Treatment-seeking young adults from families with alcohol problems. What have they been through? What state are they in?

Perceived parental alcohol problems and drinking patterns among adolescents in Sweden

Introduction

Much research into the links between parental problematic alcohol use and adolescent substance use has focused on clinically diagnosed parental alcohol disorders. Few prior studies have utilised validated measures of adolescents' perception of parental alcohol problems and considered the severity of these problems. This study examined the associations between the severity of perceived parental alcohol problems and adolescents' drinking patterns in a Swedish national sample.

Methods

We used survey information from grade 9 and 11 students (15-18 years) from 2021 (n = 9,227). Perceived parental alcohol problems were measured by the short version of The Children of Alcoholics Screening Test (CAST-6). The outcomes were: alcohol consumption during the past 12 months, frequent heavy episodic drinking (HED), and early alcohol debut (before age 14). Sociodemographic characteristics were adjusted for.

Results

Binary logistic regressions showed that the severity of perceived parental alcohol problems was associated with alcohol consumption during the past 12 months (low severity OR 1.53, p < 0.001; moderate severity OR 1.85, p < 0.001; high severity OR 2.52, p < 0.001), HED (low severity OR 1.16, n.s.; moderate severity OR 1.31, n.s.; high severity OR 1.64, p < 0.01), and early alcohol debut (low severity OR 1.57, p < 0.001; moderate severity OR 1.65, p < 0.001; high severity OR 2.20, p < 0.001).

Conclusions

Adolescents with perceived parental alcohol problems are more likely to have risky drinking patterns themselves, and the likelihood becomes higher with increased severity. Effective interventions for children whose parents have drinking problems are important, and should also take the severity of the parents' drinking problem into account.

Community reinforcement and family training (CRAFT) - design of a cluster randomized controlled trial comparing individual, group and self-help interventions

BACKGROUND

Around 585,000 people in Denmark engage in harmful use of alcohol with 140,000 suffering from outright alcohol dependence. The concerned significant others (CSOs) are affected by the drinking, often suffering almost as much as the person with alcohol use disorder. Community Reinforcement and Family Training (CRAFT) is aimed at CSOs who struggle unsuccessfully, in an effort to motivate their loved ones to stop drinking and seek treatment. The aims of this study are 1) To implement CRAFT interventions into the daily routine of operating Danish alcohol treatment centers 2) To investigate whether 6-week-individual CRAFT, 6-week-open group-based CRAFT or CRAFT based on self-help material, is efficient in getting problem drinkers to seek treatment for their alcohol problems 3) To investigate which of the three interventions (individual, group or self-directed CRAFT) is the most effective and in which group of population.

METHODS

The study is a three-arm, cluster randomized controlled trial: A: individual CRAFT, group CRAFT, and CRAFT as a self-help intervention. A total of 405 concerned significant others to persons with alcohol abuse will be recruited from 24 alcohol outpatient clinics. The participants will fill out a questionnaire regarding i.e. life quality, if the drinking person entered treatment (main outcome) and satisfaction with the intervention, at baseline and after 3 and 6 months.

DISCUSSION

We expect to establish evidence as to whether CRAFT is efficient in a Danish treatment setting and whether CRAFT is most effective at individual, group or self-help material only.

TRIAL REGISTRATION

Clinical trials.gov ID: NCT03281057 . Registration date: September 13th, 2017.

An upbringing with substance-abusing parents: Experiences of parentification and dysfunctional communication

Aim

To increase understanding of the consequences of growing up with substance-abusing parents, including how this can influence the experience of becoming a parent.

Methods

In-depth interviews were conducted with 19 parents who had participated in an Infant and Toddler Psychiatry Unit intervention programme and who had experienced substance-abusing parents in their family of origin. Directed qualitative content analysis was used to analyse the data.

Results

Analysis of the interview material revealed both a high incidence of parentification and a conspiracy of silence concerning the substance abuse that helped generate symptoms of cognitive dissonance in the children. As parents they experience a high degree of inadequacy, incompetence and stress.

Conclusion

A majority of the children who had grown up with substance-abusing parents responded by taking a parenting role for themselves, their siblings and their parents. These children, often well-behaved and seemingly competent, need to be identified and offered support as they risk developing significant psychological and emotional difficulties that can extend into adulthood. They form an extra sensitive group who may need special support up to and including the time when they become parents themselves. This finding underlines the importance of further research on parenting among those who have grown up with abusive parents.

