Parental problem drinking and anxiety disorder symptoms in adult offspring: examining the mediating role of anxiety sensitivity components

Kurzzeiteffekte und Akzeptanz einer Intervention für drogenabhängige Eltern: Das „SHIFT PLUS“ Elterntraining

Hintergrund Eltern mit einer Drogenabhängigkeit sind häufig in ihren elterlichen Kompetenzen eingeschränkt. Die Lebenswelt von Kindern, die in suchtbelasteten Familien aufwachsen, ist oft prekär, insbesondere wenn diese von der Drogensubkultur geprägt ist. Gleichzeitig stehen für Mütter und Väter mit Drogenproblemen in Deutschland keine evidenzbasierten, standardisierten Interventionen zur Verfügung.

Methode Mit SHIFT PLUS wurde ein modularisiertes Gruppenprogramm für drogenabhängige Eltern mit Kindern bis 8 Jahren entwickelt, welches ihre Elternkompetenzen und die Familienresilienz stärken sowie ihre Bereitschaft bzw. Fähigkeit zur Abstinenz fördern soll. Das Training basiert auf dem bestehenden „SHIFT“-Elterntraining für Crystal Meth-konsumierende Eltern und wurde für den gesamten Bereich der Abhängigkeit von illegalen Substanzen erweitert sowie um Module für Angehörige ergänzt. Die Umsetzung des Programms erfolgte an acht Praxisstandorten im Bundesgebiet in Kooperation von Sucht- und Jugendhilfeeinrichtungen mit N=87 teilnehmenden Eltern. Zur Evaluation der kurzzeitigen Wirkeffekte wurde ein quasi-experimentelles Forschungsdesign mit Interventions- und Wartekontrollgruppe zu zwei Messzeitpunkten realisiert. Ergänzend wurden Akzeptanz und Praktikabilität durch Teilnehmende und Trainer/innen bewertet.

Ergebnisse Das SHIFT PLUS-Elterntraining zeigte sich als praktikabel und hoch akzeptiert von teilnehmenden Müttern und Vätern, die berichteten familiäre Herausforderungen subjektiv besser bewältigen zu können. Die Wirksamkeitsevaluation zeigte zudem eine signifikante Reduktion depressiver Symptome in der IG sowie einen signifikant besseren Umgang mit dem Thema Sucht in der Familie. Ergänzend verbesserten sich beide Gruppen hinsichtlich psychischer Belastungen, Substanzkonsum und Elternkompetenz.

Schlussfolgerung Die Intervention bietet eine innovative Ergänzung zur evidenzbasierten Unterstützung suchtbelasteter Familien in Deutschland. Sie ermöglicht eine systematische Förderung elterlicher Fähigkeiten und familiärer Resilienz unter Berücksichtigung einer kooperativen Versorgung durch Jugend- und Suchthilfe. Der direkte Einbezug von Angehörigen in das Training gestattet dieser Zielgruppe zudem einen direkten, niedrigschwelligen Zugang zum Hilfesystem.

Estimating the number of children in households with substance use disorders in Germany

BACKGROUND

Parental substance misuse is reported to endanger the health and psychological development of children and adolescents. The aim of the present study was to address conceptual and methodological problems in estimating the number of children affected by parental substance misuse (CaPSM) and offer a novel approach based on survey data.

METHODS

Data came from the 2018 German Epidemiological Survey of Substance Abuse (ESA) among 18- to 64-year-olds (n = 9267) and from population statistics. DSM-IV diagnostic criteria were used to assess substance use disorder (SUD) related to tobacco, alcohol, cannabis, cocaine or amphetamine. Based on the number of household members, the number of children below age 18 years and the information on SUD status of the respondent living in this household, the number of children currently living in households with at least one member with SUD was estimated.

RESULTS

In 2018, there were 13,597,428 children younger than 18 years living in Germany. Of these, 6.9-12.3% (935,522-1,673,103) were estimated to currently live in households where at least one adult had a tobacco use disorder, 5.1-9.2% (688,111-1,257,345) in households where at least one adult had an alcohol use disorder and 0.6-1.2% (87,817-158,401) in households where at least one adult had a disorder related to the use of illicit drugs. The total number of children currently living with SUD adults in their household was estimated at 11.2-20.2% (1,521,495-2,751,796).

CONCLUSIONS

Available estimates are difficult to interpret and to compare due to a lack of clear case definitions and methodological approaches with various biases and limitations. Future estimates need to provide precise case definitions and standard approaches.

