total of 323 effect sizes, 186 independent samples, and 148 studies were included in this meta-analysis. The results showed that risk propensity was statistically positively associated with substance use (r = 0.116), as well as with all three main types of substances, including tobacco (r = 0.092), alcohol (r = 0.114), and drugs (r = 0.115). Such a link was not significantly different across substance types. Moderator analyses showed that the type of risk propensity assessments and age of the study samples moderated the association between risk propensity and one or more types of substance use.

CONCLUSIONS: The findings underscore the importance of considering the role of risk propensity in the initiation of substance use and developing early interventions to prevent substance use. Future interventions could consider early detection and targeted intervention for young people with a heightened risk propensity.