Perceived parental alcohol problems and drinking patterns in youth: A cross-sectional study of 69,030 secondary education students in Denmark

The aim of the study was to examine whether young people with parental alcohol problems have different drinking patterns than those without parental alcohol problems. Further, we examined whether the association between parental alcohol problems and young people's drinking patterns differed depending on the gender of the child and the parent, and whether more severe parental alcohol problems and cohabitation with the parent with alcohol problems was associated with earlier and heavier drinking patterns. Data came from the Danish National Youth Study 2014, a web-based national survey. 75,025 high school and vocational school students (15-25years) participated. Drinking patterns were investigated by the following outcomes: non-drinking, weekly alcohol consumption, frequent binge drinking, and early intoxication debut age. The main predictor variables were perceived parental alcohol problems, gender of the parent with alcohol problems, cohabitation with a parent with alcohol problems and severity of the parents' alcohol problems. Young people with parental alcohol problems had a higher weekly alcohol consumption (boys: 15.2 vs. 13.9 drinks per week; girls: 11.6 vs. 10.2 drinks per week), higher odds of early intoxication debut age (boys: OR=1.68 [95% CI 1.50-1.89]; girls: OR 1.95 [95% CI 1.79-2.14]), and more frequent binge drinking (boys, OR=1.16 [95% CI 1.04-1.29]; girls, OR=1.21 [95% CI 1.11-1.32]) compared to young people without parental alcohol problems. In conclusion, this study shows that young people with perceived parental alcohol problems have an earlier intoxication debut age, binge drink more frequently, and drink larger quantities per week than young people without perceived parental alcohol problems.

Perceived parental alcohol problems, internalizing problems and impaired parent - child relationships among 71 988 young people in Denmark

AIMS

To test the hypothesis that young people with perceived parental alcohol problems have poorer parent-child relationships and more emotional symptoms, low self-esteem, loneliness and depression than young people without perceived parental alcohol problems.

DESIGN

Cross-sectional analysis using data from the Danish National Youth Study 2014, a web-based national survey.

SETTING

Denmark.

PARTICIPANTS

A total of 71.988 high school and vocational school students (aged 12-25, nested in 119 schools and 3.186 school classes) recruited throughout 2014.

MEASUREMENTS

Outcome variables included internalizing problems such as emotional symptoms, depression, self-esteem, loneliness and aspects of the parent-child relationship. The main predictor variable was perceived parental alcohol problems, including the severity of the perceived problems and living with a parent with alcohol problems. Control variables included age, sex, education, ethnicity, parents' separation and economic problems in the family.

FINDINGS

Boys and girls with perceived parental alcohol problems had statistically significant higher odds of reporting internalizing problems (e.g. frequent emotional symptoms: odds ratio (OR)= 1.58 for boys; 1.49 for girls) and poor parent-child relationships (e.g. lack of parental interest: OR = 1.92 for boys; 2.33 for girls) compared with young people without perceived parental alcohol problems. The associations were not significantly stronger for mother's alcohol problems or if the young person lived with the parent with perceived alcohol problems.

CONCLUSION

Boys and girls in secondary education in Denmark who report perceived parental alcohol problems have significantly higher odds of internalizing problems and poorer parent-child relationships compared with young people without perceived parental alcohol problems.

Encounters with service professionals experienced by children from families with alcohol problems: A qualitative interview study

AIM

The aim of this study was to explore encounters with service professionals experienced in childhood and adolescence by children who grew up with parental alcohol abuse. We focused on their accounts from situations indicating children's struggles or parental drinking problems.

METHODS

Semi-structured qualitative interview study was conducted with retrospective data from nine adults. Systematic text condensation was used to understand childhood experiences from encounters with professionals.

RESULTS

Participants believed that professionals rarely recognised their parents' drinking problems. The children felt abandoned by professionals who must have noticed their struggles. Participants experienced that their appearance or behaviour was ignored and that they were not invited to talk. Professionals taking part in individual family members' problems seemed to avoid subsequent involvement in underlying parental drinking. Even when problems were obvious, participants felt that professionals took no further action. Medical and social problems were managed within very confined perspectives.

CONCLUSIONS

Specific commitment to confront cultural taboos is needed to attend to children's unmet needs. Recognising each young person's situation implies not only noticing that something is wrong, but also taking action. Children's experiences of fragmented and confined approaches towards parental drinking problems may be counteracted by better collaboration between teachers, school nurses and GPs.