Evaluation of the mindfulness-augmented "Trampoline" programme - a German prevention programme for children from substance-involved families tested in a cluster-randomised trial

BACKGROUND

Children of substance-abusing parents are at a substantial risk of developing substance-use and other mental disorders. Children involved in substance abuse - not diagnosed with substance-use problems but integrated in psychiatric treatment or youth welfare services - constitute a particular high-risk group that is in need of substance use prevention. Emerging evidence indicates that self-regulatory determinants of substance use and other mental disorders, particularly stress reactivity, are modifiable by mindfulness-based interventions, such as mindfulness-based stress reduction.

METHODS

In this ongoing cluster randomised-controlled trial, a mindfulness-augmented version of the modularised evidence-based "Trampoline" programme for children affected by parental substance use problems is evaluated in a sample of 420 children who are from substance-involved families, aged from 8 to 12 and receiving non-substance-specific care in psychiatric or youth welfare services. Larger effects on adaptive stress-coping strategies (primary outcome), internalising and externalising problem behaviours and distress due to parental substance use are expected compared to the standard "Trampoline"-programme version. Mindfulness components will be added and regularly practiced for 30 min in each validated "Trampoline" module. Moreover, the feasibility of mindfulness-based interventions in psychiatric care and youth welfare services for children suffering from emotional and behavioural problems will be investigated in this study.

DISCUSSION

Despite recruitment challenges, this study provides a unique opportunity to develop and test a promising addiction-specific, mindfulness-based intervention for a target group at risk, i.e. children from substance-involved families.

TRIAL REGISTRATION

The trial was registered in the German Clinical Trials Register on July 16th 2018 (trial registration number (TRN): DRKS00013533 ). Any important protocol modifications are to be reported immediately. Protocol version v.2.1, 15th April 2019.

The interactive effect of paternal problem drinking and maternal problem drinking on adolescent internalizing problems

INTRODUCTION

This study examined the effects of both paternal problem drinking and maternal problem drinking on adolescent internalizing problems (depression and anxiety symptomatology).

METHODS

Surveys were administered to 566 10th and 11th grade students from the Mid-Atlantic region of the U.S. in the spring of 2007 and again in the spring of 2008.

RESULTS

Although significant main effects were not observed, significant interactions were found between paternal problem drinking and maternal problem drinking for internalizing problems, especially for boys. In general, these interactions indicated that when paternal problem drinking was high, depression symptomatology and anxiety symptomatology were lower if maternal problem drinking was low.

CONCLUSIONS

Findings from this study highlight the need to consider both paternal and maternal problem drinking when examining the effects that parental problem drinking may have on adolescent adjustment.

The role of paternal drinking problems in the psychological characteristics of high school students

Background

It has been reported that children with parental drinking problems are at increased risk of drinking problems or psychiatric diseases in adulthood. The present study was conducted to examine the psychiatric characteristics of high school students according to paternal drinking problems.

Methods

The subjects were 950 high school students (390 male and 560 female). The paternal drinking problems were assessed by using the Father-Short Michigan Alcoholism Screening Test. The Alcohol Use Disorders Identification Test, Beck's depression inventory, and Beck's anxiety inventory were used to evaluate the drinking behavior, depression, and anxiety of high school students.

Results

While male students with paternal drinking problems showed significantly increased risk of anxiety (odds ratio [OR], 2.21; 95% confidence interval [CI], 1.05 to 4.63), female students with paternal drinking problems showed significantly increased risk of depression (OR, 1.84; 95% CI, 1.24 to 2.74) according to the results of logistic regression analysis with adjustments for participants' age, whether they live together with parents, their religion, club activities, and smoking habits on the basis of students without paternal drinking problems.

Conclusion

The above results suggest that paternal drinking problems lead to unstable mentalities in both male and female students, and that a family physician should address the mental state of teenagers with paternal drinking problems during clinical encounters.

Maternal and paternal alcoholism and depressive mood in college students: parental relationships as mediators of ACOA-depressive mood link

The present study examined whether suspecting one's mother versus father of alcohol abuse was associated with parent-offspring relationships, and the degree to which parent-child relationships were associated with depressive symptoms. As compared to non-ACOAs (n=288), ACOAs (n=100) reported more negative parent-child relationships (i.e., greater alienation, poorer communication, less trust, greater emotional longing, and more negative attitudes toward the parent) and increased depressive symptoms on the POMS (McNair, Lorr, & Droppleman, 1992). A closer look revealed that suspected maternal alcohol abuse was associated with more negative mother-child relationships, whereas suspected paternal alcohol abuse was associated with more negative father-child relationships. Both maternal alcohol abuse and paternal alcohol abuse predicted depressive symptoms.

Relationships among depressive mood symptoms and parent and peer relations in collegiate children of alcoholics

Relationships among adult children of alcoholics (ACOAs) and parent and peer relations and depressive mood were examined among 136 ACOAs and 436 non-ACOAs. As compared to non-ACOAs, ACOAs reported less positive relationships to mothers, fathers, and peers, and more depressive mood; however, more positive relationships to parents and peers significantly reduced the strength of the association between ACOA categorization and depressive mood. Examination of data from ACOAs alone revealed that maternal alcoholism was related to less positive relationships to their mothers and to their peers; however, paternal alcoholism did not predict the quality of the relationship to fathers, mothers, or peers. Attachment to parents and peers and the gender of the alcohol-abusing parent were associated with depressive symptoms among ACOAs.

Use of the Panic Attack Questionnaire-IV to assess non-clinical panic attacks and limited symptom panic attacks in student and community samples

Since its development in the mid-1980s, the Panic Attack Questionnaire (PAQ) has been one of the more, if not the most, commonly used self-report tools for assessing panic attacks. The usage of the instrument, however, has come amid potential concerns that instructions and descriptions may lead to an over-estimate of the prevalence of panic attacks. Furthermore, the instrument has not been revised since 1992, despite changes in DSM-IV criteria and more recent developments in the understanding of panic attacks. As a result, this paper describes a revision of the PAQ to improve the instruction and descriptive set, and to fully assess features of panic derived from recent conceptualizations. Students meeting DSM-IV panic attack criteria and those endorsing panic attacks, but not meeting criteria, showed few differences with the exception that those not meeting DSM-IV criteria typically reported a longer onset-to-peak intensity time than did Panickers. Results were cross-validated and extended using an independent Community Sample. A full descriptive phenomenology of panic attacks is described, and future directions for studying panic attacks using the PAQ are presented.

Parental drinking as a risk factor for children's maladjustment: the mediating role of family environment

In the present study, the relationships among parental drinking, family environment, and child adjustment is investigated in a community sample of 207 10-14-year-olds. Multiple aspects of perceived family environment (e.g., cohesion, organization, conflict) as well as multiple indicators of adjustment (e.g., negative affect, feelings of competence, self-esteem) are taken into consideration. Parental alcohol problems are found to be associated with low family cohesion, poor family organization, and low global self-worth of the child. A mediational analysis reveals that the relation between parental drinking and low global self-worth is mediated by family cohesion.

DRINKING AND MOTIVATIONS TO DRINK AMONG ADOLESCENT CHILDREN OF PARENTS WITH ALCOHOL PROBLEMS

AIMS

To study the influences of parental alcohol problems on adolescents' alcohol consumption and motivations to drink alcohol.

METHODS

A community sample of 1744 adolescents from schools in South Wales completed the 6-item Children of Alcoholics Screening Test, Drinking Motives Questionnaire, and survey measures of alcohol consumption.

RESULTS

Children of parents with alcohol problems constituted almost one-fifth of the sample group and were found to drink more frequently, more heavily, and more often alone than children of parents without alcohol problems. Parental alcohol problems were also related to internal motives to drink (e.g. coping) in their adolescent children. Across the entire sample, internal motives to drink interacted with parental alcohol problems in predicting alcohol consumption and drinking frequency.

CONCLUSION

Parental alcohol problems appeared to co-exist with an asocial pattern of alcohol consumption in adolescents that involves drinking alone and drinking to feel intoxicated or to forget about problems. In addition to the external, social motives to drink, which are shared by most adolescents, nearly one in five of the adolescents studied reported salient internal motives to drink that tended to coexist with alcohol problems in their parents.

Paternal alcohol abuse: relationship between child adjustment, parental characteristics, and family functioning

This study examines possible risk factors associated with child adjustment in a sample of children with alcohol abusing fathers in Norway (N = 37). Factors included are socio-economic status, severity of the fathers' alcohol abuse, parental psychological problems, and family functioning. Children of alcohol abusing fathers were found to have more adjustment problems assessed by CBCL compared to a general population sample. The findings further suggest that child adjustment in families with paternal alcohol abuse is the result of an accumulation of risk factors rather than the effects of the paternal alcohol abuse alone. Both general environmental risk factors (psychological problems in the fathers, family climate, family health and conflicts) and environmental factors related to the parental alcohol abuse (severity of the alcohol abuse, the child's level of exposure to the alcohol abuse, changes in routines and rituals due to drinking) were related to child adjustment. The results indicate the need to obtain both parents' assessments of child adjustment, as the fathers' assessment was associated with different risk factors compared to the mothers'.

Serotonin transporter gene variation is associated with alcohol sensitivity in rhesus macaques exposed to early-life stress

BACKGROUND

Decreased sensitivity to alcohol has been demonstrated to be a predictor of alcoholism in humans, and variation in the gene-linked polymorphic region of the serotonin transporter (5-HTTLPR) is associated with the response to the motor-impairing effects of alcohol. In a nonhuman primate model of excessive alcohol intake, we have shown that decreased serotonin turnover is associated with both lower initial sensitivity to alcohol and higher prospective alcohol consumption using rhesus macaques. In addition, we have demonstrated that macaques separated from their mothers and reared in peer-only groups are more likely to consume alcohol as adults.

METHOD

To examine the relationship between serotonin transporter genotype, early rearing experience, and initial sensitivity to alcohol, peer- and mother-reared, adolescent, alcohol-naive rhesus macaques (n = 123) were rated for intoxication after intravenous administration of ethanol (2.2 g/kg and 2.0 g/kg for males and females, respectively) during two testing periods. Serotonin transporter (rh5-HTTLPR) genotype was determined using polymerase chain reaction followed by gel electrophoresis, and data were analyzed using ANOVA and the Mann-Whitney U test.

RESULTS

Our analyses demonstrate an effect of serotonin transporter gene variation on ethanol sensitivity, such that animals homozygous for the l allele exhibited decreased sensitivity to the ataxic and sedating effects of alcohol. This effect remained after correction for blood ethanol concentrations and birth cohort. When animals were segregated according to rearing condition, serotonin transporter gene variation predicted intoxication scores among peer-reared animals.

CONCLUSIONS

As in some human reports, this study demonstrates a diminution in the response to alcohol in animals homozygous for the l rh5-HTTLPR allele. The phenotypic expression of this genotype in l/s animals, however, is environmentally dependent.

Effects of alcohol on cardiovascular reactivity and the mediation of aggressive behaviour in adult men and women

AIMS

Recent models have proposed several pharmacological means by which alcohol may produce heightened aggression, among them that alcohol may both hyper-arouse the reward system and diminish the threat detection system. The current study examined these hypotheses employing heart rate and blood pressure as physiological indices of arousal, examining whether arousal differed by alcohol group, and if this related to level of aggression.

METHODS

Participants were 32 males and 32 females, aged 18-30 years, screened for physical and psychological disorder, who competed on the Taylor aggression paradigm. The gender groups were further split into half sober, half intoxicated. Arousal was measured at baseline, post-beverage consumption, and post-aggression paradigm.

RESULTS

Participants in the alcohol condition initially demonstrated slight heart rate elevations and blood pressure decreases, but showed little arousal in response to the aggression paradigm, whereas sober participants demonstrated considerable arousal on both indices. Intoxicated participants were more aggressive than sober controls; men and women did not differ significantly. Regression analyses demonstrated that change in systolic blood pressure from post-beverage consumption to post-aggression paradigm acts as a mediating variable in the alcohol-aggression relationship.

CONCLUSIONS

These results lend support to the stress-response dampening model of the alcohol-aggression relationship, and moreover suggest that the magnitude of intoxicated aggression is related to the magnitude of that dampening.

Introduction to the Special Issue on "Anxiety Sensitivity and Addictive Behaviors"

Anxiety sensitivity (AS) is a cognitive, individual difference variable characterized by a fear of arousal-related bodily sensations due to beliefs that such sensations are signs of impending catastrophic physical, psychological, or social outcomes. AS has been linked to increased risk for the development and maintenance of panic attacks and anxiety disorders, and more recently has been related to risk for other psychopathological conditions including those related to substance misuse. This article introduces a special issue of Addictive Behaviors focusing on cutting edge findings on the relations of AS to substance use and abuse. We set the stage for the following series of eight novel empirical papers by providing a review of background on the ways in which AS has been hypothetically linked to increased risk for the development of substance abuse and addiction. We also consider whether AS might be differentially related to risk for abuse of specific classes of drugs with different pharmacological effects (e.g., depressants vs. stimulants). Finally, we consider how AS might be related to substance use disorder maintenance or relapse risk through its putative effects in increasing drug withdrawal severity and in lowering tolerance for withdrawal symptoms. Our overriding goal in writing this Introduction was to provide an organizational template for integrating the featured studies and to recommend promising directions for future work into the association of AS and substance use-related problems.

Substance use/abuse and anxiety sensitivity: what are the relationships?

The eight articles in this special issue on anxiety sensitivity (AS) and substance abuse provide provocative new information on the relationships, or lack of relationships, between AS and several types of substance use and abuse. The eight articles provide data that extend our understanding of the role of AS in substance abuse with younger people, people who use substances other than alcohol, people who have disorders comorbid with substance use disorders, and people who experience chronic headaches. In addition, one of the articles attempts to determine how AS develops in relationship to parental substance abuse. Finally, several of the studies show that the three Anxiety Sensitivity Index (ASI) subscales (physical concerns, social concerns, and psychological concerns) are uniquely associated with different aspects of substance use/abuse. Each of the articles is discussed as to its merits and potential domains that may require additional research. Finally, several general suggestions are provided for new directions that research on the relations of AS and substance use/abuse should take.